JCE-21-0127

A document by Riccardo Cappato. Click on the document to view its contents.

Climatic gradients frequently predict large-scale ecogeographical patterns in animal coloration, but the underlying causes are often difficult to disentangle. We examined ecogeographical patterns of reflectance among 343 European butterfly species and isolated the role of selection for thermal benefits by comparing visible and near-infrared (NIR) wavebands. NIR light accounts for ~50% of solar energy but cannot be seen by animals so functions primarily in thermal control. We found that reflectance of both dorsal and ventral surfaces shows thermally adaptive correlations with climate. This adaptive variation was more prominent in NIR than visible wavebands and for body regions (thorax-abdomen and basal wings) that are pivotal for thermoregulation. Thermal environments also predicted the reflectance difference between dorsal and ventral surfaces, which may be due to modulation between requirements for heating and cooling. These results highlight the importance of climatic gradients in shaping the reflectance properties of butterflies at a continent-wide scale.

Background: Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. Although this disease primarily involves pulmonary tissue, rapidly advancing research has established cardiac involvement in Covid-19 patients. Objective: This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. Results: Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being male. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and Brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were Non-specific and included ST-segment and T-wave changes. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. Conclusion: Due to the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (i.e. at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (OR) and their 95% confidence intervals (CI). Small study effects were assessed with the Egger’s test. Results: Twenty studies, 19 cohorts and one case-control were included. An increase of one unit of NLR was associated with a higher odds of COVID-19 severity (OR 6.6, 95% CI: 4.71 - 7.19; p<0.001) and higher odds of all-cause mortality (OR 12.7, 95% CI: 1.32, 123.36; p=0.025). No differences were found in subgroup analyses by study design. The subgroup analysis of the studies, by country of origin, showed that the strength of the association between NLR and mortality was greater in Chinese studies (OR 31.1; 95%CI 19.57 to 49.3; p<0.0001) with moderate heterogeneity (I2 =43%). In our sensitivity analysis, we found that 7 studies with low risk of bias maintained strong association between both outcomes and the NLR values (severity: OR 4.7; 95% CI 3.5 to 6.34; p < 0.001 vs mortality: OR 31.1; 95% CI 19.57 to 49.3; p <0.0001), with low (I2 = 37%) and moderate (I2 = 43%) heterogeneity for severity and mortality outcomes, respectively. No publication bias was found for studies that evaluated effects for the severity of disease. Conclusions: Higher values of NLR were associated with severity and all-cause mortality in hospitalized COVID-19 patients.

Aims Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for management of patients with COVID-19 suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have effected diagnostic performance of on-call radiologists. The aim of this study is to reveal the interpretation errors in chest-CT reports of COVID-19 suspected patients admitted to the ER. Methods COVID-19 dedicated chest-CT scans which were performed between March and June 2020 were re-evaluated and compared with the former reports of these scans and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments’ workload, COVID-19 related educational activities have examined. Results Out of 5721 Chest-CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included to this study. RT-PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in “normal” and “typical for covid” groups whereas lowest in “atypical for covid” and “not covid” groups. 5-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding number of chest CT scans performed, radiologists’ workload have found to be increased six-folds compared to the same months of the former year. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in “not covid” class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of pandemic have seem to be related with the decline of IEs within time. Conclusion COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest-CT reporting. This workload and concomitant factors have possible effects on diagnostic challenges in COVID-19 pneumonia.

Introduction: As COVID-19 disease has rapidly spread across the world, its impact has grown with increasing number of cases and mortality rate in Turkey. Aim: The aim of this study is to examine epidemiologic and clinical features of the patients that admitted to the hospital with the pre-diagnosis of coronavirus disease-2019 (COVID-19) in Turkey. Method: In this retrospective study, epidemiologic and clinical features, laboratory findings, radiologic features, therapeutic approaches and survival conditions of the patients with the pre-diagnosis of COVID-19 from March 11th to June 30th, 2020. The all data of the cases were compared in 4 groups: 1st group for the confirmed cases reverse transcriptase polymerase chain reaction (RT-PCR) +, chest computed tomography (CT) +, 2nd group for the clinically diagnosed cases (RT-PCR- CT +), 3rd group for the mild and asymptomatic cases (RT-PCR + CT-), 4th group for the suspected cases (RT-PCR - CT -). Post-hoc analysis was performed to evaluate the differences among the groups. Results: In total, 3334 patients with the pre-diagnosis of COVID-19 admitted to the emergency department. Based on the post-hoc analyses, significant differences were found among the four groups in terms of their test results of leucocytes, hemoglobin, platelets, neutrophils, urea and C-reactive protein (CRP) (p<0.001). Furthermore, the factors of age groups, hospitalization, intensive care follow-up and mortality rate of the four groups showed a significant difference among the groups (p=0.001). Conclusion: Mean of leucocytes, neutrophile and platelet values of the patients with tested positive for the RT-PCR was found lower compared to the ones with tested negative for the RT-PCR. Mean of CRP values was found higher in patients with lung involvement compared to other patient groups.

Background and aim: Peptic ulcer is considered an important public health problem and generally associated with complicated conditions such as bleeding and perforation. The aim of this study is to reflect the rate of oxidative damage in the body among patients with H. pylori positive peptic ulcer by measuring serum 8-hydroxy-2p-deoxyguanosine (8-OHdG) and its association with the level of bacterial endotoxin. Methods Patients applied to Harran University Gastroenterology Outpatient Clinic with dyspeptic complaints were enrolled in this study. According to gastrointestinal endoscopy findings, 43 patients with H.pylori positive peptiv ulcer patients and 43 healthy volunteers were included in this study. H.pylori diagnosis was detemined by H.pylori urea breath and stool antigen tests. Serum 8-OHdG and endotoxins were measued by ELISA. Results A total of 43 patients with peptic ulcer (13 females 30 males), 43 healthy individuals (16 females 27 males) ages (18- 70) years in the study. In biopsies taken endoscopically; Hp severity was mild in 19 patients (43.9%), moderate in 21 patients (48.5%), and severe in 3 patients (7.6%). 8-OHdG which has the potential to mark DNA damage level in serum samples of patients with H.pylori positive peptic ulcer, was compared with the healthy and patient group. It was observed that there was a statistically significant difference (p <0.01). In addition, a weak correlation was found between OHdG and endotoxin. Conclusion: Reactive oxygen species (ROS) produced due to increased endotoxin as a result of H. pylıori infection can attack nucleic acid in infected cells resulting in an increased in serum 8-OHdG level. H.pylori and its endotoxin had a significant in peptic ulcer pathogensis.

Objective: SARS-CoV-2 has caused nearly 4 million confirmed cases of COVID-19 worldwide in the approximately 4 months since it emerged in Wuhan, China in December 2019. Comorbidities increase morbidity and mortality in COVID-19, and many laboratory parameters have been associated with mortality. The aim of the present study was to identify the relationship between endogenous carboxyhemoglobin (COHb) level and the clinical course and prognosis of COVID-19. Methods: The study included 48 non-smokers or ex-smokers aged 18 years or older who presented to the emergency department, were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swab sample, and were treated in the pulmonary diseases ward of the Atatürk University hospital after between March 24, 2020 and April 15, 2020. The patients’ laboratory parameters and demographic data were analyzed retrospectively. Results: Prothrombin time and C-reactive protein (CRP), troponin-I, and D-dimer levels decreased in COVID-19 patients during follow-up (p=0.024, p=0.001, p=0.001, p=0.001), while PaO2/FiO2 ratio and COHb increased (p=0.002, p=0.001). COHb level at admission was significantly lower in patients who developed macrophage activation syndrome (MAS), acute respiratory distress syndrome (ARDS), and those who died compared to the other patients (p=0.002, p=0.001). COHb level on day 5 of treatment was significantly higher in patients with ARDS and patients who died (p=0.001, p=0.001).Significant correlations were detected between COHb level and CRP (r=-0.425, p=0.001), ferritin (r=-0.395, p=0.001) and PaO2/FiO2 ratio (r=0.431, p=0.001). Conclusions: COHb level may be an easily accessible biomarker that guides early follow-up and treatment planning to avoid ARDS, MAS, and mortality in COVID-19.

Aim: The present study compares the effectiveness of four different remineralization agents on the demineralized enamel of permanent human incisors. The purpose of this study is to evaluate the effectiveness of remineralization agents on the initial enamel lesion. Material- Methods: Crowns affected by demineralization were divided into two equal parts. The right halves of the teeth were subjected to no other processes after demineralization for control purposes and were kept in artificial saliva for the duration of the experiment. The left halves of the crowns were remineralized using a 5% NaF-containing fluoride varnish (GC MI Varnish GC Corp, Tokyo, Japan), a casein phosphopeptide and amorphous calcium toothpaste (GC Tooth Mousse, GC Corp, Tokyo, Japan), fluoride, hydroxyapatite, and xylitol, containing a water-soluble remineralization paste (Remin Pro™, Voco, Germany) and calcium, magnesium and phosphate-containing gel (Medical Remineralizing gel (R.O.C.S. Trading GmbH, Munich, Germany). After a 21-day remineralization process, and SEM/EDX analysis was performed, and a One Way Anova was used for statistical analysis. Results: According to EDX analysis, the R.O.C.S. medical remineralizing gel was found to have a lower Ca/P ratio than the other material groups (p =0.04). Remin Pro™, Voco, and the R.O.C.S. were higher than the control group in evaluating the Ca / P ratio (p=0.014), (p=0.025). Conclusions: The R.O.C.S group, treated with fluoride-free xylitol-containing, a remineralization agent, showed the lowest Ca/P ratio. Compared to demineralized halves of the teeth (control groups), Remin Pro™, Voco, and R.O.C.S. medical remineralizing gel may be considered as affecting on initial enamel lesions. Key Words: Remineralizing Agents, EDX, SEM, Enamel,

Background: Evidence shows that simplified SOFA scoring system has better clinical practice. Objective: This study aimed to compare the scores acquired with the simplified sequential organ failure assessment (sSOFA), simplified organ dysfunction criteria optimized for electronic health records (eSOFA), and simplified and accurate sequential organ failure assessment (sa-SOFA) for their accuracies in predicting the prognosis of septic patients. Methods: This retrospective observational study was conducted at three major academic hospitals. Clinical data from 574 patients diagnosed with sepsis following the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)were retrospectively retrieved and analyzed. Scores from the quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) were used as reference scores. The area under the receiver operating characteristic curve (AUROC) was used to compare the accuracies of eSOFA, sSOFA, and sa-SOFA scores in predicting in-hospital mortality. Results: AUROC analysis demonstrated the predictability of the five scoring systems for sepsis surveillance, listed in descending order as: sa-SOFA,0.790 (95% confidence interval [CI]: 0.754-0.822); SOFA, 0.774 (95% CI: 0.738-0.808); eSOFA,0.729 (95% CI: 0.691-0.765); sSOFA,0.681 (95% CI: 0.641- 0.719); and qSOFA,0.618(95% CI: 0.577-0.658). Moreover, sa-SOFA and SOFA scores (Z= 1.950, p = 0.051) did not significantly differ from each other in discriminatory power, but the sa-SOFA score had a higher power than either the sSOFA or eSOFA scores (p values <0.001). Conclusion: sa-SOFA showed the highest accuracy in predicting in-hospital fatality of septic patients when compared with sSOFA and eSOFA.

Mini-commentary on BJOG-20-1156.R2: Post-mortem confirmation of fetal brain abnormalities: challenges highlighted by the MERIDIAN cohort study

A document by Nathan Gold. Click on the document to view its contents.

The exact solutions of the Riemann problems for the two different perturbed macroscopic production models are considered and constructed respectively for all the possible cases. It is found that the asymptotic limits of solutions to the Riemann problem for the first kind of perturbed macroscopic production model do not coverage to those of the pressureless gas dynamics model, because the delta shock wave in the limiting situation has different propagation speed and strength from those for the pressureless gas dynamics model. In order to remedy it, the second kind of perturbed macroscopic production model is proposed, whose asymptotic limits of Riemann solutions are identical with those of the pressureless gas dynamics model.

In case of decompensated heart failure related to chemotherapy-induced cardiomyopathy, ivabradine administration could lead to favorable hemodynamics via the increase of stroke volume with reducing sinus heart rate. Assessment of the overlap between the E- and A-waves facilitates understanding the effects of ivabradine in such cases.

Sinus of Valsalva aneurysm is a rare disease characterized by the partial elevation of the aortic root. Few reports are available on the surgical treatment for infants. We report the repair of an extremely rare case of a sinus of Valsalva defect with a ventricular septal defect and right ventricular outflow tract stenosis in an infant. It was not a sinus of Valsalva aneurysm, but it exhibited abnormal partial bulging of the aortic root and forming an aneurysm-like cavity within the right ventricular myocardium. We performed direct closure of the sinus of Valsalva aneurysm-like cavities and intracardiac repair in two stages. Three years after total repair, the patient remained healthy and asymptomatic.

Structure-based computational protein design (CPD) refers to the problem of finding a sequence of amino acids which folds into a specific desired protein structure, and possibly fulfills some targeted biochemical properties. Recent studies point out the particularly rugged CPD energy landscape, suggesting that local search optimization methods should be designed and tuned to easily escape local minima attraction basins. In this paper, we analyze the performance and search dynamics of an iterated local search (ILS) algorithm enhanced with partition crossover. Our algorithm, PILS, quickly finds local minima and escapes their basins of attraction by solution perturbation. Additionally, the partition crossover operator exploits the structure of the residue interaction graph in order to efficiently mix solutions and find new unexplored basins. Our results on a benchmark of 30 proteins of various topology and size show that PILS consistently finds lower energy solutions compared to Rosetta fixbb and a classic ILS, and that the corresponding sequences are mostly closer to the native.

1. Almost all organisms grow in size during their lifetime and switch diets, trophic positions, and interacting partners as they grow. Such ontogenetic development introduces life-history stages and flows of biomass between the stages through growth and reproduction. However, current research on complex food webs rarely considers life-history stages. The few previously proposed methods do not take full advantage of the existing food web structural models that can produce realistic food web topologies. 2. We extended the niche model by Williams & Martinez (2000) to generate food webs that included trophic species with a life-history stage structure. Our method aggregated trophic species based on niche overlap to form a life-history structured population; therefore, it largely preserved the topological structure of food webs generated by the niche model. We applied the theory of allometric predator-prey body mass ratio and parameterized an allometric bioenergetic model augmented with biomass flow between stages via growth and reproduction to study the effects of a stage structure on the stability of food webs. 3. When life-history stages were linked via growth and reproduction, fewer food webs persisted while persisting food webs tended to retain more trophic species. Topological differences between persisting linked and unlinked food webs were small to modest. Temporal variability of biomass dynamics and slopes of biomass spectra were lower in the linked food webs than the unlinked ones, suggesting that a life-history stage structure enhanced stability of complex food webs. 4. Our results suggest a positive relationship between the complexity and stability of complex food webs. A life-history stage structure in food webs may play important roles in dynamics of and diversity in food webs.