bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicopathological and Molecular Characterisation of Crohn’s Disease-associated Small Bowel Adenocarcinomas
Authors: Liao Xiaoyan , Li Guangyuan , McBride Russel , Houldsworth Jane , Harpaz Noam , Polydorides Alexandros D
Published: August 2019

Background and Aims

Small bowel adenocarcinoma [SBA] is a recognised complication of Crohn’s disease [CD], but its low absolute prevalence limits opportunities for clinicopathological characterisation.

Methods

We compared the clinical, pathological, and molecular features of 48 SBA from patients with CD [CDSBA] and 29 SBAs from patients without CD [NSBA] who underwent treatment at our tertiary care centre between 2000 and 2018.

Results

Patients with CDSBA were younger than those with NSBA [mean age, 56 vs 64; p = 0.02]. Males predominated in both groups. Most CDSBA [69%] occurred in the ileum, whereas most NSBA occurred in the duodenum [38%] and jejunum [31%; p < 0.001]. Stage I tumours were more prevalent in the CDSBA [33% vs 3%; p = 0.002], although the rates of Stage IV disease and disease-specific mortality were similar in both groups. CDSBA were less likely to present a discrete mass [35% vs 93%; p < 0.001] and were more often stricturing or fistulising [75% vs 10%, respectively, p < 0.001] than NSBA. Microscopically, CDSBA were relatively heterogeneous, exhibiting at least three distinct growth patterns in 39% compared with 1% of NSBA [p = 0.01]. Low-grade tubuloglandular adenocarcinoma was the predominant pattern in 19% of CDSBA compared with 0% of NSBA [p = 0.003]. CDSBA were more frequently DNA mismatch repair proficient [90% vs 62%; p = 0.04] and exhibited profiles of frequently mutated genes similar to those of NSBA, except for IDH1 [18%] and SMAD4 [12%] mutations that occurred uniquely in CDSBA.

Conclusions

These observations, based on the largest single-centre series described hitherto, establish that CDSBA is a distinct clinical, pathological, and molecular entity.
STELO: a new tool for family physicians for the correct identification of inherited cancer syndromes
Authors: Mariani Chiara , Carnevali Ileana , Lapi Francesco , Paganini Elisa , Civitelli Chiara , Muzzolon Jessica , Franzetti Anna , Guerroni Alessandro , Tibiletti Maria Grazia
Published: August 2019

Background

The hereditary cancer syndromes represent overall <10% of all cancers. These syndromes are not irrelevant for public health because all the cancers typical of these syndromes affected young people and many members of the same family and the cancers are more aggressive than the sporadic ones and need specific surgery and medical therapy. We developed a new family assessment tool: STELO designed for family physicians to identify patients could benefit from Cancer Genetic Counselling.

Objective

Test the sensitivity and specificity of a new assessment tool for the correct identification of inherited cancer syndromes.

Methods

Retrospectively we tested the new tool on a subset of patients who had already undergone genetic counselling at the Cancer Genetic Counselling Service of ASST (Azienda Socio Sanitaria Territoriale) Settelaghi Varese, to investigate sensitivity, specificity and applicability of this new tool in routine genetic screening. STELO responses were matched against the opinion of two cancer geneticists (i.e. gold standard) who blinded each other decided if the history of these patients was properly suspected as a hereditary cancer syndrome.

Results

The Genetic Counselling Service followed 546 subjects from 2014 to 2015. STELO tool was tested retrospectively on these clinical records and resulted positive in 418 cases, out of 546 (76.5%). STELO reported, towards the gold standard, 88.5% and 52.3% of sensitivity and specificity, respectively.

Conclusions

STELO has demonstrated to have a good sensitivity. The specificity was expectedly low given that STELO has been developed for general medicine, so it needs to be simple, practical, of rapid consultation and effectively used in clinical practice.
Impacts of the rhizosphere effect and plant species on organic carbon mineralization rates and pathways, and bacterial community composition in a tidal marsh
Authors: Liu Yuxiu , Luo Min , Ye Rongzhong , Huang Jiafang , Xiao Leilei , Hu Qikai , Zhu Aijv , Tong Chuan
Published: August 2019

Despite the growing recognition regarding the carbon cycle in the rhizosphere of upland ecosystems, little is known regarding the rhizosphere effect on soil organic carbon (SOC) mineralization in tidal marsh soils. In the current study, in situ rhizobox experiments (including rhizosphere and inner and outer bulk soil) were conducted in an estuarine tidal marsh. Our results showed that a higher abundance of total bacteria, Geobacter, dsrA and mcrA and lower α-diversity were observed in the rhizosphere relative to the bulk soil. Rhizosphere effects shifted the partition of terminal metabolic pathways from sulfate reduction in the bulk soil to the co-dominance of microbial Fe(III) and sulfate reduction in the rhizosphere. Although the rhizosphere effect promoted the rates of three terminal metabolic pathways, it showed greater preference towards microbial Fe(III) reduction in the tidal marsh soils. Plant species had little impact on the partitioning of terminal metabolic pathways, but did affect the potential of total SOC mineralization together with the abundance and diversity of total bacteria. Both the rhizosphere effect and plant species influenced the bacterial community composition in the tidal marsh soils; however, plant species had a less pronounced impact on the bacterial community compared with that of the rhizosphere effect.
Thermophilic methanotrophs: in hot pursuit
Authors: Houghton Karen M , Carere Carlo R , Stott Matthew B , McDonald Ian R
Published: August 2019

Methane is a potent greenhouse gas responsible for 20–30% of global climate change effects. The global methane budget is ∼500–600 Tg y−1, with the majority of methane produced via microbial processes, including anthropogenic-mediated sources such as ruminant animals, rice fields, sewage treatment facilities and landfills. It is estimated that microbially mediated methane oxidation (methanotrophy) consumes >50% of global methane flux each year. Methanotrophy research has primarily focused on mesophilic methanotrophic representatives and cooler environments such as freshwater, wetlands or marine habitats from which they are sourced. Nevertheless, geothermal emissions of geological methane, produced from magma and lithosphere degassing micro-seepages, mud volcanoes and other geological sources, contribute an estimated 33–75 Tg y−1 to the global methane budget. The aim of this review is to summarise current literature pertaining to the activity of thermophilic and thermotolerant methanotrophs, both proteobacterial (Methylocaldum, Methylococcus, Methylothermus) and verrucomicrobial (Methylacidiphilum). We assert, on the basis of recently reported molecular and geochemical data, that geothermal ecosystems host hitherto unidentified species capable of methane oxidation at higher temperatures.
Fermentative Escherichia coli makes a substantial contribution to H2 production in coculture with phototrophic Rhodopseudomonas palustris
Authors: Sangani Amee A , McCully Alexandra L , LaSarre Breah , McKinlay James B
Published: August 2019

Individual species within microbial communities can combine their attributes to produce services that benefit society, such as the transformation of renewable resources into valuable chemicals. Under defined genetic and environmental conditions, fermentative Escherichia coli and phototrophic Rhodopseudomonas palustris exchange essential carbon and nitrogen, respectively, to establish a mutualistic relationship. In this relationship, each species produces H2 biofuel as a byproduct of its metabolism. However, the extent to which each species contributes to H2 production and the factors that influence their relative contributions were previously unknown. By comparing H2 yields in cocultures pairing R. palustris with either wild-type E. coli or a formate hydrogenlyase mutant that is incapable of H2 production, we determined the relative contribution of each species to total H2 production. Our results indicate that E. coli contributes between 32 and 86% of the H2 produced in coculture depending on the level of ammonium excreted by the R. palustris partner. The level of ammonium excretion influenced the time over which E. coliwas exposed to formate, the types of E. colifermentation products available to R. palustris, and the pH of the medium, all of which affected the contribution of each species to H2 production.
Toxoplasma gondii in vegetables from fields and farm storage facilities in the Czech Republic
Authors: Slany Michal , Dziedzinska Radka , Babak Vladimir , Kralik Petr , Moravkova Monika , Slana Iva
Published: August 2019

Infection with Toxoplasma gondii has usually been connected with consumption of improperly treated meat. However, contaminated water and products of plant origin have emerged as new sources of infection in the last few years. Here, 292 vegetable samples—carrot, cucumber and lettuce—obtained from nine farms in the Czech Republic were examined using triplex real time PCR targeting two specific T. gondii sequences. Irrigation water and water used for washing of vegetables were also included. Overall, a positivity rate of 9.6% was found in vegetables. The concentration varied between 1.31 × 100 and 9.00 × 102 oocysts/g of sample. A significant difference was found between the positivity of vegetables collected directly from fields and that of vegetables collected from farm storage rooms (4.4–8.6% vs 10–24.1%, respectively). All samples of irrigation water and water used to rinse vegetables were negative. Genotyping based on restriction fragment length polymorphism (RFLP) analysis using seven markers revealed the exclusive presence of genotype II.
Thermosensitive hydrogels as a controlled release system for alkannin to improve localized treatment of Candida vaginitis after external beam radiotherapy in vitro and in vivo
Authors: Su Jin , Ma Jia , Mo Fei , Yang Xianwei , Zhang Peipei , Zhang Jiye
Published: August 2019

External beam radiotherapy increases the risk of Candida vaginitis in cervical cancer patients, which brings a lot of insufferable influence to their life. Here, we explored the efficacy of alkannin in the treatment of Candida vaginitis after external beam radiotherapy. We exploit thermosensitive hydrogel-mediated alkannin as the topical formulation in a rat model established in our work. Periodic acid-Schiff of vaginas indicated little Candida albicans adhered to the vaginal tissue in treatment group. Additionally, hematoxylin and eosin stain revealed that inflammatory response of high dose alkannin was reduced. Above all, the animal model was first established in our work for the clinical desire. Our results suggested the promising application of alkannin for the disease with satisfying fungicidal activity and anti-inflammatory activity.
Improvement of inhibitor tolerance in Saccharomyces cerevisiae by overexpression of the quinone oxidoreductase family gene YCR102C
Authors: Chen Hongqi , Li Jie , Wan Chun , Fang Qing , Bai Fengwu , Zhao Xinqing
Published: August 2019

Budding yeast Saccharomyces cerevisiae is widely used for lignocellulosic biorefinery. However, its fermentation efficiency is challenged by various inhibitors (e.g. weak acids, furfural) in the lignocellulosic hydrolysate, and acetic acid is commonly present as a major inhibitor. The effects of oxidoreductases on the inhibitor tolerance of S. cerevisiae have mainly focused on furfural and vanillin, whereas the influence of quinone oxidoreductase on acetic acid tolerance is still unknown. In this study, we show that overexpression of a quinone oxidoreductase-encoding gene, YCR102C, in S. cerevisiae, significantly enhanced ethanol production under acetic acid stress as well as in the inhibitor mixture, and also improved resistance to simultaneous stress of 40°C and 3.6 g/L acetic acid. Increased catalase activities, NADH/NAD+ ratio and contents of several metals, especially potassium, were observed by YCR102C overexpression under acetic acid stress. To our knowledge, this is the first report that the quinone oxidoreductase family protein is related to acid stress tolerance. Our study provides a novel strategy to increase lignocellulosic biorefinery efficiency using yeast cell factory.
Reverse genetic analysis of yeast YPR099C/MRPL51 reveals a critical role of both overlapping ORFs in respiratory growth and MRPL51 in mitochondrial DNA maintenance
Authors: Sahu Pushpendra Kumar , Salim Sagar , PP Mubthasima , Chauhan Sakshi , Tomar Raghuvir Singh
Published: August 2019

The Saccharomyces cerevisiae genome contains 6572 ORFs, of which 680 ORFs are classified as dubious ORFs. A dubious ORF is a small, noncoding, nonconserved ORF that overlaps with another ORF of the complementary strand. Our study characterizes a dubious/nondubious ORF pair, YPR099C/MRPL51, and shows the transcript and protein level expression of YPR099C. Its subcellular localization was observed in the mitochondria. The overlapping ORF, MRPL51, encodes a mitochondrial ribosomal protein of large subunit. Deletion of any ORF from YPR099C/MRPL51 pair induces common phenotypes, i.e. loss of mtDNA, lack of mitochondrial fusion and lack of respiratory growth, due to the double deletion (ypr099cΔ/Δmrpl51Δ/Δ) caused by sequence overlap. Hence, we created the single deletions of each ORF of the YPR099C/MRPL51 pair by an alternative approach to distinguish their phenotypes and identify the specific functions. Both the ORFs were found essential for the functional mitochondria and respiratory growth, but MRPL51 showed its specific requirement in mtDNA stability. The mechanism of mtDNA maintenance by Mrpl51 is probably Mhr1 dependent that physically interacts with Mrpl51 and also regulates mtDNA repair. Overall, our study provides strong evidence for the protein level expression of a dubious ORF YPR099C and the bifunctional role of Mrpl51 in mtDNA maintenance.
The Admissibility of Multiple Human Rights Complaints: Strasbourg and Geneva Compared
Authors: Deprez Christophe
Published: August 2019

This article seeks to provide a comparative and up-to-date overview of the applicable rules and relevant practice of the European Court of Human Rights and of the United Nations Human Rights Committee on forum duplication in international human rights litigation. While specific inadmissibility clauses have been included in both the European Convention on Human Rights and the Optional Protocol to the International Covenant on Civil and Political Rights with a view to preventing multiple human rights petitions in relation to the same matter, their respective scopes differ. Moreover, the applicable normative framework has led to important—and diverging—judicial developments in Strasbourg and in Geneva, which may be of great significance in human rights practice and therefore deserve to be thoroughly addressed.
A Legal Analysis of a Crucial Element in Country Guidance Determinations: Country of Origin Information
Authors: Vogelaar Femke
Published: August 2019

This article examines the use of Country of Origin Information (COI) by the Immigration and Asylum Chamber of the United Kingdom Upper Tribunal in country guidance determinations. The article assesses which standards regarding the use of COI are set by the Tribunal. Furthermore, it examines how these standards are applied by the Tribunal while it assesses the general situation or the situation of a particular group of persons at risk in Iran, Somalia, and Sri Lanka. The examination of country guidance determinations shows that the Tribunal’s assessments are based on a comprehensive range of COI, including information from expert witnesses, governmental agencies, United Nations agencies, non-governmental organizations, and news agencies. However, the country guidance determinations would benefit from a more uniform, structured approach to improve the transparency of the assessment of the reliability of information and the balancing process of COI. This would ensure a visibly ‘effectively comprehensive’ decision.1
Innovation considerations in merger control and unilateral conduct enforcement
Authors: Kokkoris Ioannis
Published: August 2019

Non-price considerations in merger control and unilateral conduct enforcement have been elements of the competition authorities’ assessment in the past few decades. Recently a revamped emphasis on such factors and in particular on the importance of innovation has characterized the European Commission’s enforcement practice. The article looks into merger control cases as well as two unilateral conduct cases (Microsoft and Google Shopping) and discusses the approach the European Commission has taken on the impact of concentrations as well as of abusive conducts on innovation. The article argues that the approach the European Commission takes in assessing innovation in merger control is pragmatic and appropriate for dynamic competition that characterizes innovative markets. In relation to the assessment of the harm on innovation in unilateral conduct cases, the article emphasizes the need for a balanced approach that prevents an adverse impact on innovation incentives of the dominant company while at the same time maintains a robust approach to competition harm induced by abusive conducts.
Warriors of Self-reliance: The Instrumentalization of Afghan Refugees in Pakistan
Authors: Easton-Calabria Evan
Published: August 2019

In striking contrast to most other refugee groups, Afghan refugees in Pakistan during the 1980s have primarily been understood as a successfully self-reliant population. However, little work has hitherto focused on the international assistance programmes that sought to support their everyday self-reliance. Drawing on extensive archival research, this article presents four phases of self-reliance assistance for Afghan refugees in Pakistan between 1979 and 1995, which correspond to shifts in broader economic trends from Keynesian economics to neoliberalism. At different times the practice of self-reliance assistance promoted large-scale collective employment, individual income-generation, protection for vulnerable populations unable to succeed in the market-based economy, and finally morphed into a form of self-governance through the ‘Afghanization’ of NGOs after the Cold War. These stages of self-reliance assistance encompass periods of humanitarian focus on so-called ‘refugee dependency syndrome’ and self-reliance as psycho-social support, holding parallels to the practice and discourse of contemporaneous Anglophone Western welfare systems. This article illuminates another chapter in the history of refugee self-reliance, and demonstrates the dynamism of self-reliance as both a concept and a practice.
‘He Who Has Eyes Let Him See’: Sartorial Choice and Soteriological Destiny in R. M. Ballantyne’s Jarwin and Cuffy
Authors: Fuller Jennifer
Published: August 2019

Many literary critics have dismissed R. M. Ballantyne’s fictions as artless evangelical propaganda. However, such a blanket denunciation fails to consider both the complexity of Ballantyne’s position in a fractured Scottish church and the ongoing debates among church members and elders about the purpose of and policies regarding foreign mission efforts. Using Jarwin and Cuffy (1878), I argue that Ballantyne’s fiction explores tensions as to the nature of personal salvation, the role of the Scottish church in missionary endeavours, and the necessity of an external presentation of the acceptance of the gospel, essential to much Pacific missionary writing. While Ballantyne is often remembered as having written stories which reinforce the dominant ideals of British colonialism and evangelical Protestantism, we must remember that these ideologies were far from stable concepts.
Wellness Approaches II
Authors: Gupta Swapnil , Miller Rebecca , Cahill John D.
Published: August 2019

When considering deprescribing for a patient, in addition to personal, self-determined strategies, it is essential to evaluate the person’s interest in and potential benefit from specific modalities of psychotherapy, symptom support, and other clinical interventions—without necessarily implying that these alone are sufficient alternatives to the deprescribed treatment. This chapter further explores these adjunctive strategies for supporting people in the process of deprescribing; specifically those strategies typically housed in clinical settings, such as psychotherapy, peer support, and cognitive behavioral therapy. Particular attention is paid to the importance of sleep management in the deprescribing process and how to add supports in that area. In addition, briefly discussed are emerging, progressive and albeit controversial approaches such as open dialogue.
Cardiovascular monitoring
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

Cardiovascular instability is one of the main reasons for admission to intensive care. Situations such as hypovolaemia, heart failure, and vasoplegia are often mixed, between them making the diagnosis more challenging. Attention to details and careful monitoring are essential at this stage. This chapter discusses cardiovascular monitoring and includes discussion on electrocardiograph monitoring, arterial pressure monitoring, insertion of central venous catheters, common problems with central venous access, pulmonary artery catheters, echocardiography, clinical applications of echocardiography in the intensive care unit, Doppler, pulse pressure algorithms, non-invasive methods, monitoring mean systemic filling pressure, and detection of volume responsiveness.
Miscellaneous drugs
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses miscellaneous drugs involved in critical care and includes antibiotics, involving discussion on antibiotic usage, classification and mechanism of action of antibiotics, context of antibiotic usage, key points for appropriate use of antibiotics, resistance issues, resistant organisms, and special considerations, including selective decontamination of the digestive tract, eubiosis and dysbiosis, and the future of antimicrobial therapy. This chapter also discusses antifungals, including amphotericin B, azoles, echinocandins, flucytosine, and important considerations regarding the use of antifungals in critically ill patients; antiviral agents, including acyclovir, ganciclovir, and valganciclovir, foscarnet, cidofovir, oseltamivir, and zanamivir; and N-acetylcysteine (modes of action, indications, dosing, and side-effects).
Cardiovascular disorders
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses cardiovascular disorders and includes discussion on hypertension (including discussion treatment of uncomplicated essential hypertension, management of hypertension in different patient groups, diabetes mellitus, ethnic groups, hypertensive crises, management of hypertensive emergencies, aortic dissection, acute pulmonary oedema, ST-elevation myocardial infarction (STEMI) and acute coronary syndrome, cocaine overdose, severe pre-eclampsia and eclampsia, malignant hypertension, hypertensive encephalopathy, stroke, and drugs for the treatment of hypertensive emergencies). It also covers tachyarrhythmias (especially common pathological arrhythmias and management), bradyarrhythmias (including the causes thereof, sinus node dysfunction, atrioventricular conduction disturbance, clinical approach, pharmacotherapy, and pacing), and myocardial infarction diagnosis (describing the diagnostic tools). Non-STEMI (differential diagnoses, risk assessment, management, anti-ischaemic therapy, withdrawal of dual antiplatelet therapy, lipid-lowering therapy, and invasive versus conservative management) and STEMI (diagnosis, initial evaluation in the emergency department, prehospital care, reperfusion strategy, primary percutaneous coronary intervention, periprocedural pharmacotherapy, and structural issues after STEMI) are also discussed, as are acute heart failure (both assessment and management) and bacterial endocarditis.
Metabolic disorders
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses metabolic disorders and includes discussion on electrolyte disorders, hypernatraemia, hyponatraemia, categorizing metabolic acidosis, metabolic acidosis aetiology, metabolic alkalosis, glycaemic control in the critically ill, diabetic ketoacidosis, hyperosmolar diabetic emergencies, thyroid emergencies (thyroid crisis/thyrotoxic storm), thyroid emergencies (myxoedema coma), hypoadrenal crisis, and carcinoid.
Shock
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses shock and includes a definition and diagnosis, discussion on hypovolaemic shock (including causes of hypovolaemic shock, therapy, and the reperfusion phase), cardiogenic shock, anaphylactic shock (including pathophysiology), and pathophysiology of sepsis and multiorgan failure.
Physical disorders
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses physical disorders and includes discussion on hypothermia (including discussion on physiology of temperature regulation and pathophysiology of hypothermia, management of a cardiac arrest with associated hypothermia, rewarming of the patient, and fluids, ‘rescue collapse’, and ‘after drop’), drowning and near-drowning (explaining rescue and resuscitation of the drowning subject), rhabdomyolysis (its clinical manifestations and the complications of rhabdomyolysis), and tissue viability issues in intensive care.
The Radiology Report
Authors: Abbott Gerald F.
Published: August 2019

The radiology report must communicate the results of imaging studies to the healthcare team in a clear, accurate, and timely manner - combining the radiologist’s medical knowledge, experience, and medical judgment to communicate their observations and form a summary impression of their findings. The key elements of a radiology report are 1) Administrative information, 2) Patient identification, 3) Clinical history and indications for the examination, 4) Imaging technique, 5) Comparison with prior studies, 6) Observations / Imaging findings, 7) Summary or Impression, and 8) Signature. These elements form the basis of “structured reporting”, a communication technique endorsed by the American College of Radiology (ACR).In structured reports of thoracic imaging studies, imaging findings are organized as separate paragraphs: 1) tubes and lines, 2) lungs and airways, 3) pleura, 4) heart and mediastinum, 5) bones, and 6) soft tissues. This format is preferred by clinicians, as information pertaining to specific organ systems can be retrieved and compared to previous reports more easily.
Pulmonary Venous Hypertension and Edema
Authors: Little Brent P. , Henry Travis S.
Published: August 2019

Cardiogenic edema can be characterized in three phases: pulmonary venous hypertension, interstitial edema, and alveolar edema, each with different radiographic findings. Radiographic and clinical findings must be correlated to achieve an accurate diagnosis of pulmonary edema, as other causes of interstitial and airspace opacities can have overlapping appearances. Comparison with prior radiographs is extremely useful. Clinical information and the time course of findings should be considered to avoid misinterpretation. In the acute setting, pulmonary hemorrhage and diffuse pneumonia may manifest with bilateral perihilar consolidation and interstitial thickening. In the chronic setting, fibrosing interstitial lung disease may manifest with progressive basilar reticular opacities. Brain-type natriuretic peptide (BNP) is produced by cardiac myocytes. Serum levels are elevated in cardiogenic edema and can be used to support a suspected diagnosis of pulmonary edema at imaging. Although BNP can also be elevated in a variety of lung diseases, low BNP levels suggest a diagnosis other than cardiogenic pulmonary edema. Pulmonary edema is often diagnosed and monitored through noninvasive means, including BNP monitoring, clinical assessment, and imaging studies, rather than pulmonary artery catheterization. Treatment of cardiogenic edema usually involves medical therapy (inotropic agents and preload/afterload reduction) and ventilation support to improve oxygenation. Supportive devices such as intra-aortic balloon pumps can be used to stabilize patients with severe heart failure.
Acute Respiratory Distress Syndrome
Authors: Little Brent P. , Henry Travis S.
Published: August 2019

Adult respiratory distress syndrome (ARDS) is a clinical diagnosis of diffuse lung injury leading to severe hypoxemia in spite of high inspired oxygen concentrations. Histologically, ARDS manifests as diffuse alveolar damage (DAD). Intrapulmonary causes of ARDS include pneumonia, inhalational injuries, aspiration, and chest trauma. Extrapulmonary or systemic causes include sepsis, multi-organ failure, transfusion reaction, pancreatitis, and drug toxicity. The early exudative phase occurs within 72 hours of the precipitating cause, and usually manifests with diffuse bilateral airspace opacities. The organizing phase occurs later, with a dependent gradient of consolidation worse in the posterior lower lungs; bronchial dilatation may develop rapidly. In survivors, the lung may return to a relatively normal state, or may develop fibrosis. Fibrosis is often more severe in the anterior portions of the lungs due to the protective effect of the typically posterior, dependent consolidation and atelectasis of ARDS. Imaging findings of ARDS may appear in patients with progressive dyspnea and tachypnea who require mechanical ventilation. Pneumothorax may occur in patients with ARDS due to barotrauma, with minimal loss of volume of the ipsilateral lung due to its increased density and decreased compliance
Empyema
Authors: Walker Christopher M.
Published: August 2019

Empyema discusses the clinical features, evolution, differential diagnosis, complications, and imaging manifestations of this disease process. There are three distinct stages in the evolution of empyema: exudative stage, fibropurulent stage, and organizing stage. The majority of patients with empyema are symptomatic and present with cough, fever, chest pain, and dyspnea. A simple parapneumonic effusion manifests as a free small to moderate pleural effusion of variable size and is usually associated with adjacent consolidation. Empyema manifests as a loculated pleural effusion which may or may not be associated with adjacent consolidation. Empyema typically exhibits smooth parietal pleural thickening and enhancement indicative of an exudative pleural effusion. Approximately 50% exhibit the split pleural sign with thickening and enhancement of the visceral and parietal pleura. Complications of empyema include bronchopleural fistula, empyema necessitans, “trapped” lung, and malignant transformation. The treatment of empyema is drainage via thoracostomy tubes or surgical decortication in complicated cases.
Community-Acquired Pneumonia
Authors: Betancourt Sonia L.
Published: August 2019

Pneumonia refers to acute inflammation of the lower respiratory tract and lung parenchyma. Community Acquired Pneumonia (CAP) refers to pneumonia acquired outside of hospitals or long-term care facilities in patients without known inherited or acquired immunodeficiency or active cancer or within 48 hours after hospital admission. Chest radiographic demonstration of airspace disease helps support the diagnosis in the appropriate clinical setting. Patients with CAP are treated with antibiotics regardless of chest radiography findings. Further evaluation with Computed tomography (CT), bronchoscopy, pleural fluid analysis, etc., are reserved for patients that do not respond to treatment or in whom complications are suspected. CT is useful in assessing complications such as empyema, bronchopleural fistula, abscess, and necrotizing pneumonia. Lung abscesses and empyema are frequently associated with aspiration pneumonia.
The Immunocompromised Patient: AIDS
Authors: Bueno Juliana
Published: August 2019

Acquired immune deficiency syndrome (AIDS) is caused by infection with human immunodeficiency virus (HIV) that results in decreased immunity and favors infectious or neoplastic conditions. The onset of clinical AIDS is defined by a CD4 count of less than 200 cells/mm3 or CD4 cells < 14% of all leukocytes in an HIV-positive patient, even in the absence of opportunistic infections. Imaging abnormalities in HIV(+) should be correlated with the CD4 count to narrow the differential diagnosis. Diffuse ground glass opacities (GGO) on CT in a patient with AIDS and hypoxemia, is virtually diagnostic of Pneumocystis pneumonia (PCP). CT is indicated in HIV(+) patients with respiratory symptoms and normal chest radiographs. Suspect tuberculosis (TB) in patients with advanced AIDS and low CD4 counts presenting with consolidation and lymphadenopathy. Kaposi sarcoma (KS) may simulate cardiogenic pulmonary edema on imaging and should be suspected in patients without clinical evidence of edema.
Lung Cancer
Authors: Rosado-de-Christenson Melissa L.
Published: August 2019

Lung cancer is the leading cause of cancer related death in the USA and is strongly associated with cigarette smoking. Adenocarcinoma is the most common cell type, followed by squamous cell carcinoma, small cell lung cancer, and large cell carcinoma. Adenocarcinoma is typically a peripheral nodule or mass. Although invasive adenocarcinomas may metastasize early, many adenocarcinomas manifesting as subsolid nodules exhibit an indolent behavior. Squamous cell carcinoma and small cell lung cancer are centrally located and are intimately associated with cigarette smoking. Squamous cell lung cancer grows rapidly but metastasizes late. Small cell lung cancer is an aggressive neuroendocrine carcinoma, and affected patients often present with advanced disease and have a poor prognosis. Lung cancer has a wide variety of pulmonary manifestations on imaging including: nodules, masses, atelectasis, consolidation, and multifocal pulmonary lesions.
Pulmonary Metastases
Authors: Ternes Tyler H.
Published: August 2019

Pulmonary metastases represent spread of malignancy to the lung parenchyma. Patients with metastatic disease may present with dyspnea, cough, or hemoptysis. Alternatively, affected patients may be asymptomatic. The lungs are a common site for metastatic disease. Relatively common primary malignancies (breast, colon, lung, and kidney cancers) are the most common causes of pulmonary metastases. However, less common primary malignancies (choriocarcinoma, testicular cancers, melanoma, and sarcomas) have a higher likelihood to produce lung metastases. The vast majority of pulmonary metastases spread via the bloodstream. Hematogenous metastases are typically basilar predominant lung nodules. Metastatic nodules may be very small (miliary, < 3mm), or very large (cannonball), and may rarely be solitary. The presence of surrounding ground-glass attenuation (CT-Halo sign) often indicates surrounding hemorrhage. Some metastases may be cavitary or calcified. Pulmonary metastases may spread via the lymphatics. Asymmetric smooth or nodular interlobular septal thickening should raise concern for lymphangitic carcinomatosis. An uncommon mechanism is spread within the airways, which may result in an endobronchial lesion or post obstructive atelectasis.
Pulmonary Vasculitis
Authors: Martínez Felipe
Published: August 2019

Vasculitis refers to inflammation of blood vessel walls that results in vascular wall destruction and ischemic injury to affected organs. Common vasculitides discussed herein include Takayasu arteritis (TAK), giant cell arteritis (GCA), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides such as granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), and anti-glomerular basement membrane (anti-GBM) disease or Goodpasture syndrome. Vasculitides are further subcategorized depending of the size of the predominantly affected vessels: large, medium and small vessel vasculitis. The affected vessel size strongly influences the clinical and imaging manifestations of the disease. Intrathoracic involvement is more common in small and large vessel vasculitides. Diffuse alveolar hemorrhage (DAH), a common manifestation of vasculitis, is considered a syndrome rather than a specific entity and will be discussed in this chapter. However, it should be noted that DAH may also result from non-vasculitic etiologies. The work up and diagnosis of patients with primary vasculitides is challenging and requires close collaboration between the clinician, the radiologist and the pathologist. Radiographic abnormalities are non specific or may be absent. CT and MRI are the imaging modalities of choice for the evaluation and follow up of these patients, and should be considered despite normal radiographics.
Asbestosis
Authors: Azok Joseph T.
Published: August 2019

Asbestosis is a fibrotic pneumoconiosis resulting from the inhalation of asbestos fibers, most commonly from occupational exposure. Chest radiographs and high-resolution chest CT can detect asbestos-related disease. Pleural abnormalities include pleural plaques, pleural effusions, pleural thickening, and mesothelioma. Pleural plaques serve as a marker of asbestos exposure and are the most common imaging abnormality found in patients exposed to asbestos. Parenchymal-induced lung disease includes pulmonary fibrosis, known as asbestosis, rounded atelectasis, and lung cancer. Asbestos exposure leads to an increased risk of both lung cancer and especially mesothelioma, which is rare in the absence of asbestos exposure.
Drug-Induced Lung Disease
Authors: Henry Travis S. , Little Brent P.
Published: August 2019

Almost any medication may result in a reaction within the lungs. These reactions are often variable and include diffuse alveolar damage, organizing pneumonia, eosinophilic pneumonia, hypersensitivity reaction, interstitial pneumonitis/fibrosis, alveolar hemorrhage, pulmonary vasculitis/pulmonary hypertension, bronchiolitis obliterans, or a sarcoid-like reaction. Because these reactions may mimic their idiopathic counterparts, yet may respond to drug cessation or alternative therapies, suspicion must be high in patients with pulmonary findings who are on certain medications. This chapter will focus on the spectrum of drug reactions with the lungs. Amiodarone-related pulmonary abnormalities will also be discussed.
Postoperative Complications
Authors: Little Brent P. , Henry Travis S.
Published: August 2019

Patients are often imaged in the post-operative period, especially when symptomatic. Any procedure runs the risk of infection, hemorrhage, or pulmonary emboli but each of the surgical procedures performed within the thorax has its own unique set of potential complications. It becomes incumbent on the Radiologist to familiarize oneself with the techniques used at their own institution. In this chapter, some of the more common complications seen with lung resection, lung transplantation, aortic repair and coronary artery bypass grafting are reviewed. The goal is to provide a systematic approach to allow for thorough evaluation of these often quite ill patients.
Cysts of the Mediastinum
Authors: Carter Brett W.
Published: August 2019

Mediastinal cysts are fluid-filled lesions surrounded by a thin wall with an epithelial lining. These cysts are typically congenital, account for approximately 15-20% of all mediastinal masses, and may be found in any mediastinal compartment. Although mediastinal cysts may be initially detected on chest radiography, these lesions are optimally evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Cysts typically manifest as well-circumscribed, spherical lesions of water attenuation or signal, buy may appear heterogeneous when complicated by hemorrhage or infection. A focused differential diagnosis may be generated based on lesion location. For instance, bronchogenic cysts are most common in the middle mediastinum and pericardial cysts are typically found in the right cardiophrenic angle. Other mediastinal cysts include esophageal duplication and neurenteric cyst. Although meningocele is not a true cyst, it exhibits a cystic appearance on imaging.
Mediastinal Veins and Anomalies
Authors: Bhalla Sanjeev
Published: August 2019

The chapter titled abnormalities of systemic veins discusses a series of mediastinal venous anomalies and tributaries that may produce confusing imaging findings. Such findings may be seen on a radiograph that shows an abnormal course of a central line or catheter in one of these anomalous vessels. The more frequently encountered systemic vein variants are presented, namely left superior vena cava (SVC) and azygous continuation of an interrupted inferior vena cava (IVC). In these conditions the normal connection of a right-sided vena cava to right atrium may be altered. Commonly encountered venous tributaries, including the left superior intercostal vein (which produces the aortic nipple on radiography), the left pericardiophrenic vein, and systemic to pulmonary vein collaterals will also be included. The latter may result in right-to-left shunting and cyanosis.
Shunts, Intracardiac and Intrapulmonary
Authors: Cummings Kristopher W.
Published: August 2019

Shunts, intracardiac and intrapulmonary, are vascular communications that allow mixture of deoxygenated and oxygenated blood within the cardiovascular system. The most common intracardiac shunts encountered in adults allow left (oxygenated) to right (deoxygenated) directional shunting which over time can lead to pulmonary circulation volume overload and pulmonary hypertension. In this chapter, the most common adult intracardiac shunts (atrial septal defects, patent foramen ovale and ventricular septal defects) are discussed. Shunting can also occur at the level of the lung parenchyma with one of the most common examples being a pulmonary arteriovenous malformation (pAVM). PAVMs are very frequently inherited conditions, and their identification has implications both for the patient and immediate family members. The imaging appearances of these intracardiac and intrapulmonary lesions will be discussed.
Parallel Evolution of Complex Centipede Venoms Revealed by Comparative Proteotranscriptomic Analyses
Authors: Jenner Ronald A , von Reumont Bjoern M , Campbell Lahcen I , Undheim Eivind A B
Published: August 2019

Centipedes are among the most ancient groups of venomous predatory arthropods. Extant species belong to five orders, but our understanding of the composition and evolution of centipede venoms is based almost exclusively on one order, Scolopendromorpha. To gain a broader and less biased understanding we performed a comparative proteotranscriptomic analysis of centipede venoms from all five orders, including the first venom profiles for the orders Lithobiomorpha, Craterostigmomorpha, and Geophilomorpha. Our results reveal an astonishing structural diversity of venom components, with 93 phylogenetically distinct protein and peptide families. Proteomically-annotated gene trees of these putative toxin families show that centipede venom composition is highly dynamic across macroevolutionary timescales, with numerous gene duplications as well as functional recruitments and losses of toxin gene families. Strikingly, not a single family is found in the venoms of representatives of all five orders, with 67 families being unique for single orders. Ancestral state reconstructions reveal that centipede venom originated as a simple cocktail comprising just four toxin families, with very little compositional evolution happening during the approximately 50 My before the living orders had diverged. Venom complexity then increased in parallel within the orders, with scolopendromorphs evolving particularly complex venoms. Our results show that even venoms composed of toxins evolving under the strong constraint of negative selection can have striking evolutionary plasticity on the compositional level. We show that the functional recruitments and losses of toxin families that shape centipede venom arsenals are not concentrated early in their evolutionary history, but happen frequently throughout.
Nicotine and Toxicant Exposure Among Concurrent Users (Co-Users) of Tobacco and Cannabis
Authors: Smith Danielle M , O’connor Richard J , Wei Binnian , Travers Mark , Hyland Andrew , Goniewicz Maciej L
Published: August 2019

Background

Smoking cannabis may potentially increase exposure to numerous toxic chemicals that are commonly associated with tobacco use. There is a paucity of data related to toxicant exposures among concurrent users of tobacco and cannabis (co-users).

Methods

Data are from the Population Assessment of Tobacco and Health Study Wave 1 Biomarker Restricted-Use Files. Analyses focused on adults who provided urine samples (N = 5859). Urine samples were analyzed for biomarkers of exposure to nicotine, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, and volatile organic compounds. Using weighted linear regression, we compared adjusted geometric mean concentrations of 15 biomarkers between user groups of various tobacco product types according to their self-reported past 30-day cannabis use.

Results

Past 30-day cannabis use was similar across various types of tobacco product use subgroups (range: 13%–23%) and significantly more common compared to non-tobacco users (1.0%; p < .001). Across all groups of tobacco users, those who co-used cannabis exhibited significantly higher concentrations of the biomarker of exposure to acrylonitrile (CYMA) compared to non-cannabis users (by 39%–464%). Tobacco–cannabis co-users also showed significantly elevated levels of the biomarker of exposure to acrylamide (AAMA) compared to exclusive tobacco users, and significantly higher exposure to many polycyclic aromatic hydrocarbons (including fluorene and pyrene).

Conclusions

Co-users exhibited higher concentrations for biomarkers of exposure to many combustion byproducts, compared to exclusive tobacco users. More robust measurements of cannabis use can address potential confounding in assessments of exposures to tobacco-related constituents, and potential health effects resulting from co-use.

Implications

With disproportionately greater rates of cannabis use occurring among tobacco users, it is critical to consider how concurrent cannabis use may influence health-related outcomes among smokers. Our findings suggest potential additive toxicant exposures among co-users of tobacco and cannabis. Lack of consideration and measurement of cannabis use in assessing tobacco-related exposures may confound estimates thought to be attributable to tobacco, particularly for non-specific biomarkers. Assessing tobacco and cannabis use in tandem will allow for more precise measurement of outcomes related to one or both substances, and can provide additional information on potential health effects related to co-use.
Trichosporon japonicum Fungemia and Ventricular Assist Device Infection in an Immunocompetent Patient
Authors: Bongomin Felix , Otu Akaninyene , Calisti Giorgio , Richardson Malcolm D , Barnard James , Venkateswaran Rajamiyer , Vergidis Paschalis
Published: August 2019

Trichosporon species are emerging opportunistic yeasts that cause life-threatening disseminated disease in severely immunocompromised patients. Trichosporon japonicum is a very rare cause of invasive trichosporonosis. We describe a case of Trichosporon japonicum fungemia in an immunocompetent patient with a transcutaneous biventricular assist device.