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The computed tomography scan showed diffuse grid shadows and ground glass shadows in both lungs. Polymerase chain reaction testing of bronchoalveolar lavage fluid was positive for

. The patient was eventually diagnosed with PJP and was administered with oral trimethoprim-sulfamethoxazole. At the 6-mo review, there was no recurrence or progression.

Continued perioperative glucocorticoid use in patients with anti-MDA5-positive dermatomyositis may increase the risk of PJP.

Continued perioperative glucocorticoid use in patients with anti-MDA5-positive dermatomyositis may increase the risk of PJP.

Pompe disease has a broad disease spectrum, including infantile-onset Pompe disease (IOPD) and late-onset Pompe disease (LOPD) forms. It is a type of glycogen storage disorder belonging to autosomal recessive genetic disease, for an estimated incidence of 1/40000 among the neonatal population. In severe cases, the natural course is characterized by death due to cardiopulmonary failure in the first year after birth. However, the clinical outcomes have improved since the emergence of enzyme replacement therapy (ERT) was widely used.

The reported female case in China was an atypical IOPD, which demonstrates an unusual presentation of glycogen accumulation syndrome type II without obvious skeletal muscle involvement, and reviewed physical examination, biochemical examinations, chest radiograph, and acid α-glucosidase (GAA) mutation analysis. After 4-mo specific ERT, the case received 12-mo follow-up. Moreover, the patient has obtained a very good prognosis under ERT.

For the atypical IOPD patients, early diagnosis and treatment may contribute to good prognosis.

For the atypical IOPD patients, early diagnosis and treatment may contribute to good prognosis.

Neuroendocrine carcinoma (NEC) of the esophagus is rare and highly aggressive, and lacks biological features. Currently, there are no established standard treatments for this cancer. In this report, we describe a patient with large-cell NEC of the esophagus who was successfully treated using endoscopic submucosal dissection (ESD) combined with adjuvant chemotherapy.

A 55-year-old woman presented with intermittent mild dysphagia for 2 mo. Gastroscopy revealed a disc-shaped protruding lesion about 18 mm × 18 mm in size on the upper esophagus. Endoscopic ultrasonography demonstrated that the bulged lesion originated from the muscularis mucosa. We assessed

resections using ESD for therapeutic diagnosis to devise a safe and appropriate treatment. Histopathological examination revealed a poorly differentiated neoplasm comprising of large cells with marked nuclear atypia and multifocal necrosis. In addition, the specimens had a negative horizontal margin and vertical margins. Depth of invasion was classified as submucosa 2 (SM2) without lymphovascular invasion. These histopathological results were consistent with a diagnosis of esophageal NEC, large cell type. Adjuvant therapy has been considered for ESD patients with SM2/SM3 lesions and patients with poorly differentiated lesions. After comprehensive consideration, we initiated combination treatment,

, ESD plus adjuvant chemotherapy. The patient remained disease-free at the 2-year follow-up.

resection approach using ESD may play a vital role as a diagnostic and therapeutic modality for esophageal NEC.

En bloc resection approach using ESD may play a vital role as a diagnostic and therapeutic modality for esophageal NEC.

A cervical aortic arch (CAA) refers to a high-riding aortic arch (AA) that often extends above the level of the clavicle. This condition is very rare, with an incidence of less than 1/10000.

A 29-year-old woman was admitted to the otolaryngology department of our hospital for repeated bilateral purulent nasal discharge for the prior 3 mo. The patient was diagnosed with chronic sinusitis and chronic rhinitis at admission. A preoperative noncontrast chest computed tomography scan showed a high-riding, tortuous AA extending to the mid-upper level of the first thoracic vertebra with local cystic dilatation. A further computed tomography angiography examination showed that the brachiocephalic trunk, left common carotid artery, left vertebral artery (LVA) (slender), and left subclavian artery sequentially branched off of the aorta from the proximal end to the distal end of the AA. The proximal end of the right subclavian artery (RSCA) was tortuous and dilated. The AA showed tumor-like local expansion, with a maximum diameter of approximately 4 cm. After consultation with the department of cardiac macrovascular surgery, the patient was diagnosed with left CAA with aneurysm formation and an anomalous RSCA and LVA and was transferred to that department. The patient underwent AA aneurysm resection and artificial blood vessel replacement under general anesthesia and cardiopulmonary bypass. No abnormality was found during the 2-mo follow-up after discharge.

A CAA is a rare congenital anomaly of vascular development. The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.

A CAA is a rare congenital anomaly of vascular development. The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.

General anesthesia in critically ill patients is associated with increased risk of complications. Nerve block anesthesia is an alternative, but could be challenging in cases with surgical field that involves multiple dermatomes.

We report resection of a giant lipoma in the left shoulder and upper back under supraclavicular brachial plexus block plus T3-4 paravertebral block in an older patient with severe asthma. A 70-year-old patient presented with a slow-growing giant mass (25, 15 and 5 cm in length, width and depth, respectively) that extended from the lateral side of the left scapula to the axillary midline, and from the T5 thoracic vertebra intercostal to the mid-medial section of the left upper arm. He had sharp intermittent pain over the mass for the past 7 d. The patient also had severe bronchial asthma for the past 8 years. A pulmonary function test revealed only 20% of the predicted forced expiratory volume in 1 second (FEV1, 0.49 L). After controlling asthma with glucocorticoid, the tumor was resected under ultrasound-guided supraclavicular brachial plexus block and T3-4 paravertebral block. The surgery was completed without incident.

Ultrasound-guided regional nerve block is a viable alternative for patients with poor cardiopulmonary function undergoing shoulder, back and axillary surgery.

Ultrasound-guided regional nerve block is a viable alternative for patients with poor cardiopulmonary function undergoing shoulder, back and axillary surgery.Most people lack direct experience with wildlife and form their risk perception primarily on information provided by the media. GANT61 Smoothened inhibitor The way the media frames news may substantially shape public risk perception, promoting or discouraging public tolerance towards wildlife. At the onset of the COVID-19 pandemic, bats were suggested as the most plausible reservoir of the virus, and this became a recurrent topic in media reports, potentially strengthening a negative view of this ecologically important group. We investigated how media framed bats and bat-associated diseases before and during the COVID-19 pandemic by assessing the content of 2651 online reports published across 26 countries, to understand how and how quickly worldwide media may have affected the perception of bats. We show that the overabundance of poorly contextualized reports on bat-associated diseases likely increased the persecution towards bats immediately after the COVID-19 outbreak. However, the subsequent interventions of different conservation communication initiatives allowed pro-conservation messages to resonate across the global media, likely stemming an increase in bat persecution. Our results highlight the modus operandi of the global media regarding topical biodiversity issues, which has broad implications for species conservation. Knowing how the media acts is pivotal for anticipating the propagation of (mis)information and negative feelings towards wildlife. Working together with journalists by engaging in dialogue and exchanging experiences should be central in future conservation management.

The aim of this study was to explore expecting parents' perceptions of the Childbirth Journey as an intervention that includes medical information for parental support, constructed as a serious game.

In this qualitative study, semi-structured interviews were held with expecting parents in Sweden who were able to talk about specific parts of the Childbirth Journey they appreciated or found difficult to understand. A phenomenographic methodology was employed for data analysis.

Participants perceived the Childbirth Journey to be easily accessible and customized with reliable information. The design and features of the intervention were perceived by the expecting parents to enhance the intervention's usability, appeal, and trustworthiness. When parental couples used the Childbirth Journey together, it gave them an opportunity to discuss and better understand each other's situation. The participants proposed several changes to the existing version of the game, mostly related to extending practical information and illustrated scenarios but also to the further development of the game's design and animations. The participants found the Knowledge portal to be the most appealing part of the Childbirth Journey.

The Childbirth Journey intervention was concluded to be a valuable digital complement to in-person professional support, especially given the current COVID-19 pandemic restrictions in place in Sweden, which do not allow antenatal visits by partners. However, in its current form, the Childbirth Journey has some deficiencies and would therefore benefit from further development and exploration.

The Childbirth Journey intervention was concluded to be a valuable digital complement to in-person professional support, especially given the current COVID-19 pandemic restrictions in place in Sweden, which do not allow antenatal visits by partners. However, in its current form, the Childbirth Journey has some deficiencies and would therefore benefit from further development and exploration.

A novel telerehabilitation service provides wayfinding and self-management advice to persons with neurological, musculoskeletal, or coronavirus disease 2019 related rehabilitation needs.

We utilized multiple methods to evaluate the impact of the service. Surveys clarified health outcomes (quality of life, self-efficacy, social support) and patient experience (telehealth usability; general experience) 3-months post-call. We analysed associations between, and within, demographics and survey responses. Secondary analyses described health care utilization during the first 6 months.

Sixty-eight callers completed the survey (42% response rate). Self-efficacy was significantly related to quality of life, interpersonal support and becoming productive quickly using the service. Becoming productive quickly was significantly related to quality of life. Education level was related to ethnicity. Survey respondents' satisfaction and whether they followed the therapist's recommendations were not significantly associated with demographics.