Management of neurotrauma during COVID-19: a single centre experience and lessons for the future.

INTRODUCTION: Traumatic brain injury (TBI) is amongst the leading causes of morbidity and mortality worldwide. The unprecedented emergence of COVID-19 has mandated neurosurgeons to limit viral spread and spare hospital resources whilst trying to adapt management plans for TBI. We aimed to characterize how this affects decision-making on TBI management and drive strategies to cope with future expected waves. METHODS: Retrospective TBI data collection from a single tertiary referral unit was performed between: 01/04/2019 - 30/06/2019 ('Pre-Epidemic') and 01/04/2020 - 30/06/20 ('Epidemic'). Demographics, mechanism of injury, TBI severity, radiological findings, alcohol/anticoagulants/antiplatelets use, and management decisions were extracted. RESULTS: 646 TBI referrals were received in 'Pre-Epidemic' (N = 317) and 'Epidemic' (N = 280) groups. There was reduction in RTA-associated TBI (14.8 vs 9.3%; p = .04) and increase in patients on anticoagulants (14.2 vs 23.6%; p = .003) in the 'Epidemic' group. Despite similarities between other TBI-associated variables, a significantly greater proportion of patients were managed conservatively in local referring units without neurosurgical services (39.1 vs 56.8%; p < .0001), predominantly constituted by mild TBI. CONCLUSION: Despite COVID-19 public health measures, the burden of TBI remains eminent. Increases in local TBI management warrant vigilance from primary healthcare services to meet post-TBI needs in the community.

Risk factors for incident delirium among urological patients: a systematic review and meta-analysis with GRADE summary of findings.

BACKGROUND: Post-operative delirium is an important, yet under-researched complication of surgery. Patients undergoing urological surgery may be at especially high risk of POD, as they are often older, and interventions can be associated with conditions that trigger delirium. The main aim of this systematic review was to evaluate the available evidence for risk factors in this patient group. METHODS: Five databases were searched (MEDLINE, Web of Science, EMBASE, CINAHL and PsychInfo) between January 1987 and June 2019. The Newcastle-Ottawa Scale was used to assess for risk of bias. Pooled odds ratio or mean difference (MD) for individual risk factors were estimated using the Mantel-Haenzel and inverse variance methods. RESULTS: Seven articles met the inclusion criteria, giving a total population of 1937. The incidence of POD ranged from 5 to 29%. Three studies were deemed low risk of bias and four at a high risk of bias. Nine risk factors were suitable for meta-analysis, with age (MD 4.314 95% CI 1.597, 7.032 p = 0.002) and the clock drawing test (MD - 2.443 95% CI - 3.029, - 1.857 p < 0.001) having a statistically significant association with POD in pooled analyses. CONCLUSION: Delirium is common in urological patients. This review has identified a lack of studies in this surgical population, with wide heterogeneity and high risk of bias. It also highlights a number of potential risk factors for post-operative delirium, of which some are modifiable. However, the strength of evidence is weak at present and so future research should focus on assessing comparable risk factors in this patient group in order to inform future clinical practice. Review registration The review protocol was prospectively registered with the PROSPERO database (reference CRD42017054613).

Triacylglycerol composition of protected designation of origin cheeses during ripening. Authenticity of milk fat.

Triacylglycerol (TAG) composition by carbon number in 2 protected designation of origin cheeses, Mahón (cheese from cow milk) and Manchego (cheese from ewe milk) that were manufactured by 3 different producers was analyzed during cheese ripening using gas chromatography with a short capillary column. The TAG composition at different times during cheese ripening was also analyzed in cheeses from different batches produced at the same plant. Lipolysis levels in the Mahón and Manchego cheeses during ripening were low; free fatty acid values ranged from 2,500 to 4,000 ppm at the end of ripening. The TAG composition did not change significantly during ripening. The TAG values obtained from each cheese sample were substituted into the multiple regression equations that have been proposed to detect foreign fats in milk fat. The values obtained using the equations for bovine (proposed by the European Union) and ovine milk (proposed by our laboratory) were within the normal range. Accordingly, these equations can be considered useful for detecting foreign fat in these cheeses during the ripening period contemplated during this study.

Flow cytometry of cell proliferation through the incorporation of bromodeoxyuridine as an index of growth rate in the water flea, Daphnia magna (Crustacea, Cladocera).

BACKGROUND: In this paper, we used a small crustacean as a model to develop a method for quantifying growth rates through the measurement of a cell proliferation marker. This was done in order to study the feasibility of this assay for estimating zooplankton production in the ocean. Flow cytometry immunodetection of bromodeoxyuridine (BrdU) was performed to detect and quantify the cycling nuclei of Daphnia magna. METHODS: A combination of mechanical dissociation and cell enucleation procedures proved to be the most convenient method for preparing nuclear suspensions from whole organisms. Up to three populations of nuclei with different ploidy were observed. The relative abundance of these nuclear populations changed with the size of the flea. RESULTS: The staining technique has been optimized. The time and concentration for the maximum detection of BrdU-labeled nuclei were 3 h at 300 microM BrdU. Whole organisms can be frozen (-20 degrees C) after incubation with no changes in the final results. The method was used in different physiological conditions under controlled food and temperature in order to test the inverse relationship between physiological rates and size of organisms at several developmental stages. The quantification of BrdU-labeled nuclei in 1-6 day-old larvae showed the highest labeling index, with a mean of 95 +/- 1% (n = 22). In contrast, young animals (0.8-1.2 mm) had 25 +/- 4% (n =16, P < 0.001) and adults (>1.4mm) had 14 +/- 3% (n = 4, P < 0.001). The results obtained show an expected tendency, suggesting that a direct relationship exists between the labeling index and the instantaneous growth rate. CONCLUSIONS: Certain features of our method, such as the short times required for labeling and the possibility of preserving the samples during field experiments and under different conditions (including natural concentrations and types of food), are advantageous to the study of processes governing energy fluxes in pelagic ecosystems.

Antibodies against the COOH-terminal region of E. coli ClpP protease in patients with primary biliary cirrhosis.

BACKGROUND/AIMS: The presence of antibodies in sera from patients with autoimmune diseases is an important tool for diagnosis and for providing insights into the mechanisms leading to autoimmunity. The aim of this study was to characterize new reactive antigens in liver autoimmune diseases. METHODS: Sera of patients with liver-related autoimmune (n=74) and non-liver-related autoimmune (n= 211) diseases, non-autoimmune liver diseases (n=18) and healthy controls (n=160) were evaluated for antibodies against E. coli ClpP protease (EClpP) and 20S proteasome by immunoblot analysis. RESULTS: Antibodies against EClpP were detected in 15 of 50 patients with primary biliary cirrhosis, in only one of 100 patients with systemic lupus erythematosus, and in three healthy subjects (Chi-square 59.1, d.f. 2, p< 0.001). Antibodies to 20S proteasome were found in only 35 of 100 patients with systemic lupus erythematosus. All other sera from patients with autoimmune diseases, liver diseases other than primary biliary cirrhosis, and healthy controls were negative for both antigens. Both IgG and IgM classes of antibodies against EClpP were present in primary biliary cirrhosis patient sera with titers of 1/400-1/1000. By using recombinant techniques and peptide ELISA, the immunodominant EClpP epitope recognized by the sera from primary biliary cirrhosis patients was localized in the amino acid sequences 177-194 (QIERDTERDRFLSAPEAV) within the COOH-terminal of EClpP. Affinity-purification of these anti-EClpP antibodies and immunoabsorption experiments established that the antibodies are specific for the bacterial EClpP. CONCLUSIONS: Bacterial ECIpP has been identified as a new antigen specifically reacting with sera from approximately one third of patients with primary biliary cirrhosis.

Mitochondrial localization and oligomeric structure of HClpP, the human homologue of E. coli ClpP.

A bacterially expressed recombinant HClpP protein, the human homologue of Escherichia coli ClpP protease, was used to obtain specific polyclonal antibodies. Those antibodies identify a 26 kDa polypeptide in mitochondrial subcellular fractions of rat and human liver. Immunofluorescence and electron microscopic studies demonstrate that the mammalian homologue of ClpP is located in the mitochondrial matrix with a tendency to be found in association with the inner mitochondrial membrane. An HClpP recombinant protein with a truncated NH2terminus (missing the first 58 amino acid residues) shows a molecular mass of 26 kDa under denaturing conditions. This N-truncated HClpP recombinant protein shows a native molecular mass of 340 kDa that is identical with the native molecular mass of the partially purified protein from rat liver mitochondria. Electron microscopy shows that the N-truncated recombinant HClpP has a ring shape with seven identical morphological units in the periphery, exhibiting a 7-fold symmetry. The native molecular mass and the electron microscopic studies suggest that mitochondrial ClpP is composed of two heptameric rings with 7-fold symmetry, similar to E. coli ClpP.

Alterations in hepatic peroxidation mechanisms in thioacetamide-induced tumors in rats. Effect of a rhodium(III) complex.

A model of liver hyperplastic noduligenesis was induced in rats in vivo by long-term administration of thioacetamide (TAM; 100 mg/kg day i.p.). Three doses of 50 mg/kg of an antitumoral rhodium(III) complex were administered at 14, 9 and 5 days before the end of TAM treatment. Blood and liver were obtained from either TAM, Rh(III) complex or TAM plus Rh(III) complex-treated rats in order to determine the interaction of both (tumoral and antitumoral) substances with the biochemical pathways related to glutathione redox cycle, enzyme activities involved in the oxidative stress coupled to the NADPH/NADP pair and enzymes related to the mono-oxygenase P450 system. The results showed that TAM induced an imbalance between the activities of glutathione-coupled enzymes. Glutathione reductase activity increased along with the intoxication, while glutathione peroxidase activity decreased. Alterations in the activity of soluble glutathione peroxidase were parallel to those of catalase. These results, together with decreased activities of enzymes related to cytochrome P450 mono-oxygenase system, NADPH cytochrome P450 reductase and NADH cytochrome b5 reductase, suggest that liver cells are not protected against the peroxidative stress produced by chronic administration of TAM. The Rh(III) complex did not produce significant changes in the parameters assayed when administered alone. When this complex was administered to TAM-treated rats, significant restoration of the following activities was observed: those of NADPH-generating enzymes (glucose-6-phosphate dehydrogenase and malic enzyme), that of glutathione reductase (NADPH-consuming enzyme), NADPH-cytochrome P450 reductase and total catalase. These results, together with others in previous studies, suggest that the altered liver function induced by chronic administration of TAM can be partially restored by this rhodium complex. The mechanisms by which this complex counteracts the TAM-induced changes have not yet been established.

Sensory vagal nature and anatomical access paths to esophagus laminar nerve endings in myenteric ganglia. Determination by surgical degeneration methods.

The dependence, access paths and functional significance of the intraganglionic laminar nerve endings (IGLEs) in the esophageal wall of the cat are demonstrated. To this end Wallerian degeneration was induced on the vagus nerve by a number of surgical operations performed at the nodose ganglion level. The results show IGLEs to be sensorial receptors dependent on neuronal bodies situated in the nodose ganglion. The nerve fibers on which they depend to reach the esophageal wall gain access via the vagus and the superior laryngeal nerve.

Ultrastructure of free-ending nerve fibres in oesophageal epithelium.

For the first time, at the ultrastructural level, the existence of free-ending, intraepithelial nerve fibres has been demonstrated in the oesophagus wall of adult cats and monkeys. Their form, the way they penetrate the epithelium, their location within the epithelium and their relationships with neighbouring cells have been established. A sensory function is suggested for this type of ending.

Effects of surgical sympathectomy on laminar nerve endings in myenteric ganglia.

Extirpation of the anterior regions of the sympathetic ganglionated chain (all cervical ganglia and the four subsequent thoracic ganglia) has been carried out in the cat. Histological study of the esophagus wall has shown intraganglionic laminar endings (IGLEs) to suffer an alteration which, in time, reverts to normality. Since it is not a Wallerian degeneration as such, we conclude, contrary to what has previously been assessed by some authors, that these nerve apparatuses are not dependent either on nerve cells located in sympathetic ganglia or on nerve fibers coursing through the sympathetic trunk. Speculations are made as to why IGLEs undergo a transitory alteration after experimental destruction of nerve structures to which they are not directly related.

New contribution on the oesophageal mucous innervation in certain monkeys (Cercopithecidae).

Spindle-shaped, barrel-like, or bush-like corpuscular neural structures situated in the mucous epithelium of the upper third of the oesophagus are described. These structures are not homogeneously distributed in this area. Some are very close to the pharyngooesophageal sphincter, spanning the thickness of the epithelium and communicating with the basal membrane by means of a thin pedicle and with the lumen by a small hilus or pore, their morphology being that of a taste bud. The others are situated deeper in the mucous epithelium of the upper third, communicating with the basal membrane only by means of either a thin pedicle or a thicker one, and separated from the lumen by a thick layer of epithelial cells. The bush-like apparatuses lie closely adjacent to the basal membrane of the epithelium.

Effects of increased O2-N2 pressure and breathing apparatus on respiratory function.

The ventilatory response of four subjects was measured at rest and various intensities of exercise. Experiments were conducted in a dry pressure chamber (1) at 1 ATA and 4 ATA with the subjects breathing from a low-resistance mouthpiece, and (2) at ATA with the subjects breathing from open-circuit breathing apparatus (Royal Naval Swimmers' Air Breathing Apparatus). At 4 ATA there was significant hypoventilation and hypercapnia, together with an increased tidal volume and lower respiratory frequency. The use of the breathing apparatus tended to amplify these changes in ventilatory response. In addition, the extent of hypercapnia at 4 ATA was related to the exercise intensity. When subjects breathed from a low-resistance mouthpiece, oxygen uptake was significantly greater at 4 ATA than at the surface for the same ergometric work load, but when they breathed from the breathing apparatus, the increase in oxygen uptake was not significant in comparison to surface values. At 4 ATA bradycardia was evident at all levels of exercise but was not affected significantly by the presence of the breathing apparatus.