Does the microplastics ingestion patterns and polymer composition vary across the oceanic zones? A case study from the Indian coast.

This study explores microplastic (MP) presence in the gastrointestinal tracts of deep-sea fish from the Central Indian Ocean, off the Indian coast. Among the 27 species examined, 19 showed MP contamination, averaging 2.68 ± 0.30 (±SE) MPs per individual. Polymer analysis via FTIR and micro-Raman identified several types, including polyethylene terephthalate (PET), polyvinyl alcohol (PVA), polypropelene (PP), polyvinyl acetate (PVC), polyurethane (PU), polytetrafluoroethylene (PTFE), polyaniline (PANI), polymethyl methacrylate (PMMA), and polyethersulfone (PES), with PET being the most prevalent (33.33 %). MP ingestion was higher in benthopelagic fish and those at higher trophic levels, as indicated by comparisons across oceanic zones. Niche partitioning analysis suggests feeding behaviour as a primary influencer of MP ingestion in deep-sea fish rather than habitat or trophic level. The study proposes the potential use of deep-sea fish as indicators for assessing microplastic pollution across oceanic zones and deep-sea regions through bycatch monitoring.

Microplastic contamination in Ashtamudi Lake, India: Insights from a Ramsar wetland.

Estuaries function as temporary storage sites for plastic debris, influencing the distribution of microplastics (MPs) across ecosystems. This research delves into the presence of MPs in the water, sediment, fish, and shellfish of Ashtamudi Lake, a Ramsar wetland with brackish water located on the southwest coast of India. Given the lake's significance in supporting the livelihoods of numerous fishers and acting as a vital source of fishery resources for both local consumption and export, examining the contamination of the system by MPs becomes particularly pertinent. The highest percentage composition of MPs was found in macrofauna at 60.6% (with fish at 19.6% and shellfish at 40.9%), followed by sediment (22.8%) and water (16.7%). The primary types of MPs identified in all samples were fibers (35.6%), fragments (33.3%), and films (28%), with beads being the least represented at 3.03%. ATR-FTIR and Raman spectra analysis identified five polymers from shellfish (polypropylene, polyethylene, polystyrene, nylon, and polyvinyl chloride), five from fish guts (nylon, polypropylene, polyethylene, polyurethane, and polysiloxane), four in sediment (polypropylene, polyethylene, nylon, rayon), and four in water samples (polypropylene, polyethylene, nylon, and polystyrene). SEM-EDAX analysis of MPs obtained from the samples revealed degradation and the presence of inorganic elements such as Na, Mg, Al, Si, S, K, Cl, P, and Ca, as well as heavy metals like Pb, Mo, Rh, Pd, Ti, and Fe. The existence of these plastic polymers and heavy metals in microplastic samples poses a threat to vulnerable biota; people consume contaminated fish and shellfish, underscoring the importance of monitoring MPs in lake water. This investigation of MPs in Ashtamudi Lake highlights the system's susceptibility to plastic pollution and the bioavailability of smaller MPs to aquatic organisms. Identified sources of MPs in the lake include fishing and aquaculture activities, sewage pollution, improper solid waste management in lake watersheds, and unsustainable tourism. Upstream and downstream management interventions are recommended to address MP pollution in Ashtamudi Lake.

Counseling in menopausal women: How to address the benefits and risks of menopause hormone therapy. A FIGO position paper.

Menopause marks the end of menstrual cyclicity and, depending on individual vulnerability, has several consequences related to gonadal steroid deprivation, especially if it is premature. Menopause may be more burdensome for some women than for others. Individual factors, such as personal history, socioeconomic status, ethnicity, and current health conditions, affect symptomatology and, thereby, the menopausal experience. In addition, some menopausal symptoms, such as severe hot flashes, sleep disorders, and depression, are markers of future health risks. Counseling is a fundamental part of health care in the peri- and postmenopause periods. It must include an assessment of the patient's symptoms, needs, desires, and risk profile to address the benefits and risks of menopausal hormone therapy (MHT) on an individual basis and promote a healthy lifestyle. Indeed, healthcare practitioners can and must protect the health and lives of mid-life women by increasing awareness of menopausal symptoms and ensuring healthcare options, especially MHT. The type and duration of MHT should be tailored based on the patient's history, menopausal age, physical characteristics, and current health status so that the benefits always outweigh the risks. This FIGO position paper focuses on the benefits and risks of MHT on health domains, target organs, and systems, and on systemic and vaginal MHT regimens, to provide indications that can be used in the clinical practice for menopausal counseling. Moreover, it offers insights into what FIGO considers the mainstay for the healthcare management of women in peri- and postmenopause, worldwide.

A Case Report on Dyke-Davidoff-Masson Syndrome: A Rare Cause of Hemiparesis.

Infantile hemiparesis resulting from Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon condition, especially in patients with no positive natal history. The age of presentation is dependent on when the neurologic insult occurred, and distinctive alterations may not appear until puberty. The left hemisphere and the male gender are more frequently involved. Common findings that can be seen are seizures, hemiparesis, mental retardation, and facial changes. Characteristic MRI findings are dilation of the lateral ventricles, hemiatrophy of the cerebrum, frontal sinus hyperpneumatization, and compensatory hypertrophy of the skull. Here, we report a 17-year-old female patient who reported physiotherapy treatment after the attack of epilepsy, with the complaint of inability to use the right hand for functional activities and gait deviations. Patient examination revealed typical chronic hemiparesis of the right side with mild cognitive affection. Brain investigation confirms the diagnosis of DDMS.

Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging.

Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.

Coronial postmortem reports and indirect COVID-19 pandemic-related mortality.

AIMS: Widespread disruption of healthcare services and excess mortality not directly attributed to COVID-19 occurred between March and May 2020. We undertook the first UK multicentre study of coroners' autopsies before and during this period using postmortem reports. METHODS: We reviewed reports of non-forensic coroners' autopsies performed during the first COVID-19 lockdown (23 March to 8 May 2020), and the same period in 2018. Deaths were categorised as natural non-COVID-19, COVID-19-related, non-natural (suicide, drug and alcohol-related, traumatic, other). We provided opinion regarding whether delayed access to medical care or changes in behaviour due to lockdown were a potential factor in deaths. RESULTS: Seven centres covering nine coronial jurisdictions submitted a total of 1100 coroners' autopsies (498 in 2018, 602 in 2020). In only 54 autopsies was death attributed to COVID-19 (9%). We identified a significant increase in cases where delays in accessing medical care potentially contributed to death (10 in 2018, 44 in 2020). Lockdown was a contributing factor in a proportion of suicides (24%) and drug and alcohol-related deaths (12%). CONCLUSIONS: Postmortem reports have considerable utility in evaluating excess mortality due to healthcare and wider societal disruption during a pandemic. They provide information at an individual case level that is not available from assessment of death certification data. Detailed evaluation of coroners' autopsy reports, supported by appropriate regulatory oversight, is recommended to mitigate disruption and indirect causes of mortality in future pandemics. Maintaining access to healthcare, including substance misuse and mental health services, is an important consideration.

Excision of a rare cardiac tumor aided by endocardial electroanatomical mapping.

Glomus tumors are rare benign soft tissue lesions, most commonly found on the skin. They are an extremely rare cause of the cardiac tumor. We report a case of right atrial glomus tumor excised using a novel technique utilizing cardiac electroanatomical mapping techniques ordinarily used for arrhythmia surgery.

First report of microplastic ingestion by the alien fish Pirapitinga (Piaractus brachypomus) in the Ramsar site Vembanad Lake, south India.

This study reports on the ingestion of microplastics by the alien fish Pirapitinga, Piaractus brachypomus (Characiformes; Serrasalmidae) that escaped Vembanad lake, the largest brackish water lake in the south-west coast of India, from the aquaculture systems during flooding. Microplastics separated from the gut of 32 out of the 123 fishes (26%) examined were identified using Attenuated Total Reflectance - Fourier Transform Infrared (ATR-FTIR), and Raman Spectroscopy. In total, 69 microplastic particles, represented by fibers, foam and fragments were recovered from the fish, with sizes ranging from 0.89 to 4.85 mm. The ATR-FTIR spectral analyses revealed the presence of polymers polyethylene and Nylon 6. The occurrence of PP, Nylon 6, PET and PBT were confirmed using Raman spectroscopy. The presence of MPs in the gut content of alien fish P. brachypomus could be a reflection of the increasing microplastics pollution in the estuaries and backwaters along the south-west coast of India.

Bias in Clinical Practice.

Role of bias in errors of decision making is receiving increasing attention. It is turning out to be one of the main sources of mistakes. Hence, it is important to be aware of biases and to design strategies toward an unbiased approach. Biases are of various types, and the potential sources of bias can be related to the consultant, patients and factors related to working conditions. Availability bias, base rate neglect, confirmation bias, conjunction rule, diagnostic momentum bias, framing effect and confirmation bias are the common types, and these have been discussed in this manuscript using a scenario-based format. Two types of human thinking, the rapid intuitive mode and the slow reflective mode, their pros and cons and their role in biases are discussed. Strategies to enhance awareness of biases, tips to improve reasoning, promote freethinking, enhance decision-making skills and resorting to checklists have been deliberated to achieve an unbiased approach.

Digital pathology for intraoperative frozen section diagnosis of thoracic specimens: an evaluation of a system using remote sampling and whole slide imaging diagnosis.

BACKGROUND: Digital pathology is now used for primary diagnostic work as well as teaching, research and consultation. In our multisite institution service reorganisation led to histopathology being located in a separate hospital from some surgical specialities. We implemented remotely supervised specimen sampling and frozen section diagnosis using digital pathology. In this study we assessed the concordance of glass and digital slide diagnosis using this system. METHODS: We reviewed cases from the first 2 years of digital frozen section reporting at our institution. Cases with potential digital to glass slide discordance were reviewed by three experienced thoracic histopathologists. The reasons for discordance were determined and common themes identified. We also reviewed critical incidents relating to digital pathology during the study period. RESULTS: The study population comprised 211 cases. Frozen section to final diagnosis concordance between digital and glass slide diagnosis was found in 196 (92.6%) cases. The 15 potentially discordant cases were reviewed. Intraobserver concordance between glass and digital slide review ranged from 9/15 to 12/15 cases across the three pathologists. Glass slide review diagnosis showed better concordance with ground truth in two cases; digital slide review was more accurate in two cases. One relevant critical incident was identified during the study period. DISCUSSION: This is the largest study to examine digital pathology for thoracic frozen section diagnosis and shows that this is a safe and feasible alternative to glass slide diagnosis. Discordance between digital and glass slide diagnoses were unrelated to the processes of whole slide imaging and digital microscopy.

Myeloid Tribbles 1 induces early atherosclerosis via enhanced foam cell expansion.

Macrophages drive atherosclerotic plaque progression and rupture; hence, attenuating their atherosclerosis-inducing properties holds promise for reducing coronary heart disease (CHD). Recent studies in mouse models have demonstrated that Tribbles 1 (Trib1) regulates macrophage phenotype and shows that Trib1 deficiency increases plasma cholesterol and triglyceride levels, suggesting that reduced TRIB1 expression mediates the strong genetic association between the TRIB1 locus and increased CHD risk in man. However, we report here that myeloid-specific Trib1 (mTrib1) deficiency reduces early atheroma formation and that mTrib1 transgene expression increases atherogenesis. Mechanistically, mTrib1 increased macrophage lipid accumulation and the expression of a critical receptor (OLR1), promoting oxidized low-density lipoprotein uptake and the formation of lipid-laden foam cells. As TRIB1 and OLR1 RNA levels were also strongly correlated in human macrophages, we suggest that a conserved, TRIB1-mediated mechanism drives foam cell formation in atherosclerotic plaque and that inhibiting mTRIB1 could be used therapeutically to reduce CHD.

Histamine H4 receptor mediates chemotaxis of human lung mast cells.

The diverse effects of histamine are mediated by discrete histamine receptors. The principal repository of histamine in the body is the mast cell. However, the effects of histamine on mast cells, especially those of human origin, have not been fully elucidated. In this study, the expression of histamine receptors in human lung mast cells was evaluated. Moreover, the effects of histamine receptor engagement on both mediator release and chemotaxis were investigated. Mast cells were isolated and purified from human lung tissue. Histamine receptor expression was determined by RT-PCR and q-PCR. Both methods for the detection of histamine receptors were in accordance and human lung mast cells expressed mRNA for histamine H4 and histamine H1 receptors, variably expressed histamine H2 receptor but did not express histamine H3 receptor. The effects of selective histamine receptor agonists on the release of both pre-formed (histamine) and newly-synthesised (cysteinyl-leukotriene, prostaglandin D2) mediators were investigated. None of the agonists tested had any direct effects on mediator release. None of the agonists modulated release stimulated by anti-IgE. Further studies showed that histamine induced migration of mast cells. Chemotaxis appeared to be mediated by the histamine H4 receptor since JNJ28610244 (H4 agonist) was chemotactic for mast cells whereas 2-(2-pyridyl) ethylamine (H1 agonist) was not. Furthermore, the selective histamine H4 receptor antagonist, JNJ7777120, effectively reversed the chemotaxis of mast cells induced by JNJ28610244. Overall, these experiments identify the histamine H4 receptor as chemotactic for human lung mast cells. This mechanism might influence mast cell accumulation in the lung.

Prostaglandin D2 generation from human lung mast cells is catalysed exclusively by cyclooxygenase-1.

Mast cells are an exceptionally rich source of prostaglandin D2 (PGD2). PGD2 is pro-inflammatory and can cause bronchoconstriction. The enzyme cyclooxygenase (COX) is central to the generation of prostanoids such as PGD2. Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit COX. COX exists as two isoforms, COX-1 and COX-2. The principal aim of this study was to establish whether COX-1 and/or COX-2 mediates PGD2 generation from human lung mast cells. Mast cells were isolated from human lung tissue and purified by flotation over Percoll and immunomagnetic bead separations. The cells were activated with anti-IgE or Stem Cell Factor (SCF). The generation of PGD2 was determined by ELISA. The effects of NSAIDs (aspirin, ibuprofen, diclofenac, naproxen, indomethacin), COX-1 selective (FR122047), and COX-2 selective (celecoxib) inhibitors on PGD2 generation were determined. The expression of COX-1 and COX-2 in mast cells was determined by Western blotting. All the NSAIDs tested abrogated stimulated PGD2 generation from mast cells except aspirin which was only weakly effective. FR122047 was an effective inhibitor of PGD2 generation (EC50 ~25nM) from mast cells whereas celecoxib was ineffective. Immunoblotting indicated that COX-1 was strongly expressed in all mast cell preparations while COX-2 expression was weak. No induction of COX-2 was observed following activation of mast cells. These findings indicate that COX-1 is the principal isoform involved in generating PGD2 from human lung mast cells. These studies provide insight into the potential behaviour of NSAIDs in the context of respiratory diseases.

Spindle cell sarcoma of the mitral valve: a rare indication for mitral valve replacement.

Primary cardiac tumours are a rare finding and even rarer cause of valvular heart disease. We report a case of cardiac spindle cell sarcoma mimicking mitral valve stenosis and the subsequent operative management.

Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology.

Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented.

Recovery from desensitization of IgE-dependent responses in human lung mast cells.

BACKGROUND: Clinical desensitization and oral food immunotherapy are therapeutic interventions that allow individuals who react adversely to an allergen (drug or food) to be made tolerant to the allergen. However, tolerance is brief, and allergen hypersensitivity can recur within days following allergen withdrawal. OBJECTIVE: We hypothesize that the reason these treatments are temporary reflects rapid recovery of mast cells from a desensitized state. We sought to test this. METHODS: Desensitization of IgE-mediated histamine release from human lung mast cells was explored by methods that partially replicate the pattern of treatment during clinical desensitization. Specific and non-specific desensitization and changes in surface IgE were examined following desensitization. Recovery from desensitization was also studied. RESULTS: Desensitization of mast cell responses was readily induced with concentrations of antigen or anti-IgE that were suboptimal for secretion. There was little or no non-specific desensitization when lung mast cells were exposed to antigens. There was no loss of cell surface IgE following desensitization. Removing the desensitizing stimulus from the media following desensitization allowed the cells to recover with half-point of recovery of ~1.5 days and complete recovery after 5 days. Both the functional response and histamine content recovered within this time frame. The recovery appeared possible because both antigens and anti-IgE dissociated rapidly from cells after washing to remove excess stimulus. CONCLUSIONS AND CLINICAL RELEVANCE: Human lung mast cells readily recover from a desensitized state following removal of desensitizing antigen. This finding provides a potential explanation for the ephemeral nature of clinical desensitization.

Multi-elemental analysis of human lung samples using inductively coupled plasma mass spectrometry.

The aim of this study was to establish concentrations of a wide range of elements in human lung samples to allow better identification of potential exposures in subsequent cases. This study reports concentrations of 48 elements (Al, As, Au, B, Ba, Be, Bi, Br, Cd, Ce, Co, Cr, Cs, Cu, Fe, Ga, Gd, Ge, Hf, Hg, In, Li, Mn, Mo, Nb, Ni, Os, Pb, Pd, Pt, Rb, Re, Ru, Sb, Se, Sm, Sn, Sr, Ta, Te, Ti, Tl, Tm, V, W, Y, Zn and Zr) in fresh lung tissue samples from 54 hospital patients, of which 93% exhibited various forms of neoplasia. The lung samples were taken from unaffected, background tissue. The samples were stored as fresh tissue in alcohol, dried and microwave digested before analysis by inductively coupled mass spectrometry (ICP-MS). It was possible to establish 95th percentiles for all elements except for rhenium and for 40 elements mixed effects modelling was undertaken. Overall, the levels reported are commensurate with ranges for those elements that had been reported previously. The data were examined for gender, smoking and occupational exposures to metals. The results show that males have higher lung concentrations of Ni, Cr, Gd, Au and Be than females, but significantly lower lung concentrations of Co, Sn, W and In. Cadmium lung concentrations were significantly higher in smokers. Platinum lung concentrations were higher in those who had undergone chemotherapy and gadolinium concentrations were predictably high in those who had undergone imaging scans. More essential elements such as Cu, Br, Fe and also Ge varied the least within lung samples from individuals whilst Be, Hf and Pt had the greatest variances. Between individuals V and Li lung concentrations varied the most, whilst Cu varied least. Analysis of the data for those who reported as having previously worked with metals showed 24 of the 48 elements determined were higher than those from those who had not reported working with metals.

Evaluation of the anti-inflammatory effects of ß-adrenoceptor agonists on human lung macrophages.

The principal mechanism by which bronchodilator ß-adrenoceptor agonists act is to relax airways smooth muscle although they may also be anti-inflammatory. However, the extent of anti-inflammatory activity and the cell types affected by these agonists are uncertain. The purpose of this study was to evaluate whether ß-adrenoceptor agonists prevent pro-inflammatory cytokine generation from activated human lung macrophages. Macrophages were isolated and purified from human lung. The cells were pre-treated with both short-acting (isoprenaline, salbutamol, terbutaline) and long-acting (formoterol, salmeterol, indacaterol) ß-agonists before activation with lipopolysaccharide (LPS) to induce cytokine (TNFα, IL-6, IL-8 and IL-10) generation. The experiments showed that short-acting ß-agonists were poor inhibitors of cytokine generation. Of the long-acting ß-agonists studied, formoterol was also a weak inhibitor of cytokine generation whereas only indacaterol and salmeterol showed moderate inhibitory activity. Further experiments using the ß2-adrenoceptor antagonist ICI-118,551 suggested that the effects of indacaterol were likely to be mediated by ß2-adrenoceptors whereas those of salmeterol were not. These findings were corroborated by functional desensitization studies in which the inhibitory effects of indacaterol appeared to be receptor-mediated whereas those of salmeterol were not. Taken together, the data indicate that the anti-inflammatory effects of ß-adrenoceptor agonists on human lung macrophages are modest.