Background Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection. Methods In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes. Results We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement. Discussion While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis. © 2020 The Authors.Migrants pose many challenges to recipient countries, including preparedness and resilience of health systems and provision of access to health services. Refugees and asylum seekers comprise a heterogenous group with significant and complex health needs, including the physical and mental consequences of violence. Physicians are often on the frontline in providing care for these unassisted, vulnerable and often maligned and misunderstood population groups. The need to adopt an effective and compassionate medical approach is imperative, including an awareness of unconscious biases and differences in gender roles, decision-making, and social taboos. In addition to practical steps to promote and build a trusting relationship between patient and physician during consultations, physicians require a broad knowledge of anthropology, history, sociology, and drivers of migration such as conflict, resource scarcity and climate change for a better understanding of their patients. Copyright © 2020 The Author(s).Background Career development skills are widely advocated as part of research capacity building and strengthening efforts. However, there is a gap in knowledge on their acceptability in low- and middle-income countries. Objective This study aimed to examine how a group of 16 early-career researchers in sub-Saharan Africa experienced a career development skills course and how they perceived the utility of the course. Methods Sixteen early-career researchers registered at universities in Ethiopia, Zimbabwe, Malawi, and South Africa took part in the year-long Academic Competencies Series (ACES) course. ACES comprised ten modules covering mentoring skills, work-life balance, career strategy, teamwork, presentation skills, teaching, academic writing, engaging policy makers, grant-writing, and digital media. ACES was delivered through face-to-face workshops and via webinar as part of a broader mental health research capacity-building programme. In-depth interviews following a topic guide were conducted with particir findings suggest that courses like ACES can be applied successfully and innovatively in low-income settings. Copyright © 2020 The Author(s).Engineering technology plays a pivotal role in the delivery of health care in under-resourced countries by providing an infrastructure to improve patient outcomes. However, sustainability of these technologies is difficult in these settings oftentimes due to limited resources or training. The framework presented in this editorial focuses on establishing medical and laboratory equipment sustainability in developing countries and is comprised of four steps 1) establishing reliable in-country relationships with stakeholders, 2) identifying needs for sustainable solutions locally, 3) exploring potential solutions and assessing their effort-to-impact ratios, and 4) working with strategic partners to implement solutions with clear performance metrics. By focusing on the sustainability of donated equipment instead of the equipment itself, this method presented distinguishes itself from other philanthropic endeavors in the field by seeking to establish preventive maintenance habits that can impact clinical outcomes of a community long term. Application of this methodology is reported in the Original Research Article „A Low-Cost Humidity Control System to Protect Microscopes in a Tropical Climate” by Asp et. al. Copyright © 2020 The Author(s).Uterine didelphys is a rare type of congenital uterine anomaly resulting from incomplete fusion of the paramesonephric ducts during embryogenesis. We report the case of a 27-year-old multiparous woman who presented with ovulation-induced dicavitary dichorionic diamniotic twins in known uterine didelphys. At 29 + 5 weeks of gestation, the patient had preterm prelabour rupture of membranes followed by threatened preterm labour in the right uterus only, which settled with tocolysis. The pregnancy continued for a further 9 days, at which time uterine tightenings returned and the right cervix was fully dilated, resulting in successful vaginal delivery of the first twin, leaving the placenta in situ. The left uterus and cervix remained quiescent for a further 24 h before contractions returned, resulting in emergency caesarean section, with the successful delivery of the second twin. As a rare phenomenon, there is sparse literature on the management of dicavitary twin gestation in uterine didelphys. This case report adds to the evidence for independent functioning of uteri and cervices in cases of uterine didelphys which may enable interval delivery delay in this cohort with known increased risk of preterm birth. Crown Copyright © 2020 Published by Elsevier B.V.The Niger Delta region of Nigeria is widely recognized as a complex and contentious space for oil exploration and production. Over the past few decades, the Niger Delta has witnessed large-scale mass peaceful mobilizations and rebellion-like conditions from violent militia groups. Oil companies have been implicated in violence perpetrated by Nigerian security forces. Local host communities have suffered greatly from corruption, political instability, violence and the environmental devastation of their farmlands and fishing grounds. Oil companies have increasingly turned to corporate social responsibility (CSR) initiatives to attempt to build or repair relations with oil-producing communities. There are also governmental and non-governmental humanitarian actors supporting various initiatives in the oil-producing areas. This article highlights the challenges that one long running micro-scale development project has faced due to the COVID 19 disease outbreak and the closure of all schools in Rivers State, Nigeria in March 2020. The school closures have halted some initiatives, but our weekly nutritional program feedings have continued in new, socially distanced forms. © 2020 Elsevier Ltd. All rights reserved.Introduction Bladder leiomyoma is a rare, benign tumor of the bladder. We present the first large endovesical leiomyoma case report in Indonesia and the largest bladder leiomyoma without any post-operation symptoms. Case presentation A 42-year-old female came with painless hematuria and irritative symptoms in the past year. Cystoscopy and open excision of the tumor showed well-encapsulated papillary solid mass at trigone (7 x 6.5 × 4 cm with a weight of 800 g). Postoperative histopathology confirmed the diagnosis of endovesical leiomyoma of the urinary bladder. Conclusion Open excision of bladder leiomyoma had good outcomes on large endovesical mass patients. © 2020 The Authors.Acinetobacter junii is one of more than 50 different species belonging to the genus Acinetobacter. This bacterium is rarely reported to cause human infections. Here we described a rare case of Acinetobacter junii, which grew in urine culture approximately one month after the patient was discharged from the hospital with antibiotics for a urinary tract infection, which caused left obstructing renal calculi requiring nephrostomy tube placement. © 2020 The Authors.Introduction Giant renal cell carcinoma (volume more than 1000 cc) is a rare case. Management included surgical resection combined with targeted therapy. Case presentation We reported a case of giant clear cell renal carcinoma with 9.900 cm3 of total volume, that required surgical resection of the tumor. This is the largest giant clear cell RCC reported in Asia. Discussion Giant renal cell carcinoma management without targeted therapy was not optimal. Multimodal therapy was recommended for better outcome. Conclusion Surgical resection of Giant RCC is challenging, for that reason targeted therapy is recommended to be the alternative regardless the outcome. © 2020 Published by Elsevier Inc.Hibernoma is a rare benign lipomatous tumor derived from brown fat, which is typically found in infants. Specifically, intrascrotal hibernoma is extremely rare with only one case reported to date. We encountered the second case, which was successfully treated with surgical resection without any recurrence at 3 years. The patient was first misdiagnosed with an intrascrotal liposarcoma preoperatively. Preoperative usefulness of imaging modalities to discriminate hibernomas and liposarcomas is limited due to lack of specific features of hibernomas with its rarity. Here, we report a case of intrascrotal hibernoma in addition to a current literature review. © 2020 The Authors.Huge bladder diverticulum is uncommon but serious cause of obstructive uropathy in children. This study investigated an 18 months old boy with a huge bilateral Hutch diverticulum presented with recurrent urinary retention, underwent bilateral bladder diverticulectomy. The operative management entailed meticulous reconstruction of the lower urinary tract. Post operatively the patient restored normal voiding dynamics, and he is on regular follow up. We are reporting this case due to its rarity and to share our experience with the management and outcome in such cases. © 2020 The Authors.Urachal carcinoma is a rare neoplasm for which there is a lack of a standard effective chemotherapeutic treatment. There is also no standard treatment available for recurrent metastatic urachal carcinoma and the prognosis is generally poor. We report a case of urachal carcinoma where the patient achieved long-term disease-free survival after repeated surgeries for recurrent lung metastases. © 2020 The Authors.Double-j ureteral stents have been widely used as part of urologic practice. The main use is to provide urinary drainage from the kidney to the bladder. With the increase use, several complications are seen related to stents. We present a 17- year-old male with neglected double-j stent for eight years after right pyelolithotomy. He skipped follow up. An open surgery for extracting bladder stones and removing the encrusted double-j stent is done successfully. In conclusion, neglected double-j stent for a long time leads to major complications such as extremely encrustation, stone formation and renal hydronephrosis. © 2020 The Authors.We describe a case of unilateral renal lymphangiectasia (RLM) in a 30-year-old male with severe, refractory hypertension (HTN) and end-organ effects despite five anti-hypertensives. After diagnostic testing, the patient ultimately underwent a successful right laparoscopic nephrectomy with significant improvement of HTN. We review the literature regarding the pathophysiology and management strategies of HTN in patients with renal lymphangiectasia. © 2020 The Authors. Published by Elsevier Inc.An 8-year-old boy underwent a STING procedure for vesicoureteric reflux. 11 years later, at 19-years-old he presented with the passage of sediment per urethra every 7 weeks. CT scan demonstrated a lesion at the right VUJ. Cystoscopy revealed a 2cm suburothelial mass adjacent to the VUJ, with normal urothelium overlying it. Resection of the area revealed a white plastic-like substance, consistent with the bulking agent Deflux, which was scraped away. The patient made an uneventful recovery and at review, 3 months later, is symptom free. Our case demonstrates a rare and unusual complication of the STING procedure. Section headings Endourology, General Urology, Paediatrics. © 2020 Published by Elsevier Inc.Urethral prolapse is a circumferential protrusion of the distal urethra through the external urethral meatus. The incidence of Urethral prolapse was reported to be one in 3000, and it occurs most often in prepubertal Black females and postmenopausal White women. The possible causes and precipitating factors are not clear. Instrumentation of the urinary tract was reported to be one of rare precipitating factor. We report a case of Urethral prolapse in a child which was precipitated by traumatic accidental removal of the transurethral catheter. © 2020 The Authors.Shock wave lithotripsy (SWL) is considered a non-invasive treatment for urinary stones and usually advocated for frail patients with spinal cord injury (SCI). We report a life-threatening complication, called posterior reversible encephalopathy syndrome (PRES), in a tetraplegic person who underwent SWL for a small renal stone. Based on our experience, we recommend performing SWL with caution in SCI patients and in tertiary referral hospitals that can promptly manage similar severe complications. © 2020 Published by Elsevier Inc.The importance of histologic characterization of renal masses is increasing in the management of small renal tumors and metastatic settings of renal cell carcinoma (RCC). Tissue sampling of renal lesions is generally achieved through a percutaneous approach yet endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with cytological analysis could be more suitable in selected circumstances. We report a case of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of an anterior, mesorenal right kidney mass with a thrombus extending into the right atrium, unreachable via a percutaneous approach. © 2020 The Authors.The Sweet’s syndrome is a rare dermatosis which can be related to underlying malignancies. In this case we presented a case, who applied to our clinic with severe dermatosis and hematuria. We diagnosed high grade non-muscle invasive bladder tumor, which was treated with transurethral resection of bladder-tumor and six cycle of Bacillus Calmette-Guérin therapy. After the treatment the dermatosis was regressed almost completely. However, recurrent bladder tumor was detected at the first control cystoscopy. © 2020 Published by Elsevier Inc.Lymphoepithelioma-like carcinoma, named after nasopharyngeal lymphoepithelioma and rarely seen at genitourinary malignancy, accounts for 1%-2% along the upper and lower urinary tract. For its rarity, no published guideline can be adhered to. Roles of surgery and chemotherapy are solid, and rich Programmed Death-Ligand 1 characteristics may furthermore light on the possible immunotherapy. This female case had it at both upper and lower urinary tract simultaneously. No involved regional lymph nodes and no distant metastasis were investigated. No adjuvant chemotherapy was given after robotics-assisted left nephroureterectomy and bladder cuff excision with partial cystectomy, and no recurrence was observed. © 2020 The Authors.Condyloma acuminate (CA) is a warty lesion caused by human papilloma virus (HPV) mostly involve the external genitalia. A 65-year-old woman with a compliant of acute urinary retention came to our hospital emergency ward and the retention was resolved by placing a 6 Fr Foley catheter. On physical examination warty lesions on patient’s urethral meatus was seen and biopsy was taken. The pathology confirmed the diagnosis of CA. 5-FU was prescribed for a month and the outcome was fully satisfactory. To sum up, CA in female with AUR should be kept in mind. © 2020 Published by Elsevier Inc.Rhabdomyosarcoma of the prostate is rarely found in adults compared to rhabdomyosarcoma in other body regions. In early stage of the tumor, the symptoms are similar to other genitourinary problems, such as dysuria, urinary retention, lower abdominal pain and prostate enlargement. This condition often leads to misdiagnosis and treatment delay because of the tumor’s rapid growth. Asides from the histopathological examination, imaging had an important role in determining the diagnosis. MRI is very useful and more preferred than other imaging modalities in determining the diagnosis. © 2020 The Authors.A 4-year-old boy with posterior urethral valves and end stage kidney disease on peritoneal dialysis presented with high pressure non-compliant bladder with left ureterohydronephrosis. Inability to perform hemodialysis due to patient’s weight exclusion, imposed the necessity to preserve peritoneal dialysis. A bilateral nephrectomy by retroperitoneoscopy with extraperitoneal augmentation ureterocystoplasty using left ureter and pelvis associated with continent diversion using right ureter as umbilical stoma was performed followed by kidney transplantation. An excellent outcome with voluntary voiding without CIC is reported eighteen months later. This treatment modality is the best option to manage End Stage Kidney Disease on peritoneal dialysis in those patients. © 2020 The Authors.Appendiceal carcinoma is a rare disorder. Although imaging exams can suggest carcinoma of the appendix simulating as a primary bladder cancer a transurethral biopsy is essential for diagnosis. We reported a case of a 27-year-old man, presented with hypogastric pain associated with recurrent gross hematuria and dysuria but without any intestinal symptoms such as pain, obstruction or melena. MRI revealed an enlarged appendix contiguous with the bladder. An en-bloc resection was performed and revealed appendiceal mucinous adenocarcinoma. Carcinoma of the appendix is an important differential diagnosis to other lesions and allow a good chance of cure by en bloc resection. © 2020 The Authors.Primary renal Ewing’s sarcoma (ES) of the kidney represents a rare oncologic entity belonging to the collection of small round cell tumors, which typically feature osseous presentations. Renal ES is an aggressive disease entity with high metastatic potential, either at time of presentation or following initial extirpative therapy. Herein, we report the case of a 14-year-old female who initially presented with intermittent gross painless hematuria and a large left renal mass identified on ultrasound and confirmed on follow up MRI. Following partial nephrectomy (PN), patient was diagnosed with primary renal ES and subsequently underwent completion nephrectomy and chemotherapy. © 2020 Published by Elsevier Inc.Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We present a case of renal vein leiomyosarcoma in a patient presented with left flank pain. The patient underwent radical nephrectomy with tumour excision. © 2020 Published by Elsevier Inc.Penile fracture is a urological emergency which requires urgent assessment and surgical intervention to avoid long term complications. In this report, we describe a case in which penile MRI was used for initial assessment and surgical planning. This allowed exact localisation of the tunical tear and allowed direct incision over the tear for repair. In this case, the man avoided circumcision, which would be often required with the conventional degloving approach. © 2020 The Authors.The discovery of a kidney stone in a living kidney donor is rare. The managing technique of this situation and the timing of the treatment of the stone is not well codified. Should it be treated before the removal of the kidney or in ex-vivo after nephrectomy and in cold ischemia ? We report a case of a 60-year-old mom who donates kidney willingly to her son. The decision of the transplant team was for the removal of the left kidney (upper calyx stone of 9 mm) and the treatment of the stone in ex-vivo by flexible ureteroscopy. © 2020 The Authors.We present a case of Penile Mondor’s Disease (PMD) in a 36-year old male patient. PMD is an under-recognised and uncommon condition which presents with pain on erection and cord-like thickening of the dorsum of the penis. The diagnosis of PMD is usually confirmed with ultrasound imaging. The course of PMD is self-limiting, with multiple adjunct treatments proposed to hasten the recovery process however the evidence to support these treatments is limited. It is important both Primary Care Providers and Urologists are aware of this condition in order to provide appropriate information to patients regarding treatment options and prognosis. © 2020 Published by Elsevier Inc.Retention of the testis is one of the most common congenital malformation in male infants. The incidence of this disease is 1-2% at 1 year of age. As nonpalpable are reported around 20% of cases and in up to 30% of neonates may affect both sides. For optimal results, orchidopexy should be performed between the ages of six and eighteen months. We presented a rare case of successful in vitro fertilization after laparoscopic Fowler-Stephens orchidopexy in 30 years old man with bilateral abdominal cryptorchidism. © 2020 The Authors.Acute scrotum considered to be a common and one of the urological top emergency cases. However, acute testicular pain due to testicular vein thrombosis is rare especially if this thrombosis considered to be a complication of an infection, and not due to varicocele or malignancy-related conditions. A rare case of right epididymo-orchitis case complicated by right pampiniform plexus thrombosis, which resolved spontaneously with no anticoagulant management., Testicular vein thrombosis considered to be a rare differential diagnoses of acute scrotum presentation. With a limited number of reported cases, it requires more evaluation to develop a proper medical approach. © 2020 The Authors.This case presents an unusual variation of Zinner syndrome with a patient found to have an ectopic ureteral insertion of the seminal vesicle from a supernumerary pelvic kidney and complete duplication of the ipsilateral, otherwise normal renal unit. The case offers an interesting variant of a previously established syndrome with successful treatment involving robotic resection of an ectopic ureter and seminal vesiculectomy, resulting in resolution of the patient’s symptoms. © 2020 The Authors.This case report documents the rare occurrence of axillary metastasis in a patient with a history of typical urothelial bladder cancer. Bladder cancer rarely metastasizes to supradiaphragmatic cutaneous tissues, and this presentation confers a poorer prognosis as well as an association with atypical variants of bladder cancer. However, this paper suggests that typical pure urothelial bladder cancer may be just as aggressive as its atypical counterpart. In addition, the work-up of axillary masses in a patient with a history of bladder cancer, whether typical or variant, should include metastatic disease as part of the differential diagnosis and guide treatment strategies. © 2020 The Authors.Prostate cancer is the second most frequent among men. Bones and lymph nodes are the most common sites of metastases in advanced prostate cancer. Oral cavity metastases are rare. We report a case of 65-year-old man with a prostate adenocarcinoma revealed by gingival metastasis. We analyze through this observation the clinical, morphological and therapeutic characteristics of this neoplasia. © 2020 Published by Elsevier Inc.We describe the case of a 65-year-old patient who presented to our hospital with femoral pain. MRI and CT scan revealed a retroperitoneal abscess. We treated him with early surgical drainage and antibiotic treatment. The urine and draining pus cultures grew Achromobacter xylosoxidans. An iliopsoas abscess may show unique signs depending on its volume. To the best of our knowledge, this is the second reported case of retroperitoneal abscesses due to A. xylosoxidans. Surgical drainage appears to be effective when abscess is large. © 2020 The Author.Haemolysis and methaemoglobinaemia (MetHb) are rare metabolic complications that can occur in Alkaptonuria (AKU), for which there is no curative treatment. Presented is a case of a man who had AKU, and serves as a reminder of life-threatening complications that can occur with haemolysis and MetHb. This case presents an opportunity to revisit important considerations relating to the investigation and treatment of haemolysis and MetHb with a view to raising awareness, and in doing so hopefully reducing the uniformly fatal outcome. Additionally it is proposed that treatment of haemolysis and MetHb with nitisinone is considered as a potentially lifesaving treatment as it is believed that reducing the concentration of circulating homogentisic acid will reduce oxidative stress. © 2020 The Authors.Ceftazidime/avibactam combines ceftazidime with a new beta-lactam that successfully that inhibits Amber Class A and D carbapenemases. We report a clinical case of a 61 year-old man with a carbapenemase-producing Klebsiella pneumoniae intra-abdominal infection after an elective abdominal hernia repair. The infection was successfully managed with multiple abdominal surgeries, drainage and combined antibiotic therapy with ceftazidime/avibactam plus tigecycline. © 2020 The Author(s).A considerable amount of early breast tumors grown at a depth over 2 cm in breast tissues. With high near-infrared absorption of iron-platinum (FePt) nanoparticles, we achieved few centimeters deep photoacoustic (PA) imaging for the diagnosis of breast tumors. The imaging depth can extend over 5 cm in chicken breast tissues at the low laser energy density of 20 mJ/cm2 (≤ ANSI safety limit). After anti-VEGFR conjugation and the tail-vein injection, we validated their targeting on tumor sites by the confocal microscopy and PA imaging. Using a home-made whole-body in vivo PA imaging, we found that the nanoparticles were rapidly cleared away from the site of the tumor and majorly metabolized through the liver. These results validated the clinical potential of the FePt nanoparticles in the low-toxicity PA theragnosis of early breast cancer and showed the capacity of our whole-body PA imaging technique on monitoring the dynamic biodistribution of nanoparticles in the living body. © 2020 The Author(s).Side-viewing hollow optical waveguides allow for minimally invasive endoscopy by concentrically guiding light and sound for photoacoustic generation and detection. Here, we characterize the side-viewing photoacoustic waveguide (PWG) endoscope by scanning 7.2 μm diameter carbon fiber threads within phantom tissues and animal tissues. Photoacoustic signals are carried along the 5.5 and 10.0 cm length of the PWG with minimal attenuation. Thus, this technology enables 360°, deep-tissue photoacoustic imaging. Photoacoustic signals were identified up to 8.0 mm from the PWG imaging window in an optically clear medium. The outer diameter of this device is measured as just over 1.0 mm, with the potential to be further miniaturized due to its unique design. The PWG is an ideal candidate for a myriad of pre-clinical and clinical applications where typical photoacoustic endoscopy systems are impractical, due to their size. Presented here, is the first side-viewing photoacoustic waveguide endoscope. © 2020 Published by Elsevier GmbH.The recent outbreak of Covid19 has required urgent treatments for numerous patients. No suitable vaccines or antivirals are available for Covid19. The efficiency against Covid19 of WHO therapies of choice, that are two antivirals developed for other pathologies, is controversial. Therefore, alternative approaches are required. Intravenous (IV) Vitamin C (Vit-C) has emerged as one of the other alternatives for this purpose. Here we review the effects of IV Vit-C on the immune system response, the antiviral properties of IV Vit-C, and finally the antioxidant properties of IV Vit-C to specifically address the cytokines’ storm characteristic of the Acute Respiratory Distress Syndrome (ARDS) that occur in the later cycle of the Covid19 infectious disease. © 2020 Elsevier B.V. All rights reserved.Background Urinary incontinence (UI) is a health problem that is common in women of all ages. Besides pharmacological and surgical treatments, there are lifestyle changes and complementary and alternative medicine (CAM) to relieve UI symptoms. This study aimed to examine lifestyle arrangements and CAM use by women with UI. Methods We conducted a cross-sectional study using data from 352 women with UI. The study sample consisted of female patients that were aged 18 and above. We asked patients whether they experienced urine leakage, and included all patients with UI in the sample regardless of UI type or severity. We collected the study data by using the personal information form and Incontinence Severity Index (ISI). Results In this study, 7.1% of women with UI used CAM while 92.9% did not. We found that only the women with mixed incontinence used CAM more (p less then 0.05). The CAM techniques commonly preferred by women included prayer (48.0%), hot application (36.0%) and herbal teas (24%). While 52.2% of women stated that they benefited from CAM use, all of them (100%) stated that they experienced no side effects of CAM. The most common lifestyle changes was losing weight. Conclusion Turkish women with UI had a low rate of CAM use in this study. The use of CAM was related to age and education, and women with mixed UI used CAM more. © 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B.V.Background Rumex japonicus Houtt. (RJ) is widely distributed in Korea, Japan, and China. The root of RJ has traditionally been used to treat constipation, jaundice, hematemesis, dysfunctional uterine bleeding, and gastrointestinal diseases. According to recent studies, plants of the genus Rumex have beneficial functionalities such as anti-microbial, antioxidative, and anti-inflammatory effects. Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, is a chronic inflammatory disease characterized by an abnormal immune response and epithelial barrier dysfunction. This study evaluates the protective effect of RJ against dextran sulfate sodium (DSS)-induced colitis. Methods Male 8-week-old C57BL/6 N mice were treated with methanolic extract of RJ for 14 days, and DSS-induced groups were administered 2.5% DSS for last 7 days. After sacrifice, the length and weight of the colon were measured, and colon sections were subjected to H&E staining, immunohistochemistry and Western blotting to investigate the changes of inflammatory cytokines, tight junction and apoptosis-related factors. Results The colon of DSS-treated mouse was significantly shorter and heavier than the normal mouse. Moreover, DSS exposure induced an increase of tumor necrosis factor-α, interleukin (IL)-1β, IL-6, occludin, zonula occludens-1, p21, p53 and Bcl-2, and decreased the expressions of IL-10, claudin-2 and cleaved caspase-3 in the colon tissue. These DSS-induced changes were inhibited by RJ treatment. Conclusion Our results indicate that RJ effectively suppresses DSS-induced colitis by protecting tight junction connections in the colonic tissue. We therefore infer that RJ has the potential as a medicine or ingredient for treating colitis. © 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B.V.Background Poor ovarian response (POR) is one reason for infertility. In vitro fertilization (IVF) is frequently used to help achieve pregnancy, and performing acupuncture before IVF may promote ovulation and reduce egg retrieval pain. The purpose of this systematic review was to evaluate the effectiveness of acupuncture on clinical pregnancy rates (CPR) after IVF in women with POR. Methods Eight electronic databases were searched in January 2020, and reference lists of retrieved articles and previous review articles were hand-searched. Randomized controlled trials (RCTs) using any type of acupuncture for women with POR undergoing IVF were considered. Risk of bias was assessed using the Cochrane risk of bias standards. Results Three RCTs were included in this review. CPR and the number of retrieved oocytes were measured in two studies, while the values of anti-Mullerian hormone (AMH) and antral follicle count (AFC) were only reported in one study. In two studies, CPR was higher in the intervention group than the control group [37.8 % vs 24.3 %]. We did not conduct a meta-analysis, as there was a high level of heterogeneity in interventions among the included trials. Conclusions This study suggests that acupuncture may improve CPR, AMH, AFC and the number of retrieved oocytes in women with POR undergoing IVF. However it is difficult to conclude that acupuncture is more effective than conventional treatment. Additionally, more clinical trials are needed to evaluate the effectiveness of acupuncture on CPR and other outcomes of POR. Study registration PROSPERO CRD42018087813; https//www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018087813. © 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B.V.There is paucity of literature regarding the use of esophageal balloon manometry in the management of Pediatric Acute Respiratory Distress Syndrome. We describe our first ever experience of successful usage of esophageal balloon pressure manometry in a child with acute respiratory distress syndrome. This is a six-year-old girl who presented with shortness of breath and fever and was found to be in severe acute respiratory distress syndrome due to septic shock secondary to group A streptococcus. The patient was managed using an esophageal balloon manometry for positive end-expiratory pressure titration. She was liberated from invasive mechanical ventilation on day 7 of hospital course. Esophageal balloon manometry guided positive end-expiratory pressure for 103 out of 155 hours of ventilation with no obvious sequelae. Our case shows the feasibility of transpulmonary pressure measurements in pediatric patients. This practice may be useful to optimize management in pediatric acute respiratory distress syndrome to improve outcomes. © 2020 The Authors.Regardless of the agent, the inflammatory response is interconnected with infection. Mostly the initial response to infection is severe sepsis and characterized by a pro-inflammatory state, which then progresses to an anti-inflammatory state that develops and favors secondary infections (Florescu and Kalil, 2011) [1]. T-helper 1 (Th1) cells activated by microorganisms increase transcription of pro-inflammatory cytokines such as tumor necrosis factor (TNF-α), interferon-γ (INF-γ), and interleukin-2 (IL-2) (Hotchkiss and Karl, 2003; Brown and Jones, 2004; Russell, 2006) [[2], [3], [4]]. Different cytokines, TNF-α, interleukins, lymphokines, monokines, IFN-γ, colony-stimulating factor (CSF) and transforming growth factors, released from endothelial cells and subsequently from macrophages can induce lymphocyte activation and infiltration at the sites of infection and will exert direct antiviral effects. Subsequently, with the shift toward an anti-inflammatory state, activated T-helper 2 (Th2) cells secrete interlntercellular junctional integrity, cellular apoptosis, deregulation of coagulation, the consequent alteration of microvascular permeability, tissue edema, and shock (Steinberg et al., 2012) [7]. This increase in permeability of the endothelium is mainly due to the intercellular pathways and to a lesser extent through the transcellular leak (Steinberg et al., 2012) [7]. Such vascular hyperpermeability and multi-organ failure with severe edema, shock, acute lung injury, and even acute encephalopathy have been described in severe influenza infections (Wang et al., 2010; Armstrong et al., 2013) [8,9]. Novel drugs and vaccines such as peramivir, baloxavir marboxil, and 4 egg-based quadrivalent inactivated influenza vaccines have been added recently [10]. These changes require better and more efficient diagnostic and therapeutic approaches to avoid a fatal progression. I would like to report a child patient with H1N1 influenza, who developed rapid fatal viral septicemia. © 2020 The Author.Purpose Infection with COVID-19 potentially can result in severe outcomes and death from „cytokine storm syndrome”, resulting in novel coronavirus pneumonia (NCP) with severe dyspnea, acute respiratory distress syndrome (ARDS), fulminant myocarditis and multiorgan dysfunction with or without disseminated intravascular coagulation. No published treatment to date has been shown to adequately control the inflammation and respiratory symptoms associated with COVID-19, apart from oxygen therapy and assisted ventilation. We evaluated the effects of using high dose oral and/or IV glutathione in the treatment of 2 patients with dyspnea secondary to COVID-19 pneumonia. Methods Two patients living in New York City (NYC) with a history of Lyme and tick-borne co-infections experienced a cough and dyspnea and demonstrated radiological findings consistent with novel coronavirus pneumonia (NCP). A trial of 2 g of PO or IV glutathione was used in both patients and improved their dyspnea within 1 h of use. Repeated use of both 2000 mg of PO and IV glutathione was effective in further relieving respiratory symptoms. Conclusion Oral and IV glutathione, glutathione precursors (N-acetyl-cysteine) and alpha lipoic acid may represent a novel treatment approach for blocking NFKappaB and addressing „cytokine storm syndrome” and respiratory distress in patients with COVID-19 pneumonia. © 2020 The Authors. Published by Elsevier Ltd.Objective The aim of this study was to evaluate the effect of topical simvastatin on the osseointegration of machined-surface titanium implants. Material & methods Sixteen female Sprague-Dawley rats were used in this study in a 4-wk experimental trial. The rats were divided into two groups a test group (n = 8), in which local simvastatin was applied, and a control group (n = 8). In each of the 16 animals, a machined-surface titanium implant was surgically integrated into the tibial metaphysis. Prior to integration of the implants, 100 μl of ethanol solution containing 5 mg of simvastatin was applied to the bone sockets. The implants were then immediately integrated into the bone sockets. No simvastatin treatment was applied in the control group. At the end of the 4-wk period, the rats were sacrificed, and the implants and surrounding bone tissue were removed. The bone-implant contact (BIC) and bone filling (BF) ratios of nondecalcified histological sections were then determined. The BIC ratio was defined as the ratio of the implant surface directly in contact with the bone to the total implant surface length. The BF ratio was determined by measuring the bone-filled area at a distance of 0.5 mm from implant. Results There were no statistically significant differences in the BIC and BF ratios of the test group and control group in terms of implant osseointegration (p > 0.05). Conclusion Within the limitations of this study, we conclude that topically applied simvastatin to implant surfaces does not affect osseointegration. © 2020 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.Simultaneous presentation of tuberculosis (TB) and lymphoma in a young child is indeed a very rare entity. Malignancy such as Hodgkin’s disease (HD) most commonly causes suppression of the cell-mediated immunity, which makes the individual, especially children, more prone to tuberculous infection. One of the non-life threatening complications in these young cancer survivors is the associated dental anomalies. These can seriously impair the quality of life of teenagers and young adults. Higher incidence of caries, discoloration of teeth or even early loss of teeth requiring dental prosthesis, can be associated with the use of cytostatic drugs. These drugs can also disturb odontogenesis, resulting in the absence of tooth buds, microdontia, dilacerations or shortening of tooth roots. Some of the anticancer drugs, including busulfan, cyclophosphamide, doxorubicin etc. May particularly play a significant role in the development of dental anomalies. This paper is a short review and case report of an 11 year old child having oligodontia and secondary dental complications caused as a side effect of treatment of Hodgkin’s lymphoma with Tuberculous Lymphadenitis. © 2020 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.IoT within infectious disease epidemiology is an emerging field of research, however the ubiquitous availability of smart technologies, as well as increased risks of infectious disease spread through the globalization and interconnectedness of the world necessitates its use for predicting, preventing and controlling emerging infectious diseases•Considering the present situation in China, IoT based smart disease surveillance systems have the potential to be a major breakthrough in efforts to control the current pandemic. With much of the infrastructure itself in place already (i.e. smartphones, wearable technologies, internet access) the role this technology can have in limiting the spread of the pandemic involves only the collection and analysis of data already gathered.•More research must be carried out for the development of automated and effective alert systems to provide early and timely detection of outbreaks of such diseases in order to reduce morbidity mortality and prevent global spread. © 2020 Published by Elsevier Ltd on behalf of Fellowship of Postgraduate Medicine.We report a case of fungal and mycobacterial co-infection in an immunosuppressed patient from Southern Brazil. Histoplasmosis was diagnosed in an AIDS patient admitted to the hospital with nonspecific respiratory signs. However, 4 months post hospital discharge, the patient worsened and a co-infection with Mycobacterium avium was detected. Physicians must consider and investigate a broad spectrum of diseases which can occur as co-infections and which share the same clinical symptoms and signs in immunosuppressed patients. © 2020 The Authors.Schizophyllum commune is a basidiomycetes worldwide distributed that has emerged as cause of invasive infections in immunosuppressed patients. We present a case of a man who was simultaneously diagnosed with a small cell non-Hodgkin lymphoma and a sphenoid sinusitis by S. commune. Intraoperative observation and histology description were crucial to consider an alternative diagnosis to mucormycosis suggested by the MRI. The diagnosis was made based on PCR identification and sequencing. © 2020 The Authors.Liquiritigenin (LG), isoliquiritigenin (Iso-LG), together with their respective glycoside derivatives liquiritin (LN) and isoliquiritin (Iso-LN), are the main active flavonoids of Glycyrrhiza uralensis, which is arguably the most widely used medicinal plant with enormous demand on the market, including Chinese medicine prescriptions, preparations, health care products and even food. Pharmacological studies have shown that these ingredients have broad medicinal value, including anti-cancer and anti-inflammatory effects. Although the biosynthetic pathway of glycyrrhizin, a triterpenoid component from G. uralensis, has been fully analyzed, little attention has been paid to the biosynthesis of the flavonoids of this plant. To obtain the enzyme-coding genes responsible for the biosynthesis of LN, analysis and screening were carried out by combining genome and comparative transcriptome database searches of G. uralensis and homologous genes of known flavonoid biosynthesis pathways. The catalytic functions of candidate genes were determined by in vitro or in vivo characterization. This work characterized the complete biosynthetic pathway of LN and achieved the de novo biosynthesis of liquiritin in Saccharomyces cerevisiae using endogenous yeast metabolites as precursors and cofactors for the first time, which provides a possibility for the economical and sustainable production and application of G. uralensis flavonoids through synthetic biology. © 2020 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.Hepatic fibrosis is one kind of liver diseases with a high mortality rate and incidence. The activation and proliferation of hepatic stellate cells (HSCs) is the most fundamental reason of hepatic fibrosis. There are no specific and effective drug delivery carriers for the treatment of hepatic fibrosis at present. We found that when hepatic fibrosis occurs, the expression of CD44 receptors on the surface of HSCs is significantly increased. Based on this finding, we designed silibinin-loaded hyaluronic acid (SLB-HA) micelles to achieve the treatment of hepatic fibrosis. Meanwhile, we constructed liver fibrosis rat model using Sprague-Dawley rats. We demonstrated that HA micelles had specific uptake to HSCs in vitro while avoiding the distribution in normal liver cells and the phagocytosis of macrophages. Importantly, HA micelles showed a significant liver targeting effect in vivo, especially in fibrotic liver which highly expressed CD44 receptors. In addition, SLB-HA micelles could selectively kill activated HSCs, having an excellent anti-hepatic fibrosis effect in vivo and a significant sustained release effect, and also had a good biological safety and biocompatibility. Overall, HA micelles represented a novel nanomicelle system which showed great potentiality in anti-hepatic fibrosis drugs delivery. © 2020 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.Renal tubular epithelial cells (RTECs) are important target cells for the development of kidney-targeted drug delivery systems. Under physiological conditions, RTECs are under constant fluid shear stress (FSS) from original urine in the renal tubule and respond to changes of FSS by altering their morphology and receptor expression patterns, which may affect reabsorption and cellular uptake. Using a microfluidic system, controlled shear stress was applied to proximal tubule epithelial cell line HK-2. Next, 2-glucosamine, bovine serum albumin, and albumin nanoparticles were selected as representative carriers to perform cell uptake studies in HK-2 cells using the microfluidic platform system with controlled FSS. FSS is proven to impact the morphology of HK-2 cells and upregulate the levels of megalin and clathrin, which then led to enhanced cellular uptake efficiencies of energy-driven carrier systems such as macromolecular and albumin nanoparticles in HK-2 cells. To further investigate the effects of FSS on endocytic behavior mediated by related receptors, a mice model of acute kidney injury with reduced fluid shear stress was established. Consistent with in vitro findings, in vivo studies have also shown reduced fluid shear stress down-regulated the levels of megalin receptors, thereby reducing the renal distribution of albumin nanoparticles. © 2020 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.Combination therapy has shown its promise in the clinic for enhancing the efficacy of tumor treatment. However, the dose control of multiple drugs and their non-overlapping toxicity from different drugs are still great challenge. In this work, a single model drug, paclitaxel (PTX), is used to realize combination therapy and solve the problems mentioned above. Either PTX or its triphenylphosphine derivative (TPTX) is encapsulated in galactose-modified liposomes (GLips) to obtain GLips-P or GLips-TP, which are simply mixed in different ratios to finely control the proportion of PTX and TPTX. These mixed liposomes, GLips-P/TP, feature a cascade target delivery of PTX, from tissue to cell, and then to organelle. PTX plays a primary role to cause the cytotoxicity by microtubule bindings in cytoplasm, while TPTX is proved to increase the intracellular levels of caspase-3 and caspase-9 that cause apoptosis via a mitochondria-mediated pathway. Notably, GLips-P/TP 31 exhibited the significant drug synergy in both cytotoxicity assay of HepG2 cells and the treatment efficacy in Heps xenograft ICR mouse models. This work not only demonstrates the great promise of a cascade targeting delivery for precise tumor treatment, but also offers a novel platform to design combinatory therapy systems using a single drug. © 2020 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.Drug repurposing is an efficient strategy for new drug discovery. Our latest study found that nitazoxanide (NTZ), an approved anti-parasite drug, was an autophagy activator and could alleviate the symptom of Alzheimer’s disease (AD). In order to further improve the efficacy and discover new chemical entities, a series of NTZ-based derivatives were designed, synthesized, and evaluated as autophagy activator against AD. All compounds were screened by the inhibition of phosphorylation of p70S6K, which was the direct substrate of mammalian target of rapamycin (mTOR) and its phosphorylation level could reflect the mTOR-dependent autophagy level. Among these analogs, compound 22 exhibited excellent potency in promoting β-amyloid (Aβ) clearance, inhibiting tau phosphorylation, as well as stimulating autophagy both in vitro and in vivo. What’s more, 22 could effectively improve the memory and cognitive impairments in APP/PS1 transgenic AD model mice. These results demonstrated that 22 was a potential candidate for the treatment of AD. © 2020 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.Lappaconitine (LA), a natural compound with a novel C18-diterpenoid alkaloid skeleton, displayed extensive biological profile. Recent research on LA is focused mainly on its anti-tumor and analgesic effects, and therefore we aimed to investigate its anti-inflammatory potential. A series of novel LA derivatives with various substituents on the 20-N position was designed and synthesized. In the initial screening of LA derivatives against NO production, all the target compounds, except compound E2, exhibited excellent inhibitory ability relative to that of LA. Particularly, compound A4 exhibited the most potent inhibition with IC50 of 12.91 μmol/L. The elementary structure-activity relationships (SARs) of NO inhibitory activity indicated that replacement of the benzene ring with an electron donating group could improve the anti-inflammatory efficacy. Furthermore, compound A4 shows an anti-inflammatory mechanism by inhibiting NO, PGE2, and TNF-α generation via the suppression of NF-κB and MAPK signaling pathways.