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Introduction: In late December 2019, the coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. It quickly spread and emerged as a global pandemic with far-reaching impacts on society. As clinical research on this novel virus emerges, there is a limited amount of data that review clinical and laboratory predictors of severe disease. We present a case of a patient with severely elevated inflammatory markers who remained clinically stable during his hospital course. Case discussion: A 53-year-old male presented to the emergency room with 11 days of persistent fevers and new-onset anterior chest tightness. He was admitted to the hospital due to a reported oxygen desaturation at home to 87% (taken by his spouse, a healthcare professional) and ambulatory oxygen desaturation down to 87%. He was noted to have severely elevated inflammatory markers, lymphopenia, and computed tomography pulmonary angiograph findings consistent with COVID-19. He remained on room air and clinically stable throughout his 3-day hospital course. While his C-reactive protein levels improved, his ferritin and erythrocyte sedimentation rate continued to elevate. He was discharged home and was symptom-free within 4 days of hospital discharge. Discussion: COVID-19 has proven to be a viral disease with a high transmission rate, that has caused over 100,000 deaths in the United States, thus far. The decision to admit a patient must balance the risks of transmission with the benefit of being readily available to provide urgent supportive care should the patient develop complications. Thus, there is a significant benefit to being able to predict poor outcomes. We performed a targeted review of the literature, focusing on clinical and laboratory predictors of poor outcomes in COVID-19. Our case report and narrative review outline these findings within the context of our case.

This paper analyzes the policy remedies for dealing with North Korea's nuclear weapons and missile programs. After six nuclear tests and three recent successful ICBM tests, North Korea is close to miniaturizing nuclear warheads and establishing a reliable delivery system, thus achieving a much-feared nuclear weapons capability. In defiance of the extraordinarily tough U.N. Security Council resolutions, Pyongyang persists in developing nuclear weapons. North Korea's nuclear weapons program already has exceeded the strategic patience, of the U.S.-ROK alliance. Harsher policy options to deal with the DPRK nuclear weapons are imperative. Several drastic options, including severe sanctions, preventive bombing, nuclear armament of South Korea, are evaluated in the final round of engagement policy on guaranteeing nonaggression and a peace agreement with Pyongyang.

This paper examines how South Korea might be able to deter the growing threat from North Korea’s nuclear weapons and missile programs. North Korea’s six nuclear weapons experiments with various types of missile test fires using solid fuel and new technology pose a security threat to South Korea and the USA. The credibility of the North’s WMD capability and the military balance of two Koreas are critically analyzed. South Korea’s superior conventional weapons system, supported by U.S. strategic weapons and intelligence systems, could fend off North Korean nuclear weapons and missile attacks. However, it is imperative that the U.S.-ROK alliance continues to develop a stringent nuclear deterrence strategy and deploy a series of countermeasures, including preemptive strikes and a multilayered missile defense system, such as Kill Chain, KAMD, and THAAD, all to guard against a potential nuclear weapon attack from North Korea.

This paper sheds light on the Chinese government's recent efforts to internationalize the Renminbi (RMB). China's standing as the world's second largest economy and its more than $3.9 trillion in foreign exchange reserves could greatly leverage China's monetary power. As the United States has become heavily dependent on Chinese financial support in the wake of the recent financial crisis, China has sought to exploit this financial advantage. China may seek to influence decision-making on matters relating to future reorganization of the international monetary system. Were the RMB to become a global currency, the status of the dollar as the world's top currency would be undermined and US hegemony in the international political economy potentially challenged. However, the intent of Chinese policy-makers is not to replace the top currency status of the United States, but rather to increase Chinese policy autonomy. Since internationalization of the RMB requires a massive financial liberalization of China's domestic economy and further might threaten the vested interests of domestic groups, China has pursued internationalization of the RMB by a two-track global and regional strategy in a gradual manner.

Tooth development, or odontogenesis, is the process of tooth formation, eruption, and integration with its surrounding tissues. Human genetics and mutant animal studies have identified a complex molecular regulatory network that controls tooth development, which is mediated by evolutionarily conserved transcription factors and signaling pathways that are shared with development, maintenance, and regeneration of many other organ systems across different species. Therefore, unraveling mechanisms of tooth development provides insights into a broad range of disciplines in biology and medicine, especially tissue engineering and regenerative medicine. This article summarizes the current knowledge of tooth development and associated developmental disorders.

This paper examines the arguments and assertions of Baran’s and Sweezy’s Monopoly Capital: An Essay on the American Economic and Social Order (1966) by assessing the degree of economic efficiency or inefficiency in how surplus value and economic surplus were created by 16 major capitalist economies during the 2000s using data envelopment analysis (DEA). After assigning a score to the degree of economic efficiency/inefficiency for each country, one can then assess which factors influence the degree of efficiency/inefficiency. This paper finds empirical support for many of the arguments put forth by the authors, Baran and Sweezy, as well as others regarding the inefficiency of the use of some forms of economic activity to help absorb economic surplus and to create surplus value.

With the Occupy movement that recently took place on Wall Street and in other parts of the globe, a lot of attention has recently been given to growing income inequality. The 2008 United States financial crisis, the Great Recession, and the subsequent weak recovery have brought about a more serious focus on income inequality and the widening income gap between the top 1 percent and other groups. These events have brought about some social unrest and instability in American society perhaps not seen since the Great Depression. How much has the top 1 percent of households gained in terms of income versus the other 99 percent in the United States over the last 30 years or so? Mainstream economists and other social scientists point to various causes which have been mentioned in many scholarly and popular writings. All of these mainstream factors affecting inequality have been found to be statistically significant in one scholarly study or another. This research paper explores other major concepts to explain income inequality rather than to dispute the findings of other existing research efforts. The empirical findings of this paper support radical arguments that income accumulation of those at the top is not connected to the productivity of capital investment, but rather instead is connected to the declining incomes and exploitation of the rest of the U.S. population despite the rising output per worker of the U.S. workforce over the last 30 to 40 years.

Blunt pancreatic trauma is rare, and the reported mortality is high. The true outcomes in isolated pancreas trauma are not known, and the optimal management according to injury severity is controversial. The present study evaluated the incidence, outcomes, and optimal management of isolated blunt pancreatic injuries.National Trauma Data Bank study, including patients with blunt pancreatic trauma. Patients with major associated injuries or other severe intra-abdominal injuries were excluded. Patients' demographics, vital signs on admission, Abbreviated Injury Scale for each body area, Injury Severity Score (ISS), and therapeutic modality were extracted. Mortality and hospital length of stay were stratified according to the severity of pancreatic injury and therapeutic modality.There were 388,137 patients with blunt abdominal trauma. Overall, 12,112 patients (3.1%) sustained pancreatic injury. Isolated pancreatic injury occurred in 2,528 (0.7%) of all abdominal injuries or 20.9% of pancreatic injuries. Most injuries were low-grade Organ Injury Scale ((OIS) score of 2, 82.7%) with only a small percentage of higher-grade injuries (OIS score of 3, 7.9%; OIS score of 4, 3.9%; and OIS score of 5, 5.5%). Overall, most patients (74.1%) were managed nonoperatively. Nonoperative management was selected in 80.5% of pancreas OIS score of 2, 48.5% of OIS score of 3, and 40.9% of OIS scores of 4 to 5. The overall mortality rate was 2.4%, while in severe pancreatic trauma it was 3.0%. In minor pancreatic trauma, nonoperative management was associated with lower mortality and shorter hospital length of stay than operative management. However, in the group of patients with severe pancreatic trauma (OIS scores, 4-5) nonoperative management was associated with higher mortality and longer hospital stay than definitive operative management of the pancreas.The mortality in isolated pancreatic trauma is low, even in severe injuries. Nonoperative management of minor pancreatic injuries is associated with lower mortality and shorter hospital stay than operative management. However, in severe trauma, nonoperative management is associated with higher mortality and longer hospital stay than operative management.Prognostic study, level III; therapeutic study, level IV.

This paper investigates financial liberalization in Mexico and South Korea from a comparative international political economy perspective. Though the two countries have a different political economy background, their experiences with financial repression and liberalization were similar, as was the manner in which they handled the subsequent huge inflow of capital. During the process of financial liberalization, both governments had their policy autonomy undermined by strong domestic interest groups as well as by influential international actors. Similar situational effects also prevailed during these two countries’ financial crises: both experienced surges of international financial capital, had presidential elections during the crisis, and joined the OECD around that time. This paper sheds light on how the two countries experienced macroeconomic imbalances and financial crisis as a result of financial liberalization. The experience suggests meaningful lessons for other developing countries regar...

New findings regarding the mechanisms of action of electroconvulsive therapy (ECT) have led to novel developments in treatment technique to further improve this highly effective treatment for major depression. These new approaches include novel electrode placements, optimization of electrical stimulus parameters, and new methods for inducing more targeted seizures (eg, magnetic seizure therapy [MST]). MST is the use of transcranial magnetic stimulation to induce a seizure. Magnetic fields pass through tissue unimpeded, providing more control over the site and extent of stimulation than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is at an early stage of development. Preliminary results suggest that MST may have some advantages over ECT in terms of subjective side effects and acute cognitive functioning. Studies designed to address the antidepressant efficacy of MST are underway. As with all attempts to improve convulsive therapy technique, the clinical value of MST will need to be established through controlled clinical trials. This article reviews the experience to date with MST, and places this work in the broader context of other means of optimizing convulsive therapy in the treatment of depression.

Ehlers-Danlos syndrome-hypermobility type (EDS-HT) is a connective tissue disorder associated with chronic musculoskeletal pain. The diagnosis is based on simple clinical examination, although it is easily overlooked. Herein we present a case of EDS-HT associated with hemorrhoids and suggest that there may be an association between the two conditions.

The optimal management of fulminant or complicated diverticulitis is the subject of debate in recent literature. The most common management strategy remains resection and end colostomy or Hartmann’s procedure, first introduced in the 1940s, despite the introduction of more current approaches supported by decreased morbidity and mortality by various studies. The purpose of this paper is to provide a review of the strategies described for the management of fulminant diverticulitis and the most recent evidence available to support these approaches. We discuss the advantages and disadvantages of the Hartmann’s procedure approach, as well as the most current management strategies, and offer both citation and review of relevant recent studies.

Angiostrongylus eosinophilic meningitis is caused by infection with larvae of the rat lungworm, Angiostrongylus cantonensis. We report the case of an adult who ingested a raw, giant African snail (Achatina fulica) on the island of O‘ahu in Hawai‘i and developed an eosinophilic meningoencephalitis with severe headache, confusion, sixth cranial nerve palsy, ataxia, limb weakness, and paresthesia. He was treated with lumbar punctures to relieve pressure, high dose corticosteroids, and 14 days of albendazole. He had a prolonged convalescence, requiring 3 months of prednisone, and still had evidence of motor nerve weakness 4 months after exposure. A field investigation at the site of exposure yielded 5 of 9 Achatina fulica snails with evidence of A. cantonensis DNA by PCR. Cerebrospinal fluid samples from the patient were negative acutely but positive on day 15 of symptoms, using an investigational, real-time PCR assay. We discuss clinical management of this case in light of the current medical literature.

Intermediary signals, precociously enhancing GLUTS transcription in response to perfusion of its substrate, fructose, in the small intestine of neonatal rats, are not known. Because glucose-6-phosphatase (G6Pase), glucose-6-phosphate trans-locase (G6PT), and fructose-1,6-bisphosphatase (FBPase) expression increases parallel to or precedes that of GLUTS, we investigated the link between these gluconeogenic genes and GLUTS by using vanadate or tungstate, potent inhibitors of gluconeogenesis. Small intestinal perfusions of 20-d-old rats were performed with fructose alone, fructose + vanadate or tungstate, glucose alone, and glucose + vanadate or tungstate. As expected, fructose, but not glucose nor glucose + inhibitor perfusion, increased GLUTS mRNA abundance and fructose transport. Fructose perfusion dramatically increased G6Pase mRNA abundance but had no effect on G6Pase activity. In sharp contrast, fructose perfusion did not increase FBPase gene expression but stimulated FBPase activity. Both vanadate and tungstate significantly inhibited G6Pase activity but did not prevent the fructose-induced increases in G6Pase and G6PT gene expression. Perfusion with fructose + vanadate prevented the fructose-induced increases in fructose transport and GLUT5 mRNA abundance, whereas perfusion with fructose + tungstate did not. Interestingly, vanadate, but not tungstate, inhibited the fructose-induced increase in FBPase activity. Thus, vanadate inhibition of fructose-induced increases in FBPase activity paralleled exactly vanadate inhibition of fructose-induced increases in GLUTS mRNA abundance and activity. Fructose-induced changes in FBPase activity may regulate changes in GLUTS expression and activity in the small intestine of neonatal rats. The marked increases in intestinal G6Pase and GLUTS mRNA abundance may be a parallel response to different factors released during fructose perfusion.

Elongin C is a highly conserved, low molecular weight protein found in a variety of multiprotein complexes in human, rat, fly, worm, and yeast cells. Among the best characterized of these complexes is a mammalian E3 ligase that targets proteins for ubiquitination and subsequent degradation by the 26 S proteasome. Despite its crucial role as a component of such E3 ligases and other complexes, the specific function of Elongin C is unknown. In yeast, Elongin C is a non-essential gene and there is no obvious phenotype as associated with its absence. We previously reported that in Saccharomyces cerevisiae Elongin C (Elc1) interacts specifically and strongly with a class of proteins loosely defined as stress response proteins. In the present study, we examined the role of yeast Elc1 in the turnover of two of these binding partners, Snf4 and Pcl6. Deletion of Elc1 resulted in decreased steady-state levels of Snf4 and Pcl6 as indicated by Western blot analysis. Northern blot analysis of mRNA prepared from elc1 null and wild type strains revealed no difference in mRNA levels for Snf4 and Pcl6 establishing that the effects of Elc1 are not transcriptionally mediated. Reintroduction of either yeast or human Elongin C into Elc1 null strains abrogated this effect. Taken together, these data document that the levels of Snf4 and Pcl6 are dependent on the presence of Elc1 and that binding to Elc1 inhibits the degradation of these proteins. The results suggest a new function for yeast Elongin C that is distinct from a direct role in targeting proteins for ubiquitination and subsequent proteolysis.

Mammalian Elongin C is a 112-amino acid protein that binds to the von Hippel–Lindau (VHL) tumor suppressor and to Elongin A, the transcriptionally active subunit of the RNA polymerase II elongation factor, SIII. It is conserved in eukaryotic cells, as homologs have been identified in Saccharomyces cerevisiae, Drosophila melanogaster and Caenorhabditis elegans. The mammalian protein is thought to function as part of a ubiquitin targeting E3 ligase, yet the function in yeast has not been determined. In this report we examine the role of Elongin C in yeast and establish that yeast Elongin C may function in a mode distinct from its role as an E3 ligase. The RNA is expressed ubiquitously, albeit at low levels. Two hybrid analyses demonstrate that Elongin C in yeast interacts with a specific set of proteins that are involved in the stress response. This suggests a novel role for Elongin C and provides insights into additional potential functions in mammalian cells.