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The excision site was in his mid-axilla and fell within the embryologic milk line. Because of concern for a metastatic implant, systemic staging was performed with CT and nuclear medicine bone scan, which revealed no evidence of disease. The incidence of EBT is low, 2-6 per cent, and the incidence of ectopic breast carcinoma is largely unknown because of the limited number of cases reported, but has been reported as 0.3-0.6 per cent.1 The majority of EBC specimens (70%) are invasive ductal, and the incidence is higher in Asians.2' 3 The axilla is the most frequently involved location for EBC, and the glandular tissue is within the subcutaneous tissue and deep dermis.1 Interestingly, according to the review by Visconti et al.,3 PEBC shows a slightly higher male prevalence than other forms of breast cancer. MRI may be needed if the lesion is inadequately visualized on mammogram or US.1 If no breast lesion is identified, then ipsilateral prophylactic mastectomy is not recommended for PEBC as there is no additional survival or recurrence benefit.3 Excision of the primary tumor and axillary lymph node dissection was the main strategy in most of the published case reports.2 The role of SLNB is emerging.

Group A Streptococcus (GAS) causes a variety of diseases in humans but is not widely appreciated as a cause of meningitis. During 1997-2022, ten sites participating in the Active Bacterial Core Surveillance network in the United States identified GAS meningitis cases. We calculated annual incidence and case-fatality rates (CFRs) for 320 of those cases and determined antimicrobial resistance by whole-genome sequencing. Annual incidence of GAS meningitis ranged from 0.02 to 0.07 cases/100,000 persons. Children <1 year of age had the highest average annual incidence, 0.23 cases/100,000 children. GAS meningitis had a higher CFR (19.4%) than meningitis caused by group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae. Clindamycin resistance among GAS meningitis isolates increased from 3.2% during 1997-2002 to 17.7% during 2018-2022. Clinicians should be aware that meningitis is an uncommon but severe manifestation of invasive GAS and has a higher CFR than more established meningitis etiologies.

Abstract Persons with HIV (PWH) are at increased risk for bacterial infections, and previous publications document an increased risk for invasive meningococcal disease (IMD) in particular. This analysis provides evidence that PWH face a 6-fold increase in risk for IMD based on Active Bacterial Core surveillance data collected during 2009–2019.

During 2012, an increase in the number of pertussis cases or outbreaks was reported among most states within the United States. The majority of these cases included previously vaccinated children between the ages of 7–10 years. This underscores the growing concern regarding current immunization practices and vaccine efficacy, especially as it pertains to pertussis prevention within this age group. In the fall of 2012, an outbreak of pertussis occurred within a school district in a rural Texas county that was reflective of this national pattern. Our objective is to describe this outbreak, highlight the similarities with the national trend, and identify strategies for better disease prevention. The cases in this outbreak were interviewed and laboratory testing done. Information regarding exposure and immunization history among cases was obtained. Immunization audits of the affected institutions were also conducted. We performed a descriptive analysis of the collected data using EPI-INFO software v. 3.5.3. A total of 34 cases were identified in this outbreak, of which 23 were PCR confirmed and 11 were epidemiologically linked. Ages ranged from 5 months to 12 years, and 62% were among children aged 7–10 years. All cases were up-to-date on their pertussis vaccinations. Immunization coverage rate was over 90% within each of the affected institutions. The characteristics of this outbreak bear striking similarities to the current national trend in terms of age groups and immunization status of the affected cases. Increased focus on this vulnerable target group, including heightened scrutiny of vaccine efficacy and delivery, is indicated.

Successful combinations of radiotherapy and immunotherapy depend on the presence of live T cells within the tumor; however, radiotherapy is believed to damage T cells. Here, based on longitudinal in vivo imaging and functional analysis, we report that a large proportion of T cells survive clinically relevant doses of radiation and show increased motility, and higher production of interferon gamma, compared with T cells from unirradiated tumors. Irradiated intratumoral T cells can mediate tumor control without newly-infiltrating T cells. Transcriptomic analysis suggests T cell reprogramming in the tumor microenvironment and similarities with tissue-resident memory T cells, which are more radio-resistant than circulating/lymphoid tissue T cells. TGFβ is a key upstream regulator of T cell reprogramming and contributes to intratumoral Tcell radio-resistance. These findings have implications for the design of radio-immunotherapy trials in that local irradiation is not inherently immunosuppressive, and irradiation of multiple tumors might optimize systemic effects of radiotherapy. Lymphocytes are considered one of the most radiosensitive cell types in the body. Here the authors show that unlike circulating lymphocytes, tumor-infiltrating T cells survive therapeutic doses of irradiation, remaining functional and contributing to radiotherapy induced anti-tumor immunity.

Bacillus anthracis is a spore-forming, Gram-positive bacterium responsible for anthrax, an acute infection that most significantly affects grazing livestock and wild ungulates, but also poses a threat to human health. The geographic extent of B . anthracis is poorly understood, despite multi-decade research on anthrax epizootic and epidemic dynamics; many countries have limited or inadequate surveillance systems, even within known endemic regions. Here, we compile a global occurrence dataset of human, livestock and wildlife anthrax outbreaks. With these records, we use boosted regression trees to produce a map of the global distribution of B . anthracis as a proxy for anthrax risk. We estimate that 1.83 billion people (95% credible interval (CI): 0.59–4.16 billion) live within regions of anthrax risk, but most of that population faces little occupational exposure. More informatively, a global total of 63.8 million poor livestock keepers (95% CI: 17.5–168.6 million) and 1.1 billion livestock (95% CI: 0.4–2.3 billion) live within vulnerable regions. Human and livestock vulnerability are both concentrated in rural rainfed systems throughout arid and temperate land across Eurasia, Africa and North America. We conclude by mapping where anthrax risk could disrupt sensitive conservation efforts for wild ungulates that coincide with anthrax-prone landscapes. Occurrence modelling of Bacillus anthracis defines global human and animal risk of anthrax infection.

Purpose of Review Since the pandemic, the daily activities of many people occur at home. People connect to the Internet for work, school, shopping, entertainment, and doctor visits, including psychiatrists. Concurrently, cybercrime has surged worldwide. This narrative review examines the changing use of technology, societal impacts of the pandemic, how cybercrime is evolving, individual vulnerabilities to cybercrime, and special concerns for those with mental illness. Recent Findings Human factors are a central component of cybersecurity as individual behaviors, personality traits, online activities, and attitudes to technology impact vulnerability. Mental illness may increase vulnerability to cybercrime. The risks of cybercrime should be recognized as victims experience long-term psychological and financial consequences. Patients with mental illness may not be aware of the dangers of cybercrime, of risky online behaviors, or the measures to mitigate risk. Summary Technology provides powerful tools for psychiatry but technology must be used with the appropriate safety measures. Psychiatrists should be aware of the potential aftermath of cybercrime on mental health, and the increased patient risk since the pandemic, including from online mental health services. As a first step to increase patient awareness of cybercrime, psychiatrists should provide a recommended list of trusted sources that educate consumers on cybersecurity.

Michael Cho and colleagues report a genome-wide association study of risk for chronic obstructive pulmonary disease (COPD) in a large, multi-ancestry cohort. They identify 22 genome-wide significant loci, including 13 not previously associated with COPD and 4 not previously associated with any lung function trait. Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide 1 . We performed a genetic association study in 15,256 cases and 47,936 controls, with replication of select top results ( P < 5 × 10 −6 ) in 9,498 cases and 9,748 controls. In the combined meta-analysis, we identified 22 loci associated at genome-wide significance, including 13 new associations with COPD. Nine of these 13 loci have been associated with lung function in general population samples 2 , 3 , 4 , 5 , 6 , 7 , while 4 ( EEFSEC , DSP , MTCL1 , and SFTPD ) are new. We noted two loci shared with pulmonary fibrosis 8 , 9 ( FAM13A and DSP ) but that had opposite risk alleles for COPD. None of our loci overlapped with genome-wide associations for asthma, although one locus has been implicated in joint susceptibility to asthma and obesity 10 . We also identified genetic correlation between COPD and asthma. Our findings highlight new loci associated with COPD, demonstrate the importance of specific loci associated with lung function to COPD, and identify potential regions of genetic overlap between COPD and other respiratory diseases.

Prior studies have shown that high-fat diet (HFD) can have profound effects on the gastrointestinal (GI) tract microbiome and also demonstrate that bacteria in the GI tract can affect metabolism and lean/obese phenotypes. We investigated whether the composition of viral communities that also inhabit the GI tract are affected by shifts from normal to HFD. We found significant and reproducible shifts in the content of GI tract viromes after the transition to HFD. The differences observed in virome community membership and their associated gene content suggest that these altered viral communities are populated by viruses that are more virulent toward their host bacteria. Because HFD also are associated with significant shifts in GI tract bacterial communities, we believe that the shifts in the viral community may serve to drive the changes that occur in associated bacterial communities. Alterations in diet can have significant impact on the host, with high-fat diet (HFD) leading to obesity, diabetes, and inflammation of the gut. Although membership and abundances in gut bacterial communities are strongly influenced by diet, substantially less is known about how viral communities respond to dietary changes. Examining fecal contents of mice as the mice were transitioned from normal chow to HFD, we found significant changes in the relative abundances and the diversity in the gut of bacteria and their viruses. Alpha diversity of the bacterial community was significantly diminished in response to the diet change but did not change significantly in the viral community. However, the diet shift significantly impacted the beta diversity in both the bacterial and viral communities. There was a significant shift away from the relatively abundant Siphoviridae accompanied by increases in bacteriophages from the Microviridae family. The proportion of identified bacteriophage structural genes significantly decreased after the transition to HFD, with a conserved loss of integrase genes in all four experimental groups. In total, this study provides evidence for substantial changes in the intestinal virome disproportionate to bacterial changes, and with alterations in putative viral lifestyles related to chromosomal integration as a result of shift to HFD. IMPORTANCE Prior studies have shown that high-fat diet (HFD) can have profound effects on the gastrointestinal (GI) tract microbiome and also demonstrate that bacteria in the GI tract can affect metabolism and lean/obese phenotypes. We investigated whether the composition of viral communities that also inhabit the GI tract are affected by shifts from normal to HFD. We found significant and reproducible shifts in the content of GI tract viromes after the transition to HFD. The differences observed in virome community membership and their associated gene content suggest that these altered viral communities are populated by viruses that are more virulent toward their host bacteria. Because HFD also are associated with significant shifts in GI tract bacterial communities, we believe that the shifts in the viral community may serve to drive the changes that occur in associated bacterial communities.