COVID-19 perturbation on US air quality and human health impact assessment.

The COVID-19 stay-at-home orders issued in the United States caused significant reductions in traffic and economic activities. To understand the pandemic's perturbations on US emissions and impacts on urban air quality, we developed near-real-time bottom-up emission inventories based on publicly available energy and economic datasets, simulated the emission changes in a chemical transport model, and evaluated air quality impacts against various observations. The COVID-19 pandemic affected US emissions across broad-based energy and economic sectors and the impacts persisted to 2021. Compared with 2019 business-as-usual emission scenario, COVID-19 perturbations resulted in annual decreases of 10-15% in emissions of ozone (O3) and fine particle (PM2.5) gas-phase precursors, which are about two to four times larger than long-term annual trends during 2010-2019. While significant COVID-induced reductions in transportation and industrial activities, particularly in April-June 2020, resulted in overall national decreases in air pollutants, meteorological variability across the nation led to local increases or decreases of air pollutants, and mixed air quality changes across the United States between 2019 and 2020. Over a full year (April 2020 to March 2021), COVID-induced emission reductions led to 3-4% decreases in national population-weighted annual fourth maximum of daily maximum 8-h average O3 and annual PM2.5. Assuming these emission reductions could be maintained in the future, the result would be a 4-5% decrease in premature mortality attributable to ambient air pollution, suggesting that continued efforts to mitigate gaseous pollutants from anthropogenic sources can further protect human health from air pollution in the future.

Infusing satellite data into aerosol forecast for near real-time episode detection and diagnosis in East Asia.

A near-real-time (NRT) aerosol forecast and diagnostic approach is developed based on the system of Infusing satellite Data into Environmental Applications for East Asia, herein denoted as IDEA-EA. The design incorporates a 0.5-degree Global Forecast System (GFS) and Visible Infrared Imaging Radiometer Suite (VIIRS) aerosol and cloud retrievals for meteorological and remote sensing inputs. The primary output of IDEA-EA includes aerosol forward and backward air mass trajectory forecasts, migration visualization, and data synthesis purposed for NRT aerosol detection, monitoring, and source tracing in East Asia. Two aerosol episodes of Southeast Asia (SEA) biomass burning and Chinese haze infusion with Gobi dust are illustrated by IDEA-EA to demonstrate its forecast and source tracing capabilities. In the case of SEA biomass burning (late March 2021), forward trajectories of IDEA-EA forecasted air masses with high aerosol optical depth (AOD) from SEA affecting Taiwan. The IDEA-EA forecasts were verified by increased AOD and surface PM2.5 observations at a mountain site. In the case of the Chinese haze (October 30, 2019), backward trajectories from the northern tip of Taiwan traced air masses back to the east coast of mainland China and possibly further to the Gobi Desert. Compared with conventional numerical model simulations, the combination of the state-of-the-art aerosol remote sensing and trajectory modeling in IDEA-EA provides a cost-effective alternative for air quality management.

Airway and Hypothermia Prevention: and Treatment via STEAM The System for Thermogenic Emergency Airway Management.

Military medicine has made significant advancements in decreasing mortality by addressing the lethal triad - metabolic acidosis, coagulopathy, and hypothermia. However, casualties are still succumbing to injury. Recent conflict zones have led to the development of remarkable life-saving innovations, including the management of compressible hemorrhage and whole blood transfusions. Nevertheless, hypothermia prevention and treatment techniques remain relatively unchanged. Hypothermia prevention is anticipated to become more critical in future operations due to a predicted increase in evacuation times and reliance on Prolonged Casualty Care (PCC). This is likely secondary to increasingly distanced battlespaces and the mobility challenges of operating in semi-/non-permissive environments. Innovation is essential to combat this threat via active airway rewarming in the vulnerable patient. Thus, we propose the development, fabrication, and efficacy testing of a device in which we estimate being able to control temperature and humidity at physiologic levels in the PCC setting and beyond.

Military Medicine in American Samoa-Connecting With Indo-Pacific Partners.

With the rise of great power competition in the Indo-Pacific, Global Health Engagement can facilitate positive foreign relations. Increasing military medical outreach in American Samoa will provide improved health care in the territory, offer relevant medical training in resource-limited environments, and build connections with a community that has many uniformed members.

Lymphadenopathy secondary to tattoo ink in a patient with a history of Hodgkin lymphoma.

ABSTRACT: The finding of lymphadenopathy on physical examination and radiographically can suggest a wide range of differential diagnoses for patients, including a benign inflammatory process, infection, or malignancy. This article describes a patient with a history of Hodgkin lymphoma who developed postremission left axillary lymphadenopathy caused by deposits of tattoo ink in the node.

A Case of Multiple Sclerosis Uncovered Following Moderna SARS-CoV-2 Vaccination.

Multiple sclerosis is a demyelinating disorder of the central nervous system characterized by lesions disseminated in time and space. The diagnostic criteria for laboratory-supported definite multiple sclerosis involve two episodes of symptoms, evidence of at least one white matter lesion on MRI, and abnormal oligoclonal bands in cerebrospinal fluid. Patients usually present in their early 20s and on average have up to one flare-up per year. While vaccines play an important role in the prevention of many diseases, they have often been purported as a potential trigger of multiple sclerosis and multiple sclerosis relapses. The medical literature provides reliable information concerning the risk of developing multiple sclerosis and multiple sclerosis relapses following the administration of most vaccines, but not much is known about the novel Moderna severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) vaccine. We report the case of a 24-year-old male who presented with right-sided facial weakness, dizziness, and dysarthria two days after receiving his first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine. Imaging studies noted both acute and chronic central nervous system lesions. He met the diagnostic criteria for laboratory-supported definite multiple sclerosis. His acute flare was treated with intravenous corticosteroids and the patient was subsequently started on ocrelizumab. This case serves as an important example of the novel Moderna SARS-CoV-2 vaccine as a potential trigger of multiple sclerosis relapse. In addition, we review the literature for similar occurrences with the other COVID-19 vaccines and provide reliable guidance for COVID-19 vaccination for patients with multiple sclerosis.

Complications of a congenital iris cyst in a newborn.

ABSTRACT: Congenital iris cysts are a rare condition in infants that can lead to multiple complications. This report describes an infant born with an iris cyst who developed complications including secondary glaucoma, cataracts, and visual impairment, requiring management with multiple surgical interventions and medications.

Characterization of ground-based atmospheric pollution and meteorology sampling stations during the Lake Michigan Ozone Study 2017.

The Lake Michigan Ozone Study 2017 (LMOS 2017) in May and June 2017 enabled study of transport, emissions, and chemical evolution related to ozone air pollution in the Lake Michigan airshed. Two highly instrumented ground sampling sites were part of a wider sampling strategy of aircraft, shipborne, and ground-based mobile sampling. The Zion, Illinois site (on the coast of Lake Michigan, 67 km north of Chicago) was selected to sample higher NOx air parcels having undergone less photochemical processing. The Sheboygan, Wisconsin site (on the coast of Lake Michigan, 211 km north of Chicago) was selected due to its favorable location for the observation of photochemically aged plumes during ozone episodes involving southerly winds with lake breeze. The study encountered elevated ozone during three multiday periods. Daytime ozone episode concentrations at Zion were 60 ppb for ozone, 3.8 ppb for NOx, 1.2 ppb for nitric acid, and 8.2 µg m-3 for fine particulate matter. At Sheboygan daytime, ozone episode concentrations were 60 ppb for ozone, 2.6 ppb for NOx, and 3.0 ppb for NOy. To facilitate informed use of the LMOS 2017 data repository, we here present comprehensive site description, including airmass influences during high ozone periods of the campaign, overview of meteorological and pollutant measurements, analysis of continuous emission monitor data from nearby large point sources, and characterization of local source impacts from vehicle traffic, large point sources, and rail. Consistent with previous field campaigns and the conceptual model of ozone episodes in the area, trajectories from the southwest, south, and lake breeze trajectories (south or southeast) were overrepresented during pollution episodes. Local source impacts from vehicle traffic, large point sources, and rail were assessed and found to represent less than about 15% of typical concentrations measured. Implications for model-observation comparison and design of future field campaigns are discussed.Implications: The Lake Michigan Ozone Study 2017 (LMOS 2017) was conducted along the western shore of Lake Michigan, and involved two well-instrumented coastal ground sites (Zion, IL, and Sheboygan, WI). LMOS 2017 data are publicly available, and this paper provides detailed site characterization and measurement summary to enable informed use of repository data. Minor local source impacts were detected but were largely confined to nighttime conditions of less interest for ozone episode analysis and modeling. The role of these sites in the wider field campaign and their detailed description facilitates future campaign planning, informed data repository use, and model-observation comparison.

Tuberous sclerosis complex: A multisystem disorder.

ABSTRACT: Tuberous sclerosis complex (TSC) is a genetic disorder that affects multiple organ systems but often goes unrecognized, and a delay in diagnosis can lead to multiple complications. Healthcare professionals should be educated on the many signs and symptoms associated with the disorder, know how to treat them symptomatically, and recommend routine screening to assess for complications. Correctly identifying, diagnosing, and treating TSC can give patients a better quality of life and prevent further complications associated with the disorder.

Targeted inhibition of the BRAF pathway in a patient with stage IV melanoma.

This article describes the use of vemurafenib, a BRAF inhibitor, to achieve disease regression in a woman with extensive metastatic melanoma and the BRAF V600 gene mutation. Given the improved survival rates seen in these patients, clinicians need to be aware of long-term patient management and adverse reactions to the drug.

Active and widespread halogen chemistry in the tropical and subtropical free troposphere.

Halogens in the troposphere are increasingly recognized as playing an important role for atmospheric chemistry, and possibly climate. Bromine and iodine react catalytically to destroy ozone (O3), oxidize mercury, and modify oxidative capacity that is relevant for the lifetime of greenhouse gases. Most of the tropospheric O3 and methane (CH4) loss occurs at tropical latitudes. Here we report simultaneous measurements of vertical profiles of bromine oxide (BrO) and iodine oxide (IO) in the tropical and subtropical free troposphere (10 °N to 40 °S), and show that these halogens are responsible for 34% of the column-integrated loss of tropospheric O3. The observed BrO concentrations increase strongly with altitude (∼ 3.4 pptv at 13.5 km), and are 2-4 times higher than predicted in the tropical free troposphere. BrO resembles model predictions more closely in stratospheric air. The largest model low bias is observed in the lower tropical transition layer (TTL) over the tropical eastern Pacific Ocean, and may reflect a missing inorganic bromine source supplying an additional 2.5-6.4 pptv total inorganic bromine (Bry), or model overestimated Bry wet scavenging. Our results highlight the importance of heterogeneous chemistry on ice clouds, and imply an additional Bry source from the debromination of sea salt residue in the lower TTL. The observed levels of bromine oxidize mercury up to 3.5 times faster than models predict, possibly increasing mercury deposition to the ocean. The halogen-catalyzed loss of tropospheric O3 needs to be considered when estimating past and future ozone radiative effects.

Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series.

PURPOSE: The purpose of the study was to evaluate the results of surgical treatment in athletes with associated intra-articular hip pathology and extra-articular sports pubalgia. METHODS: Between December 2003 and September 2009, 37 hips (mean patient age, 25 years) were diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology. There were 8 professional athletes, 15 collegiate athletes, 5 elite high school athletes, and 9 competitive club athletes. Outcomes included an evaluation regarding return to sports and modified Harris Hip Score, Short Form 12 score, and visual analog scale score. RESULTS: We evaluated 37 hips at a mean of 29 months (range, 12 to 78 months) after the index surgery. Thirty-one hips underwent thirty-five athletic pubalgia surgeries. Hip arthroscopy was performed in 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia). Of 16 hips that had athletic pubalgia surgery as the index procedure, 4 (25%) returned to sports without limitations, and 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery. Of 8 hips managed initially with hip arthroscopy alone, 4 (50%) returned to sports without limitations, and 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy. Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores (P < .05) and an unrestricted return to sporting activity in 89% of hips (24 of 27). CONCLUSIONS: When surgery only addressed either the athletic pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal. Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Assessing the reversibility of the anaplerotic reactions of the propionyl-CoA pathway in heart and liver.

While a number of studies underline the importance of anaplerotic pathways for hepatic biosynthetic functions and cardiac contractile activity, much remains to be learned about the sites and regulation of anaplerosis in these tissues. As part of a study on the regulation of anaplerosis from propionyl-CoA precursors in rat livers and hearts, we investigated the degree of reversibility of the reactions of the propionyl-CoA pathway. Label was introduced into the pathway via NaH13CO3, [U-13C3]propionate, or [U-13C3]lactate + [U-13C3]pyruvate, under various concentrations of propionate. The mass isotopomer distributions of propionyl-CoA, methylmalonyl-CoA, and succinyl-CoA revealed that, in intact livers and hearts, (i) the propionyl-CoA carboxylase reaction is slightly reversible only at low propionyl-CoA flux, (ii) the methylmalonyl-CoA racemase reaction keeps the methylmalonyl-CoA enantiomers in isotopic equilibrium under all conditions tested, and (iii) the methylmalonyl-CoA mutase reaction is reversible, but its reversibility decreases as the flow of propionyl-CoA increases. The thermodynamic dis-equilibrium of the combined reactions of the propionyl-CoA pathway explains the effectiveness of anaplerosis from propionyl-CoA precursors such as heptanoate.

Identification of phenylbutyrylglutamine, a new metabolite of phenylbutyrate metabolism in humans.

Phenylbutyrate is used in humans for treating inborn errors of ureagenesis, certain forms of cancer, cystic fibrosis and thalassemia. The known metabolism of phenylbutyrate leads to phenylacetylglutamine, which is excreted in urine. We have identified phenylbutyrylglutamine as a new metabolite of phenylbutyrate in human plasma and urine. We describe the synthesis of phenylbutyrylglutamine and its assay by gas chromatography/mass spectrometry as a tert-butyldimethylsilyl or methyl derivative, using standards of [(2)H(5)]phenylbutyrylglutamine and phenylpropionylglutamine. After administration of phenylbutyrate to normal humans, the cumulative urinary excretion of phenylacetate, phenylbutyrate, phenylacetylglutamine and phenylbutyrylglutamine amounts to about half of the dose of phenylbutyrate. Thus, additional metabolites of phenylbutyrate are yet to be identified.

Assay of the concentration and (13)C isotopic enrichment of propionyl-CoA, methylmalonyl-CoA, and succinyl-CoA by gas chromatography-mass spectrometry.

We developed gas chromatography-mass spectrometry assays for the concentration and mass isotopomer distribution of propionyl-CoA, methylmalonyl-CoA, and succinyl-CoA in tissues. The assays involves perchloric acid extraction of the tissue, spiking the extract with [(2)H(5)]propionyl-CoA and [(2)H(4)]succinyl-CoA internal standards, and isolation of short-chain acyl-CoA fraction on an oligonucleotide purification cartridge. Propionyl-CoA is reacted with sarcosine and the formed N-propionylsarcosine is assayed as its pentafluorobenzyl derivative. Methylmalonyl-CoA and succinyl-CoA are hydrolyzed and the corresponding acids assayed as tert-butyl dimethylsilyl derivatives. The assay was applied to a study of [U-(13)C(3)]propionate metabolism in perfused rat livers. While propionyl-CoA is only M3 labeled, succinyl-CoA is M3, M2, and M1 labeled because of isotopic exchanges in the citric acid cycle. Methylmalonyl-CoA is M3 and M2 labeled, reflecting reversal of S-methylmalonyl-CoA mutase. Thus, our assays allow measuring the turnover of the coenzyme A derivatives involved in anaplerosis of the citric acid cycle via precursors of propionyl-CoA, i.e., propionate, odd-chain fatty acids, isoleucine, threonine, and valine.