Non-A non-B aortic dissections are an infrequent occurrence and represent a small proportion of aortic dissections. Treating this life-threatening medical emergency often requires surgeons to undertake some one of the most challenging surgical or endovascular cases in medicine. This literature review aims to define and classify non-A non-B dissections, describe their epidemiology as well as their pathology. This review also aims to discuss the range of surgical techniques employed in their treatment and management and to investigate the patient outcomes associated with each technique.

The pandemic outbreaks of coronavirus disease 2019 (COVID-19) was first discovered in Wuhan, Hubei, China in December 2019. The COVID-19 was caused by the novel coronavirus, namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It took 30 days to spread to all provinces of China [1]. Recently, the confirmed cases of COVID-19 have been reported from about 200 countries or regions on March 30, 2020, and killed almost 30 thousand people [2]. Efficient identification of the infection by SARS-CoV-2 has been one of the most important tasks to facilitate all the following counter measurements in dealing with infectious disease. In Taiwan, a COVID-19 Open Science Platform adhering to the spirit of open science: sharing sources, data, and methods to promote progress in academic research while corroborating findings from various disciplines has established in mid-February 2020, for collaborative research in support of the development of detection methods, therapeutics, and a vaccine for COVID-19. Research priorities include infection control, epidemiology, clinical characterization and management, detection methods (including viral RNA detection, viral antigen detection, and serum antibody detection), therapeutics (neutralizing antibody and small molecule drugs), vaccines, and SARS-CoV-2 pathogenesis. In addition, research on social ethics and the law are included to take full account of the impact of the COVID-19 virus.

A document by Marcin Moniuszko. Click on the document to view its contents.

An exhaustive assessment of biodiversity is a major challenge of ecological research, and molecular approaches such as the metabarcoding of environmental DNA are boosting our ability to perform biodiversity inventories. Are we actually able to assess the whole community, to unravel the intricate interactions between organisms and the impacts of global changes on the different trophic levels? The majority of metabarcoding papers published in the last years used just one or two markers and analyzed a limited number of taxonomic groups. Nevertheless, approaches are emerging that might allow “all-taxa biological inventories”. Exhaustive biodiversity assessments can be attempted by combining a large number of specific primers, by exploiting the power of universal primers, or by combining specific and universal primers to obtain good information on key taxa while limiting the overlooked biodiversity. Multiplexes of primers and shotgun sequencing may provide a better coverage of biodiversity compared to standard metabarcoding, but still require major methodological advances. We identify the strengths and limitations of different approaches, and suggest new development lines that might improve broad scale biodiversity analyses in the near future.

Harlequin Ichthyosis is a rare autosomal recessive disorder occurring in 1: 3,000,000 birth characterized by thick keratin skin with scaly appearance. Preterm deliveries, early marriage and consanguinity of marriage are some risk factors. Antenatal checkup of DNA for ABCA12 mutation helps in diagnosis but USG in places where not available.

Objectives The aim of this study was to compare patient reported pain scores and analgesia requirements between endoscopic and microscopic ear surgery. Design Prospective cohort study Setting Secondary care setting from June 2017 to December 2020. Participants Patients undergoing ear surgery performed by a single surgeon. Main outcome measures The primary outcome measure was patient reported pain as recorded by a visual analogue scale (VAS) at days 1,2,3 and 7 post-operatively. Secondary outcome measure was post-operative analgesia requirement. Results Overall, forty-nine patients encompassing 65.3 % (32/49) endoscopic and 34.7% (17/49) microscopic procedures were audited. Endoscopic procedures have statistically significant lower VAS pain threshold outcomes when compared against the microscopic procedures on post- operative day one (endoscopic group median VAS 1.5 [0.00;11.5] mm versus microscopic group median VAS 27.0 [15.0;65.0] mm); to day seven (endoscopic group median VAS 0.5 [0.00;2.75] mm versus microscopic group median VAS 9.00 [2.00;52.0] mm).  Requirement for analgesia was greater in the microscopic group at day one compared to the endoscopic group (64.5 %, 20/31 endoscopic group vs. 100 %, 17/17 microscopic; p= 0.004). Conclusion Endoscopic ear surgery is less painful and requires less analgesia in the initial post-operative period than microscopic surgery in this cohort. The overall results of this study are useful for pre-operative patient counselling and pain management in the clinical setting. Given the differing applications of microscopic and endoscopic ear surgery, further research is required to study the influence of bone removal, type of operation, and incision type on pain after ear surgery.

International guidelines have recommended the use of inhaled beta-2 agonists and systemic corticosteroids (SC) as the first-line treatment for acute asthma. Objective: To evaluate the evidence for the efficacy of inhaled corticosteroids (ICS) in addition to SC compared to SC alone in children with acute asthma in the ED or during hospitalization. Data sources: Five electronic databases were searched. Study Selection: All RCTs that compared ICS (via nebulizer or metered dose inhaler) plus SC (oral or parenteral) with placebo (or standard care) plus SC were included without language restriction. Data extraction: Two reviewers independently reviewed all studies. The primary outcomes were hospital admission or hospital length of stay [LOS], and secondary outcomes were readmissions during follow-up, ED-LOS, lung function, asthma clinical score, oxygen saturation, and heart and respiratory rates. Results: Nine studies (n=1473) met the inclusion criteria. In all the studies, the ICS was budesonide. Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreased hospital LOS by more than one day (MD= -29.08 hours [-39.9 to -18.3]; I2=0%, p=<0.00001). Moreover, adding budesonide (especially with ≥2mg doses) significantly improved the acute asthma severity score among patients at ED. Conclusions: Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreases the LOS and improves the acute asthma score in children at ED setting.

Background: Pathogenic variants in the mismatch repair (MMR) genes are the drivers of Lynch Syndrome; optimal variant interpretation is required for the management of suspected and confirmed cases. Given the onerous nature of extracting information related to genetic variants, literature searching tools which harness artificial intelligence may aid in retrieving information to allow optimum variant classification. Methods: In this study, we described the nature of discordance in a sample of 80 variants from a list of variants requiring updating by InSiGHT for ClinGen by comparing their existing InSiGHT classifications on ClinVar. Variants were searched for using a traditional method (Google Scholar) and literature searching tool (Mastermind Genomenon) independently. Descriptive statistics were used to compare: the number of articles before and after screening for relevance and the number of relevant articles unique to either method. Results: 916 articles were returned by both methods. Mastermind averaged four relevant articles per search, Google Scholar, three. Of relevant Mastermind articles, 193/308 (62.7%) were unique to it, compared to 87/202, (43.0%) for Google Scholar. All 6/80 (20%) variants with pathogenic or likely pathogenic InSiGHT classifications have newer VUS assertions on ClinVar. Conclusion: Mastermind on average returned a more relevant literature search. Google Scholar still found unique information, suggesting that Mastermind could play a complementary role.

The young water fraction (Fyw), the proportion of water younger than 2-3 months, was investigated in soil-, ground- and stream waters in the 0.56 Km2 sub-humid Mediterranean Can Vila catchment. Rain water was sampled at 5-mm rainfall intervals. Mobile soil water and groundwater were sampled fortnightly, using suction lysimeters and two shallow wells, respectively. Stream water was dynamically sampled at variable time intervals (30 minutes to 1 week), depending on flow. A total of 1,529 18O determinations obtained during 58 months were used. The usual hypothesis of rapid evapotranspiration of summer rainfall could not be maintained, leading to discard the use of an “effective precipitation” model. Soil mobile waters had Fyw up to 34%, while in ground and stream were strongly related to water table and discharge variations, respectively. In stream waters, due to the highly skewed flow duration curve, the flow-averaged young water fraction (F*yw) was 22.6%, whereas the time-averaged Fyw was 6.2%. Nevertheless, both F*yw and its exponential discharge sensitivity (Sd) showed relevant changes when different 12-month sampling periods were investigated. The availability of Sd and a detailed flow record allowed us to simulate the young water fraction that would be obtained with a virtual thorough sampling (F**yw). This showed that underestimation of F*yw is associated with missing the sampling of highest discharges and revealed underestimations of F*yw by 25% for the dynamic sampling and 66% for the weekly sampling. These results confirm that the young water fraction and its discharge sensitivity are metrics that depend more on precipitation forcing than on physiographic characteristics, so the comparisons between catchments should be based on mean annual values and inter-annual variability. They also support the dependence of the young water fraction on the sampling rate and show the advantages of flow-weighted F*yw. Water age investigations should be accompanied by the analysis of flow duration curves. In addition, the simulation of F**yw is proposed as a method for checking the adequacy of the sampling rate used.

The soil seed bank is one of the most important ecological indicators to evaluate and monitor the ecological restoration process of plant communities. We aimed to evaluate the influence of ecological restoration techniques on the plant community diversity and composition and functional group composition of the soil seed bank in two bauxite mining areas under compensatory restoration, Southeast Brazil. 30 soil samples were collected in each area (Area_A – Forest restoration by planting seedlings and nucleation techniques and Area_B – just restoration by planting seedlings). The samples were transported to a shade house and evaluated for six months, where germinated individuals were counted and identified weekly. The results indicated that the soil seed banks of the two areas are floristically similar (with a predominance of pioneer, herbaceous and native origin species), which show a higher natural regeneration potential. However, the higher species richness and abundance of zoochoric individuals in Area_A demonstrate that nucleation techniques, such as topsoil transposition and direct seeding were efficient to increase the recovery potential re-establishment. In the early successional stages, restoration techniques are more determinant in the functional group composition than in the floristic composition of the soil seed bank.

Rationale and Objectives Medical humanities are becoming increasingly popular, required, and recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We aimed to review medical school curricula in Canada, the UK, and the US. Our secondary objective was to compare the inclusion of medical humanities in the curricula with rankings of medical schools. Methods We searched the curriculum websites of all accredited medical schools in Canada, the UK, and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman’s correlation and inverse variance weighting meta-analysis. Results We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 156 in the US. Of these, 9 (56%) in Canada, 34 (73%) in the UK and 124 (79%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were Unspecified Medical Humanities, History, and Literature (Canada), Sociology and Social Medicine, Unspecified Medical Humanities, and Art (UK), and Unspecified Medical Humanities, Literature, and History (US). There was a negative relationship between the ranking of the medical school and whether they offered medical humanities. Conclusions The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK, and the US varies. The quality of our analysis was limited by the data provided on the Universities’ curriculum websites. Given the potential for medical humanities to improve medical education and medical practice, this variation should be investigated further.

Globally, more than 200 million women become pregnant each year, most of whom receive medications despite limited information on their safe use during pregnancy. The paucity of drug safety data on pregnant and breastfeeding women stems from the routine exclusion of this population from clinical trials due to scientific, ethical, regulatory and legal concerns. Consequently, at the time of initial drug approval, there may be scant safety data to inform the drug benefit-risk balance to the mother, foetus, or infant. Although momentum is growing to include this underrepresented population in clinical trials, most information on drug exposure outcomes comes from data collected in the post-marketing setting. Regulatory guidance and legislation on medication use in pregnancy and breastfeeding were reviewed globally by TransCelerate IGR PV Pregnancy and Breastfeeding Team. ICH standards and CIOMS guidelines served as benchmarks for national safety regulations and guidance. The landscape assessment identified a lack of harmonisation of global regulations on research in pregnant and breastfeeding women. This editorial focuses on the ambiguities and lack of harmonisation in global regulations on post-marketing pregnancy and breastfeeding safety studies. There is currently no ICH standard to guide these types of safety studies and, in most regions reviewed, there are no clear regulations or guidance on when and how to conduct them. While a challenging undertaking, greater clarity and harmonisation would facilitate more timely completion of post-marketing pregnancy safety studies that would ultimately generate the critical data needed to optimize benefit-risk decisions for pregnant and breastfeeding women.

This case highlights an atypical presentation of a patient with no history of mental illness who has been diagnosed with a bipolar disorder associated with severe COVID-19 symptoms. Neuroimaging was only positive for subtle white matter changes; he was treated with antipsychotics and mood-stabilizing agents until he reached partial remission.

Introduction: We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and admissions among children <18 years in South Africa, an upper-middle income setting with high inequality. Methods: Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and death was judged SARS-CoV-2 related by attending physician. Findings: 315,570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3,548,738 tests and 1.6% of all children in the country. Of children tested, 46,137 (14.6%) were positive. Children made up 2.9% (n=2,007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals (CI) 1.08 - 4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08-15.54)], age 10-14 years [aOR 4.20 (95% CI1.07-16.44)], age 15-17 years [aOR 4.86 (95% 1.28 -18.51)] vs age 1-4 years; admission to a public hospital [aOR 5.07(95% 2.01 -12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19-34.89)] vs none Conclusions: Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years and those with underlying conditions should be considered for increased testing and vaccination.

Guillain-Barre syndrome (GBS) is a rare autoimmune disease that often manifests as a post-viral complication. However, its association with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is unclear. We present a rare case of GBS secondary to COVID-19 infection complicated by rapidly progressive sensorimotor deterioration resistant to plasma exchange therapy.

Adequate nasal breathing is indispensable for athletes and nasal symptoms have been shown to inter-fere with their subjective feeling of comfortable breathing and quality of life. Nasal symptoms are caused by either structural abnormalities or mucosal pathology. Structural pathologies are managed differently from mucosal disease and therefore adequate diagnosis is of utmost importance in athletes in order to choose the correct treatment option for the individual. Literature suggests that nasal symp-toms are more prevalent in athletes compared to the general population and certain sport environments might even trigger the development of symptoms. Given the high demands of respiratory function in athletes, insight into triggering factors is of high importance for disease prevention. Also, it has been suggested that athletes are more neglectful to their symptoms and hence remain undertreated, meaning that special attention should be paid to education of athletes and their caregivers. This review aims at giving an overview of nasal physiology in exercise as well as the possible types of nasal pathology. Additionally, diagnostic and treatment options are discussed and we focus on un-met needs for the management and prevention of these symptoms in athletes within the concept of precision medicine.

A proper benchmarking on the properties of HF and its dimer inside C60 using density functional theory (DFT) based approaches is presented. For this purpose, 10 different DFT functionals following Jacob’s Ladder have been chosen. Geometrical parameters, viz., bond length, bond angle, etc., and dipole moment have been computed. Two types of orientations, viz., L-shaped and anti-parallel of (HF)2 inside C60 are considered, the latter with an extremely short hydrogen bond. HF bond lengths are elongated upon encapsulation in comparison to its free state analogue. The calculated stability of HF@C60 is functional dependent whereas, (HF)2C60 is thermodynamically unstable for all the functionals. The kinetic stability of (HF)2@C60 is observed through ADMP simulation at 300K temperature. The red shift in HF stretching frequencies is noticed in all cases. NCI analysis exhibits a non-covalent type interaction between HF dimer and the C60 cage. The total interaction energy is found to be negative for HF@C60. EDA analysis showed a high value of repulsive ΔEpauli which makes the (HF)2@C60 system unstable except for the functional BP86-D3 of GGA family. Furthermore, QTAIM analysis is performed and confirmed the presence of (3, -1) bond critical point along the hydrogen bond region for L-shaped (HF)2C60.

Covid-19 infection may have extrapulmunary manifestations such as blood hypercoagulability that may causes thrombosis in both arterial and venous system.Deep dorsal penile vein thrombosis is very rare and the most common cause is coagulation disorders.It causes penile pain especially during erection and it is diagnosed by ultrasound.