Progression and Resolution of a Post-traumatic Pleurocutaneous Fistula.

Pleurocutaneous fistula (PCF) is a pathological communication between the pleural space and subcutaneous tissue. This rare condition occurs as a complication of infection, malignancy, and therapeutic procedures such as tube thoracostomies. PCF is typically confirmed with computed tomography (CT) imaging. There is no current literature describing the post-traumatic causes of PCF. We describe a PCF related to multiple rib fractures and its rapid improvement following the placement of a chest tube. This case emphasizes the importance of prompt CT imaging in trauma patients and radiographically illustrates the progression and resolution of a post-traumatic PCF.

Gastric Ulcer Secondary to Left Gastric Artery Thrombosis.

Peptic ulcer disease (PUD) is a well-known and commonly encountered gastrointestinal (GI) pathology. Helicobacter pylori and nonsteroidal anti-inflammatory drug (NSAID) use are the cause of the majority of PUD cases, although other rare etiologies may be encountered. PUD is confirmed by endoscopic visualization of gastric ulcers, with radiographic imaging being less impactful in diagnosis. In this paper, we present a middle-aged patient who presented with PUD caused by thrombotic occlusion of the left gastric artery (LGA), with her diagnosis being made with computed tomography (CT) imaging prior to endoscopy. This case emphasizes the importance of radiographic imaging in the undifferentiated patient, as well as the unique role radiologists play in both discovering diagnoses and their etiologies.

Ultrasound-guided percutaneous coil and thrombin embolization of a left gastric artery pseudoaneurysm.

Pseudoaneurysms are a commonly encountered pathology, though pseudoaneurysms of the visceral arteries are a less frequent, but potentially deadly entity. Transarterial embolization is the typical treatment of visceral pseudoaneurysms, but success is dependent on anatomy that is conducive to selecting the supplying vessel. Abdominal ultrasound is a viable method to effectively treat visceral pseudoaneurysms when transarterial embolization is not possible. It is also an excellent example of the growing utilization of ultrasound guidance in various interventional radiologic procedures. The usefulness of ultrasound is demonstrated in this case report, where a left gastric artery pseudoaneurysm was embolized through ultrasound guidance.

Heroin Inhalation Leukoencephalopathy: An Overlooked Entity in the Opioid Epidemic.

Heroin inhalation leukoencephalopathy (HIL) is a rare complication of vaporized heroin inhalation leading to white matter degeneration resulting in a range of neurologic disturbances including softened speech, cerebellar ataxia, behavioral changes, cerebellar gait abnormalities, and even respiratory failure resulting in death in the most severe cases. Magnetic resonance imaging (MRI) most commonly demonstrates bilateral hyperintensities affecting the basal ganglia, periventricular white matter, and cerebellum. In this case report, we present a relatively mild case of HIL in a young female patient to describe the characteristic challenges associated with the condition's presentation, diagnosis, and treatment. While healthcare workers everywhere are addressing a complex and ever-changing opioid epidemic, we strive to raise awareness about HIL as only one of a variety of complications resulting from opioid use disorder.

Common Pathology With Atypical Presentation: Acute Cholangitis.

Acute cholangitis is a well-known biliary tree pathology most often encountered in patients with gallstone disease. When left untreated, acute cholangitis can lead to severe complications, including death. Therefore, identifying and properly treating acute cholangitis is crucial to avoiding such complications. This paper describes an 84-year-old female patient with acute cholangitis who presented with atypical symptoms of chest pain and cough. The patient was successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), antibiotics, and ursodeoxycholic acid. We focus on this patient's unique presentation to highlight the low incidence of Charcot's triad and Reynold's pentad in elderly patients and to emphasize the importance of formulating a broad differential in patients with non-specific symptoms.

Gastric Outlet Obstruction Caused by Acute Gastric Volvulus: A Rare Complication of Hiatal Hernia.

Hiatal hernias are commonly encountered in elderly patients, predisposing patients to the common condition of gastroesophageal reflux disease (GERD). Depending on the size of the hernia, different complications can arise. Large hernias can lead to development of gastric volvulus, obstruction, strangulation, and perforation. Therefore, management of large hiatal hernias is crucial to avoid such complications. In this paper, we describe a patient who presented with acute gastric volvulus secondary to a large hiatal hernia. She improved with conservative management and subsequently underwent successful repair of the hernia. We emphasized the importance of identifying gastric volvulus among its vague presentation for prompt management.

Assessing temperature-based adaptation limits to climate change of temperate perennial fruit crops.

Temperate perennial fruit and nut trees play varying roles in world food diversity-providing edible oils and micronutrient, energy, and protein dense foods. In addition, perennials reuse significant amounts of biomass each year providing a unique resilience. But they also have a unique sensitivity to seasonal temperatures, requiring a period of dormancy for successful growing season production. This paper takes a global view of five temperate tree fruit crops-apples, cherries, almonds, olives, and grapes-and assesses the effects of future temperature changes on thermal suitability. It uses climate data from five earth system models for two CMIP6 climate scenarios and temperature-related indices of stress to indicate potential future areas where crops cannot be grown and highlight potential new suitable regions. The loss of currently suitable areas and new additions in new locations varies by scenario. In the southern hemisphere (SH), end-century (2081-2100) suitable areas under the SSP 5-8.5 scenario decline by more than 40% compared to a recent historical period (1991-2010). In the northern hemisphere (NH) suitability increases by 20% to almost 60%. With SSP1-2.6, however, the changes are much smaller with SH area declining by about 25% and NH increasing by about 10%. The results suggest substantial restructuring of global production for these crops. Essentially, climate change shifts temperature-suitable locations toward higher latitudes. In the SH, most of the historically suitable areas were already at the southern end of the landmass limiting opportunities for adaptation. If breeding efforts can bring chilling requirements for the major cultivars closer to that currently seen in some cultivars, suitable areas at the end of the century are greater, but higher summer temperatures offset the extent. The high value of fruit crops provides adaptation opportunities such as cultivar selection, canopy cooling using sprinklers, shade netting, and precision irrigation.

Determining the ecophysiological limits of a narrow niche tropical conifer tree (Podocarpus trinitensis).

Many tropical species live close to their thermal limits within a narrow niche. Here, we investigate the ecophysiological limits of the tropical tree Podocarpus trinitensis, which is endemic to Trinidad and Tobago where most populations exist as isolated stands on hilltops. Five wild stands from a range of elevations were compared in the field with measurements of leaf temperature, canopy cover, stomatal conductance (gs), chlorophyll content and several chlorophyll fluorescence parameters. A parallel greenhouse experiment was used to acclimate seedlings to 'CONTROL' and 'HEAT' treatments (with mid-day air temperatures of 34.5 and 37 °C respectively), after which the above parameters were measured along with photosynthetic light and temperature response curves, leaf morphology and in vitro Fv/Fm thermostability. There was a positive association between improved physiological performance and elevation. In the high elevation sites, leaf temperatures were significantly lower while most of the physiological parameters were higher (gs, chlorophyll content, ɸ PSII, ETRmax and Isat90). In the greenhouse, HEAT and CONTROL plants were similar for most parameters, except leaf temperature (which was coupled with air temperature) and leaf mass per unit area (which was higher in HEAT plants). Temperature response curves showed an optimum temperature for photosynthesis of 30 ± 0.5 °C (TOpt) and in vitro Fv/Fm indicated a critical temperature of 47.4 ± 0.38 °C for HEAT and 48.2 ± 0.24 °C for CONTROL (T50), with no indication of heat acclimation. Podocarpus trinitensis was found to be shade tolerant. In the field, seedlings established under a close canopy (>95% canopy cover) and had a low light saturation point (LCP). In the greenhouse, where more light was available, seedlings retained a low light compensation point, light saturation point (LSP) and maximum photosynthetic rate (Amax). The results suggest that P. trinitensis is moderately heat tolerant with the higher elevation sites being more habitable, but stands are also able to survive near sea level under a closed canopy. The narrow niche, along with the 30 ± 0.5 °C optimum temperature for photosynthesis and the lack of thermal plasticity in critical temperature, suggests that P. trinitensis has little room to acclimate to temperatures higher than those currently experienced.

A global dataset for the projected impacts of climate change on four major crops.

Reliable estimates of the impacts of climate change on crop production are critical for assessing the sustainability of food systems. Global, regional, and site-specific crop simulation studies have been conducted for nearly four decades, representing valuable sources of information for climate change impact assessments. However, the wealth of data produced by these studies has not been made publicly available. Here, we develop a global dataset by consolidating previously published meta-analyses and data collected through a new literature search covering recent crop simulations. The new global dataset builds on 8703 simulations from 202 studies published between 1984 and 2020. It contains projected yields of four major crops (maize, rice, soybean, and wheat) in 91 countries under major emission scenarios for the 21st century, with and without adaptation measures, along with geographical coordinates, current temperature and precipitation levels, projected temperature and precipitation changes. This dataset provides a solid basis for a quantitative assessment of the impacts of climate change on crop production and will facilitate the rapidly developing data-driven machine learning applications.

Genetic variation in high light responses of Theobroma cacao L. accessions.

Cacao (Theobroma cacao L.) is a shade-tolerant tree species, but in recent years it has increasingly been cultivated under full sun conditions in an orchard system where photoinhibition is likely. Here we investigate the extent of photoinhibition in 17 cacao accessions from a range of genetic groups, growing under high light conditions. The ability of the photosynthetic systems to respond to high light was assessed using chlorophyll fluorescence parameters (diurnal F v /F m and instantaneous light response curves), and differences in photosynthetic pigment content were compared using biochemical assays. Damage due to photoinhibition was assessed using electrolyte leakage, lipid peroxidation, and reactive oxygen species scavenging systems were compared using biochemical assays (for APX, CAT and SOD). There was significant variation between the 17 accessions for photosynthetic parameters, although in all cases the light saturation points were well below the midday light levels. Light acclimation of photosynthetic pigments was evident and variation in the total chlorophyll to total carotenoid ratio was significantly correlated with electrolyte leakage. Significant genetic variation was observed across the 17 accessions in the activities of CAT, APX and SOD. Across all accessions, photoprotection appeared to be restricted by the ability of leaves to generate SOD. Significant negative correlations were observed between SOD activity and both APX activity and electrolyte leakage, while significant positive correlations were observed between electrolyte leakage and both APX and CAT activity. Accessions with higher light saturation points, as well as high carotenoid and high SOD concentrations were able to tolerate the moderately high light, however, none of the accessions were clearly superior to the commonly grown Amelonado accession. The results imply that screening for SOD activity, total carotenoid content and light saturation point can aid in selection of genotypes with better tolerance to high light.

Human Breast Milk-Derived Extracellular Vesicles in the Protection Against Experimental Necrotizing Enterocolitis.

PURPOSE: Necrotizing enterocolitis (NEC) is a leading cause of death in premature infants. Breast feeding decreases the incidence of NEC but, even with aggressive promotion of nursing in Neonatal Intensive Care Units, morbidity and mortality remain high. Previous studies from our laboratory have demonstrated that extracellular vesicles (EVs) purified from mouse and rat stem cells can protect the intestines from NEC. The aim of this study was to determine whether human breast milk (BM)-derived EVs could prevent NEC. METHODS: EVs were purified from human donor breast milk. NEC was induced in premature rat pups by exposure to asphyxia/hypothermia/hypercaloric feeds. Pups were randomized to: (1) breast fed, no injury, (2) NEC, (3) NEC + BM-derived EVs once intraperitoneally (IP), (4) NEC + BM-derived EVs enterally (PO) with each feed. Intestinal tracts were examined for histologic damage. Additionally, the effect of BM-derived EVs on intestinal epithelial cells (IEC) subjected to hypoxia/reoxygenation injury in vitro was examined. RESULTS: NEC incidence was 0% in breast-fed pups and 62% in pups subjected to NEC. IP administration of BM-derived EVs decreased NEC incidence to 29% and enteral administration further decreased NEC incidence to 11.9%. (p < 0.05). BM-derived EVs significantly increased cell proliferation and decreased apoptosis in IEC in vitro. CONCLUSION: Breast milk-derived EVs delivered either IP or enterally significantly decrease the incidence and severity of experimental NEC, protect IEC from injury in vitro, and may represent an innovative therapeutic option for NEC in the future. TYPE OF STUDY: Basic science study. LEVEL OF EVIDENCE: N/A.

Production of Tissue-Engineered Small Intestine in Rats with Different Ages of Cell Donors.

IMPACT STATEMENT: This study compared side-by-side the impact of donor age on the production of tissue-engineered small intestine (TESI). Each age represents a specific period of life: E18 for fetuses, 5-day-old pups for neonates, 21-day-old rats for weanlings, and 6-week-old rats for adults. The TESI produced was compared macroscopically and microscopically. The mechanism(s) contributing to the differences observed was explored by detecting proliferating cells in the TESI and by analyzing intestinal stem cell gene expression in donor cells. These data may provide valuable information for future application of TESI clinically.

Environmental DNA Detection of the Golden Tree Frog (Phytotriades auratus) in Bromeliads.

The analysis of environmental DNA (eDNA) is a powerful, non-destructive technique for detecting rare or hard to find freshwater organisms. In this study, we investigated the effectiveness of environmental DNA analysis as a method for detecting a rare amphibian, the golden tree frog (Phytotriades auratus). These frogs are believed to live exclusively within one species of tank bromeliad, Glomeropitcairnia erectiflora, found on the highest peaks of the island of Trinidad in the West Indies. Previous survey methods for this species involved bromeliad destruction, while here we collected and analyzed water samples from discrete pools within G. erectiflora plants for species-specific DNA. We found 1) that we can identify the presence of P. auratus in the bromeliads using environmental DNA analysis, and 2) that environmental DNA evidence indicates the presence of a previously undiscovered P. auratus population, increasing the species' range from two isolated 'sky islands' to three.

The response of contrasting tomato genotypes to combined heat and drought stress.

Efforts to maximize yields of food crops can be undermined by abiotic stress factors, particularly those related to climate change. Here, we use a range of physiological methods to detect the individual and combined effects of heat and drought stress on three contrasting varieties of tomato: Hybrid 61, Moskvich, and Nagcarlang. Seedlings were acclimated under the following treatment regimes: CONTROL (25-36°C; well-watered), DRY (25-36°C; 20% field capacity), HOT (25-42°C; well-watered) and HOT+DRY (25-42°C; 20% field capacity). In each treatment, stomatal conductance, leaf temperature, chlorophyll content, and several chlorophyll fluorescence variables (both in situ and in vitro following a heat shock treatment) were measured. Plants from the HOT treatment remained statistically similar to the CONTROL plants in most of the measured parameters, while those from the DRY treatment and especially the HOT+DRY treatment showed clear effects of abiotic stress. Hybrid 61 showed considerable resilience to heat and drought stress compared to the other varieties, with significantly cooler leaves (one day after treatments imposed) and significantly higher Fv/Fm values both in situ and in vitro. The genotypic differences in resilience to heat stress were only apparent under water-limited conditions, highlighting the need to consider leaf temperature rather than air temperature when testing for tolerance to heat stress. The most effective parameters for discriminating genotypic variation in heat and drought stress were in vitro Fv/Fm and chlorophyll content.

Quantifying the impact of exogenous abscisic acid and gibberellins on pre-maturity α-amylase formation in developing wheat grains.

To study the role of abscisic acid (ABA) and gibberellins (GA) in pre-maturity α-amylase (PMA) formation in developing wheat grain, two glasshouse experiments were conducted under controlled conditions in the highly PMA-susceptible genotype Rialto. The first, determined the relative efficacy of applying hormone solutions by injection into the peduncle compared to direct application to the intact grain. The second, examined the effects of each hormone, applied by either method, at mid-grain development on PMA in mature grains. In the first experiment, tritiated ABA ((3)H-ABA) and gibberellic acid ((3)H-GA3) were diluted with unlabelled ABA (100 µM) and GA3 (50 µM), respectively, and applied at mid-grain development using both methods. Spikes were harvested after 24, 48 and 72 h from application, and hormone taken up by grains was determined. After 72 h, the uptake per grain in terms of hormones applied was approximately 13% for ABA and 8% for GA3 when applied onto the grains, and approximately 17% for ABA and 5% for GA3 when applied by injection. In the second experiment, applied ABA reduced, whereas applied GA3 increased α-amylase activity. This confirmed that exogenously applied ABA and GA were absorbed in sufficient amounts to alter grain metabolism and impact on PMA.