bluuebunny/crossref_metadata_2025 huggingface dataset:
Heterotopic caval valve-in-valve procedure for prosthetic migration: two case reports
Authors: Grazina André , Ferreira André , Ramos Ruben , Cacela Duarte
Published: August 2023

Background

Heterotopic bicaval stenting or caval valve implantation (CAVI) either with non-dedicated balloon-expandable Sapien™ valves (Edwards Lifesciences) or with dedicated TricValve™ (Products + Features) has emerged as a safe and effective percutaneous treatment for high-risk patients with severe tricuspid regurgitation (TR). One technical difficulty of CAVI is the lack of native calcified structures to anchor the device, which may lead to paravalvular leak or migration.

Cases summary

We describe two patients with severe TR and high surgical risk who underwent CAVI procedures, both of them complicated with device migration to the right atrium (one inferior vena cava device and one superior vena cava device). Both cases were treated with a caval valve-in-valve procedure, with good technical and clinical results.

Discussion

With the recent development of several percutaneous interventions for high-risk patients with severe TR, the rate of some possible complications is not well established, and neither are the better managing strategies. Device embolization is a rare complication of transcatheter heart interventions but with potential catastrophic consequences. Less invasive strategies such as the valve-in-valve procedure may be preferable in order to avoid the exposure of these patients to complex heart surgeries with extracorporeal circulation.
Respiratory Syncytial Virus European Laboratory Network 2022 Survey: Need for Harmonization and Enhanced Molecular Surveillance
Authors: Presser Lance D , van den Akker Willem M R , Meijer Adam ,   PROMISE Investigators, Aerssens Jeroen , Ispas Gabriela , Ahani Bahar , Atwell Jessica , Begier Elizabeth , Htar Tin , Bangert Mathieu , Kramer Rolf , Vernhes Charlotte , Beutels Philippe , Bont Louis , Campbell Harry , Nair Harish , Li You , Osei-Yeboah Richard , Wang Xin , Cohen Rachel , Dos Santos Gael , Last Theo , Kumar Veena , Machin Nuria , Nohynek Hanna , Openshaw Peter , Paget John , Pollard Andrew , Teirlinck Anne
Published: August 2023

Respiratory syncytial virus (RSV) is a common pathogen causing mostly cold-like symptoms, but in very young infants and elderly individuals it can lead to severe disease and even death. There are currently promising developments both in vaccine development and in therapeutics that are expected to be approved soon. To get an impression within European countries of the laboratory diagnostics and surveillance activities, in anticipation of these developments, we queried the members of the European Respiratory Syncytial Virus Laboratory Network (RSV-LabNet, under the umbrella of the PROMISE project) via an online survey. The answers from the consortium members showed scattered monitoring and the application of a broad array of techniques in the laboratories. A majority of the members expressed strong interest in harmonization and collaboration for setting up surveillance programs and the need for sharing laboratory protocols. The additional value of RSV whole-genome sequencing is broadly appreciated, but implementation requires further development and closer collaboration. The RSV-LabNet can have an important responsibility in establishing contacts and exchange of expertise and providing a platform for communication to advance diagnostics, preparedness, and surveillance.
Stability of temocillin in outpatient parenteral antimicrobial therapy: is it a real option?
Authors: Fernández-Rubio Beatriz , Herrera-Hidalgo Laura , López-Cortés Luis E , Luque-Márquez Rafael , De Alarcón Arístides , Luque-Pardos Sonia , Fernández-Polo Aurora , Gutiérrez-Urbón José María , Rodríguez-Baño Jesús , Gil-Navarro María Victoria , Gutiérrez-Valencia Alicia
Published: August 2023

Background

Temocillin is an interesting alternative to carbapenems for susceptible Enterobacteriaceae. Although its use in outpatient parenteral antimicrobial therapy (OPAT) programmes has generated interest, this has been hampered by the lack of stability data.

Objectives

The purpose of the present study was to evaluate the physical and chemical stability of temocillin at the recommended dose for its use in OPAT programmes, contained in polypropylene infusion bags or polyisoprene elastomeric devices at different temperatures, and to describe a novel LC-MS/MS developed for the quantification of temocillin.

Methods

Temocillin daily dose (6 g) was diluted in 500 mL of 0.9% sodium chloride to obtain a final concentration of 12 g/L. This solution was stored at 4°C, 25°C, 32°C and 37°C for 72 h, both in polypropylene infusion bags and in polyisoprene elastomeric pumps. Physical and chemical stability were evaluated during 72 h after manufacturing. Solutions were considered stable if colour, clearness and pH remained unchanged and if the percentage of intact drug was ≥90%.

Results

Temocillin attained the chemical stability criterion of ≥90% of the original concentration for the whole experiment in both devices at 4°C, 25°C and 32°C. At 37°C, temocillin was stable for 24 h but its concentration dropped below 90% from that timepoint. No precipitation occurred and minor colour changes were observed.

Conclusions

Temocillin is stable under OPAT conditions and it would be an appropriate candidate for the treatment of patients who can be discharged to complete therapy in an OPAT programme. For this study, an LC-MS/MS method was developed.
Diversity of mitochondrial DNA in 3 species of great whales before and after modern whaling
Authors: Sremba Angela L , Martin Anthony R , Wilson Peter , Cypriano-Souza Ana Lúcia , Buss Danielle L , Hart Tom , Engel Marcia H , Bonatto Sandro L , Rosenbaum Howard , Collins Tim , Olavarría Carlos , Archer Frederick I , Steel Debbie , Jackson Jennifer A , Baker C Scott
Published: August 2023

The 20th century commercial whaling industry severely reduced populations of great whales throughout the Southern Hemisphere. The effect of this exploitation on genetic diversity and population structure remains largely undescribed. Here, we compare pre- and post-whaling diversity of mitochondrial DNA (mtDNA) control region sequences for 3 great whales in the South Atlantic, such as the blue, humpback, and fin whale. Pre-whaling diversity is described from mtDNA extracted from bones collected near abandoned whaling stations, primarily from the South Atlantic island of South Georgia. These bones are known to represent the first stage of 20th century whaling and thus pre-whaling diversity of these populations. Post-whaling diversity is described from previously published studies reporting large-scale sampling of living whales in the Southern Hemisphere. Despite relatively high levels of surviving genetic diversity in the post-whaling populations, we found evidence of a probable loss of mtDNA lineages in all 3 species. This is evidenced by the detection of a large number of haplotypes found in the pre-whaling samples that are not present in the post-whaling samples. A rarefaction analysis further supports a loss of haplotypes in the South Atlantic humpback and Antarctic blue whale populations. The bones from former whaling stations in the South Atlantic represent a remarkable molecular archive for further investigation of the decline and ongoing recovery in the great whales of the Southern Hemisphere.
“What If?”: Caregivers’ Experiences Following Early Childhood Concussion
Authors: Dupont Dominique , Larivière-Bastien Danaë , Caron Jeffrey G , Beaudoin Cindy , Gravel Jocelyn , Gagnon Isabelle , Burstein Brett , Beaudin Myriam , Rose Sean C , Yeates Keith O , Beauchamp Miriam H
Published: August 2023

Objective

Little is known about the symptoms, signs, and management guidelines for children under the age of 6 years after they sustain a concussion. Caregivers of such young children may have unique concerns and encounter different challenges from those of school-age children given the distinctive developmental characteristics of the early childhood period. This study aimed to explore the experience of caregivers through semistructured interviews to inform clinical practice.

Methods

Fifty caregivers of children aged 6 months to 5.99 years were interviewed 3 months postinjury for this qualitative study to document their experience in relation to their child’s accident, recovery, and healthcare provisions.

Results

Four main themes were identified: (1) visible changes associated with caregiver concerns, (2) a roller-coaster of emotions after the injury, (3) healthcare providers’ role in addressing the need for reassurance, and (4) the need for better information after the injury.

Conclusion

The findings provide critical insight into the unique experiences and information needs of caregivers of young children who sustain concussion. The challenges identified can inform healthcare professionals regarding the needs of caregivers after early concussion and contribute to building a knowledge base for the development of age-appropriate anticipatory guidance for caregiver mental health and child recovery.
SMALLER TRICHOMES WITH VARIABLE BRANCHES (SVB) and its homolog SVBL act downstream of transcription factor NAC089 and function redundantly in Arabidopsis unfolded protein response
Authors: Yu Chao-Yuan , Nakamura Yuki
Published: August 2023

The unfolded protein response (UPR) is a cellular mechanism that alleviates endoplasmic reticulum stress to maintain protein homeostasis. Although SMALLER TRICHOMES WITH VARIABLE BRANCHES (SVB) is characterized as an emerging UPR factor downstream of the IRE–bZIP60 pathway, whether its homologs participate in the plant UPR remains unknown. Here, we showed that an SVB homolog, SVB-like (SVBL), functions redundantly with SVB in endoplasmic reticulum stress tolerance. The svb-1 svbl-1 double mutant showed a hypersensitivity phenotype and had higher UPR gene expression under endoplasmic reticulum stress than single mutants and the wild type. SVB responded to endoplasmic reticulum stress by accumulating in the root epidermis and phloem cells, but SVBL did not. Ectopic expression of the UPR factor NAC089 up-regulated both SVB and SVBL genes, suggesting that SVB and SVBL work downstream of NAC089. Thus, SVB and SVBL play distinct roles that are modulated by the common upstream regulator NAC089 to cope with endoplasmic reticulum stress in Arabidopsis.
Molecular basis for inhibition of methane clathrate growth by a deep subsurface bacterial protein
Authors: Huard Dustin J E , Johnson Abigail M , Fan Zixing , Kenney Lydia G , Xu Manlin , Drori Ran , Gumbart James C , Dai Sheng , Lieberman Raquel L , Glass Jennifer B
Published: August 2023

Methane clathrates on continental margins contain the largest stores of hydrocarbons on Earth, yet the role of biomolecules in clathrate formation and stability remains almost completely unknown. Here, we report new methane clathrate-binding proteins (CbpAs) of bacterial origin discovered in metagenomes from gas clathrate-bearing ocean sediments. CbpAs show similar suppression of methane clathrate growth as the commercial gas clathrate inhibitor polyvinylpyrrolidone and inhibit clathrate growth at lower concentrations than antifreeze proteins (AFPs) previously tested. Unlike AFPs, CbpAs are selective for clathrate over ice. CbpA3 adopts a nonglobular, extended structure with an exposed hydrophobic surface, and, unexpectedly, its TxxxAxxxAxx motif common to AFPs is buried and not involved in clathrate binding. Instead, simulations and mutagenesis suggest a bipartite interaction of CbpAs with methane clathrate, with the pyrrolidine ring of a highly conserved proline residue mediating binding by filling empty clathrate cages. The discovery that CbpAs exert such potent control on methane clathrate properties implies that biomolecules from native sediment bacteria may be important for clathrate stability and habitability.
A controllable gelatin-based microcarriers fabrication system for the whole procedures of MSCs amplification and tissue engineering
Authors: Wang Zixian , Zhang Xiuxiu , Xue Limin , Wang Gangwei , Li Xinda , Chen Jianwei , Xu Ruxiang , Xu Tao
Published: August 2023

Biopolymer microbeads present substantial benefits for cell expansion, tissue engineering, and drug release applications. However, a fabrication system capable of producing homogeneous microspheres with high precision and controllability for cell proliferation, passaging, harvesting and downstream application is limited. Therefore, we developed a co-flow microfluidics-based system for the generation of uniform and size-controllable gelatin-based microcarriers (GMs) for mesenchymal stromal cells (MSCs) expansion and tissue engineering. Our evaluation of GMs revealed superior homogeneity and efficiency of cellular attachment, expansion and harvest, and MSCs expanded on GMs exhibited high viability while retaining differentiation multipotency. Optimization of passaging and harvesting protocols was achieved through the addition of blank GMs and treatment with collagenase, respectively. Furthermore, we demonstrated that MSC-loaded GMs were printable and could serve as building blocks for tissue regeneration scaffolds. These results suggested that our platform held promise for the fabrication of uniform GMs with downstream application of MSC culture, expansion and tissue engineering.
Environmental DNA metabarcoding of Danish soil samples reveals new insight into the hidden diversity of eutardigrades in Denmark
Authors: Pust Frida Løkkegaard , Frøslev Tobias Guldberg , Kristensen Reinhardt Møbjerg , Møbjerg Nadja
Published: August 2023

Tardigrades are rarely included in large biodiversity surveys, mainly because of the impracticalities that follow larger sampling and identification of these microscopic animals. Consequently, there is a lack of data on their biogeographical distribution. Here, we analyse environmental DNA sequences of eutardigrades obtained with a metabarcoding protocol on Danish soil samples collected during a national biodiversity project (Biowide). Specifically, we aimed to investigate the applicability of the V4 region (~400 bp) of the 18S rRNA marker gene to assign taxonomy to 96 eutardigrade molecular operational taxonomic units (MOTUs), using three different methods (alignment-, tree- and phylogeny-based methods). Tardigrade reference libraries are currently suffering from insufficient taxon coverage, in some cases challenging the interpretation of data based on similarity searches. This can, to some extent, be accounted for by supplementing identification with algorithms that incorporate a backbone phylogeny and infer models of evolution. Together, the present findings suggest that the V4 region of the 18S rRNA gene offers a promising tool to identify unknown MOTUs of eutardigrades to genus or family level and can, in some cases, be used to assign to species level.
Screening and Resistance Locus Identification of the Mutant fcrZ22 Resistant to Crown Rot Caused by Fusarium pseudograminearum
Authors: Li Qiaoyun , Hao Xiaopeng , Guo Zhenfeng , Qu Kefei , Gao Mingshuang , Song Gaili , Yin Zhao , Yuan Yuhao , Dong Chunhao , Niu Jishan , Yin Guihong
Published: August 2023

Crown rot caused by Fusarium pseudograminearum is a devastating wheat disease worldwide. In addition to yield losses, the fungi causing Fusarium crown rot (FCR) also deteriorate the quality and safety of food because of the production of mycotoxins. Planting resistant cultivars is an effective way to control FCR. However, most wheat cultivars are susceptible to FCR. Therefore, development of new sources and detection of loci for FCR resistance are necessary. In the present study, a resistant mutant, fcrZ22, was identified from an ethyl methane sulfonate (EMS)-mutagenized population of the cultivar Zhoumai 22, and then fcrZ22 was crossed with the wild type to produce an F2 population. Genetic analysis of the F2 population was carried out by the mixed inheritance model of major genes plus polygenes, and 20 resistant and 20 susceptible plants were selected to assemble mixed pools. Combining 660K SNP arrays, the resistance loci were detected by bulked segregant analysis. The resistance to FCR caused by F. pseudograminearum in the F2 population was in accordance with the “mixed model with two major genes of additive-epistasis effect + additive-dominant polygenes,” and the heritability of the major gene was 0.92. Twenty-one loci were detected, which were located on 10 chromosomes, namely, 1B (1), 1D (1), 2A (3), 1B (1), 3A (3), 3B (3), 4A (2), 5A (2), 7A (3), and 7B (2). Among the 21 loci, eight were new loci for FCR resistance. This is the first report of detecting loci for FCR resistance from a mutant. The results of the present study provided excellent germplasm resources for breeding wheat cultivars with FCR resistance and laid the foundation for fine mapping of FCR resistance loci.
Effects of Prebriefing Using Online Team-Based Learning in Advanced Life Support Education for Nurses
Authors: Song Eunkyoung , Issenberg S. Barry , Roh Young Sook
Published: August 2023

An effective prebriefing strategy is needed that can improve the learning outcomes of nurses in advanced life support education. This study aimed to identify the effects of prebriefing with online team-based learning on hospital nurses' knowledge, performance, and self-efficacy in advanced life support education. A nonequivalent control group pretest-posttest design was adopted. Nurses in the experimental group (n = 26) participated in prebriefing using online team-based learning followed by self-directed learning, whereas nurses in the control group (n = 27) experienced only self-directed learning before advanced life support education. Wilcoxon signed-ranks tests were used to identify the posttest-pretest differences of the study variables in each group. Both groups showed improved knowledge, individual performance, and self-efficacy after the education. Nurses in the experimental group reported higher self-efficacy scores compared with those in the control group. There were no differences between the experimental and control groups in knowledge, individual performances, or team performance. Online team-based learning as a prebriefing modality resulted in greater improvements in self-efficacy in advanced life support education.
Managing Comorbid Tobacco Use Disorder for Individuals With Schizophrenia: Challenges and Opportunities
Authors: Dhaliwal Arash K. , Bahji Anees , Danilewitz Marlon
Published: August 2023

Smoking and tobacco use disorder (TUD) is highly prevalent among individuals with serious and persistent mental illness, particularly those with schizophrenia spectrum disorders. In this clinical case column, we highlight an encounter involving a successful initiation of bupropion for smoking cessation in an individual with schizophrenia. We also review the relevant literature around the epidemiology of TUD among people with schizophrenia, highlight the increased complications and mortality secondary to TUD, and discuss relevant strategies for clinicians to support individuals with serious and persistent mental illness aiming to reduce or stop their tobacco consumption.

Le tabagisme et le trouble de l’usage du tabac (TUT) sont très répandus chez les personnes souffrant de maladies mentales graves et persistantes (MMGP), en particulier celles atteintes de troubles du spectre de la schizophrénie. Dans cette chronique de cas cliniques, nous mettons en évidence une rencontre impliquant une initiation réussie du bupropion pour le sevrage tabagique chez une personne atteinte de schizophrénie. Nous passons également en revue la littérature pertinente concernant l'épidémiologie du TUT chez les personnes atteintes de schizophrénie, soulignons l’augmentation des complications et de la mortalité secondaires au TUT, et discutons des stratégies pertinentes pour les cliniciens afin de soutenir les personnes atteintes de MMGP visant à réduire ou à arrêter leur consommation de tabac.
Exogenous histamine and H2 receptor activation and H3 receptor inhibition in nucleus accumbens modulate formalin-induced orofacial nociception through opioid receptors
Authors: Notaj Azam , Erfanparast Amir , Tamaddonfard Esmaeal , Soltanalinejad-Taghiabad Farhad
Published: August 2023

It has been demonstrated that the nucleus accumbens (NAc) plays an important role in modulation of nociception due to its extensive connections with different regions of the brain. In addition, this nucleus receives histaminergic projections from tuberomammillary nucleus. Considering the role of the central histaminergic system in nociception, the effect of histamine and its H2 and H3 receptors agonist and antagonist microinjections into the NAc on orofacial formalin nociception was investigated. In male Wistar rats, using stereotaxic surgery, two guide cannulas were bilaterally implanted into the right and left sides of the NAc. Diluted formalin solution (1.5%, 50 µl) injection into the vibrissa pad led to orofacial nociception. Immediately after injection, face rubbing was observed at 3-min blocks for 45 min. Orofacial formalin nociception was characterized by a biphasic nociceptive response (first phase: 0–3 min and second phase: 15–33 min). Microinjections of histamine (0.5 and 1 μg/site), dimaprit (1 μg/site, H2 receptor agonist) and thioperamide (2 μg/site, H3 receptor antagonist) attenuated both phases of formalin orofacial nociception. Prior microinjection of famotidine (2 μg/site) inhibited the antinociceptive effects of dimaprit (1 μg/site). Furthermore, comicroinjection of thioperamide (2 μg/site) and immepip (1 μg/site) prevented thioperamide (2 μg/site)-induced antinociception. Naloxone (2 μg/site) also prevented histamine, dimaprit- and thioperamide-induced antinociception. The results of this study demonstrate that at the level of the NAc, histamine and its H2 and H3 receptors are probably involved in the modulation of orofacial nociception with an opioid system-dependent mechanism.
Venous thromboembolism and acute myeloid leukemia: risk factors and mortality in elderly white, black and Asian patients
Authors: Faiz Ambarina S. , Guo Shuang , Sridharan Ashwin , Lin Yong , Philipp Claire S.
Published: August 2023

Risk factors for venous thromboembolism (VTE) in elderly patients with acute myeloid leukemia (AML) are not known by race.

The aim of this study was to determine the association of VTE with known risk factors and the impact of VTE on mortality in elderly white, black and Asian patients with AML.

The merged SEER-Medicare database (2000–2015) was used for patients aged at least 65 years diagnosed with AML. Multivariable logistic regression was used to examine the association of VTE with known risk factors and Cox proportional hazards regression was used to evaluate the association of VTE with mortality in white, black and Asian patients.

Among 21 403 AML patients aged at least 65years, VTE was diagnosed in 10.6% of 18 731 white patients, 13.4% of 1362 black and 5.6% of 1310 Asian patients. Overall, the adjusted risk of VTE in black patients was similar to white patients, but Asian patients had a lower risk of VTE. Risk factors for VTE in white patients were age less than 75 years, female sex, chemotherapy and comorbid medical conditions, including hypertension, anemia, chronic kidney and lung disease, hyperlipidemia, heart failure and obesity. In black patients, hyperlipidemia, and heart failure and in Asian patients, age less than 75 years, female sex, chemotherapy and hypertension and myocardial infarction were associated with VTE. Central venous catheter placement was a predictor of VTE in all three races.

Our study identified risk factors for VTE by race in elderly white, black and Asian AML patients.
Investigating the influence of long-axial versus short-axial field of view PET/CT on stage migration in lymphoma and non-small cell lung cancer
Authors: Alberts Ian , Seibel Sigrid , Xue Song , Viscione Marco , Mingels Clemens , Sari Hasan , Afshar-Oromieh Ali , Limacher Andreas , Rominger Axel
Published: August 2023

Objectives

The objective of this study was to evaluate the influence of a long-axial field-of-view (LAFOV) on stage migration using a large single-centre retrospective cohort in lymphoma and non-small cell lung cancer (NSCLC).

Methods

A retrospective study is performed for patients undergoing PET/computed tomography (CT) on either a short-axial field-of-view (SAFOV) or LAFOV PET/CT system for the staging of known or suspected NSCLC or for therapeutic response in lymphoma. The primary endpoint was the Deauville therapy response score for patients with lymphoma for the two systems. Secondary endpoints were the American Joint Committee on Cancer stage for NSCLC, the frequency of cN3 and cM1 findings, the probability for a positive nodal staging (cN1-3) for NSCLC and the diagnostic accuracy for nodal staging in NSCLC.

Results

One thousand two hundred eighteen records were screened and 597 patients were included for analysis (N = 367 for lymphoma and N = 291 for NSCLC). For lymphoma, no significant differences were found in the proportion of patients with complete metabolic response versus non-complete metabolic response Deauville response scores (P = 0.66). For NSCLC no significant differences were observed between the two scanners for the frequency of cN3 and cM1 findings, for positive nodal staging, neither the sensitivity nor the specificity.

Conclusions

In this study use of a LAFOV system was neither associated with upstaging in lymphoma nor NSCLC compared to a digital SAFOV system. Diagnostic accuracy was comparable between the two systems in NSCLC despite shorter acquisition times for LAFOV.
Intracranial atherosclerotic disease: current management strategies
Authors: Ahmed Rehan , Maqsood Hamza , Bains Rochaknaveen Singh , Gulraiz Azouba , Kamal Meraj
Published: August 2023

A stroke due to underlying intracranial large artery occlusion, which is atherosclerotic in nature, is known as intracranial atherosclerotic disease (ICAD). It is important to recognize that ischaemic stroke due to ICAD differs from extracranial disease and other stroke aetiologies and requires a nuanced approach. It is a significant cause of stroke worldwide, and severe symptomatic ICAD can present challenges from a therapeutic standpoint, including recurrent ischaemic stroke despite optimal management. Furthermore, exploring the underlying pathophysiological mechanisms responsible for the disease may be necessary while considering treatment options. This narrative review aims to provide an all-encompassing overview of this disease. Epidemiology and clinical pathophysiology will be explored in detail. The findings of large clinical trials will serve as a guide to finding the most optimized management strategies. Another critical question that arises is the treatment of acute ischaemic stroke due to large vessel occlusion with underlying intracranial atherosclerosis, is the treatment and clinical diagnosis the same as for other aetiologies of stroke (i.e. extracranial disease and nonvalvular atrial fibrillation)? Consequently, secondary prevention of patients with ischaemic stroke or transient ischaemic attack will be divided into medical therapy, risk factor control, and endovascular and surgical treatment options.
Bilateral renal angiomyolipoma with left renal artery aneurysm in tuberous sclerosis: case report and literature review
Authors: Barabrah Anas M. , Dukmak Osama N. , Toukan Anas R. , Dabbas Fida’ M. , Emar Mohammad , Rajai Alhusseini
Published: August 2023

Introduction and importance:

Tuberous sclerosis disorder (TSD) is a rare genetic disease that causes abnormal growths or tumors in various organs of the body. They are usually benign and asymptomatic. However, severe, rapidly growing tuberous sclerosis can be fatal. Renal angiomyolipomas are commonly associated with TSD, which can be further worsened by the presence of aneurysms and put the patient at risk for life-threatening hemorrhage.

Case presentation:

A 29-year-old female presented to the emergency room complaining of right flank pain with an unknown past medical history of tuberous sclerosis. The patient was suspected to have TSD as she fulfilled one of the major features of TSD required to establish a possible diagnosis. On computed tomography scan imaging, bilateral fat-density nodules were revealed in both kidneys. The largest is 7 cm in the left kidney, located at the upper pole, and was associated with a bleeding aneurysm measuring 4 cm in diameter. While the other fatty nodule was recorded at 6 cm in the right kidney at the lower pole.

Clinical discussion:

After evaluation, the patient was planned for diagnostic catheterization of the left kidney, through which selective angiography of the left kidney was done, and eventually, selective embolization of the branch supplying the left angiomyolipoma was performed.

Conclusion:

The authors finally conclude that thorough investigations, including systemic manifestations, must be taken into consideration when suspecting tuberous sclerosis, and a conservative approach must always be prioritized before taking any decision toward invasive approaches.
Primary cerebral angiosarcoma: a case report
Authors: Arafat Hasan R. , Badawi Muath , Ramahi Mahmoud , Fatayer Mohammad , Atrash Fadi
Published: August 2023

Introduction and importance:

Central nervous system sarcomas are rare tumors of mesenchymal origin. Angiosarcomas are an even rarer subtype with poor prognosis and no consensus regarding therapeutic approach.

Case presentation:

This article presents the case of a 50-year-old Palestinian female patient with a history of treated breast cancer who presented to the emergency room with a tonic-clonic seizure. Brain computed tomography showed a cerebral space-occupying lesion managed with craniotomy and gross tumor resection. Histopathology revealed an epithelioid cerebral angiosarcoma. The patient was treated with concurrent chemoradiotherapy with temozolomide resulting in the resolution of the tumor as well as symptoms and complaints.

Clinical discussion:

Primary cerebral epithelioid angiosarcoma is a highly malignant tumor of an unknown etiology. The patient history of breast created an additional challenge, as recurrence with metastasis had to be excluded. Signs of blood product degradation are an important radiological feature. According to existing literature, gross tumor resection followed by concurrent chemoradiotherapy offers the best approach and outcome.

Conclusion:

Cerebral angiosarcoma is a rare disease with a challenging therapeutic approach due to the scarcity of available literature. It should be included in the differential diagnosis of space-occupying lesions, especially in those with a history of exposure to radiotherapy. Immunohistochemistry is key for diagnosis. Surgical resection followed by concurrent chemoradiotherapy is associated with a longer disease-free survival when compared to either option alone.
Prevalence of acute myeloid leukemia and its associated risk factors at a tertiary care center: a retrospective cross-sectional study
Authors: Chaurasiya Prem S. , Lamsal Dinesh K. , Khatri Akash , Parajuli Aalok , Shrestha Prem R. , Aryal Laxmi , Pokhrel Sapana , Gurung Shekhar , Karki Saurab , Khadka Manoj
Published: August 2023

Background:

Acute myeloid leukemia (AML) is a common malignant disorder of the bone marrow, accounting for 23.1% of total leukemia cases globally in 2017. This study aimed to know the prevalence of AML in a tertiary hospital center in Nepal and assess the associated etiological factors in the causation of AML.

Materials and methods:

A hospital-based retrospective cross-sectional study was conducted among patients with acute leukemia admitted to a tertiary care center in Kathmandu from 1 April 2021 to 30 April 2022. Three hundred and ten participants with acute leukemia were selected via a convenience sampling technique. The data were entered into Microsoft Excel 365 and then analyzed using Statistical Packages for Social Sciences version 22.0.

Results:

One hundred and forty five (46.7%) out of 310 acute leukemia patients had AML. Most of the cases were male (104, 71.7%) and aged 40–49 years (36, 24.8%). The most common signs and symptoms were pallor (115, 79.3%), fever (n=92, 63.4%), and lethargy/weakness (78, 53.8%). Ninety one (62.8%) patients underwent multiple cycles of chemotherapy while 51 (35.2%) had supportive care only, and 3 (2.1%) went bone marrow transplants.

Conclusion:

The prevalence of AML was higher as compared to AML in other studies done in a similar setting. Early diagnosis and treatment are key to a good prognosis and cure in most cases.
Comparisons of the analgesic effect of different pulsed radiofrequency targets in SNI-induced neuropathic pain
Authors: Liang Ying , Zhong Shuotao , Wang Honghua , Wu Danlei , Gong Qingjuan
Published: August 2023

An injury of the peripheral nerve may lead to neuropathic pain, which could be treated with pulsed radiofrequency to the dorsal root ganglion (DRG) or peripheral nerve [the nerve trunk (NT) or proximal to the injury site (NI)]. However, it is not clear whether there is any difference in analgesic effect or maintenance among the three targets. PRF was applied to the ipsilateral L5 DRG, peripheral nerve (NT or NI) 5 days after spared nerve injury (SNI). Triptolide (10 µg/kg) or vehicle was intrathecally administered 5 days after SNI for 3 days. Mechanical withdrawal thresholds were tested after treatment at different time points. Furthermore, microglia and the P2X7 receptor (P2X7R) in the ipsilateral spinal cord were measured with immunofluorescence and western blotting, respectively. PRF + NI exerted a more remarkable analgesic effect than PRF + DRG and PRF + NT at the early stage, but PRF + DRG had a stronger analgesic effect than PRF + NI and PRF + NT at the end of our study. In addition, PRF + DRG showed no significant difference from intrathecal administration of triptolide. Moreover, SNI-induced microglia activation and upregulation of P2X7R in spinal dorsal horn could be markedly inhibited by PRF + DRG. The results suggest that the analgesic effect of PRF + DRG increased with time whereas the other two not and microglia and P2X7R in the ipsilateral spinal dorsal horn may be involved in the process.
Streptococcus sciuri sp. nov., Staphylococcus marylandisciuri sp. nov. and Staphylococcus americanisciuri sp. nov., isolated from faeces of eastern grey squirrel (Sciurus carolinensis)
Authors: Volokhov Dmitriy V. , Zagorodnyaya Tatiana A. , Furtak Vyacheslav A. , Nattanmai Geetha , Randall Linnell , Jose Sherly , Gao Yamei , Eisenberg Tobias , Delmonte Pierluigi , Blom Jochen , Mitchell Kara K.
Published: August 2023

One novel

Streptococcus

strain (SQ9-PEAT) and two novel

Staphylococcus

strains (SQ8-PEAT and GRT3T) were isolated from faeces of a wild eastern grey squirrel. The strains were non-spore-forming, non-motile Gram-positive cocci, facultative anaerobes. The genomes for these strains were sequenced. The 16S rRNA gene and core-genome-based phylogenetic analyses showed that strain SQ9-PEAT was closely related to

Streptococcus hyointestinalis

, strain SQ8-PEAT to

Staphylococcus pettenkoferi

and

Staphylococcus argensis

, and strain GRT3T to

Staphylococcus rostri

,

Staphylococcus muscae

and

Staphylococcus microti

. Average nucleotide identity and pairwise digital DNA–DNA hybridization values calculated for these novel strains compared to type strain genomes of phylogenetically related species within the genera

Streptococcus

and

Staphylococcus

clearly revealed that strain SQ9-PEAT represents a novel species of the genus

Streptococcus

and strains SQ8-PEAT and GRT3T represent two novel species of the genus

Staphylococcus

. Phenotypical features of these novel type strains differed from the features of the type strains of other phylogenetically related species. MALDI-TOF mass spectrometry supported identification of these novel species. Based on these data, we propose one novel species of the genus

Streptococcus

, for which the name Streptococcus sciuri sp. nov. with the type strain SQ9-PEAT (=DSM 114656T=CCUG 76426T=NCTC 14727T) is proposed, and two novel species of the genus

Staphylococcus

, for which the names Staphylococcus marylandisciuri sp. nov. with the type strain SQ8-PEAT (=DSM 114685T=CCUG 76423T=NCTC 14723T) and Staphylococcus americanisciuri sp. nov. with the type strain GRT3T (=DSM 114696T=CCUG 76427T=NCTC 14722T) are proposed. The genome G+C contents are 38.29, 36.49 and 37.26 mol% and complete draft genome sizes are 1 692 266, 2 371 088 and 2 237 001 bp for strains SQ9-PEAT, SQ8-PEAT and GRT3T, respectively.
Characterization of the follicular fluid microbiota based on culturomics and sequencing analysis
Authors: Wei Wenting , Zhou Yazhou , Zuo Haiyang , Li Min , Pan Zhiyuan , Liu Bin , Wang Lu , Tan Yafang , Yang Ruifu , Shang Wei , Bi Yujing , Wang Weizhou
Published: August 2023

Introduction. The human oocyte microenvironment is follicular fluid, which is important for follicle growth, ovulation and maturation of the oocyte. The micro-organisms present in follicular fluid could be a predictor of in vitro fertilization outcomes.

Hypothesis/Gap Statement. Women with follicular fluid colonized with micro-organisms can be asymptomatic, but the presence of some genera in the follicular fluid correlates with in vitro fertilization.

Aim. To confirm the existence of micro-organisms in follicular fluid, and to profile the micro-organisms present in follicular fluid sampled from women undergoing in vitro fertilization with different outcomes.

Methodology. Women undergoing in vitro fertilization (n=163) were divided into different subgroups according to their in vitro fertilization outcomes. Their follicular fluid samples were collected, and among them, 157 samples were analysed by 16S rDNA sequencing, and 19 samples were analysed using culturomics.

Results. The culturomics results suggested that the 19 follicular fluid samples were not sterile. The isolation rates for

Streptococcus

,

Finegoldia

and

Peptoniphilus

were >50 % in the 19 samples. Linear discriminant analysis effect size analysis showed differential bacteria abundance according to the pregnancy rate, the rate of normal fertilization, the rate of high-quality embryos and the rate of available oocytes. The sequencing results showed that micro-organisms could be detected in all 157 samples.

Pseudomonas

,

Lactobacillus

,

Comamonas

,

Streptococcus

and

Acinetobacter

were detected in all of the samples, but with a wide range of relative abundance.

Pseudomonas

,

Lactobacillus

,

Ralstonia

and

Vibrio

constituted a notable fraction of the microbiota.

Conclusions. Follicular fluid is not sterile. Micro-organisms in follicular fluid could be a predictor of in vitro fertilization outcomes.
Challenging the Conventional Treatment Initiation Paradigm: Early Detection of Irreversible Cellular Damage in Cardiac Biopsies of Fabry Disease Before the Formation of Gb3 Inclusion Bodies
Authors: Lee Chung-Lin , Chen Pei-Sin , Lu Yu-Ying , Yen Ching-Tzu , Huang Chun-Ying , Cheng Yen-Fu , Lin Hsiang-Yu , Hsu Chia-Lin , Chen Yun-Ru , Niu Dau-Ming
Published: August 2023

Background

Fabry disease (FD) is a rare X-linked lysosomal storage disorder that affects multiple organs including the heart. In this study, we investigated if early-stage globotriaosylceramide (Gb3) accumulation, before occurrence of inclusion bodies, could cause significant stress and irreversible damages of the cardiomyocytes in FD patients.

Methods

Immunofluorescent (IF) staining was performed on fibroblasts from FD patients with IVS4 mutation and myocardial biopsies from G3Stg/GLAko mice and IVS4 FD patients. The staining targeted interleukin-18 (IL-18), nuclear factor-κB (NF-κB), and inducible nitric oxide synthase (iNOS) as inflammatory and oxidative stress markers. Remarkably, the mouse and human myocardial biopsies selected for this study showed detectable Gb3 accumulation under fluorescence but did not exhibit typical FD (Gb3 inclusion body) pathology. Additionally, alpha-smooth muscle actin (α-SMA) IF staining was conducted to detect fibrosis.

Results

The results showed that fibroblasts and cardiomyocytes of mice and patients had significant accumulation of inflammatory markers IL-18 and NF-κB, and oxidative stress marker iNOS. The presence of fibrosis was confirmed in these myocardial biopsies through strong positive staining of α-SMA, despite the absence of typical FD pathology.

Conclusions

This study suggests that significant cellular stress and even irreversible damages could exist before the typical pathological changes (inclusion bodies formation) in cardiomyocytes of FD. Based on our findings, it is evident that to prevent irreversible damage and improve the prognosis of patients with FD, treatment should be initiated much earlier than we currently thought.

Clinical Perspective

What Is New?

Evidence suggests significant cellular stress and potential irreversible damage may precede inclusion body formation in Fabry cardiomyocytes.

Inclusion body formation likely represents a later stage event following intracellular Gb3 accumulation past a critical threshold.

What Are the Clinical Implications?

These findings indicate a need to re-evaluate conventional Fabry diagnostic criteria.

There is an emphasis on early therapeutic intervention to mitigate progressive cellular dysfunction, inflammation, and fibrosis.
The Pulse of Artificial Intelligence in Cardiology: A Comprehensive Evaluation of State-of-the-Art Large Language Models for Potential Use in Clinical Cardiology
Authors: Novak Andrej , Zeljković Ivan , Rode Fran , Lisičić Ante , Nola Iskra A. , Pavlović Nikola , Manola Šime
Published: August 2023

Introduction

Over the past two years, the use of Large Language Models (LLMs) in clinical medicine has expanded significantly, particularly in cardiology, where they are applied to ECG interpretation, data analysis, and risk prediction. This study evaluates the performance of five advanced LLMs—Google Bard, GPT-3.5 Turbo, GPT-4.0, GPT-4o, and GPT-o1-mini—in responding to cardiology-specific questions of varying complexity.

Methods

A comparative analysis was conducted using four test sets of increasing difficulty, encompassing a range of cardiovascular topics, from prevention strategies to acute management and diverse pathologies. The models’ responses were assessed for accuracy, understanding of medical terminology, clinical relevance, and adherence to guidelines by a panel of experienced cardiologists.

Results

All models demonstrated a foundational understanding of medical terminology but varied in clinical application and accuracy. GPT-4.0 exhibited superior performance, with accuracy rates of 92% (Set A), 88% (Set B), 80% (Set C), and 84% (Set D). GPT-4o and GPT-o1-mini closely followed, surpassing GPT-3.5 Turbo, which scored 83%, 64%, 67%, and 57%, and Google Bard, which achieved 79%, 60%, 50%, and 55%, respectively. Statistical analyses confirmed significant differences in performance across the models, particularly in the more complex test sets. While all models demonstrated potential for clinical application, their inability to reference ongoing clinical trials and some inconsistencies in guideline adherence highlight areas for improvement.

Conclusion

LLMs demonstrate considerable potential in interpreting and applying clinical guidelines to vignette-based cardiology queries, with GPT-4.0 leading in accuracy and guideline alignment. These tools offer promising avenues for augmenting clinical decision-making but should be used as complementary aids under professional supervision.
A community based cross-sectional study on impact assessment of COVID-19 on mental health in Central India
Authors: Gahwai Dharmendra , Dayama Sonal , Kumar Ravindra , Chandraker Sandip Kumar , Mishra Akanksha , Sahu Babita , Sharma Mini
Published: August 2023

The current study is one of few community based surveys assessing the effect of COVID -19 in rural India. It is a cross sectional study to find the prevalence of depression, anxiety and PTSD among those affected with COVID-19 disease. Generalized Anxiety Disorder Assessment (GAD-7), PHQ-9 and IES-R were used to assess prevalence levels of depression, anxiety, and PTSD among the community of Durg district of Chhattisgarh state of India. Out of total 431 participants, 44 % were male, mean age of participants was 41±14, 87% had health insurance, 40% had co-morbidities like hypertension or diabetes, half of them experienced food shortage and change in income during the pandemic. One third participants experienced death among one or more family members due to the pandemic. The mean scores of IES-R, GAD-7 and PHQ-9 were 23.59-24.91, 1.50,2.07 and 1.06-1.58 respectively. Thirty percent observed some distress, 15% reported depression and 12 % reported anxiety. The adjusted effect of death in family due to COVID-19 was found to be significantly associated with higher risk of mental distress, whereas education was associated with lower risk of distress. Depression and anxiety was more among the elderly and less among individuals living in nuclear families. Scarcity of food and change in income were significantly associated with anxiety.
Estimated population-level impact of pneumococcal conjugate vaccines against all-cause pneumonia mortality among unvaccinated age groups in five Latin American countries
Authors: Prunas Ottavia , Shioda Kayoko , Toscano Cristiana M. , Bastias Magdalena , Valenzuela-Bravo Maria Teresa , Diaz Tito Janepsy , Warren Joshua L. , Weinberger Daniel M. , de Oliveira Lucia H.
Published: August 2023

Background

Pneumococcal conjugate vaccines (PCVs) provide strong direct protection in children, while limited data are available on their indirect effect on mortality among older age groups. This multi-country study aimed to assess the population-level impact of pediatric PCVs on all-cause pneumonia mortality among ≥5 years of age, and invasive pneumococcal disease (IPD) cases in Chile.

Methods

Demographic and mortality data from Argentina, Brazil, Chile, Colombia, and Mexico were collected for various age strata considering the ≥ 5-year-old population, from 2000-2020. IPD cases in Chile were also evaluated. Time series models were employed to evaluate changes in all-cause pneumonia deaths during the post-vaccination period, with other causes of death used as synthetic controls for unrelated temporal trends.

Results

No significant change in death rates due to all-cause pneumonia was detected following PCV introduction among most age groups and countries. The proportion of IPD cases caused by vaccine serotypes decreased from 29% (2012) to 6% (2022) among ≥65 years in Chile.

Discussion

While an effect of PCV against pneumonia deaths (a broad clinical definition) was not detected, evidence of indirect PCV impact was observed among vaccine-type-specific IPD cases.