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She exhibited hypercalcemia (albumin corrected, 14.4 mg/dl) and hypoglycemia (31.0 mg/dl) for the first time. She was suspected of, and diagnosed with, adrenal insufficiency, because long-term glucocorticoid use was incidentally discontinued only 2 days before she contracted influenza. Clinical symptoms and hypercalcemia improved dramatically following initiation of treatment with hydrocortisone. Adrenal insufficiency is an unusual cause of hypercalcemia. However, hemodialysis patients tend to develop more severe hypercalcemia because of lack of urinary calcium excretion, which should not be overlooked because it may result in critical situations. In conclusion, clinicians should be aware of adrenal insufficiency with glucocorticoid withdrawal and hypercalcemia in hemodialysis patients.This narrative review aims to identify and review the extant literature describing methods and outcomes of embedding the arts and humanities (AH) into medical school curricula. The Association of American Medical Colleges changed the Medical College Admission Test (MCAT) in 2015 to place new emphasis on the role of liberal arts in the process of developing well-rounded physicians. Consequently, medical schools have been implementing more connections to creative writing, literature, theater, movies, music, and the visual arts into their curricula. To review the current literature, we focused on methods medical educators used to embed content related to AH into their curricula to shape and drive associated learning outcomes. We conducted searches in PubMed, CINAHL, PsycINFO, and ERIC for peer-reviewed articles from 2011 to 2020. The authors selected three dyads in medical humanities and reviewed articles independently followed by discussion to identify thematic links to major findings. Out of 261 articles, a total of 177 full-text articles were reviewed with 34 selected for final inclusion. Our review included articles describing curriculum development and delivery in publications from Australia, Canada, India, New Zealand, and the USA. This review showed medical educators are implementing didactic and experiential instructional approaches to embedding the arts, humanities, and social sciences into the medical school classroom. Medical educators' attempts to embed AH into medical school curricula show promising results. Unfortunately, small sample sizes, short-term interventions, and an over-reliance of subjective assessment measures limit our knowledge of the true impact of these interventions. More rigorous assessments of required and longitudinal coursework are necessary to know the true impact of participation in AH coursework for medical students.

Oral delivery of proteins, including glucagon-like peptide 1 (GLP-1) receptor agonists, is impeded by low gastrointestinal permeation. Oral semaglutide has been developed for once-daily oral administration by co-formulation of the GLP-1 analogue semaglutide with an absorption enhancer, sodium N-(8-[2-hydroxybenzoyl] amino) caprylate (SNAC, 300mg). A randomised, partially double-blind, placebo-controlled thorough QT/corrected QT (QTc) trial was conducted to confirm the absence of unacceptable QTc interval prolongation with SNAC. QT is defined as interval on the electrocardiogram, measured from the start of the QRS complex to the end of the T wave.

Part A of the study sought to identify an appropriate dose of SNAC (which was substantially higher than that used in the oral semaglutide co-formulation) for QTc assessment. Three sequential healthy volunteer cohorts were randomised to escalating single oral doses of SNAC (1.2, 2.4 or 3.6g) or placebo. Following identification of an appropriate dose, a cross-overQTc trial demonstrates that SNAC doses 12-fold higher than the 300mg dose used in the oral formulation of semaglutide do not cause unacceptable prolongation of the QTcF interval.

Clinicaltrials.gov identifier NCT02911870.

Clinicaltrials.gov identifier NCT02911870.The prognosis of congenital heart disease in children has improved, but late complications in adulthood are becoming an important problem. One late complication after congenital heart surgery is congestive liver disease, leading to liver cirrhosis and hepatocellular carcinoma (HCC). The Rastelli procedure is one of the surgical methods for transposition of the great arteries. We present the first case of HCC derived from Rastelli procedure-related congestive liver disease in a 41-year-old male. The patient underwent the Rastelli operation at 2 years of age and right ventricular outflow tract reconstruction at 10 and 35 years of age due to right ventricular outflow tract obstruction. At 41 years of age, a hepatic tumor was detected by computed tomography. Abdominal enhancing computed tomography revealed a partially hypervascular tumor in segment 2 in early phase and wash-out in late phase. The patient was diagnosed with HCC and underwent left lateral segmentectomy of the liver, splenectomy, and partial gastrectomy. The patient was discharged on the 28th postoperative day without postoperative complications. In the management of patients after the Rastelli operation, surveillance for congestive liver disease and HCC development is important, even if the patients have undergone right ventricular outflow tract reconstruction.Biologic medications are an expanding field of therapeutics for various medical conditions including cancer and inflammatory diseases. Due to their targeted approach to therapy, biologics can be less toxic than traditional systemic medications. However, as use becomes more widespread, adverse effects from biologic administration have also become apparent. Immune-related adverse events are a common mechanism by which biologics can cause on-target immune-related toxicities and both immediate and delayed-type hypersensitivity reactions. Immediate hypersensitivity reactions can be mediated by cytokine release or antibody mediated reactions, while delayed-type hypersensitivity is most often caused by serum sickness-like reactions. Additionally, biologics used for treatment of cancer using checkpoint blockade and rheumatologic disease using cytokine blockade can result in autoimmunity. Finally, when inflammatory cytokines are targeted for treatment of autoimmune or autoinflammatory disease, the host immune defense can be compromised predisposing to secondary immunodeficiency. Glutaraldehyde This review will discuss the mechanisms of these reactions and discuss examples of biologics implicated in each of these adverse events.

The Bundled Payments for Care Improvement (BPCI) initiative incentivizes participating providers to reduce total Medicare payments for an episode of care. However, there are concerns that reducing payments could reduce quality of care.

To assess the association of BPCI with patient-reported functional status and care experiences.

We surveyed a stratified random sample of Medicare beneficiaries with BPCI episodes attributed to participating physician group practices, and matched comparison beneficiaries, after hospitalization for one of the 18 highest volume clinical episodes. The sample included beneficiaries discharged from the hospital from February 2017 through September 2017. Beneficiaries were surveyed approximately 90 days after their hospital discharge. We estimated risk-adjusted differences between the BPCI and comparison groups, pooled across all 18 clinical episodes and separately for the five largest clinical episodes.

Medicare beneficiaries with BPCI episodes (n=16,898, response rate=44.5%rge, indicating that differences in care experiences did not affect functional recovery.

The proportion of respondents with favorable care experiences was smaller for BPCI than comparison respondents. However, we did not detect differences in self-reported change in functional status approximately 90 days after hospital discharge, indicating that differences in care experiences did not affect functional recovery.

Adolescent Idiopathic Scoliosis (AIS) is the most frequent spine deformity in adolescence. The cause of AIS remains unknown. Several studies show that AIS can be associated with a perception bias of gravitational vertical. In particularly, AIS patients with a right thoracic convexity exhibit deviation of the Subjective Postural Vertical. The origin of this disturbance could be located in trunk proprioceptive graciveptors. We wanted to verify this result with a population of lumbar and thoracolumbar AIS with left convexity.

It was a multicenter, cross-sectional case-control study. Thirty adolescents with left lumbar or thoraco-lumbar AIS (age 14.3 ± 1.7 years; Cobb angle 27.6° ± 6.1°) and 30 controls matched for age (14.0 ± 1.5 years), were compared for Subjective Visual Vertical (SVV) measured in static and dynamic (optokinetic stimulation) conditions, and Subjective Postural Vertical (SPV).

For SVV, there was no difference in the two groups, for static and dynamic conditions. The SPV was significantly different between the two groups (p < 0.0001). The SPV was shifted to the left for most of the AIS patients (med - 2.4°[- 3.6; - 1.7]) compared with controls (med 0°[- 0.5; 1.7]). Adolescents with AIS perceived verticality with significant greater uncertainty in postural modality than controls (p = 0.017).

Our study confirms a significant directional bias in the orientation of SPV in left lumbar or thoraco-lumbar AIS. This confirmation paves the way to a new physiopathological model focused on trunk proprioception.

III.

III.Non-invasive comparative analysis of the spectral composition of energy absorbed by crop species at leaf and plant levels was carried out using the absorption coefficient retrieved from leaf and plant reflectance as an informative metric. In leaves of three species with contrasting leaf structures and photosynthetic pathways (maize, soybean, and rice), the blue, green, and red fractions of leaf absorption coefficients were 48, 20, and 32%, respectively. The fraction of green light in the total budget of light absorbed at the plant level was higher than at the leaf level approaching the size of the red fraction (24% green vs. 25.5% red) and surpassing it inside the canopy. The plant absorption coefficient in the far-red region (700-750 nm) was significant reaching 7-10% of the absorption coefficient in green or red regions. The spectral composition of the absorbed light in the three species was virtually the same. Fractions of light in absorbed PAR remained almost invariant during growing season over a wide range of plant chlorophyll content. Fractions of absorption coefficient in the green, red, and far-red were in accord with published results of quantum yield for CO2 fixation on an absorbed light basis. The role of green and far-red light in photosynthesis was demonstrated in simple experiments in natural conditions. The results show the potential for using leaf and plant absorption coefficients retrieved from reflectance to quantify photosynthesis in each spectral range.To finish this special issue, some friends, colleagues and students of Prof. Chow (Emeritus Professor, the Research School of Biology, the Australian National University) have written small tributes to acknowledge not only his eminent career but to describe his wonderful personality.