Blubber gene expression and cortisol concentrations reveal changing physiological stress in a Southern ocean sentinel species.

The health of migratory eastern Australian humpback whales (Megaptera novaeangliae) can reflect the condition of their remote polar foraging environments. This study used gene expression (LEP, LEPR, ADIQ, AhR, TNF-α, HSP-70), blubber hormone concentrations (cortisol, testosterone), and photogrammetric body condition to assess this sentinel species during a period of unprecedented changes to anthropogenic activity and natural processes. The results revealed higher cortisol concentrations in 2020 compared to 2021, suggesting a decline in physiological stress between years. Additionally, metabolic transcripts LEPR, and AhR, which is also linked to xenobiotic metabolism, were upregulated during the 2020 southbound migration. These differences suggest that one or more environmental stressors were reduced between 2020 and 2021, with upregulated AhR possibly indicating a Southern Ocean pollutant declined between the years. This research confirms a Southern Ocean-wide decrease in whale stress during the study period and informs efforts to identify key stressors on Antarctic marine ecosystems.

A novel RT-qPCR health assay reveals differential expression of stress and immunoregulatory genes between the seasonal migrations of humpback whales (Megaptera novaeangliae).

Health information is essential for the conservation management of whale species. However, assessing the health of free-ranging whales is challenging as samples are primarily limited to skin and blubber tissue. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) offers a method to measure health from blubber RNA, providing insights into energetic status, stress and immune activity. To identify changes in health, natural differences in baseline gene expression linked to an individual's sex, reproductive status and life-history stage must first be quantified. This study aimed to establish baseline gene expression indices of health in migrating humpback whales (Megaptera novaeangliae). To do this, we developed an assay to quantify seven health-related gene transcripts (Leptin, Leptin Receptor, Adiponectin, Aryl Hydrocarbon Receptor, Tumour Necrosis Factor-α, Interleukin-6, Heat Shock Protein-70) and used Bayesian mixed effect models to assess differential baseline expression based on sex, lactation status and migration stage (northbound to and southbound from the annual breeding grounds). Results showed no significant contribution of sex to differential baseline expression. However, lactating individuals exhibited downregulated AhR and HSP-70 compared to non-lactating conspecifics. Additionally, southbound individuals demonstrated significantly upregulated HSP-70 and downregulated TNF-alpha, suggesting a relationship between these inflammation-linked transcripts and migratory fasting. Our results suggest that baseline differences due to migratory stage and lactation status should be considered in health applications of this assay. Future monitoring efforts can use our baseline measurements to better understand how gene expression is tied to population-level impacts, such as reduced prey availability or migratory stressors.

Minke whale feeding rate limitations suggest constraints on the minimum body size for engulfment filtration feeding.

Bulk filter feeding has enabled gigantism throughout evolutionary history. The largest animals, extant rorqual whales, utilize intermittent engulfment filtration feeding (lunge feeding), which increases in efficiency with body size, enabling their gigantism. The smallest extant rorquals (7-10 m minke whales), however, still exhibit short-term foraging efficiencies several times greater than smaller non-filter-feeding cetaceans, raising the question of why smaller animals do not utilize this foraging modality. We collected 437 h of bio-logging data from 23 Antarctic minke whales (Balaenoptera bonaerensis) to test the relationship of feeding rates (λf) to body size. Here, we show that while ultra-high nighttime λf (mean ± s.d.: 165 ± 40 lunges h-1; max: 236 lunges h-1; mean depth: 28 ± 46 m) were indistinguishable from predictions from observations of larger species, daytime λf (mean depth: 72 ± 72 m) were only 25-40% of predicted rates. Both λf were near the maxima allowed by calculated biomechanical, physiological and environmental constraints, but these temporal constraints meant that maximum λf was below the expected λf for animals smaller than ~5 m-the length of weaned minke whales. Our findings suggest that minimum size for specific filter-feeding body plans may relate broadly to temporal restrictions on filtration rate and have implications for the evolution of filter feeding.

A mammalian messenger RNA sex determination method from humpback whale (Megaptera novaeangliae) blubber biopsies.

The large size of free-ranging mysticetes, such as humpback whales (Megaptera novaeangliae), make capture and release health assessments unfeasible for conservation research. However, individual energetic condition or reproductive health may be assessed from the gene expression of remotely biopsied tissue. To do this, researchers must reliably extract RNA and interpret gene expression measurements within the context of an individual's sex. Here, we outline an RNA extraction protocol from blubber tissue and describe a novel mammalian RNA sex determination method. Our method consists of a duplex reverse transcription-quantitative (real-time) polymerase chain reaction (RT-qPCR) with primer sets for a control gene (ACTB) and the X-chromosome inactivation gene (XIST). Products of each RT-qPCR had distinct melting temperature profiles based on the presence (female) or absence (male) of the XIST transcript. Using high-resolution melt analysis, reactions were sorted into one of two clusters (male/female) based on their melting profiles. We validated the XIST method by comparing results with a standard DNA-based method. With adequate quantities of RNA (minimum of approx. 9 ng µl-1), the XIST sex determination method shows 100% agreement with traditional DNA sex determination. Using the XIST method, future cetacean health studies can interpret gene expression within the context of an individual's sex, all from a single extraction.

Chest CT Findings and Their Temporal Evolution in COVID-19 Pneumonia.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic originated in China in November 2019 and is caused by the SARS-CoV-2 virus. The virus binds to nasal and pharyngeal epithelial cells and migrates to the lower respiratory tract. The confirmatory test for COVID-19 infection is the reverse transcription-polymerase chain reaction (RT-PCR). Chest CT plays an important role in the diagnosis, triage, and treatment of affected individuals. We describe the findings on chest CT and their temporal evolution in COVID-19 pneumonia. METHODS: We conducted a retrospective, cross-sectional study on COVID-19-positive patients who underwent chest CT. CT images of the patients were reviewed for ground-glass opacities, consolidation, crazy-paving appearance, vascular dilatation, traction bronchiectasis, architectural distortion, and subpleural and parenchymal bands. Distribution of opacities on axial sections, ancillary findings, and co-existent lung diseases were recorded. To assess the temporal evolution of CT findings, the time in days between the onset of the first symptom and the date of the CT scan of each patient was recorded. Statistical analysis was performed. RESULTS: Ground-glass opacities, consolidation, and a combination of both were the most important features in COVID-19 pneumonia. Patients in the early stage showed simple ground-glass opacities; in the progressive stage showed consolidation and ground-glass opacities with crazy-paving appearance, subpleural and parenchymal bands, and architectural distortion; in the peak stage showed progression of these findings; and in the late stage showed interval resolution of these findings. Axial distribution of these opacities was asymmetric, with peripheral subpleural predominance involving posterior, lateral, and both these locations, associated with apicobasal gradient. CONCLUSION: Chest CT permits rapid diagnosis of COVID-19 pneumonia, enabling appropriate treatment to be instituted at the earliest. Thus, it is life-saving in resource-constrained environments.

Utility of 18 F-FDG PET/CT in pre-surgical risk stratification of patients with breast cancer.

OBJECTIVE: To determine the correlation between fluorine-18-fluorodeoxyglucose (18F-FDG) uptake values and clinicopathological prognostic markers using preoperative 18F-FDG positron emission tomography/computed tomography (PET/CT) in primary breast cancer (BC). SUBJECTS AND METHODS: One hundred and twelve patients with primary BC were studied prospectively. Pretreatment 18F-FDG PET/CT was performed. Maximum standardized uptake values (SUVmax) were compared with various clinicopathological variables. RESULTS: In a univariate analysis, SUVmax correlated well with the following prognostic variables: T stage, absence of progesterone receptor (PR), absence of estrogen receptor (ER), triple negative lesions (ER/PR and Her 2 negative) and high histologic grade. Metastatic lesions and ductal lesions had higher SUVmax than lobular carcinoma. No significant correlation was found between SUVmax,and human epidermal growth factor receptor 2 (Her-2) statusor perineural and lymphovascular invasion. Multivariate analyses showed that breast density, tumor size and PR negativity were significantly correlated with SUVmax (P=0.046 and 0.009, respectively). CONCLUSION: The pre-treatment tumor SUVmax could be utilized as an independent imaging biomarker of the tumor aggressiveness and poor prognosis. Risk stratification based on this index could play a pivotal role in alteration of treatment planning, such as neoadjuvant chemotherapy (precision oncology).

Diagnostic Accuracy of Stress Myocardial Perfusion Imaging in Diagnosing Stable Ischemic Heart Disease.

OBJECTIVE: To determine the diagnostic accuracy of Stress Myocardial Perfusion Imaging (MPI) in diagnosing Stable Ischemic Heart Disease (SIHD). METHODS: To analyze the sensitivity and specificity of Stress Myocardial Perfusion Imaging (MPI) in diagnosing Stable Ischemic Heart Disease (SIHD) by comparing with "gold standard" Coronary Angiogram. RESULTS: A total of 80 patients were studied (51 male, 29 female). 52 patients had significant stenosis in coronary angiography and 49 patients had reversible perfusion defect in myocardial perfusion imaging (MPI). MPI had a sensitivity of 88.46% and a specificity of 89.29% in diagnosing stable ischemic heart disease. CONCLUSION: Coronary Angiography remains the near gold standard in diagnosing ischemic heart disease but is associated with serious complications like stroke, arrhythmias, acute renal failure, infection, etc. Though Myocardial perfusion imaging cannot replace coronary angiogram, it can be used as a reliable and sensitive non-invasive alternate investigation to diagnose stable ischemic heart disease in high risk individuals who are unwilling for angiogram.

Non-Hodgkin's Lymphoma with Pelvic Skeletal Muscle Involvement Presenting as Low Back Ache: An Uncommon Presentation of a Rather Common Malignancy.

Lymphoma with skeletal muscle involvement is a rare clinical presentation. They may occur as primary skeletal muscle lymphoma, contiguous spread from bones or by metastatic spread. We present a rare case of non-Hodgkin's lymphoma with pelvic skeletal muscle involvement presenting as low back ache. Lymphoma as the first differential diagnosis in this case was clinched after an 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and confirmed as diffuse large B-cell lymphoma on histopathology. We seek to present an uncommon manifestation of lymphoma and highlight the role of 18F-FDG PET CT in the diagnosis, staging, and management of lymphoma.

Efficacy of stem cell in improvement of left ventricular function in acute myocardial infarction--MI3 Trial.

BACKGROUND & OBJECTIVES: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 10 [8] autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. METHODS: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). RESULTS: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 10 [8] (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. INTERPRETATION & CONCLUSIONS: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.

The common, less common and uncommon examples of exercise ECG.

We present three interesting and representative cases of exercise ECGs which were done as part of Stress Myocardial Perfusion study. Aim is to emphasize the point that the stress part of the test should be conducted by an expert in the field and recovery phase ECG records should be analyzed carefully for maximum benefit from this test.

The personality trait self-directedness predicts the amygdala's reaction to appetizing cues in fMRI.

Personality and neural response to food cues in various mesolimbic brain structures have been linked to eating disorders. We investigated the question of whether personality traits in healthy individuals correlate with the brain activation induced on confrontation with appetizing visual stimuli. Personality was assessed in 27 normal-weight participants (14 women, mean age=26.0, SD=3.3 years) with the Temperament and Character Inventory (TCI). After an overnight fast, participants viewed blocks of pictures, half containing appetizing food and the other half showing scrambled pictures as control. After each block, participants rated their appetite. Brain activation was measured using a 3T MR scanner. Food compared to control stimuli elicited a significantly higher appetite rating, as well as strong activation in the ventral and dorsal visual stream, the fusiform gyrus and consecutive limbic centres such as the parahippocampal gyrus, the amygdala, the thalamus, the insula, the ventral striatum and the orbitofrontal cortex. In a region-of-interest analysis, the TCI trait self-directedness was negatively correlated with mean blood oxygenation level dependent (BOLD) signal change in the right amygdala (r=-.43, p=.025). Ultimately, amygdala reactivity might provide a risk factor for the development of eating disorders.

Comparison of PET/CT with conventional imaging modalities (USG, CECT) in evaluation of N0 neck in head and neck squamous cell carcinoma.

BACKGROUND: Evaluation of a clinically N0 neck is mandatory in cases of squamous cell carcinoma of head and neck region in order to determine the need to address the neck. The study was designed to compare the accuracy of PET/CT scan with that of USG and CECT Neck in assessing clinically N0 neck in cases of squamous cell carcinoma of upper aerodigestive tract. METHODS: Single center, prospective, study over a 2 year period. All Cases of squamous cell carcinoma of upper aerodigestive tract with no palpable neck lymphadenopathy and who were scheduled for surgery were evaluated with USG, CECT and 18F-FDG PET/CT, of the neck. Post operative histopathology was correlated with pre-operative nodal status. Statistical analysis was done using the chi square test. RESULTS: In the 49 patients enrolled, 51 neck sides underwent dissections. Sensitivity of USG, CECT and PET-CT was 4.76%, 23.80% and 71.43% respectively while the specificity was 93.33%, 93.33% and 96.67% respectively. The positive predictive value (PPV) calculated for USG, CECT and PET-CT was 33.33%, 71%, 93.5% respectively while the negative predictive value (NPV) 58.33%, 63.63% and 82.85% respectively. CONCLUSIONS: In N0 neck in head and neck squamous cell carcinoma, though FDG-PET-CT is more accurate than either USG or CECT in staging of the neck, it is not accurate enough to alter the current treatment paradigm.

Evaluation of TMT abnormalities in asymptomatic persons using myocardial perfusion study.

Exercise ECG (TMT) is one of the very common investigations being used in the periodic medical examination of high risk professionals like airline pilots and executives. We have done a retrospective analysis of 152 asymptomatic persons who reported for myocardial perfusion imaging after being found to have positive TMT in the form of ST-T changes in inferolateral leads. Stress myocardial perfusion scan of all of them were normal. The fact that so many cases of positive TMT based on ST-T changes in inferolateral leads is found to be false positive should make us retrospect on the criteria for deciding positive TMT. The data available with other centers can be examined and a prospective multicentric study can be done to see whether the present criteria for positive TMT need revision.

A qualitative study about immigrant workers' perceptions of their working conditions in Spain.

BACKGROUND: Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions. METHODS: Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain. RESULTS: Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions. CONCLUSIONS: The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

What about odor in terminal cancer?

Daily care involving proximity with a malodorous patient in the terminal stage of cancer has often proved difficult for the caregiver. Whatever the cause of the primary cancer, three sources of noxious odor can exist or coexist: necrosis, superinfection, and perspiration and/or discharge. The proposed treatment calls for a twofold approach: internal or general and external or local. The internal treatment consists mainly of antibiotics and often involves the combined use of two drugs. Local treatment is applied "à la carte" according to the origin of the odors. Wounds, vomiting, diarrhea, and so on can be treated with specific treatments which will be discussed further.