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The value of wild pollination ecosystem services to crop production: What does gender...
Byela Tibesigwa

Byela Tibesigwa

May 11, 2020
“Men’s crops” and “women’s crops” suggest that men and women smallholder farmers in sub-Saharan Africa grow different crops. Yet, this gender division of crops is not considered in the valuation of wild pollinators to crop productivity, and therefore remains unknown, despite considerable coverage of wild pollination ecosystem services. We link a nationally representative panel survey of over 10,000 actual plots managed by male and female farmers; with spatially and temporally land cover maps; together with robust fixed-effects production function methods. We find evidence of gendered-crops and variation in pollination dependency in male- and female-managed farms. Furthermore, statistically significant fixed-effects estimates produce an exponential function which shows that proximity to wild pollinators’ natural habits - forests - is important, and that at shorter distances female-managed farms benefit four times more than male-managed farms, and this tapers off as distance increases producing convergence in benefits. We are able to conclude that conservation that preserves the natural habitants of wild pollinators will enhance crop yield especially among female-managed farms. This demonstrates the importance of gender in ecosystem services and suggests that to fully understand their benefits, gender needs to be incorporated into natural capital and sustainable development policies governing smallholder agriculture rich regions.
Systemic lupus erythematosus concurrent with COVID-19: is platelet the right target?
jing wang
Lingyan Zhou

jing wang

and 1 more

May 11, 2020
In December 2019, Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is widely spread and causes a critical threat to clinical burden and public healthcare. The outbreak of COVID-19 has aroused widespread concern in the rheumatology community.
The current perception threshold objectively evaluates pharyngeal sensory function
Xuelai LIU
Xueyan Li

Xuelai LIU

and 2 more

May 11, 2020
Objective: To evaluate pharyngeal sensory function by Current Perception Threshold (CPT) measurement from healthy and paresthetic pharynx. Methods: In total, 122 healthy volunteers and 70 patients with pharyngeal paresthetic symptoms underwent CPT evaluation. Pharyngeal paresthesia (n=70) were classified into three categories based on aetiologies: six cases with pain in pharynx; 38 neuropathic patients with glossopharyngeal nerve and/or vagus nerve injury; and 26 patients with globus pharyngeus. CPT measurements were obtained from bilateral palatoglossal arch and tongue base at 2000Hz, 250Hz and 5Hz stimulation frequencies. Results: Ranked from high to low, the CPT values for the bilateral palatoglossal arches and tongue bases were: neuropathic patients, globus pharyngeus and normal patients. The CPT values for neuropathic patients on the injured side were significantly higher than those on the healthy side (P<0.05). The CPT values for patients with pain in pharynx were significantly lower than those of normal subjects (P<0.05) when the bilateral tongue bases were stimulated. Conclusion: The CPT testing is a reliable method for objectively and quantitatively assessing pharyngeal sensory function and able to differentiate pharyngeal paresthesia between neuropathic and subjective discomfort. Pharyngeal sensory function is more sensitive in patients with pain in pharynx. Pharyngeal sensory function is significantly reduced in neuropathic patients, especially on the injured side. Patients with globus pharyngeus have pharyngeal hyposensitivity.
The expression of Programmed death ligand 2 in patients with thymoma and thymomatous...
Haoshuai Zhu
xin zhang

Haoshuai Zhu

and 7 more

May 11, 2020
Abstract Background There is a growing relationship between PD-1/PD-Ls and autoimmune disease We attempted to explore the relationship of the PD-L2 expression in patients with thymoma, especially with Myasthenia Gravis (thymomatous MG). Methods Seventy patients with thymoma who underwent surgical resection between January 2017 to December 2018 were retrospectively reviewed. The PD-L2 expression was evaluated by immunohistochemistry. The association between the PD-L2 expression and the clinicopathologic features was investigated, especially thymomatous MG. Results The PD-L2 expression was positive in 41 patients (58.6%) and negative in 29 patients (41.4%). The PD-L2 expression was significantly associated with WHO histology of type B2 and B3 thymoma (p=0.008) and the status of MG (p=0.002). In addition, PD-L2 positive tumors showed a significantly smaller tumor size (P=0.017). Ectopic thymus was significantly more often seen in the PD-L2 positive group (p=0.035). The patients with MG (p=0.001) and WHO type B2 and B3 (p=0.007) have significantly higher PD-L2 scores. Multivariate logistic regression model showed the status of MG (OR 12.601, 95%CI 2.406-65.995, p=0.02) and age (OR 0.199, 95%CI 0.046-0.863, p=0.031) were significantly associated with the expression of PD-L2. The analysis of 33 patients with MG shows age was not associated with the expression of PD-L2 (OR 0.04, 95%CI 0.001-3.2, p=0.15). Conclusions A strong expression of PD-L2 in thymoma was significantly associated with thymomatous MG and WHO histologic type B2 and B3. In addition, PD-L2 may play a potential role in the pathogenesis of thymomatous MG.
Population pharmacokinetics of propofol in neonates and infants: gestational and post...
Louis Sandra
Anne Smits

Louis Sandra

and 5 more

May 11, 2020
Aims: Develop a population pharmacokinetic model describing propofol pharmacokinetics in (pre)term neonates and infants, that can be used for precision dosing of propofol in this population. Methods: A non-linear mixed effects pharmacokinetic analysis (Monolix 2018R2) was performed, based on a pooled study population in 107 (pre)term neonates and infants. Results: 836 blood samples were collected from 66 (pre)term neonates and 41 infants originating from three studies. Body weight (BW) of the pooled study population was 3.050 (0.580 – 11.440) kg, postmenstrual age (PMA) was 36.56 (27.00 – 43.00) weeks and postnatal age (PNA) was 1.14 (0 – 104.00) weeks (median and range). A three compartment structural model was identified and the effect of BW was modeled using fixed allometric exponents. Elimination clearance maturation was modeled accounting for the maturational effect on elimination clearance until birth (by GA) and postpartum (by PNA/GA). The extrapolated adult (70 kg) population propofol elimination clearance (1.63 L min-1) is in line with estimates from previous population pharmacokinetic studies. Empirical scaling of BW on the central distribution volume (V1) in function of PNA improved the model fit. Conclusions: It is recommended to describe elimination clearance maturation by GA and PNA instead of PMA on top of size effects when analyzing propofol pharmacokinetics in populations including preterm neonates. Changes in body composition in addition to weight changes or other physio-anatomical changes may explain the changes in V1. The developed model may serve as a prior for propofol dose finding in (preterm) neonates.
Single or double-layer uterine closure techniques following cesarean: An ongoing deba...
Şafak Yılmaz Baran
Hakan Kalaycı

Şafak Yılmaz Baran

and 6 more

May 11, 2020
Objectives To examine the effects of single- and double-layer uterine closure techniques on uterine scar healing following cesarean delivery. Design Randomised controlled trial Setting University Hospital of Başkent from July 2018 to September 2019 Population This study assessed a total of 282 women between 18-45 years of age who had singleton pregnancies and had not previously undergone uterine surgeries. Methods Participants were randomized into two following treatment groups: single-layer closure with locking and double-layer closure with locking in the first layer, but not in the second layer (NCT03629028). Participants were evaluated at 6-9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. Experienced sonographers who were not informed about the uterine closure technique conducted these procedures. Results Of the 225 final participants, 116 received the double-layer closure technique, while 109 received the single-layer technique. In this regard, the niche rates and median niche depths based on transvaginal ultrasounds and sonohysterography investigations were 21%, 0.9±1.8mm, and 41%, 2.1±1.9mm (p<0.001, p<0.001), respectively. The niche rates were 37% for the single-layer group and 45.7% for the double-layer group (p=0.22). Median niche widths were higher in the double-layer group (p=0.006). Conclusions The single- and double-layer closure techniques did not produce different impacts on uterine scare niche development. However, the median niche width was higher for the double-layer closure group. Tweetable abstract There was no difference between single- and double layer closure in the rate of scar niche development following cesarean delivery. Keywords cesarean delivery, isthmocele, niche, uterine closure
Calibration of Computational Mössbauer Spectroscopy to Unravel Active Sites in FeNC-C...
Charlotte Gallenkamp
Ulrike Kramm

Charlotte Gallenkamp

and 3 more

May 11, 2020
Single atom catalysts with iron ions in the active site, known as FeNC catalysts, show high activity for the oxygen reduction reaction and hence hold promise for access to low cost fuel cells. Due to the amorphous, multi-phase structure of the FeNC catalysts, the iron environment and its electronic structure are poorly understood. While it is widely accepted that the catalytically active site contains an iron ion ligated by several nitrogen donors embedded in a graphene-like plane, the exact structural details such as the presence or nature of axial ligands are unknown. Computational chemistry in combination with Mössbauer spectroscopy can help to unravel the geometric and electronic structures of the active sites. As a first step towards this goal, we present a calibration of computational Mössbauer spectroscopy for FeN4-like environments. The uncertainty of both the isomer shift and the quadrupole splitting prediction is determined, from which trust regions for the Mössbauer parameter predictions of computational FeNC models are derived. We find that TPSSh, B3LYP, and PBE0 perform equally well; the trust regions with B3LYP are 0.13 mm s−1 for the isomer shift and 0.45 mm s−1 for the quadrupole splitting. The calibration data is made publicly available in an interactive notebook that provides predicted Mössbauer parameters with individual uncertainty estimates from computed contact densities and quadrupole splitting values. We show that a differentiation of common FeNC Mössbauer signals by a separate analysis of isomer shift and quadrupole splitting will most likely be insufficient, whereas their simultaneous evaluation will allow the assignment to adequate computational FeNC models.
Il Bioventing: una tecnologia che usa i microrganismi per degradare gli inquinanti ne...
Maddalena Gargione

Maddalena Gargione

June 26, 2020
La bonifica dei siti contaminati è una delle problematiche più rilevanti nell’ambito degli interventi di recupero e di risanamento ambientale. Si definiscono “contaminate” quelle aree in cui, a causa di sversamenti accidentali, depositi abusivi ma anche condizioni naturali, sono presenti nel suolo sostanze inquinanti tali da risultare pericolose per l’uomo e per l’ambiente. Negli ultimi decenni si sono sviluppate alcune tecniche di bonifica che sfruttano la degradazione dei contaminanti ad opera di microrganismi con lo scopo di arrecare un minore impatto sull’ecosistema e un considerevole risparmio economico. Tra le molteplici tecniche trova spazio il Bioventing, una tecnologia adoperata nella zona insatura del terreno che consente l’utilizzo di microrganismi autoctoni per la degradazione di composti organici adsorbiti dalle frazioni minerali e organiche del suolo. In questo articolo si fa riferimento ad un caso studio che ha trattato la tecnica del Bioventing per la rimozione di idrocarburi del petrolio.
The recombinant protein combination vaccine based on the fragment C of tetanus toxin...
Pengdi Chai
xiuying Pu

Pengdi Chai

and 7 more

May 11, 2020
Tetanus and diphtheria are important public health problems in many parts of the world. Since the diphtheria, tetanus toxoids and acellular pertussis vaccine (DTaP) was generally administered to children, the incidence of diphtheria and tetanus has dropped dramatically. However, with the increase of age, the anti-diphtheria and tetanus antibody in human body will decrease. DTaP is not suitable for boosting vaccine and the recombinant vaccine have more advantages than toxoid vaccines. Therefore, in this study, firstly, we expressed and purified the fragment C of tetanus toxin (TTc) and the cross-reacting material 197 (CRM197) of the diphtheria toxin mutant from E. coli BL21(DE3) expression system respectively. Moreover, the characteristics, immunogenicity of the purified protein were analyzed. Lastly, the recombinant TTc and CRM197 combination vaccine (RTCV) was constructed and antibody titers were detected. Our results displayed TTc induced Th2 immune response in mice while CRM197 could induce a mix Th1/Th2 immune response. RTCV was composed of 10 μg/mL TTc, 20 μg/mLCRM197 antigens and aluminum adjuvants (50 μg/mL). We found that the IgG and IgG1 antibody titers produced in mice were similar as those produced by DTaP, except the IgG2a antibody titers. The results above will provide technical support for the future combined recombinant protein vaccine to against diphtheria and tetanus.
Association between increase level of high-sensitive CRP (hs CRP) and non-arrhythmic...
asghar rahmani
roholla hemmati

asghar rahmani

and 2 more

May 11, 2020
Background: As elevation of serum C-reactive protein (CRP) is occurred following left ventricular dysfunction (LVD), relationship between increasing serum CRP level and abnormal changes in electrocardiography(ECG) pattern. The present study aimed to examine association between increase level of high-sensitive CRP (hs-CRP) and non-arrhythmic ECG changes and echocardiographic abnormalities in patients with acute coronary syndrome (ACS). Methods: This cross-sectional study was conducted on 120 consecutive patients finally diagnosed as ACS and hospitalized at cardiac care units (CCU). The participants were classified as the two groups with increased level or normal of hs-CRP level. Results: The patients with the increased level of hs-CRP had significantly higher level of cardiac enzymes. The group with increased level of hs-CRP experienced more ST-segment elevation myocardial infarction (STEMI) than those with normal serum hs-CRP level, but other diagnoses including unstable angina, non-STEMI, heart failure, and emergency hypertension were similarly observed in both groups. The two groups were comparable in terms of mean left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVeDD), prevalence of valvular heart diseases as well as in wall motion abnormality assessed by echocardiography. ST-segment elevation in different leads was more frequent in those with elevated hs-CRP level than in the group with normal hs-CRP condition (19.6% versus 1.4%, p = 0.001); but ST-segment depression and T wave inversion were similarly revealed in the two groups. Conclusion: Elevated level of hs-CRP can predict occurrence of STEMI, but may not be valuable to predict echocardiographic abnormalities including LVD or hypertrophy.
An insight into the inactivation of coronaviruses by biocidal agents and a suggested...
alaa shaheen

Alaa Shaheen

May 11, 2020
A new epidemic caused by SARS-CoV-2 has affected millions of people around the world with high rate of mortality. In this article, an insight into the mechanism of inactivation of some conronaviruses by formaldehyde and glutaraldehyde is presented, based on analysis of previous observations during electron microscopic examination of several members of the orthocoronavirinae subfamily, including the new virus SARS-CoV-2. A new prophylactic and therapeutic measure is suggested. However, it needs to be tested experimentally before consideration to be used solely or in adjunction to other therapies. Also, a preconditioning step against the cytokine storm of COVID-19 is proposed and a new line of research is proposed to find a broad spectrum antivirus against several members of of this subfamily.
Quantum Mechanical Studies of Physicochemical Properties on Estradiol and Isomer
Aparna Das
Bimal Banik

Aparna Das

and 1 more

May 11, 2020
The current study investigates the correlation between biological activity and physicochemical properties of a few specific estradiol isomers. Theoretical studies on the physicochemical properties of estradiol isomers were performed using different quantum mechanical methods. The computational methods used in this study include the Density Functional Theory (DFT) method, the Hartree-Fock (HF) method and Semi-empirical (AM1) method. Some physicochemical properties such as dipole moment, molecular weight, the energy of the highest occupied molecular orbital (E HOMO), the energy of the lowest unoccupied molecular orbital (E LUMO), polarizability, the octanol-water partition coefficient (Log P), polar surface area (PSA) the number of hydrogen bond donors (HBDs) and the number of hydrogen bond acceptors (HBAs), the surface area, volume of the molecule, and ovality are calculated for the isomers. However, only dipole moment values are suitable to identify a correlation of experimental biological activity of estradiol isomers. To the best of our knowledge, this is the first report on the relationships between dipole moment and biological activities of estradiol isomers. It is observed that the active compound has a significantly higher dipole moment value compared to the inactive compound. We have also analyzed the geometrical and graphical models of these isomers and related compounds to evaluate the differences in the molecular charge distributions.
Prescribing issues among older HIV-infected persons in a Mediterranean cohort: Does t...
Cora Loste
José Moltó

Cora Loste

and 10 more

May 11, 2020
AIM: The main objective was to determine the prevalence of prescribing issues in HIV-infected subjects ≥65 years according to the Beers and STOPP/START criteria and drug-drug interactions (Liverpool website). Secondary objectives were to assess the concordance between Beers and STOPP/START criteria in our population, and to identify the drugs most frequently involved in the prescribing issues. METHODS: Cross-sectional cohort study based on a systematic review of the electronic drug prescriptions of 91 HIV-infected patients aged ≥65 years. Discrepancies between prescription criteria were assessed using crosstabs and compared using the Chi-square test or Fisher exact test. RESULTS: The mean age was 72.1 (5.6) years, 75.8% had ≥3 comorbidities, and 59.3% polypharmacy. Prescribing issues were identified in 87.9%; 71.4% by STOPP/START and 45.1% by Beers. Comparing both criteria, 56.9% of prescribing issues by STOPP/START were detected by Beers, while 92.5% of those detected by the Beers criteria were detected by STOPP/START (p<0.001). Orange/red flag interactions were found in 45.1%: 3 severe (red) in 2 patients (2.2%). The most frequent drugs involved in prescribing issues were benzodiazepines (>30%). Cobicistat was the drug most frequently involved in interactions (42.9%). CONCLUSIONS: The prevalence of prescribing issues among older HIV-infected persons gives cause for concern, as it is almost 90%. Optimization strategies, including a critical review of the treatment plan, should be implemented in clinical routine by a multidisciplinary team, in particular in patients with multiple comorbidities and polypharmacy. The STOPP/START criteria should be recommended for European populations, since they seem to better detect prescribing issues.
Retrospective analysis of screening for SARS-CoV-2 in obstetrics and gynecology outpa...
Jianfeng Guo
Rui Gao

Jianfeng Guo

and 6 more

May 11, 2020
Objective: To analyze covid-19-associated test results and optimize screening procedure for obstetrics and gynecology outpatients Design: Single center retrospective study. Setting: Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, P.R. China. Population or Sample: A total of 1,051 obstetrics and gynecology outpatients were included in the study from March 12 to April 26, 2020. Methods: We collected medical records, COVID-19-associated test results and reported the visit procedure for obstetrics and gynecology outpatients. Main outcome(s) and measure(s): We analyzed covid-19-associated test results and followed up the patients. Results: After reviewing the visit procedure, a total of 1051 obstetrics and gynecology outpatients were included in the study, and a series of COVID-19 tests were conducted, which included the SARS-CoV-2 nucleic acid test, chest CT scan and SARS-CoV-2-specific serological test. The SARS-CoV-2 nucleic acid test was negative in all 1051 patients. None of the patients admitted to the hospital experienced SARS-CoV-2 infections during hospitalization. Seventy-six cases were diagnosed with abnormal uterine bleeding-related disease (excluding endometrial malignancy), 2019-nCoV antibody positive rate was 6.579%, which is greater than the average positive rate of 3.974%, and the positive rate among patients with other diseases. No nucleic acid positivity was found in the follow-up of 9 IgM+ (and IgG+) patients. Conclusions: As the peak of the epidemic has passed, a more optimized screening procedure is required to avoid hospital infections.
Maternal and neonatal outcomes in COVID-19 infected pregnancies: a prospective cohort...
Reihaneh Pirjani
Reihaneh Hosseini

Reihaneh Pirjani

and 9 more

May 11, 2020
Objective:To compare maternal and fetal consequences of Covid-19-infected pregnancies with non-infected pregnancies. Design: Prospective cohort study Setting: Iran Population: Pregnant women who were hospitalized from March 1 to April 20 2020 Methods: Participants were divided into three groups: Women with positive Covid-19 PCR test and/or positive CT scan findings in the presence of very typical clinical symptoms were classified as confirmed group,women with typical clinical symptoms along with two or more oflaboratory findings were classified as probable group and women who hadno clinical symptom of infection were classified as a control group.In order to minimize the presence of asymptomatic individuals in the control group, we used very precise exclusion criteria. Main Outcome Measures: Maternal, neonatal and pregnancy outcomes. Results:One hundred and eighty-two women enrolled including37 and 12 and 133 women inconfirmed, probable andcontrol groups respectively.Caesarean Section was carried outin total 96 women (52.74%,95%CI:45.22,68.31).Nosignificant association was found between COVID-19 infection and preterm labour(aRR:0.75,95%CI:0.30,1.87,P=0.546),low birth weight(aRR:1.15,95%CI:0.49,2.73,P=0.737), gestational diabetes(aRR:0.78,95%CI:0.26,2.33,P=0.669), preeclampsia (aRR:2.07,95%CI:0.50,8.47,P=0.310) intrauterine growth restriction(aRR:0.30, 95%CI:0.02,3.27,P= 0.327) preterm rupture of membrane(aRR:0.38,95%CI:0.04,3.30,P=0.383), stillbirth (aRR: 1.53,95%CI:0.15,14.71,P=0.712), postpartum haemorrhage (aRR:0.80,95%CI:0.11,5.57,P=0.829), neonatal intensive care unit admission (aRR:1.48,95%CI:0.38,5.78,P=0.568), neonatal sepsis(aRR:1.23,95%CI:0.68,2.20,P= 0.481) Conclusion:Given the effect of many potential factors, such as the severity of maternal infection, the time interval between the onset of symptoms in mother and childbirth, and many other factors on the effect of the virus on pregnancy outcomes, we suggest conductingmore extensive prospective studies in this field.
Sesquiterpene alcohol cedrol chemosensitizes human cancer cells by destabilizing plas...
Siddhartha Mishra
Yun Soo Bae

Siddhartha Mishra

and 5 more

May 11, 2020
Background and Purpose: Chemosensitization of cells with small molecules may improve the therapeutic index of antitumoral agents by making tumor cells sensitive to the drug regiment and thus overcoming treatment resistance and side-effects of single therapy. Cell membrane lipid rafts are known to transduce various signaling events in cell proliferation. Sensitizing cancer cells may cause modulation of membrane lipid rafts which may potentially be used in improving anticancer drug response. Experimental Approach: Cedrol, a natural sesquiterpene alcohol, was used to treat human leukemia K562 and colon cancer HT-29 cell lines and effects were observed. Key Results: Cedrol decreased the cell viability by inducing apoptosis in both cell lines by activation of pro-apoptosis protein BID and inhibition of anti-apoptosis proteins Bcl-XL, Bcl-2, and XIAP. Cedrol activated caspase-9 dependent mitochondrial intrinsic pathway of apoptosis. Furthermore, cedrol inhibited the levels of pAKT, pERK and pmTOR proteins as well as nuclear and cytoplasmic levels of p65 subunit of NF-κB. Cedrol caused redistribution of cholesterol and sphingomyelin contents from membrane lipid raft, which was confirmed by synergistic inhibition in combination with methyl-β-cyclodextrin (lipid raft disrupting agent). Lipid raft destabilization by cedrol led to the increased production of ceramides and inhibition of membrane bound NADPH oxidase 2 enzyme activity. Conclusions and Implications: Cholesterol/sphingomyelin redistributing abilities of cedrol appear as novel mechanism of growth inhibition of cancer cells. Cedrol can be classified as a natural lipid raft disrupting agent with possibilities to be use in general studies involving membrane lipid raft modifications.
Providing Care for Pediatric Cancer Patients in COVID-19 Era; Rapid Response Recommen...
Mahmoud Elzembely
Yousra  Abdelrahman

Mahmoud Elzembely

and 3 more

May 11, 2020
Coronavirus disease 2019 (COVID-19) was first described in December 2019 in Wuhan, the capital of China’s Hubei province. 1,2. On March 11, 2020, WHO declared COVID-19 as a pandemic3. The first confirmed case of COVID-19 in Egypt was reported on February 14, 2020. As of May 10, 2020, there have been 8,964 confirmed cases, 2,002 recovered and 514 deaths4.
Gynecology in the Time of Coronavirus
Jennifer Howell

Jennifer Howell

May 11, 2020
Gynecology in the Time of CoronavirusJennifer O. Howell3009 Old Clinic BuildingCampus Box 7570Chapel Hill, NC 27599919-966-5280 (p)johowell@med.unc.eduHealthcare delivery has undergone a rapid transformation as we grapple with reality in the time of the novel coronavirus. I daresay, regardless of specialty, we are all adapting new models to care for our patients, mitigate contagion, and preserve resources. Every day we structure a measured response to the number of new cases, the amount of personal protective equipment on hand, as well as the projections of lost revenue. The response of modern medicine to this pandemic is astounding. The sheer volume of e-mail memoranda, power point presentations, web-based tools, and other electronic weapons amassed against this disease cannot be underestimated. Indeed, we have a duty to treat. Can we fulfill this duty as obstetrician/gynecologists in present times without further endangering our patients, or depleting the healthcare workforce?To answer this question, it may be useful to reflect on the practice of our vocation during past pandemics. In the 14thcentury, the Black Plague caused by the bacillus Yersinia Pestiskilled twenty million people in Europe. Those who cared for the sick had only crude treatments such as bloodletting, burning incense, and bathing brows in rosewater or vinegar. Doctors commonly refused the care of patients, priests avoided burying the dead, and family members were forced to abandon their loved ones in desperation. The cause was unknown, but divine retribution was suspected. Thus, instead of advocating wearing facemasks in public, displays of self-flagellation were encouraged as protective.During the influenza pandemic of 1918, fifty million people perished worldwide. While we then understood the concepts of antisepsis and microbiology, we had little but ourselves to offer. There were still no diagnostic tests, no antibiotics, no effective vaccines, nor mechanical ventilators. There was basic ‘PPE’ to don while administering aspirin, epinephrine, and oxygen by face mask. Fortunately, the healthcare ethical code during the 1918 pandemic was robust. Patient welfare came first, even in the face of a serious risk to physician health. Public health measures such as mass closures, quarantines, and masks were in effect. There is documentation of doctors, hospitals, and morgues being overwhelmed in certain ‘hot spots,’ but there are no stories of the medical establishment closing shop. This was still the age when doctors came to your house – and by all accounts, they continued to do this work.In our work as OBGYNs, we treat many hidden conditions which require relatively invasive exams to properly assess and diagnose. Surely, there must be something in our technologic armamentarium that will allow us to persevere in the digital pandemic age. While I may not know what it was like to be healer during the Black Plague, or a doctorduring the “Spanish” flu, I am learning quickly how to be ahealth care provider during COVID-19. I introduce to you a new framework that will be adopted in the OBGYN department at our institution. I welcome all to adapt as you see fit in your local facilities. We simply must marry safety and duty. And while naturally money is a secondary concern, we simply must keep our fiscal heads above water. Our patients depend on us.______________________________________________________________________________VIRTUAL Gynecologic visitsDocument for workflow in the Ambulatory Environment.Approved by the Sub-committee of Ambulatory Operations, the Taskforce for Increasing Virtual Visits, and the Gynecology Working Group.As many of you have now heard the good news, reimbursements for “virtual” visits will be at the same rate as “in-person” appointments during COVID-19. Therefore, effective immediately please adopt this new 9-step protocol.Patients may now obtain a speculum for home use with a provider’s prescription. An updated e-tip sheet will be forthcoming on the durable goods pharmacies that are providing this service including the 10 easy steps you must follow for getting this equipment mailed to our patients.Must use only approved electronic platforms for these transactions given the sensitive patient information to be transmitted. Providers and nurses must watch an e-learning module entitled “Oh Yes We Can: Handling Sensitive Information 2.0 - Privacy Concerns, Questions, and the Law”Action item: It is expected you will watch the module in the next 24 hours!Schedulers will call the patient and inform them of their “virtual speculum tutorial.” This is a new visit type available on the last update of our EMR – called SPEC TUT, 20-minute slot. Write in notes section on the schedule tab – “patient agrees to home speculum teaching.”Patient instructed to sign up for ‘MyChart’ app and message provider directly when home equipment has arrived. We understand that many of our patients speak other languages and this may be difficult. Thanks for the incredible work you do. Kudos to our Personnel Support Managers for putting together this helpful resource entitled “My speculum has arrived” in 19 languages – click this hyperlinkmi espéculo casero ha llegado to access.Nurses will then call the patient from a private location and perform a demonstration using the ‘MySpeculum’ app which can be downloaded in 5 easy steps. An e-tip sheet from your EEP (Embedded Electronic Medical Record Professional) will be forthcoming. Nurse will then write in Notes section: “patient successful” initials, date, timeOn the day of the video pelvic exam visit, there will be a light-up speculum icon on the schedule that will turn green when your patient is “checked in” for the visit. Click the wrench icon on the schedule bar to get this notification column to appear if you do not see it. E-tip sheet coming – stay tuned.Providers – Be on time for your visit, introduce yourself, and make sure you know your patient’s location. They must be in a state, province, county, district, and territory where your medical license is valid. This is changing rapidly so in order to protect you from litigation we ask you to go to this website to check on licensing reciprocity www.incredibleamountsofbureaucracy.com. In addition, you must ensure patient location is not a fast-food drive through before connecting the camera.After the patient has placed the speculum and positioned the camera correctly – be sure to use the verbiage: “I am all done looking now.” The patient will then know they can take the speculum out.As always, be sure to properly document and use this e-smart phrase which has all the billing embedded: .COVIDDIDVIRTUALPAP______________________________________________________________________________By now the astute reader has guessed that this ‘modest proposal1’ for virtual pelvic exams is not for implementation. Instead this perspective is offered as a wry critique of our increasingly technocratic response to the crisis. A response, which I believe, has drastically changed the standard of care in our field. We must recognize that we are delaying or divorcing needed care from the laying on of hands unencumbered by evidence that this will result in acceptable outcomes. When I think of something as ludicrous as a virtual gynecologic assessment, I am haunted by yet one other epidemic not yet mentioned.Whether justified or not, the mythology of the medical establishment’s early response to HIV is not flattering. Reports abound of medical professionals dodging the ‘duty to treat’ ethos. Physicians and nurses were assured transmission would be unlikely with a bloodborne pathogen. Yet, anxious perceptions kindled debate over the long-embraced professional code of self-sacrifice. Ultimately, our better selves prevailed. Medical societies worldwide issued guidance in the 1990’s reaffirming our obligation to care for contagious patients. And now we find ourselves in an ever more bureaucratic and entrepreneurial healthcare landscape. Just how will history view our retrenchment to care via computer screen for a virus spread by droplets? Surely, the spread between two masked individuals taking proper precautions during a medical visit must be quite low. Shall we stand by our commitment to care with a human (gloved) touch and a physical exam as the gold standard? Indeed, I stand ready to wipe my patient’s brow with rosewater and vinegar, however ineffectual.If perhaps you smiled as you recognized your institution in this satire’s looking glass, then I am satisfied. Presently, it may be that humor is the best medicine we have. Perhaps laughter will lower the viral transmission rate. I will wager it is at least as effective as self-flagellation, and better than bloodletting. I will end this reflection to return to my screen with a sense of urgency – there are workflows and memos to attend to. Afterall, leadership expects this protocol to be in place next week to achieve our triple aim: reduced exposure, maximum reimbursement, and operational efficiency in these unprecedented times. You are all heroes. Thank-you for all that you do. Stay safe!
OPTN:a promising target of autophagy to treat autophagy defective diseases
Yueping Qiu
Jiajia Wang

Yueping Qiu

and 5 more

May 11, 2020
IntroductionThe lysosomal degradation pathway of autophagy is a highly conserved mechanism in eukaryotic cells and play an important role in cellular, tissue and organismal homeostasis by removing dysfunctional organelles, intracellular bacterial and aggregated proteins selectively (Zaffagnini et al. , 2016). Autophagy can be activated by cellular stress such as starvation, hypoxia, oxidative stress, protein aggregation, endoplasmic reticulum (ER) stress and others, which triggers the cell survival process and thus provides energy to the cells when energy is consumed (Levineet al. , 2019). Thus, autophagy is generally considered to be a cell survival process and play an important role in the maintenance of cellular homeostasis.At present, it is divided into three categories according to the occurrence process: Macroautophagy (also termed autophagy), Microautophagy, and Chaperone-mediated autophagy (CMA), the following refers to the first category unless otherwise specified (Wen et al. , 2016). It is generally accepted that autophagy is a more selective process than originally expected. Autophagy can be divided into different types, according to the different autophagy substrates(also called cargo), for example, aggrephagy for protein aggregates, lysophagy for damaged lysosomes, mitophagy for mitochondria and xenophagy for intracellular bacterial. Conservatively, most of these different types of selective autophagy pathways use a common mechanism.Up to now, there are 34 Autophagy-related (ATG) genes that is discovered in yeast and 15 of which are “core” ATG genes that are commonly necessary to the different pathways of autophagy (Nakatogawa et al. , 2009). The autophagosome biogenesis process can be divided into four steps, the first is the nucleation and expansion of the phagophore, the second is the formation of autophagosome, the third is the autophagosome and lysosome fuse to form autolysosome, and the last is degrades the cargos by enzymes in lysosomes.It is also generally conceded that the trigger of autophagy results in ATGs recruitment, Unc-51-like kinase 1 (ULK1) complex (consisting of ULK1/2, ATG13, FIP200 and ATG101), to the phagophore assembly site (PAS), a specific subcellular location where the nucleation of phagophore to be triggered. Then a cup-shaped structure isolation membrane is formed from the different source of membrane including mitochondria, endoplasmic reticulum. Meanwhile, ‘eat-me’ signals are necessary to cargo to be selectively recognized by several autophagy receptors that link the cargo to the autophagic membrane via their light chain 3 (LC3)-interacting region (LIR) by Atg8. The most primarily ‘eat-me’ signals is ubiquitin (Ub) chains. Atg8 is a ubiquitin-like protein, can be tightly bound to the autophagic membranes when it was cleaved at its C-termini by the ATG4 pro- teases to expose a C-terminal glycine producing the form I of the ATG8 molecule, and then conjugated to PE and being an PE-conjugated form II of ATG8 proteins. Yeast only owns the one kind of Atg8 protein, while mammals have at least seven if not more ATG8 proteins that can be fell into two subfamilies containing not less than three MAP1 light chain 3 (LC3A, B and C) and four gamma-aminobutyrate receptor-associated protein (GABARAP) and GABARAP-like proteins (ATG8L/GEC-1/GABARAPL1, GATE-16/GABARAPL2 and GABARAPL3) (Xin et al. , 2001; He et al. , 2003).Many proteins have been identified as autophagy receptors that can recognize the ‘eat-me’ signals of cargos, and the classic and wildly accepted autophagy receptors including p62, OPTN, TAX1BP1, NDP52 (Pohl et al. , 2019). Each of these receptors contains LC3 interacting regions (LIRs) that facilitate their interaction with LC3-like molecules on the autophagosome (Wildet al. , 2011; Katsuragi et al. , 2015; Tumbarello et al. , 2015).Furthermore, there is a clear etiological link between gene mutations that control autophagy and human diseases (especially neurodegenerative diseases, inflammatory diseases, and cancer) (Levine et al. , 2019). These diseases are largely untreatable and have no target for intervention that needed an interventional therapeutic target and an interventional target drug. Therefore, these genes that play an important role in autophagy have the opportunity to be the candidate therapeutic targets for these diseases. As we introduced above, the autophagy related genes mainly including Atgs and autophagy receptors. Among them, OPTN is well-documented to have a strong relationship with several disease, for example, neurodegenerative diseases, cancer, inflammatory diseases,etc . (Liu et al. , 2018; Weil et al. , 2018).OPTN is a conservative protein in many species, including human, macaques, rats, pigs, and bovine and is widely in liver, heart, brain, placenta, liver, skeletal muscle, kidney, pancreas, retina, optic nerve blood vessels and so on. OPTN was identified as a negative regulator of NF-κB that competitively binds ubiquitin with NEMO (NF-κB essential modulator) (Zhu et al. , 2007), and an autophagy receptor that connect the ubiquitinated autophagy substrate and LC3-positive autophagosome membrane (Wildet al. , 2011). What’s more, OPTN is also an autophagy inducer that induce autophagic process upon overexpression (Ying et al. , 2016). Breakthrough has been made in comprehending the molecular mechanisms of OPTN in autophagy since 2011. OPTN is an important autophagy adaptor, participate in almost every step of the autophagy process and not just as a autophagy receptor. But the existing review neither clearly clarify this point neither sort out the existing literature lucidly.Over the past decade of studies, OPTN has been involved in many biological process, and its role as autophagy receptor is a breakthrough finding which caught scientists attention in recent years. Contemporary, OPTN was closely associated with some incurable disease in human beings, such as ALS, glaucoma, Paget’s disease, Crohn’s disease, and recently cancer and diabetic nephropathy. However, the relationship between OPTN and these disease has not been well revealed and clarified. This review discusses the biological functions of OPTN in the process of autophagy and the perspective of autophagic mechanism that OPTN involved in several human diseases.The Protein Structure and Cellular Function of OPTNOptineurin(OPTN) was first identified by a yeast two-hybrid screening in order to find interacting proteins of Ad E3 14.7-kDa protein (E3-14.7K) that inhibit TNF-α functions (Li et al. , 1998), and named as FIP-2(14.7K-interacting protein). Then Klaus et al . using “Data base searching” found a NEMO-related protein that shows a strong homology to NEMO, which is the second time that OPTN come into the sight of scientists and name NRP (the first letter of each word in “NEMO-related protein”) (Schwamborn et al. , 2000). After then, more and more studies have sprung up like mushrooms that uncovering the enigma of OPTN in structure of protein, biological function and etiological link in disease.The human OPTN protein contains 577 amino acids and is a 74kD scaffold protein contains several structural domains that endow its multiple abilities. And the mouseOptn gene codes for a 584–amino acid protein (67 kD) which is 78% identical to human OPTN (Rezaie et al. , 2005). The public databases contain partial or complete sequences of OPTN homologues of macaques, rats, pigs, and bovine, all of which show a great extent of similarity to human OPTN, which means OPTN is a conserved gene that play an important role in vital activity. OPTN contains several structural domains and is consists of the structures including CC (coiled-coil) domain, LZ (leucine zipper) domain, LIR (LC3 interacting region) domain, UBAN (ubiquitin-binding domain (UBD) of ABIN proteins and NEMO) domain, ZF (zinc finger) domain. The LIR domain and UBD domain play an important role in autophagy and is the foundation of OPTN to function as an autophagy receptor. In detail, the LIR domain is the location that binding LC3II and the UBD domain is the place where attach the ubiquitinated cargos. The LC3II is an PE-conjugated form II of ATG8 proteins that can tightly bound to the autophagic membranes. So that, cargos are enclosed by autophagic membranes and turn into autophagosome and then degraded in autolysosome.Many biological function of OPTN was reported so far. Firstly, Tayebeh et al. using immunocytochemistry to found the intracellular localization of OPTN and observed the colocalization with the Golgi apparatus (Rezaieet al. , 2002). A deeper study bring this colocalization to light, OPTN plays a vital role in the maintenance of Golgi integrity (Parket al. , 2006).Secondly, OPTN shows strong homology with NEMO, and was identified as a negative regulator of NF-κB that competitively binds ubiquitin with NEMO, thus it may have role in NF-κB signaling regulation. Thirdly, Wild et al. fully proved the specific interactions between OPTN and LC3/GABARAP proteins by pull-down assays in MCF-7 cells, yeast two-hybrid transformations, and purified proteins in vitro (Wild et al. , 2011). The vital role of OPTN in autophagy has attracted greater attention in the last ten years.
Go Back To The Basics: Cardiac Surgery Trainees At The Time Of Covid-19.
Gabriella Ricciardi
Raoul Biondi

Gabriella Ricciardi

and 2 more

May 11, 2020
Keeping up with the surgical training might be difficult during the time of COVID-19 pandemic: with most of the health care resources dedicated to face this reality, trainees can improve themselves deep diving in scientific literature, study, Telemedicine and Social Media professional platforms. Moreover, they might be directly involved in COVID patient care, facing a still a still elusive disease with a high lethality rate. Often the frustration of having no valid treatment and a poor incisiveness on the natural course of the COVID19 could lead to a blue mood or a burnout. Eventually, the natural adaptability and the survival instinct prevail and teach us the real meaning of resilience. Every trainee has to be prepared for the second phase, when the new normality will force everyone to cohabit with the virus. Even the obvious teething troubles, this could be the right moment for all the Residents to “grow-up” and develop their own future Character.
Unsolved questions in prophylactic tricuspid valve repair and the possible role of tr...
Ana Paula Tagliari
Diego  Vilela Santos

Ana Paula Tagliari

and 4 more

May 11, 2020
Tricuspid regurgitation progression after left-sided surgery and its correlation with worse postoperative and long-term outcomes is a highly debated topic. Some studies support prophylactic tricuspid repair based on annulus dimension rather than on tricuspid regurgitation severity only, while others are in favor of more conservative management. Furthermore, the advent of percutaneous tricuspid valve intervention and its promising short-term outcomes has introduced a new factor to be taken into account on the tricuspid intervention decision-making process. We present a review on prophylactic tricuspid valve intervention, covering currently available data, as well as the role of transcatheter tricuspid valve intervention in this equation.
COVID-19 Patient Bridged to Recovery with Veno-Venous Extracorporeal Membrane Oxygena...
Dan Rinewalt
Antonio Coppolino

Dan Rinewalt

and 6 more

May 11, 2020
Background: In severe cases, the COVID-19 viral pathogen produces hypoxic respiratory failure unable to be adequately supported by mechanical ventilation. The role of extracorporeal membrane oxygenation (ECMO) remains unknown, with the few publications to date lacking detailed patient information or management algorithms all while reporting excessive mortality. Methods: Case report from a prospectively maintained institutional ECMO database for COVID-19. Results: We describe veno-venous (VV) ECMO in a COVID-19 positive woman with hypoxic respiratory dysfunction failing mechanical ventilation support while prone and receiving inhaled pulmonary vasodilator therapy. After nine days of complex management secondary to her hyperdynamic circulation, ECMO support was successfully weaned to supine mechanical ventilation and the patient was ultimately discharged from the hospital. Conclusions: With proper patient selection and careful attention to hemodynamic management, ECMO remains a reasonable treatment option for COVID-19 patients.
Pasteurella Multiocida Infection Resulting in a Descending Thoracic Aorta Mycotic Pse...
Eric Jeng
Gianna  Acosta

Eric Jeng

and 3 more

May 11, 2020
Title: Pasteurella Multiocida Infection Resulting in a Descending Thoracic Aorta Mycotic Pseudoaneurysm Objective: Highlight our management of a P. Multiocida infected descending thoracic aorta mycotic pseudoaneurysm Methods: Report a case of canine bite resulting in a P. Multiocida descending thoracic aorta mycotic pseudoaneurysm Results: We present a 61-year-old gentleman who was initially seen in an Emergency Department after a canine bite. He was admitted and treated with a course of IV antibiotics for P. Multiocida bacteremia and discharged. Three weeks post discharge, he continued to feel generalized malaise and work-up was significant for a descending thoracic aorta mycotic pseudoaneurysm. The patient underwent a low left posterior lateral thoracotomy and femoral-femoral cardiopulmonary bypass for complete resection and replacement with a 24 mm GelweaveTM graft (Terumo Cardiovascular Group, Ann Arbor, Michigan). Given purulence and gross infection we planned for a staged approach, with a secondary washout and omental flap for biologic coverage of the graft. The patient did well clinically and was discharged at 14 days to rehabilitation with six-week intravenous course of antibiotics. Conclusions: The patient’s clinical course with subsequent follow-up suggest that complete resection of the mycotic pseudoaneurysm, followed by omental flap coverage is a viable strategy to manage mycotic aortic infections with virulent organisms.
The Odyssey of suturing cardiac wounds: lessons from the past.
Erwan Flecher
Alain Leguerrier

Erwan Flecher

and 2 more

May 11, 2020
Cardiac wounds have been described for centuries and still remain often fatal. For a long period of time suture of a myocardial laceration was thought to be absolutely impossible if not sacrilege. It is only at the end of the 19th century that pioneers decided to defy such dogma in desperate cases. Nowadays it seems obvious that a cardiac stab wound require emergent surgery whenever possible. The story of cardiac wounds highlights nicely the change of mind that is required to accept progress and new procedures in medicine.
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