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We find a heterogeneous, geographic distribution of cumulative infection attack rates by 4 July 2020, ranging from 0.78%-15.2% across US states and 0.19%-13.2% in European countries. Our approach complements phylogenetic analyses and other surveillance approaches and provides insights that can be used to design innovative, model-driven surveillance systems that guide enhanced testing and response strategies.SARS-CoV-2 is a single-stranded RNA virus that causes coronavirus disease 2019 (COVID-19). Given its acute and often self-limiting course, components of the innate immune system are likely central in controlling virus replication thereby determining clinical outcome. Natural killer (NK) cells are innate lymphocytes with notable activity against a broad range of viruses, including RNA viruses1,2. NK cell function may be altered during COVID-19 despite increased representation of NK cells with an activated and 'adaptive' phenotype3,4. Here we show that viral load decline in COVID-19 correlates with NK cell status and that NK cells can control SARS-CoV-2 replication by recognizing infected target cells. In severe COVID-19, NK cells show remarkable defects in virus control, cytokine production and cell-mediated cytotoxicity despite high expression of cytotoxic effector molecules. Single-cell RNA-sequencing (scRNA-seq) of NK cells along the time course of the entire COVID-19 disease spectrum reveals a unique gene expression signature. Transcriptional networks of interferon-driven NK cell activation are superimposed by a dominant TGFβ response signature with reduced expression of genes related to cell-cell adhesion, granule exocytosis and cell-mediated cytotoxicity. In severe COVID-19, serum levels of TGFβ peak during the first 2 weeks of infection, and serum obtained from these patients profoundly inhibits NK cell function in a TGFβ-dependent manner. Our data reveal that untimely production of TGFβ is a hallmark of severe COVID-19 and may inhibit NK cell function and early virus control.Age-related macular degeneration (AMD) is a leading cause of blindness. Late AMD can be classified into exudative (commonly known as wet AMD [wAMD]) or dry AMD, both of which may progress to macular atrophy (MA). MA causes irreversible vision loss and currently has no approved pharmacological treatment. The standard of care for wAMD is treatment with anti-vascular endothelial growth factors (VEGF). However, recent evidence suggests that anti-VEGF treatment may play a role in the development of MA. Therefore, it is important to identify risk factors for the development of MA in patients with wAMD. For example, excessive blockade of VEGF through intense use of anti-VEGF agents may accelerate the development of MA. Patients with type III macular neovascularisation (retinal angiomatous proliferation) have a particularly high risk of MA. These patients are characterised as having a pre-existing thin choroid (age-related choroidopathy), suggesting that the choroidal circulation is unable to respond to increased VEGF expression. Evidence suggests that subretinal fluid (possibly indicative of residual VEGF activity) may play a protective role. Patients receiving anti-VEGF agents must be assessed for overall risk of MA and there is an unmet medical need to prevent the development of MA without undertreating wAMD.MAMLD1 (alias CXorf6) was first documented in 2006 as a causative gene of 46,XY differences/disorders of sex development (DSD). MAMLD1/Mamld1 is expressed in the fetal testis and is predicted to enhance the expression of several Leydig cell-specific genes. To date, hemizygous MAMLD1 variants have been identified in multiple 46,XY individuals with hypomasculinized external genitalia. Pathogenic MAMLD1 variants are likely to cause genital abnormalities at birth and are possibly associated with age-dependent deterioration of testicular function. In addition, some MAMLD1 variants have been identified in 46,XX individuals with ovarian dysfunction. However, recent studies have raised the possibility that MAMLD1 variants cause 46,XY DSD and ovarian dysfunction as oligogenic disorders. Unsolved issues regarding MAMLD1 include the association between MAMLD1 variants and 46,XX testicular DSD, gene-gene interactions in the development of MAMLD1-mediated DSD, and intracellular functions of MAMLD1.INTRODUCTION The purpose of this study was to compare clinical/demographic, functional testing and multimodal imaging features between genetically solved and genetically unsolved non-syndromic retinitis pigmentosa (nsRP) patients. METHODS Cross sectional study conducted at an inherited retinal dystrophies reference center. Consecutive patients with nsRP and available genetic testing results performed between 2018 and 2020 were included. [https://www.selleckchem.com/products/n6-methyladenosine.html find more] Genetic testing was clinically-oriented and variants were classified according to the American College of Medical Genetics and Genomics. Only class IV or V variants were considered disease-causing. Clinical/demographic, functional and imaging features were compared between genetically unsolved (G1) and genetically solved (G2) patients. RESULTS A total of 175 patients (146 families) were included 68 patients (59 families) in G1 and 107 patients (87 families) in G2. First symptoms less then 25 years, consanguinity, evidence for a particular inheritance pattern and absence of indicators for phenocopies were significantly more prevalent in G2. No significant differences were observed on best-corrected visual acuity. The visual field index and mean central retinal layer thickness were significantly higher in G1. The frequency of atypical features on multimodal imaging did not differ between groups. CONCLUSION Individual clinical/demographic, functional testing and multimodal imaging features should be considered when counselling patients about the probability of identifying disease-causing variants.<br />Early skin-to-skin contact (ESSC) is associated with rare, sudden, unexpected postnatal collapse episodes. Placing the newborn in ESSC closer to an upright position may reduce the risk of airway obstruction and improve respiratory mechanics. This study assessed whether a greater inclination of the mother's bed during ESSC would reduce the proportion of healthy term newborns (HTNs) who experienced episodes of pulse oximeter saturation (SpO2) &lt;91%.<br />We conducted a multicenter randomized controlled trial comparing the effect of the mother's bed incline, 45° versus 15°, on desaturation in HTNs during ESSC. Before delivery on 1,271 dyads, randomization was conducted, and stringent criteria to select healthy mothers and term newborns were monitored until after birth. Preductal SpO2 was continuously monitored between 10 min and 2 h after birth. The primary outcome was the occurrence of at least one episode of SpO2 &lt;91%.<br />254 (20%) mother-infant dyads were eligible for analysis (45°, n = 126; 15°, n = 128). Overall, 57% (95% confidence interval [CI] 51%-63%) of newborns showed episodes of SpO2 &lt;91%. The proportion of infants with SpO2 &lt;91% episodes was 52% in 45° and 62% in 15° (relative risk 0.80; 95% CI 0.6-1.07).<br />We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO2 &lt;91%. Desaturation episodes from 10 min to 2 h after birth occurred in more than half of HTNs.<br />We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO2 less then 91%. Desaturation episodes from 10 min to 2 h after birth occurred in more than half of HTNs.Our understanding of the transmission of anthropozoonotic diseases between humans and nonhuman primates, particularly great apes due to their close genetic relationship with humans, highlights a serious potential threat to the survival of these species. This is particularly the case at tourism sites where risk of disease transmission is increased. We focus on the interaction between tourists and the Critically Endangered Sumatran orangutan (Pongo abelii) at Bukit Lawang in the Gunung Leuser National Park, Indonesia, before and after the park was closed due to the threat of Covid-19 in April 2020. Through analysis of posts on Instagram we determine the extent of compliance by visitors with the rule to keep a minimum distance of 10 meters from orangutans and assess the positional behaviours of the orangutans. Of the 2,229 photographs we assessed between November 2019 and July 2020, 279 depicted one or more orangutans. Forty-two of these contained both a human and an orangutan, and of these all showed inappropriate behaviours (direct contact, feeding orangutans, close proximity less then 5m) providing direct evidence of noncompliance with the 10m distance rule. Most of these photographs additionally showed orangutans performing abnormal positional behaviours such as being low to or on the ground rather than their natural high position in the canopy; being near the ground and in close proximity to humans increases the risk of anthropozoonotic disease transmission. As expected, we found a significant decrease in number of photographs that were posted following the closure, and a decrease in the proportion of photographs that showed orangutans or tourists feeding orangutans. Tourists do not seem to perceive that they pose risks to the orangutans and therefore increased awareness, education and enforcement of rules by all stakeholders, tourism bodies and government officials need to be actioned in order to safeguard this important population, which is crucial to the future survival of the Sumatran orangutan.<br />Various cerebrospinal fluid (CSF) biomarkers are studied in Parkinson's disease (PD) and atypical parkinsonian syndromes (APS). Several studies found reduced 5-hydroxyindoleacetic acid (5-HIAA), the main serotonin metabolite, in PD. There is little evidence regarding its levels in APS.<br />We measured 5-HIAA in the CSF of 90 PD patients, 16 MSA patients, 26 progressive supranuclear palsy (PSP) patients, 11 corticobasal degeneration (CBD) patients, and 31 controls. We also compared the values in depressed and non-depressed patients.<br />There was a statistically significant difference in CSF 5-HIAA in PD and MSA compared to the control group (median in PD 15.8 µg/l, in MSA 13.6 µg/l vs. 24.3 µg/l in controls; P=0.0008 in PD, P=0.006 in MSA). There was no statistically significant difference in CSF 5-HIAA in PSP and CBD compared to the control group (median in PSP 22.7 µg/l, in CBD 18.7 µg/l vs. 24.3 µg/l in controls; P= 1 in both PSP and CBD). CSF 5-HIAA levels were lower in PD patients with depression compared to PD patients without depression (median 8.34 vs. 18.48, P&lt;0.0001).<br />CSF 5-HIAA is decreased in PD and MSA. The CSF 5-HIAA levels in PSP and CBS did not differ from those of the control group. There was a tendency toward lower CSF 5-HIAA in MSA than in PD, however, the results did not reach statistical significance. These results may be explained by more severe damage of the serotonergic system in synucleinopathies (PD, MSA) than in tauopathies (PSP, CBS).<br />CSF 5-HIAA is decreased in PD and MSA. The CSF 5-HIAA levels in PSP and CBS did not differ from those of the control group. There was a tendency toward lower CSF 5-HIAA in MSA than in PD, however, the results did not reach statistical significance. These results may be explained by more severe damage of the serotonergic system in synucleinopathies (PD, MSA) than in tauopathies (PSP, CBS).