Radiation of the coralline red algae (Corallinophycidae, Rhodophyta) crown group as inferred from a multilocus time-calibrated phylogeny.

The subclass Corallinophycidae is the only group of red algae characterized by the presence of calcite crystals in their cell walls. Except for the Rhodogorgonales, the remaining orders - collectively called corallines - are diverse and widely distributed, having calcified cell walls and highly variable morphology. Corallines constitute the group with the richest fossil record among marine algae. In the present study, we investigate the evolutionary history of the subclass Corallinophycidae and provide a time-calibrated phylogeny to date the radiation of the crown group and its main lineages. We use a multi-locus dataset with an extensive taxon sampling and comprehensive collection of fossil records, carefully assigned to corallines, to reconstruct a time-calibrated phylogeny of this subclass. Our molecular clock analyses suggest that the onset of crown group diversification of Corallinophycidae started in the Lower Jurassic and sped up in the Lower Cretaceous. The divergence time of the oldest order Sporolithales is estimated in the Lower Cretaceous followed by the remaining orders. We discuss the long period of more than 300 million years between the early Paleozoic records attributed to the stem group of Corallinophycidae and the radiation of the crown group. Our inferred phylogeny yields three highly-supported suprageneric lineages for the order Corallinales; we confirm the family Mastophoraceae and amend circumscription of the families Corallinaceae and Lithophyllaceae. These three families are distinguished by a combination of vegetative and reproductive features. In light of the phylogeny, we discuss the evolutionary trends of eleven morphological characters. In addition, we also highlight homoplasious characters and selected autapomorphies emerging in particular taxa.

Round opacity as a presentation of pneumocystis jirovecii pneumonia in an HIV-infected patient.

We present the case of a human immunodeficiency virus (HIV)-infected patient who arrived at our emergency department with fever, headache and exertional dyspnea. Throughout their stay, a chest x-ray was taken and a rounded opacity in his left lung was observed. CT images showed same abnormality and also ground glass opacities were seen. Symptoms and images strongly suggested a pulmonary infection due to pneumocystis jirovecii, however a presence of a round lesion should always lead to neoplasia being suspected. We empirically started treatment based on trimethoprim and sulfamethoxazole. Once available, flexible bronchoscopy and bronchoalveolar lavage was performed and stained preparations from his respiratory specimens confirmed the diagnosis of pulmonary pneumocystis infection. Finally, after 4 days of antibiotic therapy, an important clinical improvement was documented; a new chest x-ray was performed and the previous rounded opacity was absent. This finding strongly suggested a case of round pneumonia.

Timing of the evolutionary history of Corallinaceae (Corallinales, Rhodophyta).

The temporal dimension of the most recent Corallinaceae (order Corallinales) phylogeny was presented here, based on first occurrence time estimates from the fossil record. Calibration of the molecular clock of the genetic marker SSU entailed a separation of Corallinales from Hapalidiales in the Albian (Early Cretaceous ~105 mya). Neither the calibration nor the fossil record resolved the succession of appearance of the first three emerging subfamilies: Mastophoroideae, Corallinoideae, and Neogoniolithoideae. The development of the tetra/bisporangial conceptacle roofs by filaments surrounding and interspersed among the sporangial initials was an evolutionary novelty emerging at the Cretaceous-Paleogene boundary (~66 mya). This novelty was shared by the subfamilies Hydrolithoideae, Metagoniolithoideae, and Lithophylloideae, which diverged in the early Paleogene. Subclades within the Metagoniolithoideae and Lithophylloideae diversified in the late Oligocene-middle Miocene (~28-12 mya). The most common reef corallinaceans (Hydrolithon, Porolithon, Harveylithon, "Pneophyllum" conicum, and subclades within Lithophylloideae) appeared in this interval in the Indo-Australian Archipelago.

Levelling-up rhodolith-bed science to address global-scale conservation challenges.

Global marine conservation remains fractured by an imbalance in research efforts and policy actions, limiting progression towards sustainability. Rhodolith beds represent a prime example, as they have ecological importance on a global scale, provide a wealth of ecosystem functions and services, including biodiversity provision and potential climate change mitigation, but remain disproportionately understudied, compared to other coastal ecosystems (tropical coral reefs, kelp forests, mangroves, seagrasses). Although rhodolith beds have gained some recognition, as important and sensitive habitats at national/regional levels during the last decade, there is still a notable lack of information and, consequently, specific conservation efforts. We argue that the lack of information about these habitats, and the significant ecosystem services they provide, is hindering the development of effective conservation measures and limiting wider marine conservation success. This is becoming a pressing issue, considering the multiple severe pressures and threats these habitats are exposed to (e.g., pollution, fishing activities, climate change), which may lead to an erosion of their ecological function and ecosystem services. By synthesizing the current knowledge, we provide arguments to highlight the importance and urgency of levelling-up research efforts focused on rhodolith beds, combating rhodolith bed degradation and avoiding the loss of associated biodiversity, thus ensuring the sustainability of future conservation programs.

A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults.

Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.

Epiphytes provide micro-scale refuge from ocean acidification.

Coralline algae, a major calcifying component of coastal shallow water communities, have been shown to be one of the more vulnerable taxonomic groups to ocean acidification (OA). Under OA, the interaction between corallines and epiphytes was previously described as both positive and negative. We hypothesized that the photosynthetic activity and the complex structure of non-calcifying epiphytic algae that grow on corallines ameliorate the chemical microenvironmental conditions around them, providing protection from OA. Using mesocosm and microsensor experiments, we showed that the widespread coralline Ellisolandia elongata is less susceptible to the detrimental effects of OA when covered with non-calcifying epiphytic algae, and its diffusive boundary layer is thicker than when not covered by epiphytes. By modifying the microenvironmental carbonate chemistry, epiphytes, facilitated by OA, create micro-scale shield (and refuge) with more basic conditions that may allow the persistence of corallines associated with them during acidified conditions. Such ecological refugia could also assist corallines under near-future anthropogenic OA conditions.

Pulmonary Ultrasound and Diaphragmatic Shortening Fraction Combined Analysis for Extubation-Failure-Prediction in Critical Care Patients.

INTRODUCTION: Invasive respiratory support is a cornerstone of Critical Care Medicine, however, protocols for withdrawal of mechanical ventilation are still far from perfect. Failure to extubation occurs in up to 20% of patients, despite a successful spontaneous breathing trial (SBT). METHODS: We prospectively included ventilated patients admitted to medical and surgical intensive care unit in a university hospital in northern Mexico. At the end of a successful SBT, we measured diaphragmatic shortening fraction (DSF) by the formula: diaphragmatic thickness at the end of inspiration - diaphragmatic thickness at the end of expiration/diaphragmatic thickness at the end of expiration×100, and the presence of B-lines in five regions of the right and left lung. The primary objective was to determine whether analysis of DSF combined with pulmonary ultrasound improves prediction of extubation failure. RESULTS: Eighty-two patients were included, 24 (29.2%) failed to extubation. At univariate analysis, DSF (Youden's J: >30% [sensibility and specificity 62 and 50%, respectively]) and number of B-lines regions (Youden's J: >1 zone [sensibility and specificity 66 and 92%, respectively]) were significant related to extubation failure (area under the curve 0.66 [0.52-0.80] and 0.81 [0.70-0.93], respectively). At the binomial logistic regression, only the number of B-lines regions remains significantly related to extubation failure (OR 5.91 [2.33-14.98], P<.001). CONCLUSION: In patients with a successfully SBT, the absence of B-lines significantly decreases the probability of extubation failure. Diaphragmatic shortening fraction analysis does not add predictive power over the use of pulmonary ultrasound.

Non-anesthesiologist-administered Propofol is not Related to an Increase in Transcutaneous CO2 Pressure During Flexible Bronchoscopy Compared to Guideline-based Sedation: A Randomized Controlled Trial.

INTRODUCTION: Evidence for the use of non-anesthesiologist-administered propofol for sedation during flexible bronchoscopy is scarce. The main objective of this study was to determine whether non-anesthesiologist-administered propofol balanced sedation was related to higher transcutaneous CO2 pressure compared with current guideline-based sedation (combination midazolam and opioid). Secondary outcomes were post-procedural recuperation time, patient satisfaction and frequency of adverse events. METHODS: In this randomized controlled trial we included data from outpatients aged 18 years or older with an indication for flexible bronchoscopy in a university hospital in northern Mexico. RESULTS: Ninety-one patients were included: 42 in the midazolam group and 49 in the propofol group. During 60min of transcutaneous capnometry monitoring, mean transcutaneous CO2 pressure values did not differ significantly between groups (43.6 [7.5] vs. 45.6 [9.6]mmHg, P=.281). Propofol was related with a high Aldrete score at 5, 10, and 15min after flexible bronchoscopy (9 [IQR 6-10] vs. 10 [9,10], P=.006; 9 [8-10] vs. 10 [IQR 10-10], P<.001 and 10 [IQR 9-10] vs. 10 [10], respectively) and with high patient satisfaction on a visual analogue scale of 1 (not satisfied) to 10 (very satisfied) (8.41 [1.25] vs. 8.97 [0.98], P=.03). Frequency of adverse events was similar among groups (30.9% vs. 22.4%, P=.47). CONCLUSION: Compared with guideline-recommended sedation, non-anesthesiologist-administered propofol balanced sedation is not associated with higher transcutaneous CO2 pressure or with more frequent adverse effects. Propofol use is associated with faster sedation recovery and with high patient satisfaction. CLINICAL TRIAL REGISTRATION: NCT02820051.

Atrial fibrillation in an asthmatic patient with albuterol-induced lactic acidosis.

Asthma is a highly prevalent chronic respiratory disease affecting millions of people worldwide. Short-acting beta 2-agonists induce bronchodilation and usually are prescribed as a rescue medication. They are recognized as a cause of hyperlactatemia and, less frequently, lactic acidosis. Short-acting beta 2-agonists are also known for their potentially adverse cardiovascular effects, such as atrial fibrillation. Differential diagnosis and subsequent treatment of the latter entity are important due to the adverse prognosis related to it. In this case report, we describe the unusual association between albuterol-induced lactic acidosis and atrial fibrillation in a patient with an asthma exacerbation.

Eosinophil count at intensive care unit admission was not predictor of hospital mortality: results of a case control study.

BACKGROUND: Predicting mortality in the intensive care unit (ICU) is one of the biggest challenges in critical care medicine. Several studies have linked the presence of eosinopenia with adverse outcomes in different populations. METHODS: We performed a case control study to determine whether the eosinophil count at ICU admission was a predictor of hospital mortality. We included data from patients 18 years or older admitted to the medical or surgical ICU in a university hospital in northern of Mexico. Medical records of 86 non-survivors (cases) and 99 discharged alive patients (controls) were randomly reviewed; clinical records of patients with an ICU stay of less than 24 h and those whose information was incomplete were excluded. RESULTS: Median of eosinophil count at ICU admission was 0.013 (interquartile range (IQR) 0.00 to 0.57) K/µL. There was no significant statistical difference in eosinophils at admission between survivors and non-survivors (0.014 [IQR 0.00 to 0.36] vs. 0.010 [IQR 0.00 to 0.57] K/µL, P = 0.35). In the multivariate analysis, APACHE II score at ICU admission and discharge were the only mortality predictors. Survivors had a significantly greater increase in eosinophil count during the first 7 days of ICU stay (0.104 [IQR -0.64 to 0.41] vs. 0.005 [IQR -1.79 to 0.43] K/µL, P = 0.004). CONCLUSIONS: In our study, eosinophil count at ICU admission was not associated with increased hospital mortality. The larger increase in number of eosinophils observed during the first week of ICU stay in surviving patients deserves to be investigated further.

ANALYSIS OF ANCIENT DNA FROM FOSSIL CORALLINES (CORALLINALES, RHODOPHYTA)(1).

The field of molecular paleontology has recently made significant contributions to anthropology and biology. Hundreds of ancient DNA studies have been published, but none has targeted fossil coralline algae. Using regions of the SSU gene, we analyzed rDNA from fossil coralline algae of varying ages and states of preservation from Spain, Papua New Guinea (PNG), and the Great Barrier Reef (GBR). Specimens from PNG, GBR, and some localities from Spain did not contain endogenous ancient DNA. Reproducible sequence data were obtained from specimens ∼550 years old from near Cadiz, Spain, and from rocky-shore deposits in Carboneras, Almeria Province of Spain (∼78,000 years before present [YBP]). Based on BLAST searches and a phylogenetic analysis of sequences, an undescribed coralline alga belonging to the Melobesioideae was discovered in the Carboneras material as well as the following coralline genera: Jania, Lithophyllum, Lithothamnion, Mesophyllum, and Phymatolithon. DNA from fleshy brown and red macroalgae was also discovered in the specimens from Carboneras. The coralline algae identified using molecular techniques were in agreement with those based on morphological methods. The identified taxa are common in the present-day southeastern Spain littoral zone. Amino acid racemization, concentration ratios, and specific concentrations failed to show a correlation between biomolecular preservation and PCR amplification success. Results suggest that molecular investigations on fossil algae, although limited by technical difficulties, are feasible. Validity of our results was established using authentication criteria and a self-critical approach to compliance.

Pectus excavatum in an English Bulldog male: a case report / Pectus excavatum en un Bulldog Inglés: reporte de caso / Pectus excavatum num Bulldog Inglés: registro de caso

El Pectus excavatum (PE) es una deformación de la caja torácica por crecimiento anómalo del esternón y costocartílagos que recae en una depresión condroesterna. Esta anormalidad anatómica (PE) se adquiere durante la vida intrauterina, y puede ser el resultado de expresiones genómicas heredables, acortamiento del tendón central del diafragma, anormalidades en la presión intrauterina y deficiencia congénita de la musculatura en la porción craneal del diafragma. En este caso se presenta un paciente Bulldog inglés macho de 30 días de edad con alteración en el sistema respiratorio, debilidad, adinamia, taquipnea, rinorrea blanquecina, con una marcada depresión del esternón y del arco costal, confirmando por estudio radiográfico de tórax y por necropsia la presencia de un PE. Con este reporte se pretende describir esta patología en un caso clínico y contribuir al conocimiento clínico de la enfermedad, ya que las descripciones publicadas de dicha enfermedad en nuestro país son escazas.

Pectus excavatum (PE) is a thoracic wall deformity due to an anomalous growth of sternum and costal cartilages wich relapse on a condroesternal depression. This anatomical abnormality gets acquired into the uterus, and may be the result of heritable genetic expressions, such as the shortening the central tendon of the diaphragm, abnormalities in the intrauterina pressure and congenital deficiency of the musculature in the cranial portion of the diaphragm. This report illustrates the case of a 30 days English bulldog male patient which suffer of alterations in the respiratory system, weakness, adynamia, tachypnea, whitish rhinorrhea, and which has a marked depression of the sternum and rib; the presence of PE was confirmed by chest X-ray and by necropsy. The purpose of this report is to describe this sickness in a particular case and contribute to clinical knowledge of PE, since published descriptions of this condition in our country are scarce.condition in our country are scarce.

O Pectus excavatum (PE) é uma deformação da caixa torácica por crescimento anormal do esterno e cartilagens que cai numa depressão condroesternal. Esta anormalidade anatômica (PE) é adquirida durante a vida intra-uterina, e pode ser o resultado de expressões genômicas herdáveis, encurtamento do tendão central do diafragma, anormalidades na pressão intra-uterina e deficiência congênita da musculatura na porção craniana do diafragma. Neste caso se apresenta um paciente Bulldog inglês macho de 30 dias de idade com alteração no sistema respiratório, fraqueza, adinamia, taquipnéia, rinorréia blanquecina, com uma marcada depressão do esterno e do arco costal, confirmando por estudo radiográfico de tórax e por necropsia a presença de um PE. Com este registro se pretende descrever esta patologia num caso clínico e contribuir ao conhecimento clínico da doença, já que as descrições publicadas dessa doença em nosso país são escassas.