Cutaneous angiomatosis in a dog: a case report

A 1-year-old, castrated male mixed-breed dog presented with diffuse, purple lesions arranged in an irregular patchy pattern, with a slight elevation on the right hindlimb extending from the tarsus joint to the upper region of the thigh. Dermatological examinations and fungal and bacterial cultures revealed no infectious agents. The therapeutic response to antibiotics and antifungal agents was negative. A histopathology examination of the lesion revealed vascular proliferation with vasodilation and numerous varying-sized vessels. Mast-cell-dominated perivascular cuffing was also noted. The dog was diagnosed with cutaneous angiomatosis due to diffuse lesions and the histopathology findings of hemangioma.

Sarcoidosis with Rare Extrapulmonary Involvement

Sarcoidosis is a systemic granulomatous disease in which medullary involvement is a rare extrapulmonary manifestation. We present the case of a 37-year-old man with right abdominal and dorso-lumbar pain lasting for months. Computerized tomography showed renal microlithiasis and retroperitoneal, hilar and mediastinal adenopathies. Laboratory results showed an elevated erythrocyte sedimentation rate, IgG, ?2-microgobulin and angiotensin-conversion enzyme, serum calcium in the upper limit and hypercalciuria. There was a slight elevation of the CD4/CD8 ratio in bronchoalveolar lavage, without lymphocytic alveolitis. An endobronchial ganglion biopsy was inconclusive. A positron emission tomography scan demonstrated supra and infra-diaphragmatic, splenic and medullary involvement, suggesting lymphoproliferative disease (LPD). A bone marrow biopsy (BMB) revealed sarcoid-like epithelioid cell granulomas, excluding LPD. Sarcoidosis was assumed and corticosteroids were started. Although cytopenias were not present, the extensive ganglion, splenic and medullary involvement made LPD exclusion imperative, while BMB allowed for a definitive diagnosis.

Obtaining and characterizing microemulsion systems containing Alkali-Surfactant-Polymer (ASP) for advanced oil recovery application

Fluids in terms of rheological behavior can be classified into Newtonians and non-Newtonians. Newtonians are fluids that have unique and absolute viscosities, because the ratio between shear stress and shear rate is constant. In the oil industry, most fluids, such as microemulsions, oil and polymeric solutions, do not exhibit Newtonian behavior. To understand the behavior of chemical fluids, it is necessary to analyze some parameters to interpret their properties and applicability. In this context, the present work aims to obtain and characterize microemulsion systems containing Alkali, Surfactant, and Polymer, and verify their applicability in advanced oil recovery. Thus, we obtained five microemulsion systems consisting of saponified coconut oil (surfactant), Butan-1-ol (co-surfactant), kerosene (oil phase), Na2CO3 (alkali), water and different percentages of the polymer. The systems were characterized by analyzes of particle diameter, surface tension, viscosity and rheological behavior using mathematical models. Droplet sizes showed characteristic values of micellar aggregates. Surface tension presented a slight elevation when the percentage of polymer in the microemulsion increased. Through the rheological study, it was possible to observe that experimental values were better adjusted to the Ostwald-de Waele “power-law” model. As the percentage of polymer in the system increased, we calculated the apparent viscosity of the systems and observed an increasing change in viscosity values, a result of great interest to enhanced oil recovery studies.

Characteristics of Patients Meeting the New Definition of Pre-capillary Pulmonary Hypertension (Nice 2018) in a Single Japanese Pulmonary Hypertension Center

Background: The 6th World Symposium on Pulmonary Hypertension (Nice 2018) proposed a new definition of pre-capillary pulmonary hypertension (PH) as a condition with mean pulmonary artery pressure (mPAP) > 20 mmHg, pulmonary artery wedge pressure (PAWP) ≤ 15 mmHg, and pulmonary vascular resistance (PVR) ≥ 3 Wood units (WU). The characteristics and prognosis of patients with pre-capillary PH, according to this new definition, is unclear. Therefore, we determined the characteristics of patients with pre-capillary PH who had pulmonary vascular disease with slight elevation in mPAP.Methods: We retrospectively enrolled 683 patients who underwent their first right heart catheterization (RHC) at Chiba University, Japan. Among them, 489 patients met the pre-capillary PH requirement with mPAP ≥ 25 mmHg (conventional pre-capillary PH group), while 22 patients met the borderline pre-capillary PH criteria (borderline pre-capillary PH group). Results: The borderline pre-capillary PH group comprised 4.3% of the total pre-capillary PH patients, and the majority was in Group 3 (40.9%) or 4 (45.5%). The survival of the borderline pre-capillary PH group tended to be better than that of the conventional pre-capillary PH group. Conclusions: Pre-capillary PH patients, according to the Nice 2018 definition, comprised 4.3 % of the population with total pre-capillary PH and had better survival than the conventional PH pre-capillary group; moreover, the majority of the pre-capillary PH cases were either Group 3 and 4.

Alginate Oligosaccharides Alleviate the Damage of Rice Leaves Caused by Acid Rain and High Temperature

Alginate oligosaccharides (AOS) are known for functions in regulating plant growth and stress resistance. This study investigated the damage on rice leaves caused by acid rain (AR) and high temperature (HT) simultaneously, as well as the alleviating effect of AOS on these stresses. The results show that plant biomass and antioxidant enzyme activities (AEAs) after AR treatment reduced more severely under HT conditions than normal-temperature conditions. Both AR and HT triggered the accumulation of reactive oxygen species (ROS) in rice leaves. The suppressing effects of AR and HT were individual in most cases, except for AEAs. Microscopic analysis showed that pH 2 AR and HT injured leaf epidermis, particularly the bulliform cells, the veins and interveinal regions. Spraying AOS resulted in a slight elevation of biomass, a significant increase in AEAs and a remarkable decline in ROS concentrations under HT conditions with AR. Besides, the chlorophyll a contents of a leaf after pH 2 AR plus AOS treatment under HT conditions remained 66.1% of that after pH 7 treatment under normal-temperature conditions. Moreover, AOS protected the integrity of leaf tissue even after pH 3 treatment. Taken together, the above results suggest that AR and HT inhibited AEAs, led to the accumulation of ROS and damaged rice leaf. However, foliar applying AOS enhanced AEAs, scavenged ROS, and thus alleviated the stress induced by HT and AR.

Lower Leg Muscle Function: A Contributory Risk Factor of Gait and Balance Impairment after Six Minutes Walk among People with Multiple Sclerosis

Background/Purpose: Multiple sclerosis (MS) is a progressive neurological disease that results in increased fatigue, decreased muscle function, and impaired gait and balance. The purpose of this study was to evaluate the relationship between lower leg muscle function and changes in gait and balance immediately and 20 minutes after 6mins walk-induced fatigue. Methods: Six persons with MS (Patient-Determined Disease Steps 3-5) participated in the study. Perceived fatigue and demographic information were taken at baseline. Muscle fatigability and mitochondria capacity was measured in the lower leg muscles before walking. Reported fatigue (VAFS, 0-10), gait variability, gait asymmetry, and static balance were measured before and immediately after a self-paced 6 minutes treadmill walk with slight elevation, and after 20 minutes of rest. Results: Participant’s baseline MFIS score ranged from 14 - 71. There was a 173% increase in reported fatigue scores after walking. Gait was impaired with a ~26% increase in gait variability and ~40% increase in gait asymmetry immediately after walking (Cohen’s D = 0.4, 0.3 respectively). There was also ~69% increase in balance postural sway with eyes opened and a ~20% increase with eyes closed (Cohen’s D = 0.5, 0.2 respectively). Gait and balance remained impaired after 20 minutes of rest. The decline in gait parameters after walking had a negative correlation with muscle endurance (r=-0.80, p=0.03), and mitochondrial capacity (r=-0.92, p<0.01). The changes in gait and balance were more evident in participants with a higher disability. Conclusions: Six minutes of self-paced walking with slight elevation worsened gait and balance among people with MS (PwMS), which did not completely recover after 20 minutes of rest. The changes in gait after walking were associated with lower leg muscle function. Lower leg muscle function might be an important intervention target to improve gait and balance fall risk among PwMS.

Elsberg Syndrome

Context: Elsberg Syndrome (ES) is a rare syndrome associated with acute or subacute infections, often accompanied by myelitis confined to the lower spinal cord, in addition to paresthesia, weakness in the lower limbs, urinary retention, constipation, among others. It is a self-limiting disease, manifested through primary HSV type 2 infection, especially in immunocompetent patients. Case report: Male patient J.F.C., 58 years old, reports a sudden paresthesia in the lower limbs without other associated clinical conditions for approximately 2 months that progressed to paresis, cramps and loss of sphincter control. Admitted to the General Hospital of Palmas, Tocantins on 02/18/2020 with suspicion of Peripheral Polyneuropathy that was discarded after electroneuromyography. Imaging exams without relevant findings. After a week of hospitalization, multiple lesions appeared in the region of the lower third of the dorsum and buttocks, compatible with lesions by HSV (herpes simplex virus) and the diagnosis of ES was concluded. At the moment, he was undergoing treatment with acyclovir and awaiting the evolution of the condition. Conclusion: ES is an often unrecognized cause of lumbosacral radiculitis, which is why it is important to establish as a diagnosis differential. The analysis of CSF, PCR and MRI confirm the diagnosis in cases of HSV-2 lumbosacral radiculomyelitis. CSF usually reveals a lymphocytic pleocytosis and a slight elevation of proteins.

Temperature Gradient Evolution (∆t) and Glycaemia as Complementary Parameters for Diagnosis and Treatment Monitoring of Glucose Metabolism Disorders

Background: Anaesthesia and surgical interventions cause significant changes in body temperature and glycaemia control in human and in animals. Different measures were successfully applied to counter these changes. On the other hand, the treatment of acute or chronic glucose metabolism disorders based only on the evolution of serum glucose is not entirely satisfactory, using a device (ADD/) to measure the evolution of core/ deep and surface body temperatures and their difference (∆t), we investigated the relation between ∆t and glycaemia during anaesthesia in healthy and diabetic animals (rats) and during surgical operations in humans. Therefore, we followed the spontaneous evolution of glycaemia and body temperatures during anaesthesia and surgical stress, with or without interventions (insulin and glucose perfusion) to verify/justify the possibility of the intervention monitoring following ∆t evolution. Methods: Fifty two Wistar rats were used, 26 as controls and 26 with an experimental diabetes induced with streptozotocin to investigate the effect of anaesthesia and surgical stress alone. Another group of 26 Wistar rats were used in the same conditions plus insulin and glucose intravenous injection. The experiments were conducted in standard conditions of room temperature. After anaesthetics administration glycaemia was measured every 15-30min. Deep and superficial temperatures and their difference ΔT were registered continuously using an ADD device. Results: In intact anaesthetized animals after a slight elevation during the first 30 minutes, glycaemia decreased regularly with time during anaesthesia body temperature gradient (∆t) absolute values depended on the position of the temperature sensors and on ambient temperature, but their evolution was the same: slight initial decrease, stabilization and slight elevation before waking. Correlation between the two parameters was not evident. Thoracic surgery caused a more pronounced temperature decrease and glycaemia changes than anaesthesia alone (∆t not measured). In diabetic animals, as a rule glycaemia remained high during the operation time, the variations of ∆t values were more important and prolonged, as a rule ∆t was lower in diabetic animals than in healthy ones. Correlation with glycaemia could not be detected. Comparison between investigation results in animals before and after diabetes induction has pointed the important differences due to the disease and confirmed that ∆t reactions always preceded glycaemia ones) that explain the absence of correlation between these parameters). In all the series anaesthetic overdose could cause a temporary negative ∆t even in presence of normo- or hyperglycaemia. Ambient temperature elevation >30°C during the sessions caused an increase of all investigated features absolute values but none of their evolution. Taking into account the quick reaction of ∆t to modifications of external and internal conditions, monitoring glycaemia disorders by balanced insulin and glucose intravenous injection guided by ∆t evolution was tried with positive encouraging results. Clinical observations were added which results were close to the experimental ones, as well when concerning the influence of external (temperature) and internal (anaesthesia), metabolic factors, as when confirm possibility of monitoring insulin administration with energetic feedback. Conclusion: This study confirms that stress, ambient temperature and anaesthesia can alter both glycaemia and body temperature evolution, and that more profoundly in diabetes. It has shown a high sensibility of ∆t to the metabolic changes due to these factors. It ought to allow a valuable algorithm elaboration for glucose and insulin administration in automatic monitoring of energetic balance by a new ADD-CIGT device.

Severe 2019 novel coronavirus pneumonia may cause lung bullae and bronchiectasis: A case report and concise literature review

Most of the critically ill novel coronavirus 2019 pneumonia (NCP) patients progress promptly, and soon match the ARDS diagnostic criteria. When mechanical ventilation and prone position cannot reverse the fatal hypoxia—extra-corporeal-membrane-oxygenation (ECMO) will be applied as a salvage treatment if available. Here, we report a novel coronavirus 2019 pneumonia (NCP) patient, a male, 67 years old, who was treated with ECMO for 30 days. In the midst, bronchoscopy was utilized to comprehend the airway lesions and clear secretions. And computed tomography (CT) scans were performed before and after the treatment of ECMO. In the recovering phase of his disease, the patient experienced multiple times pneumothorax on both sides. Some newly developed lung bullae in the subpleural area and modest bronchiectasis were found by the CT scan. The newly developed lung bullae was the probable cause of pneumothorax. Notably, in the whole process of his illness, the serum IL-6 only had a slight elevation in the early period, there is no typical cytokine storm as that was seen in non-COVID-19 ARDS. After 3-months meticulous treatment, the patient made a full recovery and now is discharged from our hospital. Though COVID-19 may not cause typical cytokine storm, the inflammation in lung may inflict severe damage to lung. Severe NCP may cause lung bullae and bronchiectasis, making the patients hard to be weaned from mechanical ventilation or ECMO.

Continuous Maternal Hemodynamics Monitoring at Delivery Using a Novel, Noninvasive, Wireless, PPG-Based Sensor

Objective: To evaluate continuous monitoring of maternal hemodynamics during labor and delivery utilizing an innovative, noninvasive, reflective photoplethysmography-based device. Study design: The Biobeat Monitoring Platform includes a wearable wristwatch monitor that automatically samples cardiac output (CO), blood pressure (BP), stroke volume (SV), systemic vascular resistance (SVR), heart rate (HR) every 5 s and uploads all data to a smartphone-based app and to a data cloud, enabling remote patient monitoring and analysis of data. Low-risk parturients at term, carrying singletons pregnancies, were recruited at early delivery prior to the active phase. Big data analysis of the collected data was performed using the Power BI analysis tool (Microsoft). Next, data were normalized to visual presentation using Excel Data Analysis and the regression tool. Average measurements were compared before and after rupture of membranes, epidural anesthesia, fetal delivery, and placental expulsion. Results: Eighty-one parturients entered analysis. Epidural anesthesia was associated with a slight elevation in CO (5.5 vs. 5.6, L/min, 10 min before and after EA, p < 0.05) attributed to a non-significant increase in both HR and SV. BP remained stable as of counter decrease in SVR (1361 vs. 1319 mmHg⋅min⋅mL−1, 10 min before and after EA, p < 0.05). Fetal delivery was associated with a peak in CO after which it rapidly declined (6.0 vs. 7.2 vs. 6.1 L/min, 30 min before vs. point of delivery vs. after delivery, p < 0.05). The mean BP remained stable throughout delivery with a slight increase at fetal delivery (92 vs. 95 vs. 92.1 mmHg, p < 0.05), reflecting the increase in CO and decrease in SVR (1284 vs. 1112 vs. 1280 mmHg⋅min⋅mL−1, p < 0.05)with delivery. Placental expulsion was associated with a second peak in CO and decrease in SVR. Conclusions: We presented a novel application of noninvasive hemodynamic maternal monitoring throughout labor and delivery for both research and clinical use.