Perspectives of Interstitial Lung Disease Patients and Carers During COVID-19.

Aim To gain an understanding of the impact of COVID-19 on the daily life, healthcare needs, mental wellbeing and outlook of patients with Interstitial Lung Disease (ILD) and their caregivers. Methods ILD patients and caregivers were invited to participate in a quantitative survey. Respondents could self-select to then participate in in-depth structured telephone interviews. Survey data was compared to Department of Health COVID-19 public opinion tracker findings for the comparable time period. Results There were 170 survey respones (111 patients and 59 caregivers) and 14 in-depth interview participants. 32% (n=36) of patients and 42% (n=25) of caregivers expressed extreme worry regarding COVID-19 on a 1-10 scale. 83% (n=92) of patients expressed concern about safe hospital access, 33% (n=37) had received a telephone consultation with their clinician, 43% (n=48) reported test delays, 47% (n=52) were exercising less, 23% (n=26) reported worse sleep and 15% (n=17) reported being financially worse off. Carers reported that sleep was worse for 58% (n=34), 42% (n=25) reported being worse off financially, and 40% (n=24) reported a worse diet. Worry (66%, n=39), stress (51%, n=30), anxiety (49%, n=29) were commonly reported by carers. Discussion ILD patients and caregivers reported higher levels of worry regarding COVID-19 compared to the general public. Alternative pathways for quality ILD patient care and interventions to reduce the burden of care on ILD caregivers are required.

Is the development of desalination compatible with sustainable development of the Arabian Gulf?

The development of desalination has been essential to the rapid economic development of the countries bordering the Arabian Gulf. The current production capacity of sea water desalination plants drawing water from Gulf is over 20 million m3 day-1, which may rise to 80 million m3 day-1 by 2050. Whilst supporting aspects of sustainable development related to water and sanitation, desalination impacts the marine environment through impingement and entrainment of organisms in intakes, and through thermal, brine and chemical discharges. This may compromise other objectives for sustainable development related to sustainable use of the oceans. Under business as usual scenarios, by 2050, the impact of individual desalination plants will combine causing a regional scale impact. Without mitigating actions to avoid the business as usual scenario, by 2050, desalination in combination with climate change, will elevate coastal water temperatures across more than 50% of the Gulf by at least 3 °C, and a volume of water equivalent to more than a third of the total volume of water between 0 and 10 m deep will pass through desalination plants each year. This will adversely impact the coastal ecosystem of the Gulf, with impacts on biodiversity, fisheries and coastal communities and may cause potential loss of species and habitats from the Gulf. Given the significant implications of these preliminary findings, and in light of the precautionary approach to management, it is recommended that mitigating options addressing behavioural, regulatory and technological change are rapidly evaluated and implemented to avoid the development of desalination in the region along a business as usual pathway, and multidisciplinary research studies should be conducted to reduce uncertainty in predictions of future impacts.

Reconstructive cranioplasty using a porcine small intestinal submucosal graft.

A six-year-old border collie was presented with a solid mass on the dorsal cranium. Histological examination showed the mass to be a multilobular tumour of bone. A magnetic resonance imaging scan confirmed deformation of the dorsal cranium with compression of the cerebral hemispheres. A craniotomy was performed to excise the mass and overlying skin, resulting in a substantial deficit of calvarium and skin. A cranioplasty using a small intestinal submucosal (SIS) graft was performed to reconstruct the calvarial defect. A local myocutaneous advancement flap was elevated and positioned over the cranioplasty to close the skin deficit. The outcome of this reconstruction was aesthetic and functional. The small intestinal submucosal graft provided satisfactory mechanical support and was a suitable physical barrier in place of the calvarial bone. Histological examination of the small intestinal submucosal graft 128 days after implantation showed that the graft had been replaced by a dense network of collagenous tissue, with small focal areas of partially mineralised woven bone merging with a fibrocartilaginous matrix of the deeper margin. Histological examination also confirmed regrowth of the multilobular tumour of bone in the region of the small intestinal submucosal graft indicating that it is only a suitable implant if adequate surgical margins are obtained.

Parotidectomy for the treatment of parotid sialocoele in 14 dogs.

OBJECTIVES: To describe the presentation, diagnosis, cause, complications and outcome in 14 dogs that presented with a parotid sialocoele and that were treated by complete parotidectomy. MATERIAL AND METHODS: Multi-institutional retrospective study. RESULTS: Each dog presented with a non-painful, fluctuant, soft tissue mass over the lateral aspect of the face in the region of the parotid salivary gland. Diagnosis was made by sialoradiography (3/14), CT (3/14), ultrasound (11/14) and MRI (2/14). The cause of the sialocoele could be determined in 8 of 14 patients and included: foreign body (2/14), sialolithiasis (1/14), neoplasia (3/14), salivary gland lipomatosis (1/14) and trauma (1/14). Treatment incurred one anaesthetic complication (regurgitation) and seven postoperative surgical complications [self-limiting seroma formation (2/14), haemorrhage (1/14), wound dehiscence (1/14), abscessation 7 months postoperatively (1/14) and facial nerve paralysis (2/14)]. Sialocoele did not recur in any dog during a median follow-up time of 14 months. CLINICAL SIGNIFICANCE: Parotidectomy has been considered a technically challenging procedure but can have a good success rate with long-term resolution of the clinical symptoms. Intra- and postoperative complications are reasonably common.

Analysis of lactate concentrations in canine synovial fluid.

OBJECTIVE: To report synovial fluid lactate concentrations in normal and pathological canine joints. STUDY DESIGN: Controlled, prospective study. METHODS: Lactate was measured in synovial fluid using a hand-held meter and the rest of the fluid was sent to a commercial laboratory for analysis. Samples were divided into four groups; group 1: control, group 2: osteoarthritis, group 3: immune-mediated inflammatory arthritis, and group 4: septic arthritis. Statistical analysis was performed to compare lactate concentrations between the four groups and to examine the predictive value of lactate in the diagnosis of septic arthritis. A correlation was sought between synovial fluid lactate and synovial fluid total nucleated cell count and total protein. RESULTS: Seventy-four samples were investigated from 55 dogs. Statistical analysis found that lactate concentrations were significantly higher in the septic arthritis group than in each of the other three groups. No significant correlation could be found between synovial fluid lactate concentrations and synovial fluid total nucleated cell count or synovial fluid total protein. Lactate concentration was found to be a useful predictor of septic arthritis, with a low concentration pointing towards exclusion rather than a high concentration to the diagnosis of septic arthritis. CLINICAL SIGNIFICANCE: Synovial fluid lactate concentration is not a good marker for osteoarthritis or immune-mediated inflammatory arthritis, but it is significantly increased in septic arthritis and could help the clinician in ruling out this condition in a quick and cost-effective way.

Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature.

Twenty-two patients with colonic arterio-venous malformations (AVM) are reported and 218 other cases in the English literature are reviewed. Of our patients, 16 (73%) underwent right hemicolectomy because of repeated episodes of rectal bleeding or iron-deficiency anemia. Ten (63%) of these patients have remained in good health with no further evidence of intestinal bleeding after surgery. In six (37%) recurrent episodes of rectal bleeding or iron deficiency anemia have gone unexplained despite thorough work-up including repeat arteriography. Our experience and that in the literature suggests: 1. Most AVM's (78%) occur in the cecum or right colon, the jejunum being the next most common site. 2. Patients with AVM's tend to be elderly with a strong history of cardiovascular disease. A potential association between aortic stenosis, intestinal bleeding, and AVM's is suggested. However, prospective studies are needed to confirm this relationship. 3. In younger patients AVM's tend to occur at atypical sites such as the small bowel. 4. Surgical removal of an AVM cannot be expected to be uniformly curative. The causes of recurrent bleeding after surgery include: incomplete resection of the initial AVM, occult AVM's missed on arteriography and left behind at surgery, and the appearance of new AVM's postoperatively. The cause of bleeding in many patients with recurrence however, remains undiagnosed despite repeat angiography.

Focal lymphoid hyperplasia (pseudolymphoma) of the esophagus.

Focal lymphoid hyperplasia is an uncommon but ubiquitous lesion. It occurs most commonly in the gastrointestinal tract in association with chronic peptic ulcer disease of the stomach. We describe the hitherto unrecognized association of lymphoid hyperplasia in the esophagus with chronic stenosing ulcerating esophagitis and Barrett's mucosa. This association is considered to be analogous to the more prevalent coexistence of lymphoid hyperplasia and chronic peptic ulcer disease in the stomach.

Epithelioid hemangioendothelioma of liver. Clinicopathological correlation of 10 cases treated by orthotopic liver transplantation.

We present a review of the clinicopathologic features of a series of 10 patients with hepatic epithelioid hemangioendothelioma treated by orthotopic liver transplantation. This tumor has an unpredictable prognosis. Morphological features predictive of biological behavior were not identified in these patients. It appears that metastatic spread at the time of surgery is not a significant contraindication to surgery and has no correlation with survival. Nine patients are alive (5-134 months), five disease free and four with tumor. The etiology of this tumor is unknown. However, there is an association of oral contraceptive use with this tumor in four (66%) of the six female patients in this series and in 37% of such reported cases.

Transplantation of the small intestine: the pathologist's perspective.

Small-bowel transplantation is now ready for clinical trials. The surgical techniques and methods for immunosuppression and monitoring bowel status have been developed in animal models over the past 30 years. Several attempts at small-bowel transplantation in humans have already been reported. In the course of future trials, pathologists will be involved in the monitoring of the posttransplant course by mucosal biopsies and functional studies, including maltose and xylose absorption tests. The morphology of rejection has been studied in canine and rat models. Activated lymphocytes and plasma cells infiltrate the lamina propria and invade crypt epithelium, causing "cryptitis." Villous blunting ensues, resulting eventually in necrosis. Graft survival without immunosuppression is about 10 days. Under Cyclosporine immunosuppression, a lymphoplasmacytic infiltrate has been noted around nerves and vessels in the submucosa. The overlying mucosa may be relatively normal. End-stage bowel is characterized by a contracted, scarred mass. Due to the large amount of lymphoid tissue in the allograft, graft-versus-host disease is a significant problem in small-bowel transplantation.

Evaluation of gastric biopsies for neoplasia: differences between Japanese and Western pathologists.

Cited variations in the evaluation of gastric endoscopic biopsies for neoplasms between pathologists in Japan and those in the United States and Europe (the West) may have stemmed from several causes. The five-tiered group classification of the Japanese Research Society for Gastric Cancer (JRSGC) for interpretation of biopsies is not used in the West. Some differences may also exist in the morphologic criteria to reach a diagnosis of dysplasia or carcinoma. The goals of this study were to test the Western and Japanese classifications of gastric dysplasia and adenocarcinoma and to assess the differences between four Japanese and seven Western pathologists. One hundred biopsies, 20 from each of the five categories of the JRSGC scheme as determined by one observer, were collected. The Japanese observers used the JRSGC system, expressed in Roman numerals, whereas Western pathologists used a five- or six-tiered scheme expressed in diagnostic terms. Pairwise agreement was evaluated using k statistics within both groups. Consensus diagnosis on each biopsy was accepted as the opinion of the majority. The sensitivity and specificity of each reviewer for a certain diagnosis were also assessed. The intragroup agreements were moderate for both the Japanese (mean k = 0.663) and the Westerners (mean k = 0.652). The pairwise agreements between Japanese and Western observers were low (mean k = 0.542). Overall, the sensitivity was low for all Japanese observers for the diagnosis of dysplasia (38.7% vs 92.5%), and the sensitivity for the diagnosis of adenocarcinoma was high in both groups but higher among the Japanese observers (93.9% and 85.2%, respectively). Overall, the Japanese-Western interobserver agreement was moderate. The JRSCG scheme did not translate into higher interobserver agreement among Japanese observers. The sensitivity for the diagnosis of gastric adenocarcinoma was high for both groups, but the specificity was low among the Japanese. The cause seemed to be centered around the diagnosis of dysplasia in the Western system, which was a lesion frequently interpreted as carcinoma in Japan because of the different definitions of carcinoma in each system. Such a discrepancy might be important because it may explain some of the differences in the prevalence and prognosis of early gastric cancer between Japan and the West. An international effort is needed to harmonize morphologic criteria and analyze whether therapeutic consequences may stem from such discrepancies.

Fibrolamellar carcinoma of the liver: an immunohistochemical study of nineteen cases and a review of the literature.

Hepatocellular carcinoma (HCC) is a rapidly fatal neoplasm of high worldwide prevalence. Fibromellar carcinoma (FLC), a variant of HCC, lacks the dismal prognosis of "ordinary" HCC (O-HCC) and is characterized by a diagnostic histologic appearance. The current study analyzes the clinical characteristics, immunohistochemistry, and treatment of nineteen cases of FLC. These data, together with a detailed review of the literature, further characterize this unique variant. FLC affects younger patients and lacks the male predominance of O-HCC. Also, FLC lacks specific association with cirrhosis, hepatitis B virus infection, use of oral contraceptives, and alcohol abuse, all of which are implicated in other hepatic tumors. This, along with differences in serum tumor marker prevalence (AFP, B12 binding protein) suggests that its pathogenesis differs from that of O-HCC. Despite these differences, FLC shares a common differentiation with O-HCC. The increased amounts in FLC of stainable alpha-1-antitrypsin, fibrinogen, and C-reactive protein, all of which are acute phase reactants and normal hepatocyte products, implies better differentiation of FLC cells. Finally, the better prognosis of FLC is supported by this study, since only two of the 19 patients died because of tumor. This contrasts with the reported survival of patients with O-HCC, usually measured in weeks. Hepatic transplantation may hold promise for future patients with "surgically unresectable" FLC as procedure-related complications are overcome.

Colonic ganglioneuroma.

Ganglioneuromas are neuroectodermal tumors that are found in diverse anatomic sites, but they are very uncommon in the colon. We observed a patient with partial colonic obstruction whose roentgenogram had a napkin-ring construction that was thought to be carcinoma. On resection, pathologic examination showed a ganglioneuroma. Mesenchymal neoplasms of various histologic types occur thoughout the gastrointestinal tract. Neurogenic tumors are not uncommon in Von Recklinghausen's neurofibromatosis and multiple mucosal neuroma syndrome, but solitary lesions unassociated with these conditions are rare. To our knowledge, this complication in the colon is only the second such reported case. We believe that this case is noteworthy because of its clinical and roentgenographic resemblance to carcinoma.

Oestrogens and oestrogenic activity in raw and treated water in Severn Trent Water.

Sewage effluent discharged to surface water has been shown to contain human hormones, particularly oestrogens, and synthetic chemicals which may be able to disrupt the endocrine system. Since many surface waters which receive sewage effluent are subsequently used as drinking water sources, it is important to demonstrate that treated drinking water is not contaminated. Oestrogenic activity in rivers and drinking water in the region of Severn Trent Water was studied using a combination of bioassay, to integrate exposure over time, and advanced chemical analysis. There was little or no evidence of substances that were oestrogenic, even in waters receiving significant amounts of sewage effluent. Oestrogenic activity, as measured in the rainbow trout vitellogenin assay, was seen at the Tame/Trent confluence but this activity was relatively weak. There was no activity detected at raw water intakes and no hormones or substances that are oestrogenic were detected in the final drinking water.

Toxicity characterisation of organic contaminants in stormwaters from an agricultural headwater stream in south east England.

The transient movement of pesticides at biologically active concentrations during storm events is considered to be a cause of biological impoverishment in some headwater streams. The programme of work described sought to identify compounds that are the cause of toxic effects during such events. Along with targeted pesticide analysis, toxicity identification evaluation (TIE) procedures were used to identify compounds with a demonstrated toxic effect. These procedures were specifically directed towards isolating and attributing toxicity to classes of organic contaminants in samples collected from an English headwater stream during a storm event. The organic load was isolated by means of solid-phase extraction (SPE). Bioassay of the SPE extract at x 100 whole water concentrations confirmed that the samples contained substances toxic to Daphnia magna, although the raw samples were not toxic. Targeted pesticide analysis identified simazine and diuron as the major pesticides present and, using a toxicity unit (TU) approach. were shown to be responsible for a significant amount of the observed concentrate toxicity during a runoff event. However, they were not present in sufficient quantities to be totally responsible for a more toxic later event. By simplification of the SPE isolate using reverse-phase HPLC, fractions from which were tested for toxicity, the cause of concentrate toxicity in the later event was isolated to two discrete fractions. GC-MS analysis of these fractions identified nonylphenol. endosulfan sulphate and pendimethalin as present, with the majority of toxicity attributed to nonylphenol (NP). The main advantage of the TIE approach is that it allows biological active compounds with a demonstrated effect to be identified that may not be selected by more traditional techniques.

Immunomagnetic T-lymphocyte depletion (ITLD) of rat bone marrow using OX-19 monoclonal antibody.

Graft versus host disease (GVHD) may be abrogated and host survival prolonged by in vitro depletion of T lymphocytes from bone marrow (BM) prior to allotransplantation. Using a mouse anti-rat pan T-lymphocyte monoclonal antibody (OX19) bound to monosized, magnetic, polymer beads, T lymphocytes were removed in vitro from normal bone marrow. The removal of the T lymphocytes was confirmed by flow cytometry. Injection of the T-lymphocyte-depleted bone marrow into fully allogeneic rats prevents the induction of GVHD and prolongs host survival.

Comparison of biomarker and pathological responses in flounder (Platichthys flesus L.) induced by ingested polycyclic aromatic hydrocarbon (PAH) contamination.

This study investigated the response of biomarker measurements and histopathological indicators of polycyclic aromatic hydrocarbon (PAH) exposure in the flounder (Platichthys flesus L.). Flounder were fed food spiked with a mixture of four PAHs at an environmentally relevant range of concentrations for either one or six months. Ethoxyresorufin-O-deethylase (EROD) activity was elevated following 1 month exposure to PAH concentrations up to 50 mgkg(-1) in food. Bile metabolite concentrations were found to increase with PAH concentration, up to 500 mgkg(-1) PAH. By comparison, no DNA adducts were detected and there were no significant histopathological changes observed. After 6 months exposure, EROD levels were not elevated but bile metabolites showed a similar dose dependent relationship as in the 1 month experiment, while DNA adducts were only detected in the highest PAH exposure groups. No significant histopathological changes were observed. The results are discussed with respect to the implications for the use of these methods in environmental monitoring studies.

Acute phase protein concentrations in dogs with nasal disease.

The concentrations of C-reactive protein (CRP), serum amyloid A, haptoglobin (Hp) and α(1)-acid glycoprotein were measured in dogs with clinical signs of nasal disease and compared with those of healthy dogs in order to determine the expression of these proteins in cases of canine nasal disease. A significant difference (P<0.001) between the symptomatic group and the control group was found for both CRP and Hp. Among the animals with nasal disease, a significant intergroup difference (P<0.05) was found in the expression of Hp between dogs with aspergillosis and those with chronic rhinitis.