Tension chylothorax following pneumonectomy

AbstractPost-pneumonectomy chylothorax is an uncommon complication following surgery, with an estimated incidence of less than 0.7%. Post-pneumonectomy tension chylothorax, where rapid accumulation of chyle in the post-pneumonectomy space results in hemodynamic compromise, is exceedingly rare, with just 7 cases previously reported. All prior cases of tension chylothorax were managed operatively with decompressive chest tube placement followed by open thoracic duct repair. Our case is the first reported tension chylothorax to be managed conservatively by thoracostomy drainage coupled with a period of parenteral nutrition followed by a medium chain triglyceride-restricted diet

The effects of a video intervention on posthospitalization pulmonary rehabilitation uptake

Rationale: Pulmonary rehabilitation (PR) after hospitalizations for exacerbations of chronic obstructive pulmonary disease (COPD) improves exercise capacity and health-related quality of life and reduces readmissions. However, posthospitalization PR uptake is low. To date, no trials of interventions to increase uptake have been conducted.Objectives: To study the effect of a codesigned education video as an adjunct to usual care on posthospitalization PR uptake.Methods: The present study was an assessor- and statistician-blinded randomized controlled trial with nested, qualitative interviews of participants in the intervention group. Participants hospitalized with COPD exacerbations were assigned 1:1 to receive either usual care (COPD discharge bundle including PR information leaflet) or usual care plus the codesigned education video delivered via a handheld tablet device at discharge. Randomization used minimization to balance age, sex, FEV1 % predicted, frailty, transport availability, and previous PR experience.Measurements and Main Results: The primary outcome was PR uptake within 28 days of hospital discharge. A total of 200 patients were recruited, and 196 were randomized (51% female, median FEV1% predicted, 36 [interquartile range, 27-48]). PR uptake was 41% and 34% in the usual care and intervention groups, respectively (P = 0.37), with no differences in secondary (PR referral and completion) or safety (readmissions and death) endpoints. A total of 6 of the 15 participants interviewed could not recall receiving the video.Conclusions: A codesigned education video delivered at hospital discharge did not improve posthospitalization PR uptake, referral, or completion

Sympathetic-transduction in untreated hypertension

Transduction of muscle sympathetic nerve activity (MSNA) into vascular tone varies with age and sex. Older normotensive men have reduced sympathetic transduction so that a given level of MSNA causes less arteriole vasoconstriction. Whether sympathetic transduction is altered in hypertension (HTN) is not known. We investigated whether sympathetic transduction is impaired in untreated hypertensive men compared to normotensive controls. Eight untreated hypertensive men and 10 normotensive men (age 50 ± 15 years vs. 45 ± 12 years (mean ± SD); p = 0.19, body mass index (BMI) 24.7 ± 2.7 kg/m(2) vs. 26.0 ± 4.2 kg/m(2); p = 0.21) were recruited. MSNA was recorded from the peroneal nerve using microneurography; beat-to-beat blood pressure (BP; Finapres) and heart rate (ECG) were recorded simultaneously at rest for 10 min. Sympathetic-transduction was quantified using a previously described method. The relationship between MSNA burst area and subsequent diastolic BP was measured for each participant with the slope of the regression indicating sympathetic transduction. MSNA was higher in the hypertensive group compared to normotensives (73 ± 17 bursts/100 heartbeats vs. 49 ± 19 bursts/100 heart bursts; p = 0.007). Sympathetic-transduction was lower in the hypertensive versus normotensive group (0.04%/mmHg/s vs. 0.11%/mmHg/s, respectively; R = 0.622; p = 0.006). In summary, hypertensive men had lower sympathetic transduction compared to normotensive individuals suggesting that higher levels of MSNA are needed to cause the same level of vasoconstrictor tone

Placing the Common Era in a Holocene context: millennial to centennial patterns and trends in the hydroclimate of North America over the past 2000 years

A synthesis of 93 hydrologic records from across North and Central America, and adjacent tropical and Arctic islands, reveals centennial to millennial trends in the regional hydroclimates of the Common Era (CE; past 2000 years). The hydrological records derive from materials stored in lakes, bogs, caves, and ice from extant glaciers, which have the continuity through time to preserve low-frequency ( \u3e 100 year) climate signals that may extend deeper into the Holocene. The most common pattern, represented in 46 (49 %) of the records, indicates that the centuries before 1000 CE were drier than the centuries since that time. Principal component analysis indicates that millennial-scale trends represent the dominant pattern of variance in the southwestern US, northeastern US, mid-continent, Pacific Northwest, Arctic, and tropics, although not all records within a region show the same direction of change. The Pacific Northwest and the southernmost tier of the tropical sites tended to dry toward present, as many other areas became wetter than before. In 22 records (24 %), the Medieval Climate Anomaly period (800–1300 CE) was drier than the Little Ice Age (1400–1900 CE), but in many cases the difference was part of the longer millennial-scale trend, and, in 25 records (27 %), the Medieval Climate Anomaly period represented a pluvial (wet) phase. Where quantitative records permitted a comparison, we found that centennial-scale fluctuations over the Common Era represented changes of 3–7% in the modern interannual range of variability in precipitation, but the accumulation of these long-term trends over the entirety of the Holocene caused recent centuries to be significantly wetter, on average, than most of the past 11 000 years

Ensuring phenotyping algorithms using national electronic health records are FAIR:Meeting the needs of the cardiometabolic research community

Phenotyping algorithms enable the extraction of clinically-relevant information (such as diagnoses, prescription information, or a blood pressure measurement) from electronic health records for use in research. They have enormous potential and wide-ranging utility in research to improve disease understanding, health, and healthcare provision. While great progress has been achieved over the past years in standardising how genomic data are represented and curated (e.g. VCF files for variants), phenotypic data are significantly more fragmented and lack a common representation approach. This lack of standards creates challenges, including a lack of comparability, transparency and reproducibility, and limiting the subsequent use of phenotyping algorithms in other research studies. The FAIR guiding principles for scientific data management and stewardship state that digital assets should be findable, accessible, interoperable and reusable, yet the current lack of phenotyping algorithm standards means that phenotyping algorithms are not FAIR. We have therefore engaged with the community to address these challenges, including defining standards for the reporting and sharing of phenotyping algorithms. Here we present the results of our engagement with the community to identify and explore their requirements and outline our recommendations to ensure FAIR phenotyping algorithms are available to meet the needs of the cardiometabolic research community

Ensuring phenotyping algorithms using national electronic health records are FAIR:Meeting the needs of the cardiometabolic research community

Phenotyping algorithms enable the extraction of clinically-relevant information (such as diagnoses, prescription information, or a blood pressure measurement) from electronic health records for use in research. They have enormous potential and wide-ranging utility in research to improve disease understanding, health, and healthcare provision. While great progress has been achieved over the past years in standardising how genomic data are represented and curated (e.g. VCF files for variants), phenotypic data are significantly more fragmented and lack a common representation approach. This lack of standards creates challenges, including a lack of comparability, transparency and reproducibility, and limiting the subsequent use of phenotyping algorithms in other research studies. The FAIR guiding principles for scientific data management and stewardship state that digital assets should be findable, accessible, interoperable and reusable, yet the current lack of phenotyping algorithm standards means that phenotyping algorithms are not FAIR. We have therefore engaged with the community to address these challenges, including defining standards for the reporting and sharing of phenotyping algorithms. Here we present the results of our engagement with the community to identify and explore their requirements and outline our recommendations to ensure FAIR phenotyping algorithms are available to meet the needs of the cardiometabolic research community

Comparing Common Techniques for Calculating Parasite Prevalence

Raccoons (Procyon lotor) are the final host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease, known as larva migrans encephalopathy. Diagnostic tools for detecting the presence of B. procyonis within a raccoon population include necropsy, fecal flotation, and latrine analysis. Necropsies yield the highest measure of prevalence, with fecal flotation and latrine analysis often underestimating infection rates. We necropsied 225 raccoons gathered from 10 townships of Clark and Greene Counties in Ohio. We collected fecal samples from 95 raccoons negative for B. procyonis at necropsy. We suspended the feces in Sheather’s solution to float any eggs, and prepared slides from this solution. Nearly 14% of raccoons negative at necropsy for B. procyonis possessed eggs in their feces. We used a chi squared test for equality of distributions to determine the likelihood that a positive fecal analysis is related to B. procyonis prevalence or to the area in which the raccoon was trapped. These data will help us determine how well fecal analyses estimate parasite prevalence

Does Baylisascaris procyonis Phylogeny Correlate with That of the Raccoon (Procyon lotor)

Baylisacaris procyonis, commonly known as the raccoon roundworm, is a parasite that inhabits the small intestine of the North American raccoon (Procyon lotor). Although humans do not typically become the definitive host, humans can become infected through handling soil containing eggs. B. procyonis can induce serious health complications in cases of human infection, including degenerative retinal and behavioral changes, coma, and even death. High prevalence of B. procyonis in a raccoon population increases the probability of transference to human hosts. In our study, we analyzed the genetic structure of B. procyonis harvested from raccoons of southwestern Ohio, and compared this to the genetic structure of the raccoons they inhabited. It is our hypothesis that the genetic structuring of the roundworms is the same as the genetic structuring of the raccoons. We isolated DNA from the roundworms using the method outlined in the DNA Minikit (Qiagen). Our research team isolated DNA from each roundworm sample and sent it to the Plant-Microbe Genomics Facility at The Ohio State University for gene amplification and sequencing. We built phylogenetic trees using these sequences, and compared these trees to some constructed for the raccoons. The correlations drawn between the raccoon and B. procyonis phylogenetic trees will help us better understand the relationship between the two species

Baylisascaris procyonis Impacts Raccoon (Procyon lotor) Diets

Raccoons (Procyon lotor) are the definitive host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is responsible for a dangerous neurological disease known as larva migrans encephalopathy. Raccoons are omnivorous animals and rely on various food items. Dietary analyses help determine how a raccoon changes its diet in response to environmental features. Raccoons eat whatever food resource is most convenient and abundant. Parasite infections can potentially affect host eating habits in order to keep the host alive and active longer. In this study, we analyzed the diets of necropsied raccoons from ten townships of Clark and Greene Counties by examining their stomach contents. We categorized stomach contents by separating out plant material, vertebrate tissue, and invertebrate tissue. We measured the total stomach mass and the mass of plant material alone in order to compare and obtain a percentage of plant material in the raccoons’ diet. We conducted two chi-squared tests for equality of distributions. We tested the null hypotheses that raccoons from townships with high prevalence (\u3e60%) have the same vertebrate tissue and plant tissue prevalence as raccoons from townships with low roundworm prevalence

Does Baylisascaris procyonis Impact Raccoon (Procyon lotor) Genetics?

Raccoons (Procyon lotor) are the final host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease, known as larva migrans encephalopathy. Phylogenetic trees illustrate co-evolutionary events between species living in a symbiotic relationship with each other. Throughout the coevolution of host and parasite, many aspects of a population affect the way the members interact with one another and with symbiotic species. In order to evaluate the relationship between host and parasite in regards to diet, we isolated DNA from intestinal wall tissue, amplified a portion of exon 2 from MHC II, and sent our samples to Ohio State University for sequencing. We calculated heterozygosities for the nine townships we surveyed. We used a chi-squared test for equality of distributions to test whether raccoons from townships with above 60% prevalence have different heterozygosity for this locus than other raccoons. These data will help us to understand the relationship between raccoons and raccoon roundworm