Background Aortic Aneurysm (AA) is a common atherosclerotic condition, accounting for nearly 6,000 deaths in England and up to 175,000 deaths globally each year. The pathological outward bulging of the aorta typically results from atherosclerosis or hereditary connective tissue disorders. AAs are usually asymptomatic until spontaneous rupture or detected on incidental screening. 8 in 10 patients do not survive the rupture and die either before reaching hospital or from complications following surgery. Similar to other cardiovascular pathologies (CVPs), AA is thought to be subject to chronobiological patterns of varying incidence. Methods We performed a literature review of the current literature to evaluate the association between circadian rhythms, seasonal variations, and genetic factors and the pathogenesis of AA, reviewing the impact of chronobiology. Results The incidence of AA is found to peak in the early morning (6 AM – 11 AM) and colder months, and conversely troughs towards the evening and warmer months, exhibiting a similar pattern of chronobiological rhythm as other CVPs such as myocardial infarcts, or cerebrovascular strokes. Conclusion Literature suggests there exists a clear relationship between chronobiology and the incidence and pathogenesis of ruptured AA; incidence increases in the morning (6am - 11am), and during colder months (December – January). This is more pronounced in patients with Marfan Syndrome, or vitamin D deficiency. The underlying pathophysiology and implications this has for chronotherapeutics, are also discussed. Our review shows a clear need for further research into the chronotherapeutic approach to preventing ruptured AA in the journey towards precision medicine.
1. Trait differences among plant species can favor species coexistence. The role that such differences play in the assembly of diverse plant communities maintained by frequent fires remains unresolved. This lack of resolution results in part from the possibility that species with similar traits may coexist because none has a significant fitness advantage and in part from the difficulty of experimental manipulation of highly diverse assemblages dominated by perennial species. 2. We examined a 65-year chronosequence of losses of herbaceous species following fire suppression (and subsequent encroachment by Pinus elliottii) in three wet longleaf pine savannas. We used cluster analysis, similarity profile permutation tests and k-R cluster analysis to identify statistically significant functional groups. We then used randomization tests to determine if the absence of functional groups near pines was greater (or less) than expected by chance. We also tested whether tolerant and sensitive species were less (or more) likely to co-occur by chance in areas in savannas away from pines in accordance with predictions of modern coexistence theory. 3. Functional group richness near pines was lower than expected from random species extirpations. Wetland perennials with thick rhizomes and high leaf water content, spring-flowering wetland forbs (including Drosera tracyi), orchids, Polygala spp., and club mosses were more likely to be absent near pines than expected by chance. C3 grasses and sedges with seed banks and tall, fall-flowering C4 grasses were less likely to be absent near pines than expected by chance. Species sensitive to pine encroachment were more likely to co-occur with other such species away from pines at two of the three sites. 4. Results suggest that herb species diversity in frequently-burned wet savannas is maintained in part by a weak fitness (e.g., competitive) hierarchy among herbs, and not as a result of trait differences among co-occurring species.
Fetal hematometrocolpos is a rare finding with an incidence of 1 in 16,000 female births. Timely diagnosis enables clinicians to formulate an appropriate management plan for the newborn. We present a case of fetal hematometrocolpos managed exclusively by prenatal and postnatal ultrasound scans allowing for effective immediate postnatal surgical treatment.
Objective: The aim of this study is establish the optimal non- invaszive urine sample collection method for the microbiota studies. Methodology: 12 men with bladder carcinoma underwent first voided and midstream urine collection. Urine samples were analyzed by using V3-V4 regions of bacterial 16s ribosomal RNAs. Bacterial groups with relative abundance above 1% were analyzed in first voided urine and midstream urine samples at phylum, class, order, and family level. At the genus level, all of the identified bacterial groups’ relative abundances were analyzed. The statistical significance (p<0.05) of differences between first voided and midstream urine sample microbiota were evaluated using the Wilcoxon test. Results: According to analysis, 8 phyla, 14 class, 23 orders, 39 families, and 29 different genera were identified in the first voided and the midstream urine samples. Statistical differences were not identified between first voided and mid-stream urine samples of all bacteria groups except the Clostridiales at order level (p:0.04) and Clostridia at class level (p:0.04). Conclusions: Either first voided or midstream urine samples can be used in urinary microbiota studies as we determined that there is no statistically significant difference between them regarding the results of 16s ribosomal RNA analysis. What’s known? According to widespread acceptance, first voided urine and midstream urine should be collected separately for standard microbiologic evaluation. What’s new? We found that there is no exact statistically significant difference between two collection methods even on microbiota analysis. We believe that either first voided or midstream uyrine samples can be used in urinary microbiota studies.
Accurate assessment of right ventricular (RV) function is drawing a growing attention. Pressure-volume (PV) loop analysis is the gold standard method for evaluating RV function; however, it is not widely employed due to its invasive nature and complexity. The present report is the first to have drawn a RV PV loop in a patient with pulmonary hypertension, with a simultaneous recording of RV pressure and volume using high fidelity micromanometry and 3D echocardiography. This allows for less invasive and simple assessment of RV function, potentially promoting better understanding and management of pulmonary hypertension and other cardiovascular diseases.
Phytoplasmas (Mollicutes, Acholeplasmataceae), vector-borne obligate bacterial plant-parasites, infect nearly 1,000 plant species and unknown numbers of insects, mainly leafhoppers (Hemiptera, Deltocephalinae), which play a key role in transmission and epidemiology. Although the plant-phytoplasma-insect association has been evolving for >300 million years, nearly all known phytoplasmas have been discovered as a result of the damage inflicted by phytoplasma diseases on crops. Few efforts have been made to study phytoplasmas occurring in non-economically important plants in natural habitats. In this study, a sub-sample of leafhopper specimens preserved in a large museum biorepository was analyzed to unveil potential new associations. PCR screening for phytoplasmas performed on 227 phloem-feeding leafhoppers collected worldwide from natural habitats revealed the presence of 6 different previously unknown phytoplasma strains. This indicates that museum collections of herbivorous insects represent a rich and largely untapped resource for discovery of new plant pathogens, that natural areas worldwide harbor a diverse but largely undiscovered diversity of phytoplasmas and potential insect vectors, and that independent epidemiological cycles occur in such habitats, posing a potential threat of disease spillover into agricultural systems. Larger-scale future investigations will contribute to a better understanding of phytoplasma genetic diversity, insect host range, and insect-borne phytoplasma transmission and provide an early warning for the emergence of new phytoplasma diseases across global agroecosystems.
Arrhythmia Induced Cardiomyopathy: What are Predictors of Myocardial Recovery?Acile Nahlawi BS, Marwan M. Refaat MDDepartment of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, LebanonRunning Title: AIC and Predictors of Myocardial RecoveryDisclosures: NoneFunding: NoneKeywords: Cardiac Arrhythmias, Cardiovascular Diseases, Heart Diseases, Congestive Heart Failure, CardiomyopathyWords: 958 (excluding references)Correspondence:Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FRCPAssociate Professor of MedicineDirector, Cardiovascular Fellowship ProgramDepartment of Internal Medicine, Cardiovascular Medicine/Cardiac ElectrophysiologyDepartment of Biochemistry and Molecular GeneticsAmerican University of Beirut Faculty of Medicine and Medical CenterPO Box 11-0236, Riad El-Solh 1107 2020- Beirut, LebanonFax: +961-1-370814Clinic: +961-1-759616 or +961-1-355500 or +961-1-350000/+961-1-374374 Extension 5800Office: +961-1-350000/+961-1-374374 Extension 5353 or Extension 5366 (Direct)Email: firstname.lastname@example.orgCardiomyopathies cause a significant public health burden and improvement in sudden cardiac death risk stratification helped in decreasing mortality by improved pharmacotherapy as well as device implantations including implantable cardiac defibrillators and cardiac resynchronization therapy [1-4]. Arrhythmia induced cardiomyopathy (AIC) is a major cause of non-ischemic cardiomyopathy and heart failure (HF) worldwide . It is characterized by an impairment of left ventricular systolic function secondary to high heart rate (tachycardia-induced), asynchrony (frequent premature ventricular contractions-induced or right ventricular pacing-induced) or an irregular rhythm (such as atrial fibrillation-induced) that serves as the trigger of AIC and this is mediated by calcium mishandling. The distinctive feature of AIC is the substantial improvement in left ventricular systolic function following arrhythmia suppression or elimination . Atrial Fibrillation (AF) is concomitantly present with and potentially the cause of 10 to 50% of HF cases . AIC is an important, commonly encountered and potentially reversible entity that is often under-recognized. The exact incidence and prevalence of AIC remains poorly defined in the literature . In some studies, it was present in as high as 50% of patients with AF undergoing ablation, while it was reported to be present in 10% of patients with focal atrial tachycardia undergoing ablation . In addition, very little attention, if any, is given to AIC in major trials on AF and HF, despite its significant implications on morbidity and mortality and the promising benefits of treatment . Many aspects of AIC are yet to be understood. In fact, few studies limited by small sample size constitute our main source of knowledge on extent and predictors of ventricular recovery after treatment initiation in patients with AIC [9,10].In their multicenter retrospective study, Gopinathannair et al. aimed to assess the degree of recovery of the left ventricular systolic function after suppression/elimination of the underlying arrythmia and to evaluate factors influencing this response such as baseline patient and arrhythmia characteristics. The study sample comprised 243 patients from 3 different institutions whose charts were reviewed retrospectively (no recruitment timeframe was indicated). The patient characteristics studied included baseline left ventricular ejection fraction (LVEF), presence of structural heart disease (SHD) [ defined as significant coronary artery disease, prior myocardial infarction, hemodynamically significant valvular heart disease, or other structural cardiomyopathies] and medications used. As for the arrhythmia characteristics, they included arrhythmia duration and arrhythmia type. The authors used echocardiography as the imaging modality to determine extent of ventricular function recovery by comparing myocardial function before and after treatment of the culprit arrhythmia. The echocardiographic parameters that were assessed included LVEF, LV end-diastolic and end-systolic diameters, left atrial dimension, valvular abnormalities, right ventricular systolic pressures, and pulmonary arterial pressures.In contrast to reported literature on the topic, Gopinathannair et al. found that none of the studied patient and arrhythmia characteristics had a significant effect on the recovery of ventricular function. Their results showed that initiation of aggressive arrhythmia treatment is warranted in patients with suspected AIC, regardless of arrhythmia duration, arrhythmia type, severity of baseline LVEF, and underlying structural heart disease. This was concluded based on the consistent substantial improvement in LVEF after arrhythmia suppression/elimination, mainly through rhythm control, across all different subgroups. In fact, the extent of LVEF improvement was similar whether comparing the group with known arrhythmia duration [KN] to that with unknown arrhythmia duration [UKN] (21.2±9 % vs 19.4±11 %, p-value =0.16) or comparing the group with longest arrhythmia duration to the rest (21.5±7.5 % vs 21.0 ± 9.2%, p-value=0.77). On the other hand, greatest improvement was seen in the group with lowest initial LVEF (24±17 vs 19±7%; p-value <0.0001), making low index LVEF the only predictor of LVEF recovery after arrhythmia treatment in patients with AIC. However, the LVEF in these patients did not reach complete normalization; they had lower post-treatment LVEF compared to other groups (45±14 vs 54±8%; p<0.0001), a finding consistent with the available literature. Also similar to previous studies, the authors found that patients with PVCs experienced smaller extent of recovery compared to other arrhythmia types. The authors concluded by stressing the importance of suspecting AIC in patients having cardiomyopathy with a persistent arrhythmia and initiating aggressive arrhythmia treatment regardless of initial patient and arrhythmia characteristics.As for the limitations of the study by Gopinathannair et al., there are few to mention. First, the study had a retrospective design and therefore findings only serve to generate hypotheses that need further testing and validation. Second, there is a lack of a control group to exclude interference of confounding factors. Although the use of Angiotensin-Converting Enzyme inhibitors (ACEi)/ Angiotension receptor blockers (ARB) did not independently predict LVEF improvement in multivariate analysis, it could still be a confounder given the lower rates of ACEi/ARB use in the cohort. Third, the timeframe of the study and the period of follow-up were not clearly defined. Fourth, there is lack of blinding of echocardiographic analyses which can potentially lead to inter- and intra-observer variability. Finally, the sample population was not diverse as it consisted in its majority of Caucasians.The Gopinathannair et al. study demonstrated several points of strength. Among these are its multicenter nature and its relatively larger sample size compared to similar studies, giving its findings more weight. Moreover, the authors appropriately and clearly defined their inclusion and exclusion criteria. Furthermore, no funding was needed for the study which potentially frees it from direct or indirect influences on its design, execution and interpretation. Finally, the study has successfully improved our understanding of predictors of ventricular recovery in patients with AIC and showed that patients with AIC who had the longest duration of arrhythmia still had LV systolic function improvement with arrhythmia suppression/elimination. This study paves the way for prospective studies and randomized clinical trials to validate the generated hypotheses and corroborate the observational findings.
This systematic review evaluates the efficacy and safety of biologicals for chronic rhinosinusitis with nasal polyps (CRSwNP) compared to the standard of care. Pubmed, EMBASE and Cochrane Library were searched for RCTs. Critical and important CRSwNP-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. RCTs evaluated (dupilumab-2, omalizumab-4, mepolizumab-2, reslizumab-1) included 1236 adults, with follow-up 20-64 weeks. Dupilumab reduces the need for surgery (NFS) and oral corticosteroid (OCS) use (RR 0.28; 95%CI 0.20-0.39, moderate certainty) and improves with high certainty smell (mean difference (MD) +10.54; 95%CI +9.24 to +11.84) and quality of life (QoL) (MD -19.14; 95%CI 95%CI -22.80 to -15.47), with fewer treatment-related adverse events (TAEs) (RR 0.95; 95%CI 0.89-1.02, moderate certainty). Omalizumab reduces NFS (RR 0.85; 95%CI 0.78 to 0.92, high certainty), decreases OCS use (RR 0.38; 95%CI 0.10-1.38, moderate certainty), improves with high certainty smell (MD +3.84; 95%CI +3.64 to +4.04) and QoL (MD -15.65; 95%CI -16.16 to -15.13), with increased TAE (RR 1.73; 95%CI 0.60-5.03, moderate certainty). There is low certainty for mepolizumab reducing NFS (RR 0.78; 95%CI 0.64 to 0.94) and improving QoL (MD -13.3; 95% CI -23.93 to -2.67) and smell (MD +0.7; 95%CI -0.48 to +1.88), with increased TAEs (RR 1.64; 95%CI 0.41-6.50). The evidence for reslizumab is very uncertain.
Purpose: Clinical treatment of gastrointestinal neoplasms in patients with severe coronary stenosis is difficult, and it remains controversial to perform staged or simultaneous surgeries. The purpose of this study was to retrospectively analyze the feasibility and indications for simultaneous gastrointestinal tumor resection and off-pump coronary artery bypass (OPCAB) graft surgery. Methods: Data collected from a total of five patients, including three patients with gastric cancer and two patients with colorectal cancer, who underwent simultaneous radical cancer resection and OPCAB between September 2010 and October 2019, were retrospectively analyzed. Among these patients, one had an incomplete colonic obstruction. All patients had severe coronary stenosis, and one experienced acute heart failure before surgery. OPCAB was performed first, followed by the radical cancer resection. Results: All five patients were discharged from hospital without perioperative death, major cardiovascular events or anastomotic leakage. The mean postoperative hospital stay was 9.4 days. One patient experienced slight gastrointestinal bleeding after surgery, which improved with conservative treatment. After a mean follow-up of 39 months, two patients with gastric cancer died from tumor metastasis at 28 months and 37 months, while the remaining three patients did not have tumor recurrence or metastasis. None of the patients experienced myocardial ischemia. Conclusion: It is safe and feasible to perform simultaneous OPCAB and gastrointestinal surgeries on the premise of strictly controlling the indications for patients with gastrointestinal tumors complicated with severe coronary artery stenosis.
Chimpanzees Pan troglodytes are the closest extant relative of modern humans, and are often used as a model organism to help understand prehistoric human behavior and ecology. Originally presumed herbivorous, chimpanzees have been observed hunting 24 species of birds, ungulates, rodents, monkeys, and other primates, using an array of techniques from tools to group cooperation. Using the literature on chimpanzee hunting behavior and diet from 13 studies, we aimed to determine the prey preferences of chimpanzees. We extracted data on prey-specific variables such as targeted species, their body weight, and their abundance within the prey community, and hunter-specific variables such as hunting method, and chimpanzee group size and sex ratio. We used these in a generalized linear model to determine what factors drive chimpanzee prey preference. We calculated a Jacobs’ Index value for each prey species killed at two sites in Uganda and two sites in Tanzania. Chimpanzees prefer prey with a body weight of 7.6 ± 0.4 kg or less, which corresponds to animals such as juvenile bushbuck Tragelaphus scriptus and guereza colobus monkeys Colobus guereza. Sex ratio in chimpanzee groups appears to drive chimpanzee prey preference, where chimpanzees increasingly prefer prey when in male-dominated groups. Prey preference information from chimpanzee research can assist conservation management programs by identifying key prey species to manage, as well as contribute to a better understanding of the evolution of human hunting behavior.
Objectives: Studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted from person to person via airborne droplets. It is unclear whether it can be shed into human milk and transmitted to a child via breastfeeding.We investigated the presence of SARS-CoV-2 RNA in human milk samples of 15 mothers with coronavirus disease 19(COVID-19) and in the throat swab samples of their infants. Methods: This is a prospective observational study in which breast milk samples were collected from 15 mothers with COVID-19. The presence of SARS-CoV-2 RNA in the whole human milk samples of the patients was investigated using RT-qPCR. All of the infants underwent a clinical follow-up during their 14-day isolation and their throat swab samples were tested for SARS-CoV-2 RNA. Results: Of 15 mothers with COVID-19, SARS-CoV-2 RNA was detected in milk samples from 4 mothers. The throat swab samples from these mothers’ infants were found to be positive for SARS-CoV-2 RNA. Three of the four mothers were breastfeeding. In addition, during the 14-day isolation, all but three of the mothers breastfed their infants. Of the 12 breastfed infants, while the test for SARS-CoV-2 RNA in throat swab samples was negative in six of the infants, the other six infants, who had mild COVID-19 symptoms, tested positive for SARS-CoV-2 RNA.Clinical outcomes of all mothers and infants were uneventful. Conclusion: To our knowledge, this is the first case series with the largest number of cases with SARS-CoV-2 RNA positivity in human milk samples of mothers with COVID-19. However, we believe that the benefits of breastfeeding may outweigh the risk of SARS-CoV-2 infection in infants
A 61 years old male had minimally symptomatic SARS-CoV-2 infection while taking everolimus. He remained RT-PCR positive for viral RNA for 52 days. Pegylated interferon for 4 weeks led to viral RNA clearance. The observations support consideration and further evaluation of combination therapy with everolimus plus interferon for COVID-19.
This report describes Streptococcus suis meningitis with ventriculitis in a 66-year-old kushiyaki chef, which presented with fever and meningeal irritation signs. Cerebrospinal fluid testing revealed increased cell counts and protein levels, and presence of gram-positive cocci. Kushiyaki chefs are at high risk of this infection and prophylaxis should be considered.
Background. First vaccines for prevention of Coronavirus disease 2019 (COVID-19) are becoming available but there is a huge and unmet need for specific forms of treatment. In this study we aimed to evaluate the potent anti-SARS-CoV-2 effect of siRNA both in vitro and in vivo. Methods. To identify most effective molecule out of a panel of 15 in silico designed siRNAs, an in vitro screening system based on vectors expressing SARS-CoV-2 genes fused with the firefly luciferase reporter gene and SARS-CoV-2-infected cells was used. The most potent siRNA, siR-7, was modified by Locked nucleic acids (LNAs) to obtain siR-7-EM with increased stability and was formulated with the peptide dendrimer KK-46 for enhancing cellular uptake to allow topical application by inhalation of the final formulation - siR-7-EM/KK-46. Using the Syrian Hamster model for SARS-CoV-2 infection the antiviral capacity of siR-7-EM/KK-46 complex was evaluated. Results. We identified the siRNA, siR-7, targeting SARS-CoV-2 RNA-dependent RNA polymerase (RdRp) as the most efficient siRNA inhibiting viral replication in vitro. Moreover, we have shown that LNA-modification and complexation with the designed peptide dendrimer enhanced the antiviral capacity of siR-7 in vitro. We demonstrated significant reduction of virus titer and total lung inflammation in the animals exposed by inhalation of siR-7-EM/KK-46 in vivo. Conclusions. Thus, we developed a therapeutic strategy for COVID-19 based on inhalation of a modified siRNA-peptide dendrimer formulation.
Background Physical distancing and facemask use are worldwide recognized as effective non-pharmaceutical interventions (NPIs) against the coronavirus disease 2019 (COVID-19). Since January 2020, Taiwan has introduced both NPIs but their effectiveness on non-COVID-19 respiratory viruses (NCRVs) remain underexplored. Methods This retrospective observational study examined electronic records at a tertiary hospital in northern Taiwan from pre-COVID (January–December 2019) to post-COVID period (January–May 2020). Patients with respiratory syndromes were tested for both enveloped (e.g. influenza virus and seasonal coronavirus) and non-enveloped RVs (e.g. enterovirus and rhinovirus) using multiplex reverse-transcription polymerase chain reaction assays. Monthly positivity rates of NCRVs among adult and pediatric patients were analyzed with comparison between pre- and post-COVID periods. Results A total of 9693 patients underwent 12127 multiplex RT-PCR tests. The average positivity rate of NCRVs reduced by 11.2% (25.6% to 14.4%) after nationwide PHIs. Despite the COVID-19 pandemic, the most commonly identified enveloped and non-enveloped viruses were influenza virus and enterovirus/rhinovirus, respectively. Observed reduction in NCRV incidence was predominantly contributed by enveloped NCRVs including influenza viruses. We did not observe epidemiological impacts of NPIs on non-enveloped viruses but an increasing trend in enterovirus/rhinovirus test positivity rate among pediatric patients. Our data were validated using Taiwan’s national notification database. Conclusions Our frontline investigation suggests that the current NPIs in Taiwan might not effectively control the transmission of non-enveloped respiratory viruses, despite their protective effects against influenza and seasonal coronavirus. Hydrogen peroxide or chloride-based disinfectants should be integrated into national preventative strategies against respiratory viral infections in the post-COVID-19 era.