Investigation of pathophysiologic trends in Caucasian and Afro-American hypertensives by means of heart rate variability recording during upright tilt-table testing

The incidence of hypertension is more prevalent among the Afro-American population than the Caucasians and there is not a satisfactory explanation for this discrepancy. Heart Rate Variability (HRV) has been demonstrated to reflect the relative activities of the sympathetic (SMP) and parasympathetic (PSMP) divisions of the autonomic nervous system (ANS). This study consisted in comparing the HRV, as well as the blood pressure (BP) of four different groups during up-right tilt table testing. The subjects were grouped by age, gender, race and health condition. Analysis in time and frequency domain was applied to the data. In the frequency domain, the LF and HF bands were studied. In the time domain, a new parameter was proposed to analyze the data. As a result, the ratio of the FIF area, from the supine to the standing positions, was higher in the hypertensive group than the normotensive one, and the ratio of the LF area was higher in the normotensives than the others. On the other hand, Afro-Americans had a higher LF area ratio than Caucasians and a lower HF area ratio

Bile Cast Nephropathy: A Pathologic Finding with Manifold Causes Displayed in an Adult with Alcoholic Steatohepatitis and in a Child with Wilson’s Disease

Bile cast nephropathy (BCN) is seen in patients who have acute kidney injury and severe hyperbilirubinemia due to a wide range of hepatobiliary system diseases. Findings seen by renal biopsy include acute tubular injury with necrotic and sloughed epithelial cells, yellow-green pigment within tubular epithelial cells, and pigmented granular casts. Hall’s special stain for bile turns these casts green. In recent years, BCN has been described in a small number of case reports and clinical studies primarily in the setting of severe liver dysfunction. We present 2 diverse cases of BCN. The first involves an adult with hepatorenal syndrome secondary to alcoholic steatohepatitis and early cirrhosis. Second, we describe the first reported case of BCN in a child with fulminant hepatic failure due to Wilson’s disease. Our cases expand the spectrum of causative diseases, and they provide further evidence that BCN is a distinct pathologic entity which may be found in both adult and pediatric patients with a variety of severe liver diseases

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96).ConclusionT-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates

Educación ambiental y sociedad. Saberes locales para el desarrollo y la sustentabilidad

EL LIBRO PERMITE REFLEXIONAR SOBRE LA IMPORTANCIA DE FOMENTAL LA EDUCACIÓN AMBIENTAL PARA RESOLVER LA PROBLEMÁTICA AMBIENTALEL LIBRO PRESENTA DIFERENTES TRABAJOS QUE ESTUDIAN EL TEMA D ELA SUSTENTABILIDAD, ENFATIZANDO LA IMPORTANCIA DE LA EDUCACIÓN AMBIENTAL Y LA TRANSDISCIPLINANINGUN

Respuesta funcional de la larva de Pseudodoros clavatus (Fabricius, 1794) (Diptera: Syrphidae) al áfido negro del matarratón Aphis craccivora Koch, 1854 (Hemiptera: Aphididae)

Se determinó la respuesta funcional de la larva de Pseudodoros clavatus (Fabricius, 1794) al áfido negro del matarratón [Gliricidia sepium (Jacq.) Kunth ex Walp. (Fabaceae)] Aphis craccivora Koch, 1854 bajo condiciones de laboratorio. Esta respuesta fue estudiada a las densidades de 30, 40, 50, 60, 70, 80 y 100 áfidos (ninfas de tercer y cuarto instar). Varios modelos matemáticos fueron aplicados a los datos de depredación usando análisis de regresión para determinar la relación existente entre el número de áfidos depredados y las densidades del áfido. Los valores de F y R2 fueron usados como criterio para evaluar los modelos. Las curvas de respuesta funcional se ajustaron mejor y mostraron el valor más alto de R2 para el modelo Polinomial indicando una fuerte correlación entre el aumento de áfidos depredados por P. clavatus y las diferentes densidades de A. craccivora. El coeficiente de determinación para el modelo de Holling sugiere que P. clavatus se comporta típicamente como un depredador que responde al tipo de curva II

Proliferative Glomerulonephritis with Monoclonal Immunoglobulin G Lambda Deposits: Report of the First Pediatric Case

Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) is a recently described, uncommon renal disorder which is considered a monoclonal gammopathy of renal significance. Although some patients will have a detectable monoclonal spike, overt hematologic malignancy is found in only a minority. Most patients with PGNMID are over the age of 50 years, and to our knowledge no cases have been reported in children or adolescents. Renal biopsy shows variable histologic patterns by light microscopy, with membranoproliferative and membranous patterns being most common. Immunofluorescence microscopy demonstrates restriction to a single immunoglobulin G heavy chain isotype and a single light chain subtype. Electron microscopy reveals granular, unorganized deposits. We report a rare pediatric case which occurred in a 17-year-old female. The rarity of this entity in the adult population has not permitted a standard treatment regimen to be established. Our adolescent patient was treated with multiple treatment regimens including prednisone, mycophenolate mofetil, rituximab, bortezomib, and daratumumab. Our case demonstrates that awareness of this disorder by pediatric nephrologists and pathologists is vital to guide accurate disease classification, prognosis, and treatment

Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series

  Acute fibrinous and organising pneumonia (AFOP) is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561). We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.  </p

Searching for the Progenitor Galaxy of Omega Centauri Using RR Lyrae Spectra

International audienceRadial velocities of 32 RR Lyrae stars from the Catalina Real-time Transient Survey in the neighborhood of Omega Centauri were measured from low-resolution spectra taken by the Goodman Spectrograph on SOAR, Cerro Pachón, Chile. An over-density of stars with the same velocity as the cluster would imply that these stars were once part of ω Cen but have since been tidally stripped, supporting the hypothesis that ω Cen is the remain of a nucleated dwarf galaxy. This study is the most complete of any one similar, covering an area of 100 sq. degrees around the cluster and using RR Lyrae stars known to have similar distance to the cluster. Statistical tests comparing the distribution of RR Lyrae velocities to the expected distribution of velocities of halo stars show no over-density of stars at the velocity of ω Cen or any other velocity, discarding the presence of any substructure in this part of the sky

Series of rare lung diseases mimicking imaging patterns of common diffuse parenchymal lung diseases

Diffuse parenchymal lung diseases (DPLDs) encompass a variety of restrictive and obstructive lung pathologies. In this article, the authors discuss a series of rare pulmonary entities and their high-resolution computed tomography imaging appearances, which can mimic more commonly encountered patterns of DPLDs. These cases highlight the importance of surgical lung biopsies in patients with imaging findings that do not show typical imaging features of usual interstitial pneumonia