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Chiew Yong Ng,1 Jia Ying Chai,1 Jhi Biau Foo,2,3 Nor Hamdan Mohamad Yahaya,4 Ying Yang,5 Min Hwei Ng,1 Jia Xian Law1 1Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, 56000, Malaysia; 2School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, 47500, Selangor, Malaysia; 3Centre for Drug Discovery and Molecular Pharmacology (CDDMP), Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, 47500, Malaysia; 4Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia; 5School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, UKCorrespondence: Jia Xian LawCentre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, Kuala Lumpur, 56000, MalaysiaTel +603 9145 7677Fax +603 9145 7678Email danieljx08@gmail.com; lawjx@ppukm.ukm.edu.myAbstract: Treatment of cartilage defects such as osteoarthritis (OA) and osteochondral defect (OCD) remains a huge clinical challenge in orthopedics. OA is one of the most common chronic health conditions and is mainly characterized by the degeneration of articular cartilage, shown in the limited capacity for intrinsic repair. OCD refers to the focal defects affecting cartilage and the underlying bone. The current OA and OCD management modalities focus on symptom control and on improving joint functionality and the patient’s quality of life. Cell-based therapy has been evaluated for managing OA and OCD, and its chondroprotective efficacy is recognized mainly through paracrine action. Hence, there is growing interest in exploiting extracellular vesicles to induce cartilage regeneration. In this review, we explore the in vivo evidence of exosomes on cartilage regeneration. A total of 29 in vivo studies from the PubMed and Scopus databases were identified and analyzed. The studies reported promising results in terms of in vivo exosome delivery and uptake; improved cartilage morphological, histological, and biochemical outcomes; enhanced subchondral bone regeneration; and improved pain behavior following exosome treatment. In addition, exosome therapy is safe, as the included studies documented no significant complications. Modifying exosomal cargos further increased the cartilage and subchondral bone regeneration capacity of exosomes. We conclude that exosome administration is a potent cell-free therapy for alleviating OA and OCD. However, additional studies are needed to confirm the therapeutic potential of exosomes and to identify the standard protocol for exosome-based therapy in OA and OCD management.Keywords: extracellular vesicle, exosome, chondrocyte, cartilage, osteoarthritis

Shin-Hong Chen,1 I-Shiang Tzeng,2– 4 Chou-Chin Lan,5,6 Jau-Yuan Chen,7 Chau Yee Ng,8 Yao-Chin Wang,9 Wen-Lin Su,5 Giou-Teng Yiang,10 Tsu-Yi Chen,10 Chih-Wei Wu,5 Po-Chun Hsieh,11 Chan-Yen Kuo,4 Meng-Yu Wu10 1Department of Education and Research, Taiwan Adventist Hospital, Taipei 10556, Taiwan; 2Department of Statistics, National Taipei University, Taipei 10478, Taiwan; 3Department of Applied Mathematics; Department of Exercise and Health Promotion, Chinese Culture University, Taipei 11114, Taiwan; 4Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; 5Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; 6School of Medicine, Tzu-Chi University, Hualien 97004, Taiwan; 7Department of Family Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; 8Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung 10507, Taiwan; 9Department of Emergency Medicine, Min-Sheng General Hospital, Taoyuan 33044, Taiwan; 10Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; 11Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, TaiwanCorrespondence: I-Shiang Tzeng No. 289, Jianguo Road, Xindian Dist, New Taipei City 231, TaiwanTel +886-2-6628-9779 ext. 3119Email istzeng@gmail.comBackground: Emergency room (ER) physicians need to face clinically suspected pneumonia patients in the front line of medical care and must do to give major medical interventions if patients show severity in pneumonia.Methods: The data of pneumonia-related ER visit rates were categorized based on the International Classification of Disease (ICD) Codes (480– 486) between 1998 and 2012. We use an age-period-cohort (APC) model to separate the pneumonia-related ER visit rates to identify the effects of age, time period, and cohort for a total of 1,813,588 patients.Results: The age effect showed high risk for pediatric and elder populations. There is a significant increasing period effect, which increased from 1998 to 2012. The cohort effect tended to show an oscillation from 1913 to 1988 and the reverse in a recent cohort. Furthermore, the visit rate of pneumonia showed an increase from 1998 to 2012 for both genders.Conclusion: Age is a risk factor for pneumonia-related ER visits, especially for children and adolescents and older patients. Period and cohort effects were also found to increase the pneumonia visit rates. An APC model used to provide an advance clue for trend of pneumonia-related ER visit rates diversified.Keywords: age-period-cohort, age-adjusted emergency rooms visit rates, pneumonia

Chun-Bing Chen,1–6 Ming-Ying Wu,1–4 Chau Yee Ng,1–5 Chun-Wei Lu,1–6 Jennifer Wu,1–4,6 Pei-Han Kao,1–4,6 Chan-Keng Yang,4–7 Meng-Ting Peng,4,6–7 Chen-Yang Huang,4,6–7 Wen-Cheng Chang,4,6–7 Rosaline Chung-Yee Hui,1–4 Chih-Hsun Yang,1–4 Shun-Fa Yang,8,9 Wen-Hung Chung,1–4,6,10,11 Shih-Chi Su1–4,10 1Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; 2Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan; 3Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; 4College of Medicine, Chang Gung University, Taoyuan, Taiwan; 5Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 6Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; 7Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; 8Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 9Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan; 10Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; 11Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China Abstract: With the increasing use of targeted anticancer drugs and immunotherapies, there have been a substantial number of reports concerning life-threatening severe cutaneous adverse reactions (SCARs), including Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome, and acute generalized exanthematous pustulosis. Although the potential risks and characteristics for targeted anticancer agent- and immunotherapy-induced SCAR were not well understood, these serious adverse reactions usually result in morbidity and sequela. As a treatment guideline for this devastating condition is still unavailable, prompt withdrawal of causative drugs is believed to be a priority of patient management. In this review, we outline distinct types of SCARs caused by targeted anticancer therapies and immunotherapies. Also, we discuss the clinical course, latency, concomitant medication, tolerability of rechallenge or alternatives, tumor response, and mortality associated with these devastating conditions. Imatinib, vemurafenib, and rituximab were the top three offending medications that most commonly caused SJS/TEN, while EGFR inhibitors were the group of drugs that most frequently induced SJS/TEN. For drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis, imatinib was also the most common offending drug. Additionally, we delineated 10 SCAR cases related to innovative immunotherapies, including PD1 and CTLA4 inhibitors. There was a wide range of latency periods: 5.5–91 days (median). Only eight of 16 reported patients with SCAR showed clinical responses. Targeted anticancer drugs and immunotherapies can lead to lethal SCAR (14 deceased patients were identified as suffering from SJS/TEN). The mortality rate of TEN was high: up to 52.4%. The information compiled herein will serve as a solid foundation to formulate ideas for early recognition of SCAR and to discontinue offending drugs for better management. Keywords: acute generalized exanthematous pustulosis, drug rash, eosinophilia, Stevens–Johnson syndrome, toxic epidermal necrolysis, targeted therapy, immunotherapy

Photodissociation by ultraviolet radiation is the key destruction pathway for CS in photon-dominated regions, such as diffuse clouds. However, the large uncertainties of photodissociation cross sections and rates of CS, resulting from a lack of both laboratory experiments and theoretical calculations, limit the accuracy of calculated abundances of S-bearing molecules by modern astrochemical models. Here we show a detailed ab initio study of CS photodissociation. Accurate potential energy curves of CS electronic states were obtained by choosing an active space CAS(8,10) in MRCI+Q/aug-cc-pV(5+d)Z calculation with additional diffuse functions, with a focus on the B and C 1Σ+ states. Cross sections for both direct photodissociation and predissociation from the vibronic ground state were calculated by applying the coupled-channel method. We found that the C - X (0 - 0) transition has extremely strong absorption due to a large transition dipole moment in the Franck-Condon region, and the upper state is resonant with several triplet states via spin-orbit couplings, resulting in predissociation to the main atomic products C (3 P) and S (1 D). Our new calculations show that the photodissociation rate under the standard interstellar radiation field is 2.9-10-9 s-1, with a 57% contribution from C - X (0 - 0) transition. This value is larger than that adopted by the Leiden photodissociation and photoionization database by a factor of 3.0. Our accurate ab initio calculations will allow more secure determination of S-bearing molecules in astrochemical models.

Despite more than 30 years of searching, the compact object in Supernova (SN) 1987A has not yet been detected. We present new limits on the compact object in SN 1987A using millimeter, near-infrared, optical, ultraviolet, and X-ray observations from ALMA, VLT, HST, and Chandra. The limits are approximately 0.1 mJy ( erg s-1 cm-2 Hz-1) at 213 GHz, 1 L o ( erg s-1 cm-2 Hz-1) in the optical if our line of sight is free of ejecta dust, and 1036 erg s-1 ( erg s-1 cm-2 Hz-1) in 2-10 keV X-rays. Our X-ray limits are an order of magnitude less constraining than previous limits because we use a more realistic ejecta absorption model based on three-dimensional neutrino-driven SN explosion models. The allowed bolometric luminosity of the compact object is 22 L o if our line of sight is free of ejecta dust, or 138 L o if dust-obscured. Depending on assumptions, these values limit the effective temperature of a neutron star (NS) to -8 MK and do not exclude models, which typically are in the range 3-4 MK. For the simplest accretion model, the accretion rate for an efficiency η is limited to M o yr-1, which excludes most predictions. For pulsar activity modeled by a rotating magnetic dipole in vacuum, the limit on the magnetic field strength (B) for a given spin period (P) is G s-2, which firmly excludes pulsars comparable to the Crab. By combining information about radiation reprocessing and geometry, we infer that the compact object is a dust-obscured thermally emitting NS, which may appear as a region of higher-temperature ejecta dust emission.

NASA's Genesis mission reveals that the rare isotope 15N is approximately seven times more enriched than the rare isotopes 17O and 18O in the terrestrial planets relative to the Sun. Here, we explain this peculiar observation under the framework of self-shielding and the difference in chemical reactivity between the excited O(1 D) [N(2 D)] and the ground O(3 P) [N(4 S)] states produced by VUV photodissociation of CO [N2]. After weighting the absorption cross-sections for individual photodissociation bands, and taking into account the mutual shielding by H2, the CO/N2 ratio, and the partition of O and N among gas:ice:dust phases in the solar nebula, we show that the trapping of N(2 D) via hydrogenation is favored over that of O(1 D). This provides a possible explanation of the Genesis results and supports the self-shielding model as the primary mechanism for generating isotopic anomalies of O and N in the early solar nebula.

The branching ratios for the N(4S) + N(2D), N(4S) + N(2P), and N(2D) + N(2D) channels are measured for the photodissociation of in the vacuum ultraviolet (VUV) region of 100,808-122,159 cm-1 using the VUV-VUV pump-probe approach combined with velocity-map-imaging-photoion detection. No evidence of forming the ground-state N(4S) + N(4S) products is found. No potential barrier is observed for the N(2D) + N(2D) channel, but the N(4S) + N(2P) channel has a small potential barrier of ≈740 cm-1. The branching ratios are found to depend on the symmetry of predissociative N2 states instead of the total VUV excitation energy, indicating that N2 photodissociation is nonstatistical. When the branching ratios for N(4S) + N(2D) and N(4S) + N(2P) products are plotted as a function of the VUV excitation energy for the valence N21Πu and states, oscillations in these ratios are observed demonstrating how these channels are competing with each other. These data can be used to select both the velocity and internal states of the atomic products by picking the quantum state that is excited. High-level ab initio potential energy curves of the excited N2 states are calculated to provide insight into the mechanisms for the observed branching ratios. The calculations predict that the formation of both N(4S) + N(2D) and N(4S) + N(2P) channels involves potential energy barriers, in agreement with experimental observations. A discussion of the application of the present results to astronomy, planetary sciences, and comets is given.

The state-to-state photodissociation of CO2 is investigated in the VUV range of 11.94-12.20 eV by using two independently tunable vacuum ultraviolet (VUV) lasers and the time-sliced velocity-map-imaging-photoion (VMI-PI) method. The spin-allowed CO(X(1)Σ(+); v = 0-18) + O((1)D) and CO(X(1)Σ(+); v = 0-9) + O((1)S) photoproduct channels are directly observed from the measurement of time-sliced VMI-PI images of O((1)D) and O((1)S). The total kinetic energy release (TKER) spectra obtained based on these VMI-PI images shows that the observed energetic thresholds for both the O((1)D) and O((1)S) channels are consistent with the thermochemical thresholds. Furthermore, the nascent vibrational distributions of CO(X(1)Σ(+); v) photoproducts formed in correlation with O((1)D) differ significantly from that produced in correlation with O((1)S), indicating that the dissociation pathways for the O((1)D) and O((1)S) channels are distinctly different. For the O((1)S) channel, CO(X(1)Σ(+); v) photoproducts are formed mostly in low vibrational states (v = 0-2), whereas for the O((1)D) channel, CO(X(1)Σ(+); v) photoproducts are found to have significant populations in high vibrationally excited states (v = 10-16). The anisotropy β parameters for the O((1)D) + CO(X(1)Σ(+); v = 0-18) and O((1)S) + CO(X(1)Σ(+); v = 0-9) channels have also been determined from the VMI-PI measurements, indicating that CO2 dissociation to form the O((1)D) and O((1)S) channels is faster than the rotational periods of the VUV excited CO2 molecules. We have also calculated the excited singlet potential energy surfaces (PESs) of CO2, which are directly accessible by VUV excitation, at the ab initio quantum multi-reference configuration interaction level of theory. These calculated PESs suggest that the formation of CO(X(1)Σ(+)) + O((1)S) photoproducts occurs nearly exclusively on the 4(1)A' PES, which is generally repulsive with minor potential energy ripples along the OC-O stretching coordinate. The formation of CO(X(1)Σ(+)) + O((1)D) photofragments can proceed by non-adiabatic transitions from the 4(1)A' PES to the lower 3(1)A' PES of CO2via the seam of conical intersections at a near linear OCO configuration, followed by the direct dissociation on the 3(1)A' PES. The theoretical PES calculations are consistent with the experimental observation of prompt CO2 dissociation and high rotational and vibrational excitations for CO(X(1)Σ(+)) photoproducts.

The state-to-state photodissociation of CO2 is investigated in the VUV range of 11.94-12.20 eV by using two independently tunable vacuum ultraviolet (VUV) lasers and the time-sliced velocity-map-imaging-photoion (VMI-PI) method. The spin-allowed CO(X(1)Σ(+); v = 0-18) + O((1)D) and CO(X(1)Σ(+); v = 0-9) + O((1)S) photoproduct channels are directly observed from the measurement of time-sliced VMI-PI images of O((1)D) and O((1)S). The total kinetic energy release (TKER) spectra obtained based on these VMI-PI images shows that the observed energetic thresholds for both the O((1)D) and O((1)S) channels are consistent with the thermochemical thresholds. Furthermore, the nascent vibrational distributions of CO(X(1)Σ(+); v) photoproducts formed in correlation with O((1)D) differ significantly from that produced in correlation with O((1)S), indicating that the dissociation pathways for the O((1)D) and O((1)S) channels are distinctly different. For the O((1)S) channel, CO(X(1)Σ(+); v) photoproducts are formed mostly in low vibrational states (v = 0-2), whereas for the O((1)D) channel, CO(X(1)Σ(+); v) photoproducts are found to have significant populations in high vibrationally excited states (v = 10-16). The anisotropy β parameters for the O((1)D) + CO(X(1)Σ(+); v = 0-18) and O((1)S) + CO(X(1)Σ(+); v = 0-9) channels have also been determined from the VMI-PI measurements, indicating that CO2 dissociation to form the O((1)D) and O((1)S) channels is faster than the rotational periods of the VUV excited CO2 molecules. We have also calculated the excited singlet potential energy surfaces (PESs) of CO2, which are directly accessible by VUV excitation, at the ab initio quantum multi-reference configuration interaction level of theory. These calculated PESs suggest that the formation of CO(X(1)Σ(+)) + O((1)S) photoproducts occurs nearly exclusively on the 4(1)A' PES, which is generally repulsive with minor potential energy ripples along the OC-O stretching coordinate. The formation of CO(X(1)Σ(+)) + O((1)D) photofragments can proceed by non-adiabatic transitions from the 4(1)A' PES to the lower 3(1)A' PES of CO2via the seam of conical intersections at a near linear OCO configuration, followed by the direct dissociation on the 3(1)A' PES. The theoretical PES calculations are consistent with the experimental observation of prompt CO2 dissociation and high rotational and vibrational excitations for CO(X(1)Σ(+)) photoproducts.

Thirty years after the discovery of HIV-1, the early transmission, dissemination, and establishment of the virus in human populations remain unclear. Using statistical approaches applied to HIV-1 sequence data from central Africa, we show that from the 1920s Kinshasa (in what is now the Democratic Republic of Congo) was the focus of early transmission and the source of pre-1960 pandemic viruses elsewhere. Location and dating estimates were validated using the earliest HIV-1 archival sample, also from Kinshasa. The epidemic histories of HIV-1 group M and nonpandemic group O were similar until ~1960, after which group M underwent an epidemiological transition and outpaced regional population growth. Our results reconstruct the early dynamics of HIV-1 and emphasize the role of social changes and transport networks in the establishment of this virus in human populations.

We present a generally applicable experimental method for the direct measurement of nascent spin-orbit state distributions of atomic photofragments based on the detection of vacuum ultraviolet (VUV)-excited autoionizing-Rydberg (VUV-EAR) states. The incorporation of this VUV-EAR method in the application of the newly established VUV-VUV laser velocity-map-imaging-photoion (VMI-PI) apparatus has made possible the branching ratio measurement for correlated spin-orbit state resolved product channels, CO(ã(3)Π; v) + O((3)P0,1,2) and CO(X̃(1)Σ(+); v) + O((3)P0,1,2), formed by VUV photoexcitation of CO2 to the 4s(10 (1)) Rydberg state at 97,955.7 cm(-1). The total kinetic energy release (TKER) spectra obtained from the O(+) VMI-PI images of O((3)P0,1,2) reveal the formation of correlated CO(ã(3)Π; v = 0-2) with well-resolved v = 0-2 vibrational bands. This observation shows that the dissociation of CO2 to form the spin-allowed CO(ã(3)Π; v = 0-2) + O((3)P0,1,2) channel has no potential energy barrier. The TKER spectra for the spin-forbidden CO(X̃(1)Σ(+); v) + O((3)P0,1,2) channel were found to exhibit broad profiles, indicative of the formation of a broad range of rovibrational states of CO(X̃(1)Σ(+)) with significant vibrational populations for v = 18-26. While the VMI-PI images for the CO(ã(3)Π; v = 0-2) + O((3)P0,1,2) channel are anisotropic, indicating that the predissociation of CO2 4s(10 (1)) occurs via a near linear configuration in a time scale shorter than the rotational period, the angular distributions for the CO(X̃(1)Σ(+); v) + O((3)P0,1,2) channel are close to isotropic, revealing a slower predissociation process, which possibly occurs on a triplet surface via an intersystem crossing mechanism.

Photodissociation of CO2 is investigated between 13.540 eV and 13.678 eV using the time-sliced velocity-mapped ion imaging (TSVMI) apparatus that is combined with one-color and two-color pump-probe VUV + VUV and VUV + UV detection schemes by probing oxygen fragments at different levels. Several CO2 dissociation channels are directly observed from the ion images, namely CO(X (1)Σ(+)) + O((1)D), CO(X (1)Σ(+)) + O((1)S), CO(a (3)Π) + O((3)P), CO(a (3)Π) + O((1)D), CO(a' (3)Σ(+)) + O((3)P), CO(d (3)Δ) + O((3)P) and CO(e (3)Σ(-)) + O((3)P), whereas no CO(X (1)Σ(+)) + O((3)P) production has been found. The product kinetic energy distributions of these channels are reported for the first time. Possible dissociation mechanisms have been discussed based upon the product vibrational and rotational distributions.

Photodissociation of CO2 is investigated between 13.540 eV and 13.678 eV using the time-sliced velocity-mapped ion imaging (TSVMI) apparatus that is combined with one-color and two-color pump-probe VUV + VUV and VUV + UV detection schemes by probing oxygen fragments at different levels. Several CO2 dissociation channels are directly observed from the ion images, namely CO(X (1)Σ(+)) + O((1)D), CO(X (1)Σ(+)) + O((1)S), CO(a (3)Π) + O((3)P), CO(a (3)Π) + O((1)D), CO(a' (3)Σ(+)) + O((3)P), CO(d (3)Δ) + O((3)P) and CO(e (3)Σ(-)) + O((3)P), whereas no CO(X (1)Σ(+)) + O((3)P) production has been found. The product kinetic energy distributions of these channels are reported for the first time. Possible dissociation mechanisms have been discussed based upon the product vibrational and rotational distributions.

The branching ratios for the spin-forbidden photodissociation channels of (12)C(16)O in the vacuum ultraviolet (VUV) photon energy region from 102,500 (12.709 eV) to 106,300 cm(-1) (13.180 eV) have been investigated using the VUV laser time-slice velocity-map imaging photoion technique. The excitations to three (1)Σ(+) and six (1)Π Rydberg-type states, including the progression of W(3sσ) (1)Π(v' = 0, 1, and 2) vibrational levels of CO, have been identified and investigated. The branching ratios for the product channels C((3)P) + O((3)P), C((1)D) + O((3)P), and C((3)P) + O((1)D) of these predissociative states are found to depend on the electronic, vibrational, and rotational states of CO being excited. Rotation and e/f-symmetry dependences of the branching ratios into the spin-forbidden channels have been confirmed for several of the (1)Π states, which can be explained using the heterogeneous interaction with the repulsive D'(1)Σ(+) state. The percentage of the photodissociation into the spin-forbidden channels is found to increase with increasing the rotational quantum number for the K(4pσ) (1)Σ(+) (v' = 0) state. This has been rationalized using a (1)Σ(+) to (1)Π to (3)Π coupling scheme, where the final (3)Π state is a repulsive valence state correlating to the spin-forbidden channel.

A congenital diaphragmatic hernia is very uncommon among adults. A diaphragmatic hernia is primarily acute in onset and it is usually identified after trauma. It occurs mostly on the left side. We would like to report a 68-year-old male who presented with a 4-day history of acute intestinal obstruction with a background history of change in bowel habit for a month secondary to a rightdiaphragmatic hernia. He did not have any history of trauma. Clinical examination revealed a distended abdomen with high pitched bowel sound and no palpable mass. The right lung was inaudible on auscultation. Computed tomography scan was consistent with a right diaphragmatic hernia and acute intestinal obstruction. We highlight the late onset of a congenital diaphragmatic hernia and emphasize the vital need for perioperative management to ensure a promising surgical outcome. [ABSTRACT FROM AUTHOR]