We're presenting a unique case where a 2 month old female presented with URI symptoms at a local clinic and went into cardiac arrest after a nasopharyngeal swab test was done. Subsequent work up revealed she had an intrapericardial mass and a large pericardial effusion, which may have precipitated the arrest. The patient recovered after emergent pericardiocentesis and subsequent pericardial mass excision via sternotomy and pericardiectomy. The infant was recovering appropriately at her 4 month post-op follow up.

Environmental DNA (eDNA) metabarcoding is a common tool for measuring and cataloguing biodiversity, yet standard methodological approaches to generate metabarcoding data sets have yet to emerge, in part due to challenges understanding the biological and technical biases that affect eDNA profiles. Here, we explore how two experimental choices – depth of sequencing of PCR amplicon libraries and the number of PCR replicates – influence estimates of α and β diversity. We extracted DNA from six soil samples from three ecologically distinct locations, performed 24 PCR replicates from each using two common metabarcodes, and sequenced each to an average depth of 83,898 reads. We found PCR replicates are consistent in composition and relative abundance of abundant taxa, allowing differentiation of samples and sites. However, rare taxa were unique to one or a few replicates, suggesting that even large numbers of experimental replicates may be insufficient to catalogue biodiversity fully. We recommend that to differentiate sites, separately sequencing only a minimum of two PCR replicates to a depth that allows 1,000 reads identified to taxa, is sufficient to differentiate sites. We also conclude that metabarcoding is impractical for exhaustive taxonomic inventory and, because rare taxa are not amplified consistently, taxonomic tallies that rely on consensus among replicates artificially lower richness estimates. These findings provide new considerations for eDNA experimental design and data interpretation.

Although early postoperative outcomes after Fontan improved in the modern era, the convincing evidence in the resource-scare setting was sparse. Our study aimed to determine the incidence of early Fontan failure (EFF) in a contemporary series of palliated patients and to identify its potential risk factors. A single-center retrospective study was conducted between 2012 and 2019 on 145 patients undergoing the Fontan procedure. The primary outcome of interest was EFF, defined as death, Fontan takedown, or listing for heart transplantation prior to hospital discharge or within 30 postoperative days. Our study reported the incidence of EFF of 9.66% (n = 14: thirteen deaths, and one Fontan takedown). In the univariate analysis for pre-operative data, the anatomical diagnosis of unbalanced atrioventricular (AV) septal defect, situs inversus form, AV valve regurgitation, large aorta-pulmonary circulation in Doppler echocardiography, elevated pulmonary artery pressure (PAP), and elevated pulmonary vascular resistance were significantly associated with EFF. At the Fontan, four risk factors influencing EFF included pulmonary artery reconstruction, AV valve repair, bleeding, and elevated PAP. Post-operative edema was also significantly associated with EFF. A final reduced model with multivariate logistic regression analysis indicated preoperative elevated PAP, AV valve repair at Fontan, and postoperative elevated PAP were independent predictors for EFF. In conclusion, EFF is relatively high in our series, and is associated with significant mortality. Patients with a single ventricle physiology undergoing preoperative elevated PAP, AV valve repair at Fontan, and postoperative elevated PAP were identified as independent risk factors to predict EFF.

Organisms exposed to endocrine disruptors in early life can show altered phenotype later in adulthood. Although the mechanisms underlying these long-term effects remain poorly understood, an increasing body of evidence points toward the potential role of epigenetic processes. In the present study, we exposed hatchlings of an isogenic lineage of the self-fertilizing fish mangrove rivulus for 28 days to 4 and 120 ng/L of 17-α-ethinylestradiol. After a recovery period of 140 days, reduced representation bisulfite sequencing (RRBS) was performed on the liver in order to assess the hepatic genome-wide methylation landscape. Across all treatment comparisons, a total of 146 differentially methylated fragments (DMFs) were reported, mostly for the group exposed to 4 ng/L, suggesting a non-monotonic effect of EE2 exposure. Gene ontology analysis revealed networks involved in lipid metabolism, cellular processes, connective tissue function, molecular transport and inflammation. The highest effect was reported for nipped-B-like protein B (NIPBL) promoter region after exposure to 4 ng/L EE2 (+ 21.9%), suggesting that NIPBL could be an important regulator for long-term effects of EE2. Our results also suggest a significant role of DNA methylation in intergenic regions and potentially in transposable elements. These results support the ability of early exposure to endocrine disruptors of inducing epigenetic alterations during adulthood, providing plausible mechanistic explanations for long-term phenotypic alteration. Additionally, this work demonstrates the usefulness of isogenic lineages of the self-fertilizing mangrove rivulus to better understand the biological significance of long-term alterations of DNA methylation by diminishing the confounding factor of genetic variability.

Breast cancer is a heterogeneous pathology. There are subgroups with different molecular characteristics, and they must be identified to direct the therapy and to have a clear prognosis. HER2/neu (human epidermal growth receptor factor 2/neuro glioblastoma derived oncogene homolog) receptor overexpression is a characteristic that must be evaluated in each population. We apply the monoclonal antibody technique in the indigenous population of Peru, we also correlate the presence of the receptor with global survival. It’s an experimental, prospective and analytical study. Twenty three samples were evaluated, obtained from patients with adenocarcinoma of the breast. The HER2/neu expression was determined by immunohistochemical technique (monoclonal antibodies). The results were verified 10 cases were positive for overexpression (43.47%). The negative cases were 13 (56.52%). The overall survival at 3 years was 69.90% for the Her2/neu positive and 85.00% for negative, showed statistically significant differences (p=0.017). Finally, it was feasible to apply the monoclonal antibody technique and to statistically correlate HER2/neu overexpression with TNM clinical stage, predicting less survival when present. Applying an immunohistochemical technique is feasible in native Peruvian women. The main benefit is to apply biological therapy with monoclonal antibodies, according to their molecular profile.

The optimal growth, maturation and function of bioengineered tissues are mediated by both biochemical and physical cues. We here describe a 3D biomimetic environment directing stem cells towards a chondrogenic phenotype. This system comprises a collagen hydrogel and poly-lactic-co-glycolic acid microcarriers (PLGA-MCs) engineered to protect, carry and release a human Transforming Growth Factor b1 (hTFGb1) payload. PLGA-MCs were prepared using supercritical emulsion extraction technology and integrated into a collagen hydrogel co-seeded with human Bone Marrow Mesenchymal Stem Cells (hBM-MSCs). Testing different concentrations of hTFGb1 supplemented to cell monolayer cultures suggested 10 ng/mL as the most appropriate concentration to promote upregulation of SRY-Related HMG-BOXGene 9 (4-fold) and collagen type II (2-fold) specific markers, at Day 16. A similar growth factor concentration was delivered within the 3D bioengineered environment cultured in a dynamic via a custom perfusion bioreactor. A chondrogenic commitment was obtained as indicated by upregulation of collagen type II (5-fold) and downregulation of collagen types I and III (both 0.1-fold) at Day 16. Histological analysis confirmed the remodeling of the synthetic extracellular matrix in where an enhanced mass exchange was described by FEM analysis of fluid-dynamics and related nutrient mass transfer within the 3D construct. This study supports the use of 3D bioengineered scaffolds cultured in a dynamic environment as a suitable tissue engineered model to study chondrogenic differentiation in vitro and opens perspectives for an injectable collagen-based advanced therapy system.

Small bowel volvulus is a rare cause of small bowel obstruction, but must be considered as the likely diagnosis when mesenteric ‘whirlpool sign’ is present on imaging. Peritonism with such imaging findings warrants prompt intervention.

Rationale: The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods: This was a multicenter study assessing complications developed during one year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year were analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results: A total of 312 patients were included, 150 in the control group and 162 in the intervention group. 90 day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p=0.94), new admissions (p= 0.84) or cardiovascular events (p=0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p=0.29; PCT p=0.44; proADM p=0.52). Conclusions: Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.

Persistent pain affects 20% of adults and can impair one’s daily functioning and well-being. Psychoeducational group interventions can be effective in aiding pain management and coping strategies, however the time commitment for most evidence-based programs (10-20 hours) leads to access barriers and delivery challenges in primary care. A mixed-methods, program evaluation was conducted on a low intensity, three-session, manualized group pilot psychoeducational intervention in a primary care practice, emphasizing pain education, behavioral strategies, and pain-alleviating activities. Eighty-two percent of the clinic’s panel of individuals with persistent pain (N=128) and being prescribed opioid pain medication attended at least one class (N=105). Attendees experienced significant pre-post improvements in self-reported pain functioning and favorable satisfaction ratings by patients and medical staff. However only 51% attended all three groups, despite frequent class offerings and heavily encourage by the patient’s medical providers. This study reviews the potential promise and limitations of a low-intensity, limited session pain group to aid pain-related functioning. Additional investigation is warranted to optimize participant attendance, group format and frequency, and outcome assessment.

This study

Epidemic diseases contiguously propagate between propitious substances, along with sub-rosa characteristics specifically contiguousness and replication speed may expound ferocity of epidemic diseases such as COVID-19. Most likely, due to high contiguous velocity; in very short time COVID-19 may have become global pandemic disease and key menace to manhood. Deterrence of propagation may help in devastate virus transmogrify using instantaneous traceability of individualized health activities and trackability of public footprints using smart devices, radiography, and social networks.

Rationale, aims and objectives: Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Guidelines for the management of this complication are scarce, often resulting in differences in treatment strategy use among patients. The aims of this study were to evaluate the management of POAF in a cardiac surgery department, characterise the extent of its variability and develop a standardised protocol. Methods: Data from patients who underwent cardiac surgeries with subsequent POAF between 1 January 2017 and 1 June 2018 were analysed in this single-centre observational retrospective study. The primary outcome was the difference in the proportions of patients whose first POAF episodes were treated with a rate control (RaC) strategy, a rhythm control (RhC) strategy and both among hospital units (intensive care unit [ICU], intermediate care unit [IMCU] and general ward [GW]). Secondary outcomes included the mean duration of POAF episodes, POAF recurrences, and the management of anticoagulation. Results: Data from 97 patients were included in this study. The POAF management strategy differed significantly among hospital units (ICU: RhC 75.0%, RhC and RaC 19.4%, RaC 0.0%; IMCU: RhC 40.4%, RhC and RaC 34.6%, RaC 13.5%; GW: RhC 22.2%, RhC and RaC 33.3%, RaC 44.4%; p = 0.001). Ninety-five (97.9%) patients converted to sinus rhythm after the first POAF episode; 51.2% of these conversions occurred within 8 h after onset. POAF recurred in 56.7% of patients. Considering all POAF episodes, 83 (85.6%) patients received amiodarone as part of the RhC strategy. Based on these results, a hospital working group developed a standardised protocol for POAF management. Conclusions: POAF management was heterogeneous at our institution. This paper highlights the need for clear practice guidelines based on large prospective studies to provide care according to best practices for all patients undergoing cardiac surgery.

PURPOSE: To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. DESIGN: Retrospective cases series study. METHODS: 63cases (84 eyes) of RP with cataract were collected including 30 males and 33 females. Phacoemulsification with 3.0mm clear corneal incision was performed in all the patients. IOL+CTR implantation was performed in 44 eyes, and only IOL implantation was performed in 40 eyes. All cases were followed up at 1 week and 1, 3, 6 months after the surgery to compare the best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count and complications before and after the surgery. RESULTS: all surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6 months after surgery was 0.91±0.88 LogMAR. It improved a little compared with the BCVA(1.3±0.7LogMAR) before surgery and there was a signifcant difference in statistic(P=0.003). Four cases of capsule contraction syndrome(CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was signifcant difference in statistic about the incidence of CCS between two groups(P=0.047). CONCLUSIONS: Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is helpful to reduce the complications caused by capsule contraction.

Biomonitoring of complex heterogeneous environments is highly challenging. Fish in deep water bodies occupy different habitats, therefore a combination of survey methods has traditionally been used. Environmental DNA (eDNA) metabarcoding is a novel monitoring tool that can overcome spatial heterogeneity in a highly sensitive and entirely non-invasive manner. However, taxon detection probability is dependent on real-time environmental variables. In this study, three reservoirs were sampled in two seasons using a spatiotemporally distributed sampling design covering major environmental gradients. In all sampling campaigns, 31 fish taxa were detected which exceeded expectations. Data reliability was confirmed by a tight positive correlation between individual taxon scores derived from gillnet sampling and eDNA site occupancy. Analyses confirmed anticipated trends, such as the highest number of taxa were observed in the largest water body, and more taxa were detected in inflows and littoral regions compared to open water. The most important factors for fish distribution were temperature, age and trophic status (expressed as total Chlorophyll a concentration) of water bodies. Taxon detection reflected ecological niches of individual species, e.g. warm water wels catfish (Silurus glanis) and cold water salmonids. This study provides further evidence that eDNA metabarcoding is suitable for ecological study in heterogeneous environments and may substitute conventional fish sampling techniques.

Both aquatic and terrestrial biodiversity information can be detected in riverine water environmental DNA (eDNA). However, the monitoring effectiveness (i.e., the proportion of aquatic and terrestrial biodiversity information detected in riverine water eDNA samples) is unknown. To investigate the monitoring effectiveness, we introduced the concept of watershed biological information flow (WBIF) and proposed that the monitoring effectiveness depended on the transportation effectiveness of the WBIF. Then, the monitoring effectiveness could be assessed in the WBIF framework. Here, we conducted a monitoring effectiveness assessment case study in a watershed on the Qinghai-Tibet Plateau according to analysis of the bacterial operational taxonomic unit (OTU) assemblages detected in riverine water eDNA samples and riparian soil eDNA samples during three seasons. The results showed that (1) the downstream-to-upstream monitoring effectiveness: only 76% of the bacterial OTUs could be detected 1 km downstream in spring and more than 97% and 96% could be detected in summer and autumn, respectively. (2) The river-to-land monitoring effectiveness: more than 62% of the bacterial OTUs in riparian soil eDNA samples could be detected in adjacent riverine water eDNA samples on rainy summer days and 16% and 48% could be detected on cloudy spring and autumn days, respectively. These results suggested that riverine water eDNA was viable for simultaneously monitoring aquatic and terrestrial bacterial biodiversity and that rainy days in summer or autumn were suitable sampling times on the Qinghai-Tibet Plateau. More studies on monitoring effectiveness in other taxonomies and in other watersheds with different climatic conditions are needed.

Arabidopsis Casparian strip membrane domain proteins (CASPs) form a transmembrane scaffold to recruit lignin biosynthetic enzymes for Casparian strip (CS) formation. Compared with Arabidopsis, rice root is more complex with a CS of the exodermis and sclerenchyma and a CS that does not block propidium iodide entry into the stele. Rice CASP1 is highly similar to AtCASPs, but it is not required for CS formation. Its mutation results in early leaf senescence and fewer tillers and does not change the CS structure and permeability. OsCASP1 is mainly located in the nuclear membrane. Its expression is concentrated in the root stele and at small lateral root tips and can be induced by salt stress. OsCASP1 mutation causes ectopic suberin deposition in small lateral roots and ion imbalances in the plant. Homeostatic disorder induces nutrient recycling and accelerate leaf senescence. To our knowledge, OsCASP1 is the first CASP to be described in the nuclear membrane; it modulates suberin deposition and does not involve CS formation, representing a novel regulatory mode of CASPs.

Deep learning has the potential to revolutionize process analytical technology in the pharmaceutical industry. Here, we used Raman spectroscopy-based deep learning strategies to develop a tool for detecting microbial contamination. We built a Raman dataset for microorganisms that are common contaminants in the pharmaceutical industry for Chinese Hamster Ovary (CHO) cells, which are often used in the production of biologics. Using a convolution neural network (CNN), we classified the different samples comprising individual microbes and microbes mixed with CHO cells with an accuracy of 95-100%. The set of 12 microbes spans across Gram-positive and Gram-negative bacteria as well as fungi. We also created an attention map for different microbes and CHO cells to highlight which segments of the Raman spectra contribute the most to help discriminate between different species. This dataset and algorithm provide a route for implementing Raman spectroscopy for detecting microbial contamination in the pharmaceutical industry.

Mesenteric cysts are rare tumours that are difficult to diagnose given their vague symptomatology such as abdominal pain and nausea. Our case demonstrates a patient presenting with suspected ureteric colic, whereby early imaging revealed this rarity