Ventilator-associated Pneumonia After Elective Cardiac Surgery Caused by Pneumocystis Jirovecii

Ventilator-associated pneumonia is a severe complication among patients undergoing cardiac surgery. Although hospital-acquired bacterial pathogens, often multidrug resistant, are the most frequent cause, non-bacterial atypical and opportunistic agents traditionally associated with immunocompromise are increasingly recognized. We describe ventilator-associated pneumonia due to Pneumocystis jirovecii in the absence of traditional risk factors for Pneumocystis pneumonia in a patient after cardiac surgery

Major CD4 T-Cell Depletion and Immune Senescence in a Patient with Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) results from primary defects in phagocytic reactive oxygen species (ROS) production. T-cell evaluation is usually neglected during patients’ follow-up, although T-cell depletion has been reported in CGD through unknown mechanisms. We describe here a 36-year-old patient with X-linked CGD with severe CD4 T-cell depletion <200 CD4 T-cells/μl, providing insights into the mechanisms that underlie T-cell loss in the context of oxidative burst defects. In addition to the typical infections, the patient featured a progressive T-cell loss associated with persistent lymphocyte activation, expansion of interleukin (IL)-17-producing CD4 T-cells, and impaired thymic activity, leading to a reduced replenishment of the T-cell pool. A relative CD4 depletion was also found at the gut mucosal level, although no bias to IL-17-production was documented. This immunological pattern of exhaustion of immune resources favors prompt, potentially curative, therapeutic interventions in CGD patients, namely, stem-cell transplantation or gene therapy. Moreover, this clinical case raises new research questions on the interplay of ROS production and T-cell homeostasis and immune senescence

Interoceptive cardiac signals selectively enhance fear memories

Fear is coupled to states of physiological arousal. We tested how learning and memory of threat, specifically conditioned fear, is influenced by interoceptive signals. Forty healthy individuals were exposed to two threat (conditioned stimuli [CS+], paired with electrocutaneous shocks) and two safety (CS-) stimuli, time-locked to either cardiac ventricular systole (when arterial baroreceptors signal cardiovascular arousal to brainstem), or diastole (when these afferent signals are quiescent). Threat learning was indexed objectively using skin conductance responses (SCRs). During acquisition of threat contingencies, cardiac effects dominated: Stimuli (both CS+ and CS-) presented at systole evoked greater SCR responses, relative to stimuli (both CS+ and CS-) presented at diastole. This difference was amplified in more anxious individuals. Learning of conditioned fear was established by the end of the acquisition phase, which was followed by an extinction phase when unpaired CSs were presented at either the same or switched cardiac contingencies. One day later, electrocutaneous shocks triggered the reinstatement of fear responses. Subsequent presentation of stimuli previously encoded at systole evoked higher SCRs. Moreover, only those participants for whom stimuli had the same cardiac-contingency over both acquisition and extinction phases retained conditioned fear memory (i.e., CS+ > CS-). Our findings reveal two important cardiac afferent effects on threat learning and memory: 1) Cardiac signals bias processing toward threat; and 2) cardiac signals are a context for fear memory; altering this context can disrupt the memory. These observations suggest how threat reactivity may be reinforced and maintained by both acute and enduring states of cardiac arousal. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Field Theory for a Deuteron Quantum Liquid

Based on general symmetry principles we study an effective Lagrangian for a neutral system of condensed spin-1 deuteron nuclei and electrons, at greater-than-atomic but less-than-nuclear densities. We expect such matter to be present in thin layers within certain low-mass brown dwarfs. It may also be produced in future shock-wave-compression experiments as an effective fuel for laser induced nuclear fusion. We find a background solution of the effective theory describing a net spin zero condensate of deuterons with their spins aligned and anti-aligned in a certain spontaneously emerged preferred direction. The spectrum of low energy collective excitations contains two spin waves with linear dispersions -- like in antiferromagnets -- as well as gapped longitudinal and transverse modes related to the Meissner effect -- like in superconductors. We show that counting of the Nambu-Goldstone modes of spontaneously broken internal and space-time symmetries obeys, in a nontrivial way, the rules of the Goldstone theorem for Lorentz non-invariant systems. We discuss thermodynamic properties of the condensate, and its potential manifestation in the low-mass brown dwarfs.Comment: 19 LaTeX pages; v2: 2 refs added, JHEP versio

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.
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Domestic violence against elderly with disability

Abuse against elders with disabilities is a growing problem as the world population ages. Though they require mandatory reporting, these cases are most frequently not detected or not reported by health professionals for a variety of reasons, including the difficulty of making an accurate diagnosis. By performing a retrospective analysis of alleged domestic violence cases against elders with moderate or severe disability, presented to medical forensic examination at the North Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, in Porto, between 2005 and 2013 (n = 70), we aimed to improve our knowledge of some demographic and forensic characteristics of these cases as well as improve their detection and prevention. The most frequently reported type of abuse was physical (86%), allegedly perpetrated by male abusers (63%) living with their victims (90%), who were most commonly their children (47%) or partners (49%; when victims are married). The victims were most frequently female (63%) who had motor disabilities (49%) and presented a history of previous episodes of abuse in 74% of cases; however, only 28% were previously reported. The physical consequences were most frequently minor injuries (95%) with permanent consequences (scars) in only 6.8% of the cases. The injuries were multiple in the majority of the cases (64%), and the preferred locations were the head and neck (75%). Elderly females with motor disabilities appear to have a greatest risk of domestic violence, which translates, most frequently, into multiple injuries that are mainly in the head and neck

Qualidade de vida de pacientes submetidos à cirurgia bariátrica: estudo transversal

Purpose: Analyze factors that influenced the quality of life (QoL) of patients after bariatric surgery. Methods: A cross-sectional study was carried out, involving 307 adult bariatric surgery patients between 2012 and 2014. Data was obtained from the electronic patient records and telephone interviews. To assess the QoL, the World Health Organization Quality of Life-Bref (WHOQOL-bref) was used. A simple linear regression model was constructed, adjusted by sociodemographic variables, with p&lt;0.05. Results: The domains with the worst scores were the physical (mean=58.45; SD±10.42) and environmental (mean=65.19; SD±11.36). The best domains were the social (mean=76.51; SD±15.71) and psychological (mean=68.70; SD±15.71). In the linear regression model, it was observed that time since the surgery was inversely associated with the physical health domain. For each month post-bariatric surgery, the patient’s average score dropped by 2.66 points, adjusted by sex and age. Conclusions: Time since the surgery could be an important determinant of the physical domain score of quality of life. Identifying the quality of life after bariatric surgery and influential factors is fundamental to prepare these patients for the changes deriving from the weight loss.Objetivo: Analizar los factores que influyeron en la calidad de vida (CV) de los pacientes después de la cirugía bariátrica. Métodos: Se llevó a cabo un estudio transversal en el que participaron 307 pacientes adultos con cirugía bariátrica entre 2012 y 2014. Se han obtenido los datos de los registros electrónicos de los pacientes y de sus entrevistas telefónicas. Después se construyó un modelo de regresión lineal simple, ajustado por variables sociodemográficas, con p &lt;0.05. Para evaluar la CV, se utilizó la Calidad de Vida Breve de la Organización Mundial de la Salud (WHOQOL-bref). Resultados: Los dominios con las peores puntuaciones fueron el físico (media = 58,45; SD ± 10,42) y ambiental (media = 65,19; SD ± 11,36). Los mejores dominios fueron el social (media = 76.51; SD ± 15.71) y psicológico (media = 68.70; SD ± 15.71). En el modelo de regresión lineal, se observó que el tiempo desde la cirugía se asoció inversamente con el dominio de la salud física. Por cada mes posterior a la cirugía bariátrica, el puntaje promedio del paciente se redujo en 2.66 puntos, ajustado por sexo y edad. Conclusión: El tiempo transcurrido desde la cirugía puede ser un determinante importante de la puntuación del dominio físico de la calidad de vida. Identificar la calidad de vida después de la cirugía bariátrica y los factores influyentes es fundamental para preparar a estos pacientes para los cambios derivados de la pérdida de peso.Objetivo: Analisar os fatores que influenciaram a qualidade de vida (QV) dos pacientes após a cirurgia bariátrica. Método: Realizado um estudo transversal envolvendo 307 pacientes adultos submetidos à cirurgia bariátrica, no período de 2012 a 2014. Os dados foram obtidos por meio de prontuário eletrônico e entrevistas telefônicas. Para avaliar a QV, foi utilizada a World Health Organization Quality of Life-bref (WHOQOL-bref). Um modelo de regressão linear simples foi construído, ajustado por variáveis sociodemográficas, com p &lt;0,05.Resultados: Os domínios com os piores escores foram físico (média = 58,45; DP ± 10,42) e ambiental (média = 65,19; DP ± 11,36). Os melhores domínios foram o social (média = 76,51; DP ± 15,71) e o psicológico (média = 68,70; DP ± 15,71). No modelo de regressão linear, observou-se que o tempo desde a cirurgia foi inversamente associado ao domínio saúde física. Para cada mês pós-cirurgia bariátrica, a pontuação média do paciente caiu em 2,66 pontos, ajustada por sexo e idade. Conclusão: O tempo desde a cirurgia pode ser um importante determinante do escore do domínio físico de QV. Identificar a QV após a cirurgia bariátrica e fatores que a influenciam é fundamental para preparar esses pacientes para as mudanças decorrentes da perda de peso

For livestock losses, a conservation scientist's ‘exceptional’ may be a farmer's ‘unacceptable’: A commentary to Ballejo et al. (2020)

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recor

Placenta-specific Slc38a2/SNAT2 knockdown causes fetal growth restriction in mice

Fetal growth restriction (FGR) is a complication of pregnancy that reduces birth weight, markedly increases infant mortality and morbidity and is associated with later-life cardiometabolic disease. No specific treatment is available for FGR. Placentas of human FGR infants have low abundance of sodium-coupled neutral amino acid transporter 2 (Slc38a2/SNAT2), which supplies the fetus with amino acids required for growth. We determined the mechanistic role of placental Slc38a2/SNAT2 deficiency in the development of restricted fetal growth, hypothesizing that placenta-specific Slc38a2 knockdown causes FGR in mice. Using lentiviral transduction of blastocysts with a small hairpin RNA (shRNA), we achieved 59% knockdown of placental Slc38a2, without altering fetal Slc38a2 expression. Placenta-specific Slc38a2 knockdown reduced near-term fetal and placental weight, fetal viability, trophoblast plasma membrane (TPM) SNAT2 protein abundance, and both absolute and weight-specific placental uptake of the amino acid transport System A tracer, 14C-methylaminoisobutyric acid (MeAIB). We also measured human placental SLC38A2 gene expression in a well-defined term clinical cohort and found that SLC38A2 expression was decreased in late-onset, but not early-onset FGR, compared with appropriate for gestational age (AGA) control placentas. The results demonstrate that low placental Slc38a2/SNAT2 causes FGR and could be a target for clinical therapies for late-onset FGR

Role of geometrical cues in bone marrow-derived mesenchymal stem cell survival, growth and osteogenic differentiation

Mesenchymal stem cells play a vital role in bone formation process by differentiating into osteoblasts, in a tissue that offers not a flat but a discontinuous three-dimensional (3D) topography in vivo. In order to understand how geometry may be affecting mesenchymal stem cells, this study explored the influence of 3D geometry on mesenchymal stem cell-fate by comparing cell growth, viability and osteogenic potential using monolayer (two-dimensional, 2D) with microsphere (3D) culture systems normalised to surface area. The results suggested lower cell viability and reduced cell growth in 3D. Alkaline phosphatase activity was higher in 3D; however, both collagen and mineral deposition appeared significantly lower in 3D, even after osteogenic supplementation. Also, there were signs of patchy mineralisation in 3D with or without osteogenic supplementation as early as day 7. These results suggest that the convex surfaces on microspheres and inter-particulate porosity may have led to variable cell morphology and fate within the 3D culture. This study provides deeper insights into geometrical regulation of mesenchymal stem cell responses applicable for bone tissue engineering