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BACKGROUND: Proper documentation is essential for patient care. The popularity of artificial intelligence (AI) offers the potential for improvements in neurosurgical note-writing. The study aimed to assess how AI can optimize documentation in neurosurgical procedures. METHODS: Thirty-six notes were included. All identifiable data were removed. Essential information, such as perioperative data and diagnosis, was sourced from these notes. ChatGPT 4.0 was trained to draft notes from surgical vignettes using each surgeon's note template. One hundred forty-four surveys, with a surgeon or AI note, were shared with three surgeons to evaluate accuracy, content, and organization using a five-point scale. Accuracy was the factual correctness. Content was the comprehensiveness. Organization was the arrangement of the note. Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) scores quantified each note's readability. RESULTS: The mean AI accuracy (4.44) was not different from the mean surgeon accuracy (4.33, p = 0.512). The mean AI content (3.73) was lower than the mean surgeon content (4.42, p < 0.001). The mean AI organization (4.54) was greater than the mean surgeon organization (4.24, p = 0.064). The mean AI note's FKGL (13.13) was greater than the mean surgeon FKGL (9.99, p <0.001). The mean AI FRE (21.42) was lower than the mean surgeon FRE (41.70, p <0.001). CONCLUSION: AI notes were on par with surgeon notes in accuracy and organization, but lacked in content. Additionally, AI notes utilized language at an advanced reading level. These findings underscore the potential for ChatGPT to enhance the efficiency of neurosurgery documentation.
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Understanding intricate microbial interactions in the environment is crucial. This is especially true for the relationships between nutrients and bacteria, as phosphorus, nitrogen and organic carbon availability are known to influence bacterial population dynamics. It has been suggested that low nutrient conditions prompt the evolutionary process of genome streamlining. This process helps conserve scarce nutrients and allows for proliferation. Genome streamlining is associated with genomic properties such as %GC content, genes encoding sigma factors, percent coding regions, gene redundancy, and functional shifts in processes like cell motility and ATP binding cassette transporters, among others. The current study aims to unveil the impact of nutrition on the genome size, %GC content, and functional properties of pelagic freshwater bacteria. We do this at finer taxonomic resolutions for many metagenomically characterized communities. Our study confirms the interplay of trophic level and genomic properties. It also highlights that different nutrient types, particularly phosphorus and nitrogen, impact these properties differently. We observed a covariation of functional traits with genome size. Larger genomes exhibit enriched pathways for motility, environmental interaction, and regulatory genes. ABC transporter genes reflect the availability of nutrients in the environment, with small genomes presumably relying more on metabolites from other organisms. We also discuss the distinct strategies different phyla adopt to adapt to oligotrophic environments. The findings contribute to our understanding of genomic adaptations within complex microbial communities.
Subject(s)
Bacteria , Genome, Bacterial , Lakes , Metagenomics , Nitrogen , Nutrients , Phosphorus , Bacteria/genetics , Bacteria/classification , Bacteria/metabolism , Metagenomics/methods , Phosphorus/metabolism , Nutrients/metabolism , Nitrogen/metabolism , Lakes/microbiology , Europe , Base Composition , Carbon/metabolism , Genome Size , Microbiota/genetics , PhylogenyABSTRACT
Over the last decade, the therapeutic landscape for hematological malignancies (HMs) has witnessed a remarkable surge in the development of novel biological and small-molecule-targeted immunomodulatory agents. These therapies have drastically improved survival, but some come at the cost of increased risk of bacterial, viral, and/or fungal infections and on-target off-tumor immunological side effects. To mitigate such risks, physicians must be well informed about infectious complications and necessary preventive measures, such as screening, vaccinations, and antimicrobial prophylaxis. Furthermore, physicians should be vigilant about the noninfectious side effects of these agents that can mimic infections and understand their potential drug-drug interactions with antimicrobials. Strengthening and harmonizing the current surveillance and reporting system for drug-associated infections in real-world settings is essential to better ascertain the potential infections associated with these agents. In this review, we aimed to summarize the infection risks associated with novel agents used for specific HMs and outline recommended strategies for monitoring and prophylaxis.
Subject(s)
Hematologic Neoplasms , Molecular Targeted Therapy , Humans , Hematologic Neoplasms/complications , Hematologic Neoplasms/drug therapy , Molecular Targeted Therapy/methods , Adult , Mycoses/prevention & control , Mycoses/drug therapyABSTRACT
Introduction Patients with subarachnoid hemorrhages (SAH) with external ventricular drains (EVD) can develop chronic hydrocephalus (HCP), requiring permanent cerebrospinal fluid (CSF) diversion via an external shunt. Two different strategies have been used to assess for dependence on EVD: 1) prompt closure, and 2) gradual weaning. Gradual weaning of EVDs is performed by increasing drainage resistance to outflow over days. However, when to start one strategy or the other is up to the physician. No uniform guidelines exist raising a question: Are standardized criteria necessary to initiate the EVD weaning process for SAH patients to increase the safety of EVD discontinuation and reduce the need for a shunt? This study shares criteria used to initiate EVD weaning that displayed increased safety of EVD discontinuation for patients with subarachnoid hemorrhage requiring EVD, particularly with regards to length of hospital stay (LOS), hospital-acquired infection rates, and ventriculoperitoneal shunt/endoscopic third ventriculostomy (VPS/ETV) placement. Methods One hundred and fifty-one SAH patients from January 2016 to January 2019 were analyzed. 60 aneurysmal SAH (aSAH) and 18 non-aneurysmal nontraumatic SAH (naSAH) patients required EVD placement. A gradual EVD weaning protocol was initiated if patients met the following criteria: 1. The reason for EVD placement has resolved or is resolving, 2. The quantity of CSF output is <250mL over 24 hours, 3. Quality of CSF is nonbloody, 4. Intracranial Pressure (ICP) must be within normal limits, and 5. The patient must be neurologically stable. It was acceptable to initiate the weaning process when the patient had mild cerebral vasospasm, but not moderate to severe cerebral vasospasm. EVD weaning was performed by increasing the drain (chamber) height by 5 millimeters of mercury every 24 hours if the criteria were met. Charts were reviewed for LOS, infection rates, and rate of VPS/ETV. Gender, age, race, wean failure incidence, Hunt-Hess scores, modified Fisher scores, and syndrome of inappropriate antidiuretic hormone/cerebral salt wasting (SIADH/CSW) rates were obtained. Results The average LOS for aSAH patients with EVD was 20.35 days. The incidence of VPS/ETV was 11%. A chi-square analysis revealed that aSAH patients had higher rates of VPS/ETV placement (p<0.001) and EVD wean failures (p<0.001) than naSAH patients. aSAH patients had a lower incidence of VPS/ETV placement of 11% compared to 21% nationally. Conclusions Standardized criteria to initiate EVD weaning provided a reduction in VPS/ETV placement among aSAH patients compared to national averages and provided a uniform approach to EVD management. Comparable infection rates and LOS for SAH patients requiring EVDs compared to national averages were found.
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PURPOSE: Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction. METHODS: PubMed was queried for articles using the keywords "uppermost instrumented vertebra", "upper thoracic", "lower thoracic", and "adult spinal deformity". RESULTS: Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine. CONCLUSION: The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.
Subject(s)
Spinal Fusion , Thoracic Vertebrae , Humans , Thoracic Vertebrae/surgery , Thoracic Vertebrae/diagnostic imaging , Spinal Fusion/methods , Spinal Fusion/instrumentation , Kyphosis/surgery , Spinal Curvatures/surgery , Spinal Curvatures/diagnostic imaging , AdultABSTRACT
Development of Plasmodium-specific humoral immunity is critically dependent on CD4 Th cell responses and germinal center (GC) reactions during blood-stage Plasmodium infection. IL-21, a cytokine primarily produced by CD4 T cells, is an essential regulator of affinity maturation, isotype class-switching, B cell differentiation, and maintenance of GC reactions in response to many infection and immunization models. In models of experimental malaria, mice deficient in IL-21 or its receptor IL-21R fail to develop memory B cell populations and are not protected against secondary infection. However, whether sustained IL-21 signaling in ongoing GCs is required for maintaining GC magnitude, organization, and output is unclear. In this study, we report that CD4+ Th cells maintain IL-21 expression after resolution of primary Plasmodium yoelii infection. We generated an inducible knockout mouse model that enabled cell type-specific and timed deletion of IL-21 in peripheral, mature CD4 T cells. We found that persistence of IL-21 signaling in active GCs had no impact on the magnitude of GC reactions or their capacity to produce memory B cell populations. However, the memory B cells generated in the absence of IL-21 exhibited reduced recall function upon challenge. Our data support that IL-21 prevents premature cellular dissolution within the GC and promotes stringency of selective pressures during B cell fate determination required to produce high-quality Plasmodium-specific memory B cells. These data are additionally consistent with a temporal requirement for IL-21 in fine-tuning humoral immune memory responses during experimental malaria.
Subject(s)
CD4-Positive T-Lymphocytes , Interleukins , Malaria , Plasmodium , Animals , Mice , B-Lymphocytes , CD4-Positive T-Lymphocytes/metabolism , Germinal Center/immunology , Germinal Center/metabolism , Malaria/immunology , Memory B Cells/immunology , Mice, Inbred C57BL , Plasmodium/immunologyABSTRACT
Nanotechnology has emerged as a revolutionary technology that has been applied in the oil and gas industry for over a decade, spanning the upstream, midstream, and downstream sectors. Nanotechnology has made significant contributions to the exploration of crude oil and natural gas, both in underground and deep-water environments. It has also played a crucial role in improving the drilling process, enabling the extraction of oil and gas resources from beneath the Earth's surface. Nanoparticles, with their unique physical and chemical properties, such as high specific surface area, high pore volume, and small size, have demonstrated considerable potential in the oil industry. Extensive research has been conducted to explore various types of nanoparticles for advanced applications, including oil exploration, drilling, production, and enhanced oil recovery (EOR). Moreover, nanomaterials have found applications in downstream and intermediate sectors, such as crude oil refining, natural gas processing, and transportation and storage of petroleum products. Ongoing advancements in nanomaterial synthesis methods, the exploration of new nanomaterial uses, and understanding the remarkable properties of nanomaterials will continue to make them increasingly valuable in the oil and gas sector. The oil and gas industry recognises the potential of nanotechnology and nanoparticles and is investing significantly in research and development in this area. This comprehensive review aims to summarise successful applications of nanotechnology while addressing associated challenges. It serves as a valuable resource for future research and application endeavours in the field, highlighting the potential of nanotechnology in the oil and gas industry.
Subject(s)
Nanostructures , Petroleum , Natural Gas , Industry , TechnologyABSTRACT
Hemoglobin switching is a complex biological process not yet fully elucidated. The mechanism regulating the suppression of fetal hemoglobin (HbF) expression is of particular interest because of the positive impact of HbF on the course of diseases such as ß-thalassemia and sickle cell disease, hereditary hemoglobin disorders that affect the health of countless individuals worldwide. Several transcription factors have been implicated in the control of HbF, of which BCL11A has emerged as a major player in HbF silencing. SOX6 has also been implicated in silencing HbF and is critical to the silencing of the mouse embryonic hemoglobins. BCL11A and SOX6 are co-expressed and physically interact in the erythroid compartment during differentiation. In this study, we observe that BCL11A knockout leads to post-transcriptional downregulation of SOX6 through activation of microRNA (miR)-365-3p. Downregulating SOX6 by transient ectopic expression of miR-365-3p or gene editing activates embryonic and fetal ß-like globin gene expression in erythroid cells. The synchronized expression of BCL11A and SOX6 is crucial for hemoglobin switching. In this study, we identified a BCL11A/miR-365-3p/SOX6 evolutionarily conserved pathway, providing insights into the regulation of the embryonic and fetal globin genes suggesting new targets for treating ß-hemoglobinopathies.
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Wastewater treatment processes can eliminate many pollutants, yet remainder pollutants contain organic compounds and microorganisms released into ecosystems. These remainder pollutants have the potential to adversely impact downstream ecosystem processes, but their presence is currently not being monitored. This study was set out with the aim of investigating the effectiveness and sensitivity of non-target screening of chemical compounds, 18S V9 rRNA gene, and full-length 16S rRNA gene metabarcoding techniques for detecting treated wastewater in receiving waters. We aimed at assessing the impact of introducing 33 % treated wastewater into a triplicated large-scale mesocosm setup during a 10-day exposure period. Discharge of treated wastewater significantly altered the chemical signature as well as the microeukaryotic and prokaryotic diversity of the mesocosms. Non-target screening, 18S V9 rRNA gene, and full-length 16S rRNA gene metabarcoding detected these changes with significant covariation of the detected pattern between methods. The 18S V9 rRNA gene metabarcoding exhibited superior sensitivity immediately following the introduction of treated wastewater and remained one of the top-performing methods throughout the study. Full-length 16S rRNA gene metabarcoding demonstrated sensitivity only in the initial hour, but became insignificant thereafter. The non-target screening approach was effective throughout the experiment and in contrast to the metabarcoding methods the signal to noise ratio remained similar during the experiment resulting in an increasing relative strength of this method. Based on our findings, we conclude that all methods employed for monitoring environmental disturbances from various sources are suitable. The distinguishing factor of these methods is their ability to detect unknown pollutants and organisms, which sets them apart from previously utilized approaches and allows for a more comprehensive perspective. Given their diverse strengths, particularly in terms of temporal resolution, these methods are best suited as complementary approaches.
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Water is an essential element in nature. It is used in drinking, irrigation, and industry mainly. Human health is directly linked to groundwater quality and is affected by poor groundwater quality caused by excessive fertilizer application and unhygienic circumstances. Because of increased pollution, investigating the water quality became a point of research for many researchers. There are numerous approaches to assessing water quality, and statistical methods are essential among them. This review paper discusses Multivariate Statistical Techniques, including Cluster Analysis, Principal Component Analysis, Factor Analysis, Geographical Information System, and Analysis of Variance, to name a few. We have presented the significance of each method concisely and how it is being used. In addition, an extensive table is prepared to demonstrate the individual technique along with the computational tool, the type of water bodies, and their respective regions. The advantages and disadvantages of the statistical techniques are also discussed therein. It is found that Principal Component Analysis and Factor Analysis are widely explored techniques.
Subject(s)
Drinking Water , Groundwater , Water Pollutants, Chemical , Humans , Environmental Monitoring/methods , Water Quality , Cluster Analysis , Water Pollutants, Chemical/analysisABSTRACT
The histogenesis of the rare primary cutaneous epithelioid rhabdomyosarcoma (PCERMS) remains unclear, with the morphological and immunophenotypic appearance of a rhabdomyosarcoma but a genomic profile consistent with sarcomatoid undifferentiated malignant melanoma (SUMM). Here, we provide comprehensive clinical, histopathological, and genomic analysis of a putative PCERMS presenting in an elderly patient. Histopathologic examination revealed an ulcerative tumefactive lesion with diffuse replacement of the dermis by sheets of malignant epithelioid cells with a rhabdoid appearance. By immunohistochemistry, the tumor cells were strongly and diffusely positive for desmin and myogenin. Comprehensive genomic analysis with a 542 gene DNA-based sequencing panel revealed likely biallelic NF1 inactivation (mutation and deletion), TERT promoter mutation, and a high tumor mutation burden (>100 mutations/mB) with features of a UV-mutational signature, which are all genomic features that can be seen in undifferentiated malignant melanoma. This case provides evidence of a close relationship at a molecular level between PCERMS and SUMM. Molecular genomic characterization of a larger cohort of PCERMS is warranted for further elucidation.
Subject(s)
Melanoma , Rhabdomyosarcoma , Sarcoma , Skin Neoplasms , Soft Tissue Neoplasms , Humans , Aged , Biomarkers, Tumor/genetics , Skin Neoplasms/genetics , Skin Neoplasms/pathology , Melanoma/genetics , Rhabdomyosarcoma/pathology , Sarcoma/pathology , Soft Tissue Neoplasms/pathology , Melanoma, Cutaneous MalignantABSTRACT
OBJECTIVE: Patients with triple-negative breast cancer (TNBC) frequently develop resistance to chemotherapy. Studies have shown that microRNAs (miRNAs) are often aberrantly expressed in TNBC and are associated with drug resistance. However, a prognostic strategy that correlates miRNAs with chemotherapy resistance remains largely unknown. METHODS: To identify breast cancer chemoresistance-associated miRNAs, the miRNA microarray dataset GSE71142 was downloaded from the Gene Expression Omnibus database. Differentially expressed miRNAs (DE-miRNAs) in chemoresistant groups were identified using the LIMMA package in R. Potential target genes were predicted using the miRTarBase 9. Functional and pathway enrichment analyses was done using WebGestalt. A protein-protein interaction network was visualized using Cytoscape software. The top six hub genes regulated by DE-miRNAs were identified using the random forest model. The chemotherapy resistance index (CRI) in TNBC was defined as sum of the median expression levels of the top six hub genes. The association of CRI with distant relapse risk was evaluated using point-biserial correlation coefficient in the validation cohorts of patients with TNBC. The correlation between CRI and cumulative hazard rate was estimated using the Cox model, and the predicted rate of distant relapse was obtained from the Breslow-type estimator of the survival function. All statistical computations were performed using Origin2019b. RESULTS: A total of 12 DE-miRNAs were screened, including six upregulated and six downregulated miRNAs in chemoresistant breast cancer tissues compared with chemosensitive tissues. Based on fold changes, miR-214-3p, miR-4758-3p, miR-200c-3p, miR-4254, miR-140-3p, and miR-24-3p were the top six most upregulated miRNAs, whereas miR-142-5p, miR-146-5p, miR-1268b, miR-1275, miR-4447, and miR-4472 were the top six most downregulated miRNAs. The top three hub genes for upregulated miRNAs were RAC1, MYC, and CCND1 and for downregulated miRNAs were IL-6, SOCS1, and PDGFRA. CRI was significantly associated with the risk of distant relapse. CONCLUSION: CRI predicted survival benefits with reduced hazard rate.
Subject(s)
MicroRNAs , Triple Negative Breast Neoplasms , Humans , Triple Negative Breast Neoplasms/drug therapy , Triple Negative Breast Neoplasms/genetics , MicroRNAs/metabolism , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/genetics , Protein Interaction Maps/genetics , Genomics , Gene Expression Regulation, NeoplasticABSTRACT
Assessments of health-related quality of life (HRQOL) are conducted by health systems to improve patient-centered care. Studies have shown that the COVID-19 pandemic poses unique stressors for patients with cancer. This study investigates change in self-reported global health scores in patients with cancer before and during the COVID-19 pandemic. In this single-institution retrospective cohort study, patients who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) at a comprehensive cancer center before and during the COVID-19 pandemic were identified. Surveys were analyzed to assess change in the global mental health (GMH) and global physical health (GPH) scores at different time periods (pre-COVID: 3/1/5/2019-3/15/2020, surge1: 6/17/2020-9/7/2020, valley1: 9/8/2020-11/16/2020, surge2: 11/17/2020-3/2/2021, and valley2: 3/3/2021-6/15/2021). A total of 25,192 surveys among 7209 patients were included in the study. Mean GMH score for patients before the COVID-19 pandemic (50.57) was similar to those during various periods during the pandemic: surge1 (48.82), valley1 (48.93), surge2 (48.68), valley2 (49.19). Mean GPH score was significantly higher pre-COVID (42.46) than during surge1 (36.88), valley1 (36.90), surge2 (37.33) and valley2 (37.14). During the pandemic, mean GMH (49.00) and GPH (37.37) scores obtained through in-person were similar to mean GMH (48.53) and GPH (36.94) scores obtained through telehealth. At this comprehensive cancer center, patients with cancer reported stable mental health and deteriorating physical health during the COVID-19 pandemic as indicated by the PROMIS survey. Modality of the survey (in-person versus telehealth) did not affect scores.
Subject(s)
COVID-19 , Neoplasms , Humans , Pandemics , COVID-19/epidemiology , Quality of Life , Retrospective Studies , Patient Reported Outcome Measures , Neoplasms/epidemiologyABSTRACT
The four evolutionary stages have brought us to Industry 4.0. Industry 4.0 is nothing but the 4th Industrial Revolution which will change the production processes. The implementation of Industry 4.0 in the pharmaceutical sector will make the manufacturing of complex drugs easier. The arrival of Industry 4.0 and its advanced technologies such as artificial intelligence (AI), robotics, and the Internet of Things (IoT) makes the processes flexible. Industry 4.0 was introduced to reduce the human workforce and make the complicated processes unchallenging. It is used in all aspects of pharmaceutical sector like analysis, diagnosis, manufacturing, and packaging. The main aim of this paper is to comprehensively elucidate how Industry 4.0 has played a significant role in sustainable development (SD). Industry 4.0 in sustainability decreases the research efforts and examines the research sector's opportunities. This paper also discusses the impact of Industry 4.0 on sustainable development. Industry 4.0 constructs a bridge between industry and sustainability leading to sustainable development. Sustainability can be achieved by adopting innovative techniques of Industry 4.0 in manufacturing. Moreover, Industry 4.0 provides potential benefits for enhancing pharmaceutical production concerning flexibility, expenses, standards, and safety. It is noticed that Industry 4.0 has a beneficial impact on sustainable development by implementing advanced technologies leading to flexible manufacturing processes.
Subject(s)
Drug Industry , Sustainable Development , Humans , Artificial Intelligence , CommerceABSTRACT
Desalination is a tried-and-true method for obtaining clean water from the ocean's brackish waters and recycling and reusing water. It requires a fair amount of energy, so it is necessary to create sustainable energy systems to lessen energy use and environmental impact. For thermal desalination procedures, thermal sources can be great heat sources. This paper's research focuses on thermoeconomically optimized multi-effect distillation and geothermal desalination systems. Collecting hot water from subsurface reservoirs is a well-established method of generating electricity through geothermal sources. Low-temperature geothermal sources, which have a temperature of less than 130 °C, can be utilized for thermal desalination systems, for example, multi-effect distillation (MED). Geothermal desalination is affordable, and it is possible to produce power simultaneously. Because it only uses clean, renewable energy and produces no greenhouse gasses or other pollutants, it is also safe for the environment. The viability of any geothermal desalination plant will be influenced by the location of the geothermal resource, feed water supply, cooling water source, water market, and concentrate disposal site. Geothermal energy can directly supply heat for a thermal desalination system or indirectly give electrical power to reverse the osmosis (RO) membrane-based desalination plant.
Subject(s)
Geothermal Energy , Water Purification , Water Purification/methods , Distillation , Water , Cold TemperatureABSTRACT
Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.
Subject(s)
COVID-19 , Stroke , Female , Humans , Male , Middle Aged , Anticoagulants/therapeutic use , COVID-19/complications , Infarction, Middle Cerebral Artery/therapy , Infarction, Middle Cerebral Artery/complications , Stroke/etiology , Thrombectomy/methods , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome , Case Reports as TopicABSTRACT
Microbial communities in freshwater streams play an essential role in ecosystem functioning via biogeochemical cycling. Yet, the impacts of treated wastewater influx into stream ecosystems on microbial strain diversity remain mostly unexplored. Here, we coupled full-length 16S ribosomal RNA gene Nanopore sequencing and strain-resolved metagenomics to investigate the impact of treated wastewater on a mesocosm system (AquaFlow) run with restored river water. Over 10 days, community Bray-Curtis dissimilarities between treated and control mesocosm decreased (0.57 ± 0.058 to 0.26 ± 0.046) based on ribosomal protein S3 gene clustering, finally converging to nearly identical communities. Similarly, strain-resolved metagenomics revealed a high diversity of bacteria and viruses after the introduction of treated wastewater; these microbes also decreased over time resulting in the same strain clusters in control and treatment at the end of the experiment. Specifically, 39.2% of viral strains detected in all samples were present after the introduction of treated wastewater only. Although bacteria present at low abundance in the treated wastewater introduced additional antibiotic resistance genes, signals of naturally occurring ARG-encoding organisms resembled the resistome at the endpoint. Our results suggest that the previously stressed freshwater stream and its microbial community are resilient to a substantial introduction of treated wastewater.