The arginine methyltransferase Prmt1 coordinates the germline arginine methylome essential for spermatogonial homeostasis and male fertility.

Arginine methylation, catalyzed by the protein arginine methyltransferases (PRMTs), is a common post-translational protein modification (PTM) that is engaged in a plethora of biological events. However, little is known about how the methylarginine-directed signaling functions in germline development. In this study, we discover that Prmt1 is predominantly distributed in the nuclei of spermatogonia but weakly in the spermatocytes throughout mouse spermatogenesis. By exploiting a combination of three Cre-mediated Prmt1 knockout mouse lines, we unravel that Prmt1 is essential for spermatogonial establishment and maintenance, and that Prmt1-catalyzed asymmetric methylarginine coordinates inherent transcriptional homeostasis within spermatogonial cells. In conjunction with high-throughput CUT&Tag profiling and modified mini-bulk Smart-seq2 analyses, we unveil that the Prmt1-deposited H4R3me2a mark is permissively enriched at promoter and exon/intron regions, and sculpts a distinctive transcriptomic landscape as well as the alternative splicing pattern, in the mouse spermatogonia. Collectively, our study provides the genetic and mechanistic evidence that connects the Prmt1-deposited methylarginine signaling to the establishment and maintenance of a high-fidelity transcriptomic identity in orchestrating spermatogonial development in the mammalian germline.

Impact of salinity stress on cotton and opportunities for improvement through conventional and biotechnological approaches.

Excess salinity can affect the growth and development of all plants. Salinization jeopardizes agroecosystems, induces oxidative reactions in most cultivated plants and reduces biomass which affects crop yield. Some plants are affected more than others, depending upon their ability to endure the effects of salt stress. Cotton is moderately tolerant to salt stress among cultivated crops. The fundamental tenet of plant breeding is genetic heterogeneity in available germplasm for acquired characteristics. Variation for salinity tolerance enhancing parameters (morphological, physiological and biochemical) is a pre-requisite for the development of salt tolerant cotton germplasm followed by indirect selection or hybridization programs. There has been a limited success in the development of salt tolerant genotypes because this trait depends on several factors, and these factors as well as their interactions are not completely understood. However, advances in biochemical and molecular techniques have made it possible to explore the complexity of salt tolerance through transcriptomic profiling. The focus of this article is to discuss the issue of salt stress in crop plants, how it alters the physiology and morphology of the cotton crop, and breeding strategies for the development of salinity tolerance in cotton germplasm.

Recent Progress of Fluorescent Carbon Dots and Graphene Quantum Dots for Biosensors: Synthesis of Solution Methods and their Medical Applications.

In the fields of health and biology, fluorescent nanomaterials have emerged as highly potential and very useful candidates for use in biosensor applications. These typical highly powerful nanomaterials are carbon dots (CDs) and graphene quantum dots (GQDs) among many other metallic nanomaterials. In the context of medical biosensors, this review article investigates the techniques of synthesis, and many uses of these nanomaterials, the obstacles that they face, and the potential for their future. We cover the significance of fluorescent nanomaterials, their use in the medical field, as well as the several techniques of synthesis for CDs and GQDs, including ultrasonication, hydrothermal, electrochemical method, surface modification, and solvothermal. In addition, we also discuss their biomedical applications, which include biomolecule detection, disease diagnosis and examine the obstacles and prospective possibilities for development of ultra-bright, ultra-sensitive, and selective biosensors for use in in-vivo research.Fluorescent carbon dots and graphene quantum dots is synthesized by using several types of raw material and methods. These Carbon dots and graphene quantum dots are used in the medical field includes detection of biomaterials, detection of cancer, virus and mutation in DNA.

Exploitation of various physio-morphological and biochemical traits for the identification of drought tolerant genotypes in cotton.

BACKGROUND: Drought is one of the limiting factors for quality and quantity of cotton lint in tropical and sub-tropical regions. Therefore, development of drought tolerant cotton genotypes have become indispensable. The identification of drought tolerant genotypes is pre-requisite to develop high yielding cultivars suitable for drought affected areas. METHODS: Forty upland cotton accessions were selected on the basis of their adaptability and yield. The collected germplasm accessions were evaluated at seedling stage on the basis of morphological, physiological and biochemical parameters. The experiment was conducted under controlled conditions in greenhouse where these genotypes were sown under different levels of drought stress by following factorial under completely randomized design. The data were collected at seedling stages for root and shoot lengths, relative leaf water content, excised leaf water losses, peroxidase content and hydrogen peroxide concentrations in leaf tissues. RESULTS: The biometrical analysis revealed that germplasm is significantly varied for recorded parameters, likewise interaction of genotypes and water stress was also significantly varied. The cotton germplasm was categorized in eight clusters based on response to water stress. The genotype Cyto-124 exhibited lowest H2O2 content under drought conditions, minimum excised leaf water loss under stress environment was exhibited by genotypes Ali Akber-802 and CEMB-33. Overall, on the basis of morphological and biochemical traits, SL-516 and Cyto-305 were found to be drought tolerant. Genotypes 1852 - 511, Stoneville 15-17 and Delta Pine-55 showed low values for root length, peroxidase activity and higher value for H2O2 contents. On the basis of these finding, these genotypes were declared as drought susceptible. CONCLUSION: The categorization of cotton germplasm indicating the differential response of various parameters under the control and drought stress conditions. The recorded parameters particularly relative leaf water contents and biochemical assays could be utilized to screen large number of germplasm of cotton for water deficit conditions. Besides, the drought tolerant genotypes identified in this research can be utilized in cotton breeding programs for the development of improved cultivars.

Comparative transcriptomic and evolutionary analysis of FAD-like genes of Brassica species revealed their role in fatty acid biosynthesis and stress tolerance.

BACKGROUND: Fatty acid desaturases (FADs) are involved in regulating plant fatty acid composition by adding double bonds to growing hydrocarbon chain. Apart from regulating fatty acid composition FADs are of great importance, and are involved in stress responsiveness, plant development, and defense mechanisms. FADs have been extensively studied in crop plants, and are broadly classed into soluble and non-soluble fatty acids. However, FADs have not yet been characterized in Brassica carinata and its progenitors. RESULTS: Here we have performed comparative genome-wide identification of FADs and have identified 131 soluble and 28 non-soluble FADs in allotetraploid B. carinata and its diploid parents. Most soluble FAD proteins are predicted to be resided in endomembrane system, whereas FAB proteins were found to be localized in chloroplast. Phylogenetic analysis classed the soluble and non-soluble FAD proteins into seven and four clusters, respectively. Positive type of selection seemed to be dominant in both FADs suggesting the impact of evolution on these gene families. Upstream regions of both FADs were enriched in stress related cis-regulatory elements and among them ABRE type of elements were in abundance. Comparative transcriptomic data analysis output highlighted that FADs expression reduced gradually in mature seed and embryonic tissues. Moreover, under heat stress during seed and embryo development seven genes remained up-regulated regardless of external stress. Three FADs were only induced under elevated temperature whereas five genes were upregulated under Xanthomonas campestris stress suggesting their involvement in abiotic and biotic stress response. CONCLUSIONS: The current study provides insights into the evolution of FADs and their role in B. carinata under stress conditions. Moreover, the functional characterization of stress-related genes would exploit their utilization in future breeding programs of B. carinata and its progenitors.

DOCUMENTATION OF TRYPANOSOMA EVANSI IN CAPTIVE TIGERS AND LIONS IN PUNJAB (2016-2018), PAKISTAN.

Trypanosoma evansi is an important hemoparasite of a variety of animal species worldwide. This parasite is a threat to the health of domestic animals as well as wild animals, particularly those managed in captivity. The current study investigated the presence of T. evansi in captive tigers (Panthera tigris tigris) and lions (Panthera leo) in Pakistan. In total, 24 blood samples from 11 tigers and 3 lions (n = 14) were collected during the course of roughly 3 yr (2016-2018). Eighteen samples were subjected to both microscopic and molecular evaluation for the presence of T. evansi; the remaining 6 samples were processed for PCR only. Of the 18 samples tested by both methods, 3 (16%) and 8 (44%) were positive by microscopy and PCR, respectively. This highlights the higher sensitivity of PCR over microscopy for detection of trypanosomes. Of the 24 total samples evaluated by PCR, 12 (50%) were positive. The three sequences obtained showed 99% identity with variant surface glycoprotein genes of the different isolates of T. evansi. The sensitivity, specificity, positive predictive value, and negative predictive value of microscopy in identifying T. evansi was 37.5, 100, 100, and 66.7%, respectively, considering PCR as the gold standard. We recommend rigorous monitoring of captive tigers and lions for hemoparasites, particularly in winter and early spring in areas with high infection rate of this parasite, preferably via PCR.

KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths?

AIMS: Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively. METHODS: This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length. RESULTS: A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy. CONCLUSION: We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.

Surgical versus transcatheter aortic valve replacement: Impact of patient-prosthesis mismatch on outcomes.

BACKGROUND: The hemodynamics of most prosthetic valves are often inferior to that of the normal native valve, and a significant proportion of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) have high residual transaortic pressure gradients due to prosthesis-patient mismatch (PPM). As the experience with TAVR has increased and long-term outcomes are reported, a close look at the PPM literature is required in light of new evidence. METHODS: For this review, we searched the Embase, Medline, and Cochrane databases from 2000 to 2022. Articles reporting PPM as an outcome following aortic valve replacements were identified and reviewed. RESULTS: The impact of PPM on clinical outcomes in aortic valve replacement has not been clear as multiple studies failed to report PPM incidence. However, the PPM outcomes after SAVR vary more widely than after TAVR, ranging from 8% to 80% in SAVR and from 24% to 35% in TAVR. Incidence of severe PPM following redo SAVR ranges from 2% to 9% and following valve-in-valve TAVR is from 14% to 33%, however, while PPM is higher in valve-in-valve TAVR, patients had better survival rates. CONCLUSIONS: The gap between valve performance and clinical outcomes in SAVR and TAVR could be reduced by carefully selecting patients for either treatment option. Understanding predictors of PPM can add to the safety, effectiveness, and increased survival benefit of both SAVR and TAVR.

Genome-wide investigation and expression analysis of APETALA-2 transcription factor subfamily reveals its evolution, expansion and regulatory role in abiotic stress responses in Indica Rice (Oryza sativa L. ssp. indica).

Rice is an important cereal crop that serves as staple food for more than half of the world population. Abiotic stresses resulting from changing climatic conditions are continuously threating its yield and production. Genes in APETALA-2 (AP2) family encode transcriptional regulators implicated during regulation of developmental processes and abiotic stress responses but their identification and characterization in indica rice was still missing. In this context, twenty-six genes distributed among eleven chromosomes in Indica rice encoding AP2 transcription-factor subfamily were identified and their diverse haplotypes were studied. Phylogenetic analysis of OsAP2 TF family-members grouped them into three clades indicating conservation of clades among cereals. Segmental duplications were observed to be principal route of evolution, supporting the higher positive selection-pressure, which were estimated to be originated about 10.57 to 56.72 million years ago (MYA). Conserved domain analysis and intron-exon distribution pattern of identified OsAP2s revealed their exclusive distribution among the specific clades of the phylogenetic tree. Moreover, the members of osa-miR172 family were also identified potentially targeting four OsAP2 genes. The real-time quantitative expression profiling of OsAP2s under heat stress conditions in contrasting indica rice genotypes revealed the differential expression pattern of OsAP2s (6 genes up-regulated and 4 genes down-regulated) in stress- and genotype-dependent manner. These findings unveiled the evolutionary pathways of AP2-TF in rice, and can help the functional characterization under developmental and stress responses.

A Gait-Based Real-Time Gender Classification System Using Whole Body Joints.

Gait-based gender classification is a challenging task since people may walk in different directions with varying speed, gait style, and occluded joints. The majority of research studies in the literature focused on gender-specific joints, while there is less attention on the comparison of all of a body's joints. To consider all of the joints, it is essential to determine a person's gender based on their gait using a Kinect sensor. This paper proposes a logistic-regression-based machine learning model using whole body joints for gender classification. The proposed method consists of different phases including gait feature extraction based on three dimensional (3D) positions, feature selection, and classification of human gender. The Kinect sensor is used to extract 3D features of different joints. Different statistical tools such as Cronbach's alpha, correlation, t-test, and ANOVA techniques are exploited to select significant joints. The Coronbach's alpha technique yields an average result of 99.74%, which indicates the reliability of joints. Similarly, the correlation results indicate that there is significant difference between male and female joints during gait. t-test and ANOVA approaches demonstrate that all twenty joints are statistically significant for gender classification, because the p-value for each joint is zero and less than 1%. Finally, classification is performed based on the selected features using binary logistic regression model. A total of hundred (100) volunteers participated in the experiments in real scenario. The suggested method successfully classifies gender based on 3D features recorded in real-time using machine learning classifier with an accuracy of 98.0% using all body joints. The proposed method outperformed the existing systems which mostly rely on digital images.

Evaluation of heavy metal phytoremediation potential of six tree species of Faisalabad city of Pakistan during summer and winter seasons.

Environmental pollution induced by heavy metals has been identified as a leading threat in the modern era. Woody tree species may play a crucial role in the removal of heavy metals from soil and air, thus minimizing pollution potential. The present study was designed to evaluate the phytoremediation potential of six tree species; Azadirachta indica, Cassia fistula, Conocarpus erectus, Eucalyptus camaldulensis, Morus alba, and Populus deltoids, respectively, in the industrial and residential areas of Faisalabad based on the concentrations of lead (Pb), zinc (Zn), cadmium (Cd), and copper (Cu) in their leaves and barks in winter (2018) and summer (2019) seasons. The seasonal contents of heavy metals in both the leaves and barks of these trees decreased in the order of: Zn > Pb > Cu > Cd at both study sites. The highest heavy metal contents were recorded in the leaves and barks of trees grown in the industrial areas as compared to residential areas, with leaves and barks having higher contents of heavy metals in the summer than winter. The tree species exhibited significantly different capacity for heavy metal accumulation, with the accumulation of Cd decreased in the order of: E. camaldulensis > M. alba > C. erectus > A. indica > P. deltoids > C. fistula, and while the order varied for different heavy metals. Overall, M. alba, E. camaldulensis and A. indica performed well in accumulating the targeted heavy metals from the ambient environment. Among the six tree species grown commonly in Faisalabad city, M. alba, E. camaldulensis, and A. indica are recommended for the industrial and residential areas due to their phytoremediation capacity for heavy metals.

Comparison of efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections.

Objective: To compare efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections. Methods: Prospective Observational Study was conducted at Department of Surgery, Pakistan Ordinance Factories (POF) Hospital, Wah Cantt for duration of two years (January 2018-December 2019). A sample size of 140 diabetic foot infection patients (70 patients in each group) was calculated using WHO calculator. DFI patients were selected through non probability (consecutive) sampling technique. All patients signed consent forms before participation into study. Patients were randomly divided into two group (computer generated random number table); Group-A patients were given systemic antibiotics alone while Group-B was given combination of gentamicin cream and systemic antibiotics. SPSS version 24 was utilized for analysis purpose. Chi-square test was applied in our study. Results with p value ≤0.05 found significant. Results: Total 140 patients were included in study. There were 87(62.1%) male and 53(37.9%) females in our data. Mean age of patients was 46 years±11.3SD. Group-B (combination of gentamicin and systemic antibiotics) showed significant reduction in inflammation (p=0.03), culture negativity(p=0.001), increase clinical cure (p=0.02) and pathological eradication (p=0.03) as compared to Group-A (systemic antibiotics alone). Gender, age and duration of diabetes mellitus had insignificant association with outcomes (p>0.05). Conclusion: Diabetic foot infections are significant contributors of morbidity in our country. Combination of gentamicin cream with systemic antibiotics is highly effective in inflammation reduction, increasing clinical cure rate and pathological eradication as compared to systemic antibiotics alone in diabetic foot infections. Early identification of risk factors, proper patients care and multidisciplinary approach for diabetic foot infections prevention is required.

Genome-wide association and transcriptome analysis of root color-related genes in Gossypium arboreum L.

MAIN CONCLUSION: The significant number loci and candidate genes of root color in Gossypium arboreum are identified and provide a theoretical basis of root color for cotton. A stimulating phenomenon was observed on the 4th day of sowing in the root color of some G. arboreum accessions that turned red. To disclose the genetic mechanisms of root color formation via genome and transcript levels, we identified the significant number of SNPs and candidate genes that are related to root color through genome-wide association study (GWAS) and RNAseq analysis in G. arboreum. Initially, 215 no. of G. arboreum accessions was collected, and the colors of root on the 4th, 6th and 9th day of germination were recorded. The GWAS demonstrated that 225 significant SNPs and 47 candidate genes have been identified totally. The strongest signal SNP A04_91824 could greatly distinguish the root color with most "C" allele accessions have displayed white and "T" allele accessions displayed red. RNAseq was performed on accessions having the white and red root, and results revealed that 12 and 138 DEGs were detected on 2nd and 4th day, respectively. ACD6, UFGT, and LYM2 were the most related genes of root color, later, verified by qRT-PCR. The mature zone of red and the white roots was observed by the histological section method, and results shown that cells were more closely arranged in the white root, and both average cell length and cell width were longer in the red root. This study will be helpful to cotton breeders for utilization of several elite genes and related SNPs related to root color, in addition to find linkage with economically important traits of interests.

The Spin1 interactor, Spindoc, is dispensable for meiotic division, but essential for haploid spermatid development in mice.

In mammals, germline development undergoes dramatic morphological and molecular changes and is epigenetically subject to intricate yet exquisite regulation. Which epigenetic players and how they participate in the germline developmental process are not fully characterized. Spin1 is a multifunctional epigenetic protein reader that has been shown to recognize H3 "K4me3-R8me2a" histone marks, and more recently the non-canonical bivalent H3 "K4me3-K9me3/2" marks as well. As a robust Spin1-interacting cofactor, Spindoc has been identified to enhance the binding of Spin1 to its substrate histone marks, thereby modulating the downstream signaling; However, the physiological role of Spindoc in germline development is unknown. We generated two Spindoc knockout mouse models through CRISPR/Cas9 strategy, which revealed that Spindoc is specifically required for haploid spermatid development, but not essential for meiotic divisions in spermatocytes. This study unveiled a new epigenetic player that participates in haploid germline development.

Genome-wide identification and characterization of HSP70 gene family in four species of cotton.

Heat shock proteins (HSPs) are important elements of the cellular group of molecular chaperones. Specifically, HSP70 proteins protect cells from being damaged when plants are exposed to environmental stresses. These proteins are catalysts that manage the correct folding of other proteins, and they play a key role in the development of tolerance against biotic and abiotic stresses. In the present study, 113 HSP70 genes were retrieved from the available genome assemblies of four cotton species, including Gossypium hirsutum, G. barbadense, G. arboreum, and G. raimondii. The HSP70 genes were clustered into 11 subfamilies based on phylogeny. One hundred and nine (109) gene duplications were found across these four species. Localization of genes revealed that several HSP70 genes reside in the cytoplasm. Synonymous and non-synonymous substitution rates revealed that functional segregation of HSP70 genes in cotton is due to purifying selection. Furthermore, HSP70 genes in cotton are expressed constitutively during developmental stages. These findings are valuable to understand the complex mechanism of HSP70 gene regulation that occurs in signaling pathways in response to plant stress.

Exogenous application of black cumin (Nigella sativa) seed extract improves maize growth under chromium (Cr) stress.

Accumulation of non-essential heavy metals like chromium (Cr) is among major abiotic stresses, which adversely affect crop growth. Hexavalent chromium [Cr(VI)] is the most dangerous form negatively affecting the growth and productivity of crops. This study evaluated the role of black cumin extracts (BCE) in improving growth and productivity of maize genotypes under different concentrations of Cr(VI). Two maize genotypes ("Neelum" and "P1543") were grown under 0, 4, 8 and 12 mg Cr(VI) kg-1 concentrations. The BCE was applied as foliar spray at three concentrations (0, 10 and 20%) at 25 and 45 days after sowing. Increasing Cr(VI) concentration significantly (p < 0.05) reduced seed germination, root and allometric traits, gas exchange attributes and relative water contents of tested genotypes. Hybrid maize genotype better tolerated tested Cr(VI) concentrations than synthetic genotype with lower Cr accumulation and better allometric and gas exchange traits. Exogenous application of 20% BCE proved effective in lowering the adverse effects of Cr(VI) toxicity on maize genotypes. It is concluded that 20% BCE could be used to improve maize performance through better allometric and gas exchange traits under different Cr(VI) concentrations. Nonetheless, actual mechanisms involved in improved Cr(VI)-tolerance of maize with BCE application must be explored. Novelty statement Black cumin has been widely used to reduce Cr toxicity in animals. However, the role of black cumin in reducing Cr toxicity in plants has never been studied. The present study was conducted to infer the role of different concentrations of black cumin extract in improving the growth of synthetic and hybrid maize genotypes under different levels of Cr stress. It is concluded that black cumin extract could be used to lower Cr toxicity in maize grown under Cr-contaminated soils.

Painful, irreducible inguinal swelling: A rare presentation of retroperitoneal venous malformation in a boy - A case report.

A 10-year-old boy presented at the Paediatric Emergency service of National Institute of Child Health in November 2019 with a painful and irreducible right inguinal swelling. Exploration revealed a reddish-blue tissue mass protruding through the deep ring extending into the base of the scortum. Further dissection showed the swelling to be in continuity with multifocal retroperitoneal vascular malformations scattered along the posterior and lateral abdominal wall. This swelling was excised and histopathology result confirmed the diagnosis of venous variety of vascular malformation. This is an unusual case of a retroperitoneal venous malformation in a child, clinically mimicking a strangulated inguinal hernia.

Outcome of minimally invasive plate osteosynthesis using locking compression plate in long bone fractures.

OBJECTIVE: To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) using locking compression plate in long bone fractures. METHODS: This was a prospective study for the long bones fracture managed by MIPO using locking compression plate in thirty patients from January to December 2017. All the skeletally mature patients and the patients with osteoporotic bones were included. Patients with open injuries, paediatric patients and plating done in non-traumatic conditions were excluded. Patients were followed as outpatient after one week, six weeks, after three months and then after 6 months. RESULTS: Among 30 patients, 12(40%) were males and 18 (60%) females with male to female ratio 1:1.5. Average age of 30 patients was 59.5 ± 16.72 years (Range =21 to 91 years). Mean duration of surgery was 98.0±27.1 (Range=50 to 150) minutes. Majority 14(46.7%) had operative time 90-110 minutes. There were two complications, one (3.3%) had screw pull out and other had deep infection. CONCLUSIONS: LCP system is a reliable and safe tool that extends the options for fixation by plating and has advantages over the other systems in term of stability that can be achieved with it especially in osteopenic bones.

Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications.

BACKGROUND: Although diffuse alveolar damage and respiratory failure are the key features of coronavirus disease 2019 (COVID-19), the involvement of other organs such as the kidney has also been reported. The reports of the incidence of acute kidney injury (AKI) in COVID-19 patients vary widely. In this study, we report our unique experience with AKI in COVID-19 patients in a low socioeconomic and predominantly ethnic minority group and provide its incidence, risk factors, and prognosis to expand the current understanding of this complication. METHODS: In this single-center, retrospective cohort study, we analyzed the data of 469 COVID-19 patients admitted to the Brookdale University Hospital in Brooklyn, NY, from March 18 through April 23, 2020. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Both univariate and multivariate analyses were performed to determine the association of AKI with in-hospital mortality. RESULTS: The median age was 66 years (interquartile range [IQR] 25-75; range 19-101 years), and 268 (57.14%) patients were male. Estimated glomerular filtration rate (eGFR) as determined by the Modification of Diet in Renal Disease Study Equation was low (<60 mL/min/1.73 m2) in 207 (44.1%) patients. During hospitalization, 128 (27.3%) patients developed AKI, and the incidence was significantly higher in those patients presenting with a low eGFR (N = 81, 39.1%; p < 0.001). Male sex, hypertension, the use of angiotensin-converting enzyme inhibitors and non-steroidal anti-inflammatories, hemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, and admission elevated ferritin, creatinine kinase, brain natriuretic peptide, and troponin 1 were identified as the risk factors for in-hospital AKI. Ninety-seven (28.45%) patients died in the non-AKI group versus 91 (71.1%) in the AKI group (p < 0.001). The Cox proportional hazard model after adjusting for age, gender, comorbidities, hemodynamic status, and PF ratio (arterial oxygen partial pressure [PaO2]/fractional inspired oxygen [FiO2]) determined that on admission, an elevated blood urea nitrogen (hazard ratio [HR]: 1.75; 95% confidence interval [CI] 1.23-2.48), a low eGFR (HR 1.43; CI 1.1-2.03), AKI stage 1 (HR 1.14; CI 0.64-2.03), AKI stage 2 (HR 1.86; CI 1.03-3.56), and AKI stage 3 (HR 2.1; CI 1.3-2.81) were independent risk factors for in-hospital mortality. Renal replacement therapy (RRT) did not improve survival in stage III AKI. CONCLUSION: AKI in our hospitalized COVID-19 patients was common and carried a high mortality, especially in patients with AKI stage 3. RRT did not improve survival. Policy changes and planning for this high incidence of AKI in COVID-19 patients and its associated high mortality are necessary at the local and national levels.

Review of cerebral perfusion strategies for aortic surgery with application for minimally invasive approaches.

Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during a circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra-operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery. Hemiarch and ascending aortic surgery is associated with a higher risk of mortality and morbidity. Attention to the optimal approach and cerebral protection strategy has been shown to significantly affect outcomes and mitigate risk.