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4 predicted 72-h mortality with a sensitivity of 79.31% and a specificity of 98.08% (area und the curve (AUC) = 0.94; p < 0.0001; MCCs = 0.81). The positive likelihood ratio was 41; the positive predictive value was 92.20%. Adrenal gland-to-spleen ratio was also best suited to predict the 24-h and overall mortality. ICCs of HU measurements in adrenal gland, IVC, and spleen indicated a high interrater agreement (ICC 0.95-0.99).
To conclude, the adrenal-to-spleen ratio in CT in portal venous phase may serve as an imaged-based predictor for short, intermediate, and overall mortality and as reproducible prognostic marker for patient outcome.
To conclude, the adrenal-to-spleen ratio in CT in portal venous phase may serve as an imaged-based predictor for short, intermediate, and overall mortality and as reproducible prognostic marker for patient outcome.
The objectives were to assess the skeletal age of patients with skeletal open bite and to estimate and compare the mean chronological age related to CS3 and CS4 (cervical stage, CS) and the duration of the pubertal growth spurt (PGS).
Orthodontic records of 145 patients were analyzed in this retrospective cross-sectional study. The study group comprised 104patients with skeletal open bite (angle between cranial base plane line [NS] and mandible base plane line [ML] > 39° according to Steiner), whereas the control group comprised 41patients with normal anteroposterior and vertical measurements. Skeletal age was assessed using the 6‑stage CVM (cervical vertebral maturation) method according to Baccetti. Quantitative variables were characterized by means of the arithmetic mean and standard deviation. The PGS duration was calculated as the difference between the means of the chronological ages related to CS3 and CS4.
In the study group, the arithmetic means related to CS3 and CS4 were 11.12and 13.54yearsl measurements. The PGS in males begins later than in females. Knowledge on the longer growth spurt in patients with skeletal open bite compared to patients with normal anteroposterior and vertical relationships can be useful in the selection of an appropriate therapeutic method and also provides information about the possibility of a longer and thus more effective orthopedic approach directed at positive change in the vertical growth pattern during intense bone remodeling.Early death in sepsis occurs frequently; however, specific causes are largely unknown. An autopsy can contribute to ascertain causes of death. The objective of the study was to determine discrepancies in clinical diagnosis and postmortem findings in septic intensive care unit (ICU) patients deceased within 48 h after ICU admission. All septic ICU patients who deceased within 48 h after ICU admission were identified and included. Four intensivists determined the clinical cause of death by medical record review. An autopsy was performed within 24 h of death. Clinical diagnosis and postmortem findings were compared and classified as autopsy-identified missed clinical diagnoses and autopsy-refuted diagnoses. Class I and II missed major diagnoses using the Goldman criteria were scored. Between 2012 and 2017, 1107 septic patients were admitted to ICU. Of these, 344 patients (31%) died, of which 97 patients (28%) deceased within 48 h. In 32 (33%) early deceased patients, an autopsy was agreed. There were 26 autopsy-identified missed clinical diagnoses found, mostly myocardial infarction (n = 4) and pneumonia (n = 4). In four patients (13%), a class I discrepancy was found. In fourteen patients (42%), a class II discrepancy was found. In conclusion, an autopsy is an important diagnostic tool that can identify definite causes of death. These diagnoses deviate from diagnoses established during admission in early deceased sepsis patients.This paper briefly summarizes the late-breaking session "Pathology and COVID-19" that took place at the virtual congress of the German Society of Pathology on June 6, 2020. The lectures tackled a broad variety of aspects, including the German Registry for COVID-19 autopsies (DeRegCOVID), the detection methods of SARS-CoV‑2 in pathological material, the typical lung findings in severe COVID-19 cases, the distinct (micro)vascular changes and the cardiac and gastrointestinal involvement in COVID-19. In summary, in this first scientific meeting in German pathology on the COVID-19 pandemic, it became clear that pathologists in Germany, Austria and Switzerland have reacted very quickly to the pandemic and have established an autopsy program that has led to medically highly relevant findings.The CT and MRI scans of a 70-year-old male patient revealed a mass in the pancreatic head and a 2.8-cm peripancreatic lymph node. Under steroid therapy the mass did not show regression. Finally, a pancreatoduodenectomy was performed. Histologically, Rosai-Dorfman disease (RDD) was diagnosed. RDD is a rare histiocytic disorder with usually nodal but sometimes also extranodal involvement. Herein we report a rare case of extranodal RDD with intrapancreatic localization.COVID-19 disease is a systemic inflammatory viral reaction starting with the viral phase followed by the inflammatory phase. The first phase is rather mild and asymptomatic with only a small subset of infected patients turning into the inflammatory phase with high mortality. Patients with pre-existing cardiovascular diseases and cardiovascular risk factors pose a considerably higher risk to develop severe or lethal COVID-19 disease course. COVID-19 affects not only the epithelial cells of the lung parenchyma via ACE2, but also endothelial cells across the whole body thus leading to generalized endothelial damage and inflammation, so-called endotheliitis. The histological morphology of endotheliitis comprises the accumulation of lymphocytes, plasma cells and macrophages beneath the endothelial cells and within the perivascular spaces. Endothelial cells play an important role in the regulation of vascular tone and the maintenance of vascular homeostasis. Endotheliitis thus can shift the vascular equilibrium towards more pronounced vasoconstriction with subsequent organ ischemia, inflammation with associated tissue edema and a procoagulant state. BAY-293 solubility dmso Patients with pre-existing endothelial dysfunction (male sex, smoking, hypertension, diabetes, obesity, and established cardiovascular disease) are particularly vulnerable and have adverse outcomes in COVID-19. This is a rationale for approaches to stabilize the endothelium. Most of these findings have been established from autopsies since the outbreak of the pandemic.
To evaluate the feasibility, safety and long-term efficacy of super-selective trans-catheter arterial embolization for the management of intractable bladder bleeding.
The records of 20 patients with intractable haematuria referred urgently for selective arterial embolization after failed conventional therapy, between 2013 and 2018, were retrospectively analyzed. Primary outcomes were technical (cessation of extravasation and/or stasis of flow within the target vessel) and clinical (bleeding control) success. Secondary outcomes included complication and re-intervention rates.
Technical success was 90% (18/20 cases), as in 2 cases, embolization was not feasible. Super-selective embolization of the vesical arteries was feasible in 15/18 cases (83.3%). Selective proximal occlusion of the anterior division of the internal iliac artery was performed in two cases (11%) and embolization of the anterior division after coil blockage of the posterior division was performed in one case (5%). Bilateral and unilaterabviate the need for emergency surgery.The Red Queen hypothesis depicts evolution as the continual struggle to adapt. link2 According to this hypothesis, new genes, especially those originating from nongenic sequences (i.e., de novo genes), are eliminated unless they evolve continually in adaptation to a changing environment. Here, we analyze two Drosophila de novo miRNAs that are expressed in a testis-specific manner with very high rates of evolution in their DNA sequence. We knocked out these miRNAs in two sibling species and investigated their contributions to different fitness components. We observed that the fitness contributions of miR-975 in Drosophila simulans seem positive, in contrast to its neutral contributions in D. melanogaster, whereas miR-983 appears to have negative contributions in both species, as the fitness of the knockout mutant increases. As predicted by the Red Queen hypothesis, the fitness difference of these de novo miRNAs indicates their different fates.
Sarcopenia, defined as a decline in both muscle mass and function, has been recognized as a major determinant of poor outcome in hemodialysis patients. It is generally assumed that sarcopenia is driven by muscle atrophy related to protein energy wasting. However, dynapenia, defined as weakness without atrophy, has been characterized by a different disease phenotype from sarcopenia. The aim of this study was to compare the characteristics and prognosis of sarcopenic and dynapenic patients among a prospective cohort of chronic haemodialysis (CHD) patients.
Two hundred and thirty two chronic haemodialysis patients were enrolled from January to July 2016 and then followed prospectively until December 2018. At inclusion, weakness and atrophy were respectively evaluated by maximal voluntary force (MVF) and creatinine index (CI). Sarcopenia was defined as the association of weakness and atrophy (MVF and CI below the median) while dynapenia was defined as weakness not related to atrophy (MVF below the median, andnPCR and dialysis vintage.
Screening for muscle functionality is highly warranted to identify patients with muscle functional impairment without muscle atrophy. By contrast to sarcopenia, dynapenia should appear as a phenotype induced by uremic milieu, characterized by young patients with low Charlson score and poor prognosis outcome independently of serum albumin, hs-CRP, haemoglobin, nPCR and dialysis vintage.Ultraconserved elements (UCEs) are stretches of hundreds of nucleotides with highly conserved cores flanked by variable regions. link3 Although the selective forces responsible for the preservation of UCEs are unknown, they are nonetheless believed to contain phylogenetically meaningful information from deep to shallow divergence events. Phylogenetic applications of UCEs assume the same degree of rate heterogeneity applies across the entire locus, including variable flanking regions. We present a Wright-Fisher model of selection on nucleotides (SelON) which includes the effects of mutation, drift, and spatially varying, stabilizing selection for an optimal nucleotide sequence. The SelON model assumes the strength of stabilizing selection follows a position-dependent Gaussian function whose exact shape can vary between UCEs. We evaluate SelON by comparing its performance to a simpler and spatially invariant GTR+Γ model using an empirical data set of 400 vertebrate UCEs used to determine the phylogenetic position of turtles. We observe much improvement in model fit of SelON over the GTR+Γ model, and support for turtles as sister to lepidosaurs. Overall, the UCE-specific parameters SelON estimates provide a compact way of quantifying the strength and variation in selection within and across UCEs. SelON can also be extended to include more realistic mapping functions between sequence and stabilizing selection as well as allow for greater levels of rate heterogeneity. By more explicitly modeling the nature of selection on UCEs, SelON and similar approaches can be used to better understand the biological mechanisms responsible for their preservation across highly divergent taxa and long evolutionary time scales.
