Search Results (60)

Myocardial calcification is an uncommon complication associated with end-stage chronic kidney disease (CKD) in feline patients. This report describes the clinical and multimodal imaging features of metastatic calcification in a 10-year-old castrated male mixed-breed cat. The patient presented with dyspnea and anorexia, and was diagnosed with IRIS Stage 4 CKD. Laboratory findings revealed severe hyperphosphatemia and an elevated calcium–phosphorus product (CPP) of 135 mg²/dL², based on total calcium. This value significantly exceeds 70 mg²/dL², a threshold associated with a high probability of inducing soft tissue mineralization. Echocardiography revealed extensive hyperechoic foci with posterior acoustic shadowing in the interventricular septum and left ventricular wall. Functional assessment demonstrated a restrictive diastolic filling pattern, suggesting increased myocardial stiffness and congestive heart failure. Computed tomography (CT) further visualized systemic involvement, showing diffuse, amorphous calcifications (400–900 HU) in the myocardium, multifocal aortic wall, and extracardiac tissues. Despite intensive treatment with diuretics and renal support, the patient was euthanized eight days later due to progressive renal failure. This case illustrates that the interaction between metastatic calcification and uremic cardiomyopathy (UC) can result in refractory heart failure, underscoring the value of combined echocardiography and CT in evaluating end-stage renal disease. Full article

Background and Objectives: To study the bony compartmentalization of the jugular foramen in comparison with existing anatomical models. Materials and Methods: We carried out the study on 59 undamaged dry adult human skulls of known age and sex. Two independent examiners with 10 years of experience in anatomical studies by visual inspections determined the type of osseous septation at the inner surface of the jugular foramina. Relationships between jugular foramen morphology and laterality were assessed at the foraminal level, while associations with age groups and sex were evaluated at the skull level. The data obtained was analyzed using the chi-square statistical test to determine the possibility that two or more variables were associated. Results: Different types of jugular foramina were observed: a single foramen without bony spurs was rarely observed (0.9%). Bipartite and tripartite partial or total foramina were frequent (42.2% and 51.4%, respectively). Partial quadripartite foramina were more rarely observed (5.5%). Complete bony bridges were observed in 13 right and 11 left jugular foramina (24/109, 22.01%). Statistical analysis revealed no significant differences in the occurrence of bony bridges in relation to sex, age, laterality, or foramen partition. As regards the bipartite foramina on the left, we found that in males the frequency was higher in older subjects compared to younger ones; although statistical significance was not reached (p = 0.054). Furthermore, the absence of the intrajugular process from the occipital bone was much higher (45.9%) than that from the temporal bone (1.8%), and this difference was statistically significant (p = 0.0001). Conclusions: The jugular foramen from our studies appears mostly septate. These partitions fit well into the anatomical models existing in the literature for the jugular foramina. Our study fits into the anatomical models of the septum and subdivision of the jugular foramen, especially the bipartite and tripartite ones, even if there are differences related to the behavior of the meninges present in some current anatomical models. The existing literature relates primarily to ethnic groups other than our study, which was conducted on European skulls. Full article

Chondrosarcoma of the maxillofacial skeleton is a rare malignant tumor characterized by cartilaginous differentiation and locally invasive growth. Diagnosis is particularly challenging in low-grade tumors because histological features often overlap with those of benign chondroma. We describe a 62-year-old woman with a recurrent cartilaginous tumor of the hard palate. After previous resections in 2013 and 2022, a third recurrence was detected. MRI showed a lobulated lesion at the anterior hard palate contiguous with the nasal septum. A two-staged treatment was performed, starting with a minimal invasive access Brown class 2a maxillectomy guided by a patient-specific cutting guide. Pending histological confirmation, an obturator prosthesis was placed to seal the oroantral communication. Histopathology confirmed a low-grade chondrosarcoma with clear margins of at least 5 mm. A second-stage reconstruction was performed a year later using a posterior pedicle lateral nasal wall flap (inferior turbinate flap) and palatal rotation flap restored nasal lining and oral mucosa. This approach achieved oncologic clearance with excellent functional outcomes. The case highlights the value of image-guided maxillectomy and staged regional flap reconstruction. Full article

Background: Fulminant type 1 diabetes (FT1D) is a rare but life-threatening subtype of type 1 diabetes. The concurrence of FT1D with myocarditis is uncommon and attracts further clinical attention. Case Presentation: A 33-year-old female was transferred by a local hospital to West China Hospital because of altered consciousness, abrupt onset of hyperglycemia with ketoacidosis, significantly increased cardiac biomarkers, and ST segment elevations. Her random blood glucose at the local hospital was 50.19 mmol/L. Insulin infusion and fluid resuscitation were started immediately before referral. On admission, her random blood glucose was 14.17 mmol/L. HbA1C and glycosylated albumin (GA) were 6.3% and 21.45%, respectively. Her fasting C-peptide level was 0.022 nmol/L. Anti-Glutamic Acid Decarboxylase (anti-GAD) antibody was 25.06 IU/mL. FT1D was diagnosed based on the 2012 New Diagnosis Criteria of FT1D. Electrocardiogram showed significant ST segment elevation in leads II, III, aVF, and V3-V6. Echocardiography revealed a mildly reduced left ventricular ejection fraction (LVEF) of 46%. Coronary angiography displayed no abnormality. Cardiac magnetic resonance imaging revealed areas of increased signal intensity in the interventricular septum, basal and mid inferolateral walls, and apical inferior wall and subepicardial late gadolinium enhancement (LGE), particularly in the lateral aspects of the left ventricle on T2-weighted imaging (T2WI). Acute myocarditis was diagnosed based on the European Society of Cardiology 2013 Task Force Criteria. She was treated with insulin, fluid resuscitation, and supportive care, leading to rapid recovery of ketoacidosis and cardiac function. At the four-month follow-up, she remained on insulin therapy with good glycemic control but persistent low C-peptide levels. Conclusion: This case report raises awareness about FT1D, determines the differential diagnosis of acute cardiac presentations in an FT1D patient, and highlights clinical reasoning so that clinicians can recognize and manage similar presentations on time. Full article

Background: Occupational exposure to aerosol particles can pose a substantial health risk. The study aimed to characterise the deposition of occupationally relevant aerosols in a 3D anatomical adult nasal cavity model under steady and unsteady flows. Materials: The deposition of aerosolised wheat flour, pine wood sanding dust, carbon black, and Arizona Test Dust A3 was quantified under steady flows (5, 7.5, and 20 L/min per nostril) and an unsteady breathing pattern generated by the commercial breathing simulator. Image analysis with custom software quantified the area covered by deposited particles. The Downstream Penetration Index (DPI) was determined from the outlet mass. Results: The highest segmental deposition occurred in the anterior segment of the lateral wall (WA) and septum (SA), with moderate values in the middle lateral wall (WM) and the lowest in the posterior lateral wall (WP, nasopharynx) and septum (SP). Arizona Test Dust A3 and carbon black demonstrated higher middle-posterior deposition and DPI, consistent with finer particle size distributions (PSD) and greater sub-10 µm fractions. In contrast, wheat flour and pine wood dust, with larger median particle sizes and lower sub-10 µm fractions, showed stronger anterior filtration and lower DPI. Increased flow enhanced anterior filtration of coarse particles and shifted deposition forward, aligning with increased inertial impaction, but elevated DPI for fine particles. Under unsteady flow, deposition was intermediate between 7.5 and 20 L/min. Conclusions: This study shows that PSD, morphology, and flow conditions influence nasal deposition. Coarse aerosols were filtered in the anterior nose, while fine-rich aerosols showed relatively greater middle-posterior deposition and higher DPI. These findings are essential for assessing occupational exposure and developing interventions and prevention strategies. Full article

Cocaine-related deaths present significant diagnostic challenges due to the nonspecific nature of cardiac histopathology and the limited reliability of postmortem toxicology, often affected by redistribution phenomena. This study investigated the postmortem heart expression and distribution of an anti-cocaine monoclonal antibody, aiming to evaluate immunohistochemistry (IHC) as a potential complementary tool for diagnosing cocaine-related fatalities. Fifteen cases of acute cocaine-related death, with toxicological data exclusively positive for cocaine, were examined and compared to ten cases negative for drug abuse. Cardiac samples from the lateral left ventricular wall and interventricular septum underwent IHC using an experimentally optimized protocol. All cocaine-related cases demonstrated clear and widespread immunopositivity, with varying staining intensities across a semi-quantitative scale. Immunostaining localized consistently to nuclear and myofibrillar compartments and showed no association with postmortem interval (mean PMI 72.33 h; range 30–144). Control samples exhibited no staining. Positive immunostaining also highlighted cardiomyocyte alterations related to cocaine toxicity, particularly hypercontracted fibers with myofibrillar rhexis and contraction band necrosis. While these findings align with the established cocaine-induced myocardial injury, the intense nuclear staining observed may further reflect oxidative DNA damage associated with cocaine exposure. This study provides novel evidence supporting the applicability of anti-cocaine IHC in postmortem investigations. The technique may serve as a valuable adjunct in detecting cocaine distribution within cardiac tissue, particularly when toxicological data are inconclusive or unavailable. Full article

Cardiac myosin inhibitors have been shown to improve diastolic function in patients with obstructive hypertrophic cardiomyopathy (HCM). Comparative studies to evaluate the diastolic effects of mavacamten versus alcohol septal ablation (ASA) have yet to be examined. In this single-center retrospective analysis, we compared echocardiographic parameters of diastolic function in adult patients with obstructive HCM treated with mavacamten (n = 23) or ASA (n = 22). Baseline imaging was obtained prior to therapy, and follow-up imaging was obtained five months after ASA and or initiation of mavacamten. Left-sided filling pressures (E/e’) improved with both ASA (18.6 versus 15.3, p < 0.001) and mavacamten (17.4 versus 13.5, p = 0.01). Among patients who underwent ASA, mitral annular tissue velocity (e’) was increased at the lateral annulus (6.0 versus 6.1, p = 0.02) with a trend to improvement at the septum (4.0 versus 5.0, p = 0.14). Similarly, among patients treated with mavacamten, septal e’ was increased (6.0 versus 6.7, p < 0.01) and a trended improvement was observed for the lateral e’ (5.7 versus 7.0, p = 0.06). Mavacamten therapy was also associated with an improvement in the LA volume index (45.6 versus 34.5, p < 0.001). Patients treated with ASA were older, more likely to have used tobacco, and had greater limitation in functional status. In this retrospective analysis, ASA and mavacamten were similarly associated with improvements in echocardiographic parameters of diastolic function and left-sided filling pressures, though mavacamten had a more discernible effect on the left-atrial volume index. Larger studies are required to further characterize the relative efficacy of the two therapeutic modalities. Full article

Two new species of free-living marine nematodes from mangrove wetlands of Beihai, Guangxi province in China, are described and illustrated. Trissonchulus sinensis sp. nov. is characterized by a head continuous with the body, an amphidial fovea pouch-shaped, pharynx expanding gradually but not forming a posterior bulb, spicules sclerotized, blade-shaped, slightly curved ventrally, proximal part enlarged with a prominent central septum, posterior part slender and handle-like; gubernaculum small, composed of two distally connected sheet-like structures with tooth-like ends, and lacking apophysis. Metachromadora sinica sp. nov. is characterized by a cuticle that is finely annulated, labial sensilla papilliform, cephalic setae four in number, amphideal fovea loop-shaped, exhibiting a double-contoured appearance, pharyngeal bulb well-developed, internal cuticular lumen tripartite, lateral epidermal ridges present, spicules slender with an enlarged capitulum, gubernaculum boat-shaped, precloacal supplements absent, tail conical with two setose protuberances, three pairs of subventral preanal setae, and a pair of papillae situated anterior to the anus. Nearly full-length SSU sequences and D2-D3 of LSU sequences are provided for the new species. Phylogenetic analysis of SSU provided support for the current classification status of the two new species. In the SSU phylogenetic tree, the family Ironidae was recovered as a separate monophyletic clade. However, the phylogenetic relationships within the family Desmodoridae were complicated, and the subfamilies Desmodorinae and Spiriniinae were polyphyletic. A comprehensive taxonomic approach combining morphological observations and molecular phylogeny construction would be particularly valuable in a more robust nematode taxonomy. Full article

Background/Objectives: Myocarditis can occur in patients with coronavirus disease 2019 (COVID-19) as part of the systemic involvement of this infectious syndrome. The persistence of this non-ischemic late gadolinium enhancement (LGE) pattern can be considered an indicator of ongoing myocardial involvement or a sequela of myocarditis. We aimed to assess the effects of LGE on cardiac function and morphology in patients with COVID-19 admitted in intensive care unit for acute respiratory distress syndrome. Methods: Fifty patients (age 59 ± 11, female n = 15) were enrolled. Results: The prevalence of LGE was 33.3%. LGE was present in the lateral wall in all patients except for one, with LGE positivity at the interventricular septum. In general, patients with and without LGE had similar CMR variables values. In one case, LGE was associated with regional wall motion abnormality. The factor associated with LGE was the duration of hospitalization (7.97 ± 3.8 and 12.5 ± 6.7 days in patients without and with LGE, p = 0.007). Conclusions: LGE non-ischemic pattern was not associated with left ventricular dilatation or dysfunction or remodeling in patients with severe clinical manifestation of COVID-19. LGE is mainly present in patients with more prolonged duration of hospitalization. LGE may represent a residual scar with limited prognostic impact that larger multicenter studies could confirm. Full article

The image represents the post-mortem heart of a 28-year-old female patient, diagnosed in childhood with complete common atrioventricular canal defect. At time of diagnosis, the family refused surgery, as did the patient during her adulthood. Despite being advised against pregnancy, she became pregnant. On presentation to hospital, she was cyanotic, with clubbed fingers, and hemodynamically unstable, in sinus rhythm, with Eisenmenger syndrome and respiratory failure partially responsive to oxygen. During pregnancy, owing to systemic vasodilatation, the right-to-left shunt is increased, with more severe cyanosis and low cardiac output. Echocardiography revealed the complete common atrioventricular canal defect, with a single atrioventricular valve with severe regurgitation, right ventricular hypertrophy, pulmonary artery dilatation, severe pulmonary hypertension and a hypoplastic left ventricle. The gestational age at delivery was 38 weeks. She gave birth to a healthy boy, with an Apgar score of 10. The vaginal delivery was chosen by an interdisciplinary team. The cesarean delivery and the anesthesia were considered too risky compared to vaginal delivery. Three days later, the patient died. The autopsy revealed hepatomegaly, a greatly hypertrophied right ventricle with a purplish clot ascending the dilated pulmonary arteries and a hypoplastic left ventricle with a narrowed chamber. A single valve was observed between the atria and ventricles, making all four heart chambers communicate, also insufficiently developed interventricular septum and its congenital absence in the cranial third. These morphological changes indicate the complete common atrioventricular canal defect, with right ventricular dominance, which is a rare and impressive malformation that requires mandatory treatment in early childhood in order for the condition to be solved. Full article

Hydrocephalus is a frequently observed congenital malformation of the central nervous system in domestic animals; however, its occurrence in wild species remains underreported. This study documents a clinical case of congenital hydrocephalus in a red fox cub (Vulpes vulpes) admitted to the “Visul Luanei” Wildlife Rehabilitation Center. The individual exhibited neurological deficits characterized by depressed mental status, incoordination, dromomania, behavior changes, and blindness. Diagnostic imaging, including radiography and magnetic resonance imaging (MRI), revealed a domed cranial morphology and severe dilation of the ventricular system. Notably, the lateral ventricles were markedly enlarged, with the absence of the septum pellucidum, resulting in a unified ventricular cavity. During electroencephalography (EEG) performed under general anesthesia, a high voltage and low frequency, predominantly featuring delta waves background activity was observed on all traces. Due to the poor prognosis and lack of clinical improvement, euthanasia was performed. This case contributes to the limited knowledge regarding central nervous system malformations in wild canids and underscores the need for further research on congenital neurological disorders in wildlife species. Full article

Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To evaluate for anatomical changes of the IT, lamina and the globes, after sinus surgery and the durability of inferior turbinate outfracture. Methods: A total of forty-four patients who underwent revision endoscopic sinus surgery that included complete ethmoidectomy and IT outfracture were matched. Pre- and post-operative computed tomography scans (CT) were used for evaluating and measuring the anatomical changes in different planes. The posterior globe position in the axial plane, the distance between the lamina papyracea (IOD_Axial, IOD_Coronal) in coronal and axial planes and the distance from the IT to the septum (IT_M) and the lateral nasal wall (IT_L) were measured. Results: There were 16 women and 28 men. Mean follow-up time (time from procedure to post-operative CT scan) was 38.9 ± 20.1 months. Statistically significant lateralization of the IT was observed with IT_L (95%CI 1.1 mm to 1.5 mm p < 0.0001) and IT_M (95%CI −1.5 mm to −1.1 mm; p < 0.0001). No statistically significant differences were seen in IOD_Axial and IOD_Coronal in pre-op and post-op CT scans. (p = 0.23 and p = 0.7, respectively) and no significant displacement of the globe in antero-posterior direction was seen (p = 0.915). Conclusions: IT outfracture appears to have a durable effect on IT position that lasts for several years. Ethmoidectomy did not cause the medialization of the laminae nor altered the position of the globes. Full article

Background/Objectives: Maternal thyroid function plays a crucial role in fetal brain development, yet the potential impact of maternal hypothyroidism and thyroid autoimmunity on fetal intracranial structures remains inadequately explored. To investigate the impact of maternal hypothyroidism and thyroid autoimmunity on fetal intracranial structures, focusing on potential alterations in critical brain parameters during mid-gestation. Methods: This prospective case-control study included pregnant women between 18 and 24 weeks of gestation. Participants were divided into three groups: hypothyroidism and antibodies (Ab) group, hypothyroidism and Ab(–) group, and the control group. Ultrasonographic measurements of fetal intracranial structures such as the posterior lateral ventricle (PLV), cavum septum pellucidi (CSP), cisterna magna (CM), thalamus, and transcerebellar diameter (TCD) were recorded and compared. Results: A total of 153 pregnant women were evaluated (n = 52 in the hypothyroidism and Ab(+) group, n = 51 in the hypothyroidism and Ab(−) group, and n = 50 in the control group). Although most of the biometric parameters were similar across the groups, the hypothyroidism and Ab(+) group exhibited significantly lower PLV and thalamus measurements compared to the control group (p < 0.05). Additionally, there was a notable difference in the BMI among the groups, with hypothyroid participants (with or without antibodies) showing higher rates of being overweight or obese. Conclusions: Maternal hypothyroidism and the presence of thyroid autoantibodies may be associated with subtle changes in fetal brain structures during the mid-gestation period, particularly in the thalamus and PLV. Full article

We have used single molecule tracking to investigate dynamics of four penicillin-binding proteins (PBPs) in Bacillus subtilis to shed light on their possible modes of action. We show that Pbp2a, Pbp3, Pbp4, and Pbp4a, when expressed at very low levels, show at least two distinct states of mobility: a state of slow motion, likely representing molecules involved in cell wall synthesis, and a mode of fast motion, likely representing freely diffusing molecules. Except for Pbp4, all other PBPs showed about 50% molecules in the slow mobility state, suggesting that roughly half of all molecules are engaged in a substrate-bound mode. We observed similar coefficients for the slow mobility state for Pbp4 and Pbp4a on the one hand, and for Pbp2a and Pbp3 on the other hand, indicating possible joint activities, respectively. Upon induction of osmotic stress, Pbp2a and Pbp4a changed from a pattern of localization mostly at the lateral cell membrane to also include localization at the septum, revealing that sites of preferred positioning for these two PBPs can be modified during stress conditions. While Pbp3 became more dynamic after induction of osmotic stress, Pbp4 became more static, showing that PBPs reacted markedly differently to envelope stress conditions. The data suggest that PBPs could take over functions in cell wall synthesis during different stress conditions, increasing the resilience of cell wall homeostasis in different environmental conditions. All PBPs lost their respective localization pattern after the addition of vancomycin or penicillin G, indicating that patterns largely depend on substrate availability. Our findings show that PBPs rapidly alter between non-targeted motion through the cell membrane and capture at sites of active cell wall synthesis, most likely guided by complex formation with other cell wall synthesis enzymes. Full article

Gestational diabetes mellitus (GDM) is a prevalent medical complication in pregnancy that is rapidly escalating worldwide, with epidemic implications. This systematic review aims to identify fetal brain changes using neurosonography and pinpoint potential markers for the early diagnosis of GDM. We conducted a literature search from 6 January 2013 to 4 September 2024 to identify studies examining fetal brain development using ultrasound in pregnancies affected by GDM compared to uncomplicated pregnancies. The outcome measures included the cavum septum pellucidum (CSP), corpus callosum (CC), lateral ventricle (LV), cisterna magna (CM), transcerebellar diameter (TCD), cerebral fissures (CF), and others. For pregnancies affected by GDM, results were reported. Five studies were included. The findings suggest that the width of the CSP was larger in fetuses of mothers with GDM compared to the control group, and the mean widths of LVs were also larger in the fetuses of diabetic mothers compared to the control group. The influence of GDM on fetal brain development as assessed by neurosonography necessitates thorough investigation in future studies. Full article