A lipidomic screen of hyperglycemia-treated HRECs links 12/15-Lipoxygenase to microvascular dysfunction during diabetic retinopathy via NADPH oxidase

Retinal hyperpermeability and subsequent macular edema is a cardinal feature of early diabetic retinopathy (DR). Here, we investigated the role of bioactive lipid metabolites, in particular 12/15-lipoxygenase (LOX)-derived metabolites, in this process. LC/MS lipidomic screen of human retinal endothelial cells (HRECs) demonstrated that 15-HETE was the only significantly increased metabolite (2.4 ± 0.4-fold, P = 0.0004) by high glucose (30 mM) treatment. In the presence of arachidonic acid, additional eicosanoids generated by 12/15-LOX, including 12- and 11-HETEs, were significantly increased. Fluorescein angiography and retinal albumin leakage showed a significant decrease in retinal hyperpermeability in streptozotocin-induced diabetic mice lacking 12/15-LOX compared with diabetic WT mice. Our previous studies demonstrated the potential role of NADPH oxidase in mediating the permeability effect of 12- and 15-HETEs, therefore we tested the impact of intraocular injection of 12-HETE in mice lacking the catalytic subunit of NADPH oxidase (NOX2). The permeability effect of 12-HETE was significantly reduced in NOX2−/− mice compared with the WT mice. In vitro experiments also showed that 15-HETE induced HREC migration and tube formation in a NOX-dependent manner. Taken together our data suggest that 12/15-LOX is implicated in DR via a NOX-dependent mechanism.National Institutes of Health Grant 5R01EY023315 and National Priorities Research Program Grant 4-1046-3-284 from the Qatar National Research Fund (a member of Qatar Foundation). This study was also supported in part by the National Center for Research Resources, National Institutes of Health Grant S10RR027926

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of routine cerebral CT angiography on treatment decisions in infective endocarditis.

BACKGROUND:Infective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE. METHODS:From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke's criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥ 5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention. RESULTS:The mean age was 30.43 ± 8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture. CONCLUSIONS:Routine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE

Household food waste generation during COVID-19 pandemic and unprecedented economic crisis: The case of Lebanon

Background: The COVID-19 pandemic has interrupted economies and food systems globally, leading to substantial consequences on food waste, which is also influenced by political and economic factors. To date, information on the attitudes and behaviors of households regarding food waste generation in developing countries like Lebanon, witnessing a multifaceted economic and COVID-19 crisis, is scarce. Previous studies reported that around one third of the food produced in Lebanon gets lost or wasted. This study aims to update the attitudes and behaviors determining household food waste in Lebanon in light of the COVID-19 pandemic and unprecedented economic crisis. Methods: Participants (n = 1251) from the five governorates of the country filled out a structured questionnaire composed of 3 sections and 31 questions. The variable “eat everything prepared” was used as a proxy for food waste. The effects of different socio-behavioral and demographic characteristics on household food waste generation in the country were estimated using a Logistic regression on STATA. Results: Most participants (69%) reported that the economic crisis had a greater impact on their food shopping and eating behaviors compared to the COVID-19 pandemic. In comparison, 65% reported that their household food waste generation did not change because of the COVID-19 pandemic, and 47% reported that their household food waste generation decreased because of the economic crisis. Employment status, income, educational level, and the number of householders did not affect food waste generation. Feelings of guilt, thinking of ways to use leftovers, and frequent preparation of more dishes were negatively associated with food waste generation while eating out and buying special offers showed the opposite effect. Conclusion: Our findings provide a better understanding of more effective community-based food waste-related interventions in Lebanon. Future research is still needed to explain the medium and long-term effects of COVID-19 and the economic crisis on food waste-related behaviors in the country since the behavioral changes uncovered in the current study might be temporary during the pandemic and the economic crisis and not permanent. This issue should be verified in the future using longitudinal surveys

CT/CTA findings.

<p>*one patient had a silent cerebral hemorrhage associated with silent ICMA.</p><p>CT/CTA findings.</p

Angiography findings of the studied patients.

<p>Angiography findings of the studied patients.</p

Clinical features.

<p>*defined as, 1. Nosocomial infection: infection contracted ≥ 48 hours after hospital admission. 2. Non nosocomial infection: infection appearing ≤ 48 hours of hospital admission within: a) 1 month of receiving IV cannulation, chemotherapy or dialysis; b) 3 months of admission into an acute care facility, c) any time of admission to a nursing home.</p><p>**sepsis, major artery embolization, heart failure, death.</p><p>Clinical features.</p

CTA showing a small 3.5 mm ICMA of the right MCA.

<p>CTA showing a small 3.5 mm ICMA of the right MCA.</p

Proteomic profile of cerebrospinal fluid in patients with multiple sclerosis using two dimensional gel electrophoresis

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