Comprehensive molecular and morphological resolution of blubber stratification in a deep-diving, fasting-adapted seal.

Blubber is a modified subcutaneous adipose tissue in marine mammals that provides energy storage, thermoregulation, hydrodynamic locomotion, and buoyancy. Blubber displays vertical stratification by lipid content, fatty acid composition, and vascularization, leading to the assumption that deeper blubber layers are metabolically active, while superficial layers are mainly structural and thermoregulatory. However, few studies have examined functional stratification of marine mammal blubber directly, especially in pinnipeds. We characterized morphological and transcriptional differences across blubber layers in the northern elephant seal, a deep-diving and fasting-adapted phocid. We collected blubber from seals early in their fasting period and divided blubber cores into three similarly sized portions. We hypothesized that the innermost blubber portion would have higher 1) heterogeneity in adipocyte size, 2) microvascular density, and 3) expression of genes associated with metabolism and hormone signaling than outer blubber. We found that adipocyte area and variance increased from outermost (skin-adjacent) to innermost (muscle-adjacent) blubber layers, suggesting that inner blubber has a higher capacity for lipid storage and turnover than outer blubber. Inner blubber had a higher proportion of CD144+ endothelial cells, suggesting higher microvascular density. In contrast, outer blubber had a higher proportion of CD4+ immune cells than inner blubber, suggesting higher capacity for response to tissue injury. Transcriptome analysis identified 61 genes that were differentially expressed between inner and outer blubber layers, many of which have not been studied previously in marine mammals. Based on known functions of these genes in other mammals, we suggest that inner blubber has potentially higher 1) adipogenic capacity, 2) cellular diversity, and 3) metabolic and neuroendocrine signaling activity, while outer blubber may have higher 1) extracellular matrix synthesis activity and 2) responsiveness to pathogens and cell stressors. We further characterized expression of nine genes of interest identified by transcriptomics and two adipokines with higher precision across blubber layers using targeted assays. Our study provides functional insights into stratification of blubber in marine mammals and a molecular key, including CD144, CD4, HMGCS2, GABRG2, HCAR2, and COL1A2, for distinguishing blubber layers for physiological and functional studies in seals.

Secondary organizing pneumonia associated with sertraline: A case report.

Cryptogenic organizing pneumonia is a rare idiopathic interstitial lung disease, with a well-defined clinical-radiological and pathological entity. It may also be secondary to several causes. Rapid clinical and imaging improvement is usually obtained with corticosteroid therapy. We report here, to the best of our knowledge, a unique case of organizing pneumonia associated with Sertraline, a selective serotonin reuptake inhibitor, commonly used in antidepressant therapy.

Illustration of a fatal radiation-induced lung aneurysm: Is central lung stereotactic radiotherapy to be banned?

Stereotactic body radiation therapy is still controversial for inoperable patients with central lung lesion. We report the case of a 59-year-old woman with previous history of head and neck squamous cell carcinoma who was treated by lung stereotactic body irradiation for an inoperable lymph node in station 10R. One year after, a fibroscopy showed a necrosis of the right main bronchus mucosae and the CT showed a radio-induced aneurysm protruding into the right inferior lobular bronchus. The patient eventually died a few hours later with a massive haemoptysis. This case highlights the potential toxicity of central lung stereotactic body radiation therapy and raises the question of its legitimacy.

Is there a proper way to treat shortened oesophagus? About a series of 67 patients.

INTRODUCTION AND OBJECTIVE: During the work-up of gastro-oesophageal reflux disease (GORD) patients, barium swallow may show a shortened oesophagus with a non-reducible gastro-oesophageal junction. In our department, in such cases, a Collis-Nissen operation is usually planned. But, the proper reducibility of the gastro-oesophageal junction (GOJ) in the abdomen is difficult to assess peroperatively. The aim of this study is to compare retrospectively the follow-up of an oesophageal lengthening procedure (Collis-Nissen gastroplasty) versus a standard Nissen in the management of patients with primary short oesophagus or secondary to previous Nissen fundoplication. PATIENTS AND METHODS: Between 01/2000 and 12/2009, 67 patients with a short oesophagus on X-Ray were operated on for proven GORD: 27 (Group A) underwent a Collis-Nissen fundoplication. In 40 patients (Group B), the GOJ was reduced easily and a standard Nissen fundoplication was judged sufficient by the experimented surgeon. Follow up included Quality of Life evaluation using the Gastrointestinal Quality of Life Index (GIQLI) and a barium swallow. RESULTS: 64 patients agreed to participate. Mean follow up was 46 months (4-122). Mean postoperative GIQLI score was 108 in group A, 97 in group B. Barium swallow was performed in 61 patients. In group A, seven patients out of 25 (28%) presented a intrathoracic migration on X-Ray while in group B, it was noted in 20 patients (55%). CONCLUSION: According literature, Collis gastroplasty allows a tension-free fundoplication to be performed to correct a shortened oesophagus. Though our series of brachy-oesophagus is small, it confirms a better outcome after a Collis-Nissen gastroplasty, compared to the classical Nissen fundoplication.

[Clinical case of the month. Cerebrovascular accident related to arterial brachiocephalic trunk stenosis]. / Le cas clinique du mois. Accident ischémique cérébral sur sténose du tronc artériel brachiocéphalique.

The authors report the case of a 47-year old man, admitted for syncope and left-sided motor deficit. Diagnostic investigations revealed a right middle cerebral artery embolic stroke, secondary to a critical stenosis of the arterial brachiocephalic trunk, harboring a floating thrombus. The treatment options for occlusive lesions of the brachiocephalic trunk are discussed, as well as the optimal delay between stroke and brain revascularization.