Ischemic Colitis in a Middle-Aged Man With COVID-19: Case Report and Review of Literature.

Introduction: Coronavirus disease 2019 (COVID-19) was a pandemic that began in 2019 and continues to have morbid and deadly consequences throughout the world. During the beginning of the pandemic, many considered older adults and immunocompromised younger adults to be the only populations at risk for the severe consequences of COVID-19. Throughout the pandemic, this was proven wrong with several case reports and studies showing that relatively younger adults can also suffer serious consequences from this perplexing virus. Case Presentation: We report a rare case of ischemic colitis in a 42-year-old obese man who presented to the emergency department with quintessential COVID-19 symptoms. During his hospital course, he developed not only respiratory failure but also ischemic colitis, although he had no past medical history of any coagulopathy and was never on any pressors. Conclusion: As more case reports are being published, it has become evident that COVID-19 has the ability to cause serious extrapulmonary consequences due to an imposed state of hypercoagulability, and younger adults are at risk of facing these consequences, especially if they are obese. Thus, it is imperative that younger adults seek out the COVID-19 vaccine when available to them not only to protect those most vulnerable around them but also to protect themselves from these complications.

Intrahepatic microbes govern liver immunity by programming NKT cells.

The gut microbiome shapes local and systemic immunity. The liver is presumed to be a protected sterile site. As such, a hepatic microbiome has not been examined. Here, we showed a liver microbiome in mice and humans that is distinct from that of the gut and is enriched in Proteobacteria. It undergoes dynamic alterations with age and is influenced by the environment and host physiology. Fecal microbial transfer experiments revealed that the liver microbiome is populated from the gut in a highly selective manner. Hepatic immunity is dependent on the microbiome, specifically the bacteroidetes species. Targeting bacteroidetes with oral antibiotics reduced hepatic immune cells by approximately 90%, prevented antigen-presenting cell (APC) maturation, and mitigated adaptive immunity. Mechanistically, our findings are consistent with presentation of bacteroidetes-derived glycosphingolipids to NKT cells promoting CCL5 signaling, which drives hepatic leukocyte expansion and activation, among other possible host-microbe interactions. Collectively, we reveal a microbial/glycosphingolipid/NKT/CCL5 axis that underlies hepatic immunity.

Clinicopathologic Characteristics and Prognosis of Invasive Papillary Carcinoma of the Breast.

BACKGROUND: Invasive papillary carcinoma (IPC) of the breast is thought to carry a more favorable prognosis than invasive ductal carcinoma (IDC). The aim of this study is to investigate the clinicopathological characteristics between IPC and IDC and their prognosis using a large nationwide data set. METHODS: Female patients diagnosed with malignant IPC and IDC between 2005 and 2014 were analyzed. Patients with incomplete survival data, stage 0/IV, unknown stage, or recurrent disease were excluded. Five-year overall survival was compared between IPC and IDC. RESULTS: Among 308,426 patients, 1147 had IPC and 307,279 had IDC. IPC presented more in older postmenopausal women, black Americans, and people who had government insurance. IPC had larger tumor size, lower-grade, and earlier-stage disease, less node-positive disease, higher hormone positivity, and lower human epidermal growth factor receptor 2 amplification. Adjuvant radiation and chemotherapy rates were lower in IPC than those in IDC. IPC had a similar 5-year overall survival as compared with IDC overall (86.8% versus 88.7%) (P = 0.06). Age, pathologic stage, and radiation treatment were shown to be independent prognostic factors of IPC. CONCLUSIONS: IPC has a similar prognosis as IDC, suggesting that these patients should follow the same treatment protocols.