Biopolymer encapsulated silver nitrate nanoparticle substrates with surface-enhanced Raman spectroscopy (SERS) for Salmonella detection from chicken rinse.

Salmonella is commonly found on broiler chickens during processing. This study investigates the Salmonella detection method that reduces the necessary time for confirmation, by collecting surface-enhanced Raman spectroscopy (SERS) spectra from bacteria colonies, applied to a substrate of biopolymer encapsulated AgNO3 nanoparticles. Chicken rinses containing Salmonella Typhimurium (ST) were analyzed by SERS and compared to traditional plating and PCR analyses. SERS spectra from confirmed ST and non-Salmonella colonies appear similar in spectra composition, but with different peak intensities. t-Test on the peak intensities showed that ST and non-Salmonella colonies were significantly different (α = 0.0045) at 5 peaks, 692 cm-1, 718 cm-1, 791 cm-1, 859 cm-1, and 1018 cm-1. A support vector machine (SVM) classification algorithm was able to separate ST and non-Salmonella samples with an overall classification accuracy of 96.7 %.

Crossing low/moderate-level donor-specific antibodies during heart transplantation.

Donor-specific antibodies (DSAs) in patients prior to heart transplantation are associated with increased risk of rejection and can lead to longer waitlist times, but it is not known whether patients with low/moderate-level DSA at transplant have acceptable post-transplant outcomes. We performed a single-center, retrospective review to examine outcomes associated with crossing pre-existing low/moderate-level DSA. We assessed 864 patients awaiting heart transplantation between 2010 and 2018, identified 67 patients with low/moderate-level DSA and compared them to patients who were sensitized without DSA at the time of heart transplantation, as well as a control group of non-sensitized patients. Outcomes included 3-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE), and 1-year freedom from rejection. In the first-year post-transplant, there was decreased freedom from antibody-mediated rejection (AMR) in the patients with pre-existing DSA compared with patients sensitized without DSA and non-sensitized patients. However, the DSA group experienced similar 3-year post-transplant survival, freedom from CAV, and freedom from NF-MACE compared with the other study groups. Our findings suggest that crossing low/moderate-level DSA does not lead to worse outcomes in heart transplantation and may offer a viable way to increase a sensitized patient's chance to obtain a suitable donor.

Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment.

Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.

High thrombus burden despite thrombolytic therapy in ST-elevation myocardial infarction in a patient with COVID-19.

Consideration of thrombolysis as first-line reperfusion therapy in patients with COVID-19 and STEMI is recommended by ACC/SCAI guidelines. We describe a patient with COVID-19, who presented with ST-elevation myocardial infarction and was treated with thrombolysis and anticoagulation. He was later found to have a significant persistent thrombus burden requiring thrombectomy and stent placement. Invasive hemodynamics on multiple high-dose pressers revealed a high cardiac output state with low systemic vascular resistance, consistent with distributive rather than cardiogenic shock. Our case illustrates that thrombolytic therapy alone may not be adequate in patients with STEMI and COVID-19, as well as the importance of early invasive hemodynamics in management of shock in patient with STEMI and COVID-19 infection.

Case Series of Bedside Renal Cell Carcinoma Detected by Point-of-Care Ultrasound in the Ambulatory Setting.

Background: Kidney and renal pelvic cancer was the sixth most common cancer in men and 10th most common in women in the United States in 2018. Renal cell carcinoma (RCC), accounts for 86% of malignancies of the kidney. RCC patients are often asymptomatic; up to 25-30% have metastases at diagnosis. Few present with the triad of gross hematuria, flank pain, and abdominal mass. In RCC patients, 36% had 2 symptoms of the triad, and 60% had gross hematuria as 1 symptom. Point-of-care ultrasound (POCUS) offers a way to identify clinically meaningful anatomic abnormalities. This case series presents 3 patients in whom routine POCUS examination performed in an outpatient cardiology clinic found asymptomatic renal masses, resulting in surgical resection and cure of early-stage RCCs. Case Presentation: Patient 1: 54-year-old female with hypertension (HTN). Two solid masses were identified with POCUS in the right kidney. Patient 2: 63-year-old male with coronary artery disease (CAD) and HTN was seen at an 8-month follow-up visit. A 6-cm mass was identified in the left kidney. Patient 3: 69-year-old male with CAD, HTN, and smoking history seen at 5-month follow-up visit. A 3-cm mass in the right kidney was identified. Conclusions: Incorporating POCUS into the routine physical examination in the ambulatory care setting may improve rates of detection and increase the pretest probability of identifying renal pathology with formal imaging studies. With minimal clinician training, earlier and increased detection of asymptomatic RCC may result in improved patient survival.

Detection of Salmonella from chicken rinsate with visible/near-infrared hyperspectral microscope imaging compared against RT-PCR.

Salmonella is an organism of importance to the poultry industry with increasingly stringent government regulatory standards. Real-time polymerase chain reaction (RT-PCR) and plating procedures on nutrient enriched growth media have been the standard detection methods of Salmonella from broiler chicken carcasses for years. These methods are proven, but offer disadvantages in the amount of time or reoccurring sample cost. Here, we propose the use of a hyperspectral microscope imaging system (HMI) for comparison to standard detection methods. Broiler chicken carcasses were rinsed and plated on Salmonella selective agar. Colonies from plates were picked and RT-PCR was used as a confirmation test to verify plating results, while HMI was collected from the same colonies. Spectral signatures of cells were extracted between 450 and 800 nm from HMI collected with 100x objective. A quadratic discriminant analysis (QDA) was used to classify cells as either Salmonella positive or negative (n = 341). Spectra preprocessing minimized the influence of cellular shape on the spectra, increasing the initial classification accuracy of 81.8-98.5%, yielding a sensitivity of 1.0, and a specificity of 0.963. Results showed the potential as an initial investigation of HMI as a microbial confirmation tool, compared to RT-PCR.