Identifying the Sylvian Triangle on CT angiography: A technique for detecting distal middle cerebral artery occlusions.

Medium vessel occlusions (MeVOs), defined as occlusion of the M2/M3 and A2/A3 segments of the middle cerebral artery (MCA) and anterior cerebral artery, can be challenging to visualize on CT angiography (CTA) and MR angiography (MRA), given the anatomic complexity of the mid- and distal intracranial vasculature and smaller vessel caliber (Leary MC, Kidwell CS, Villablanca JP, et al. Validation of computed tomographic MCA "dot" sign: an angiographic correlation study. Stroke 2003; 34: 2636-2640; Luijten SPR, Wolff L, Duvekot MHC, et al. Diagnostic performance of an algorithm for automated large vessel occlusion (LVO) detection on CTA. J Neurointerv Surg 2022; 14: 794-798). In turn, the appearance of a sudden vessel cutoff in these vascular distributions on CTA or MRA is not always straightforward and may represent true occlusion, variant anatomy, and/or artifact (Leary MC, Kidwell CS, Villablanca JP, et al. Validation of computed tomographic MCA "dot" sign: an angiographic correlation study. Stroke 2003; 34: 2636-2640; Luijten SPR, Wolff L, Duvekot MHC, et al. Diagnostic performance of an algorithm for automated LVO detection on CTA. J Neurointerv Surg 2022; 14: 794-798). Given the importance of rapidly establishing an accurate diagnosis in the setting of stroke, combined with recent clinical trials and movements promoting the efficacy of endovascular therapeutic approaches to treat MeVOs, it remains imperative to detect such occlusions accurately and quickly on imaging. In turn, we present five imaging patterns of the Sylvian Triangle on sagittal reformatted images from CTA Head examinations, which our practice has utilized to assess patency of the M2 and M3 divisions. This approach is rapidly deployable and can be utilized by radiology and non-radiology healthcare providers alike, thus facilitating rapid and accurate diagnosis of MeVO, timely evaluation of candidacy for endovascular therapy, and ultimately supporting favorable door-to-intervention time and successful patient outcomes.

Tips for Transient Perivascular Inflammation of the Carotid Artery Syndrome.

BACKGROUND: Idiopathic carotidynia, also known as transient perivascular inflammation of the carotid artery (TIPIC) syndrome, is a rare, self-limited, clinical-radiologic entity. Over the years, the diagnosis of carotidynia has been controversial, but recent pathologic, radiologic, clinical, and laboratory findings support an inflammatory etiology. CASE REPORT: A 61-year-old woman with a history of hypertension, left lower extremity liposarcoma, and right internal jugular port placement 2 weeks prior with initiation of chemotherapy presented to the emergency department with right neck pain and swelling of the lateral neck and lower face for the past 3 days. Computed tomography-neck with IV contrast revealed marked mural thickening of the right common carotid artery, which can be seen with carotidynia (Fay syndrome and TIPIC syndrome) and vasculitis. The patient had elevated inflammatory markers and was treated clinically for carotidynia with ibuprofen, evaluated by vascular surgery, and discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The causes of acute neck pain are diverse, ranging from nonemergent to surgically emergent etiologies. As radiologists and emergency physicians, we believe TIPIC syndrome is a rare entity with important clinical impact deserving attention, as it is not typically included in medical training and is usually learned only through years of clinical experience and practice. TIPIC syndrome requires a unique combination of both clinical and radiologic findings to diagnose accurately and appropriately. It is important to be familiar with this diagnosis because treatment is focused on symptomatic relief without the need for invasive procedures. Our goal was to increase awareness of this uncommon diagnosis to improve patient care by preventing unnecessary invasive procedures and aid in timely and accurate diagnosis.

Regional Variability in the Prevalence of Food Insecurity and Diet Quality among United States Children.

Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index-HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in the FNAP, and 88% were enrolled in school lunch programs. Children in urban areas were significantly more likely to report household food insecurity than those in rural areas (29.15% vs. 19.10%). The overall HEI-2015 score was 48.2. The associations between child/household FSS and FNAP participation as well as between child/household FSS and diet quality did not differ by urban/rural residence status, irrespective of the children's age groups. There is a need for improvement in children's diet quality, regardless of age or urban/rural residence. The findings suggest that improving children's diets requires broader action as well as the prioritizing of children in urban areas experiencing food insecurity in future dietary interventions.

Small bowel obstruction with bowel ischemia due to ingestion of water-absorbing bead.

Foreign body aspiration accounts for 7% of accidental deaths in children under age 4 (4). Children between the ages of 6 months and 3 years of age, adolescent boys and children with mental health issues are at the highest risk of foreign body ingestion. Coins are the most commonly swallowed foreign body in the United States (US) and in other countries those related food such as fish bones are most common (10). Most cases are accidental and pass harmlessly through the gastrointestinal tract with low mortality (10). The most common complication is esophageal obstruction particularly at the thoracic inlet. However, the object can become lodged anywhere in the gastrointestinal tract. We present an unusual case of small bowel obstruction and bowel ischemia secondary to superabsorbent polymer water bead ingestion in a pediatric patient.

Functional specialization of chloroplast vesiculation (CV) duplicated genes from soybean shows partial overlapping roles during stress-induced or natural senescence.

Soybean is a globally important legume crop which is highly sensitive to drought. The identification of genes of particular relevance for drought responses provides an important basis to improve tolerance to environmental stress. Chloroplast Vesiculation (CV) genes have been characterized in Arabidopsis and rice as proteins participating in a specific chloroplast-degradation vesicular pathway (CVV) during natural or stress-induced leaf senescence. Soybean genome contains two paralogous genes encoding highly similar CV proteins, CV1 and CV2. In this study, we found that expression of CV1 was differentially upregulated by drought stress in soybean contrasting genotypes exhibiting slow-wilting (tolerant) or fast-wilting (sensitive) phenotypes. CV1 reached higher induction levels in fast-wilting plants, suggesting a negative correlation between CV1 gene expression and drought tolerance. In contrast, autophagy (ATG8) and ATI-PS (ATI1) genes were induced to higher levels in slow-wilting plants, supporting a pro-survival role for these genes in soybean drought tolerance responses. The biological function of soybean CVs in chloroplast degradation was confirmed by analyzing the effect of conditional overexpression of CV2-FLAG fusions on the accumulation of specific chloroplast proteins. Functional specificity of CV1 and CV2 genes was assessed by analyzing their specific promoter activities in transgenic Arabidopsis expressing GUS reporter gene driven by CV1 or CV2 promoters. CV1 promoter responded primarily to abiotic stimuli (hyperosmolarity, salinity and oxidative stress), while the promoter of CV2 was predominantly active during natural senescence. Both promoters were highly responsive to auxin but only CV1 responded to other stress-related hormones, such as ABA, salicylic acid and methyl jasmonate. Moreover, the dark-induced expression of CV2, but not of CV1, was strongly inhibited by cytokinin, indicating similarities in the regulation of CV2 to the reported expression of Arabidopsis and rice CV genes. Finally, we report the expression of both CV1 and CV2 genes in roots of soybean and transgenic Arabidopsis, suggesting a role for the encoded proteins in root plastids. Together, the results indicate differential roles for CV1 and CV2 in development and in responses to environmental stress, and point to CV1 as a potential target for gene editing to improve crop performance under stress without compromising natural development.

Chemical Characterization and Evaluation of the Antihyperglycemic Effect of Lychee (Litchi chinensis Sonn.) cv. Brewster.

Lychee is a fruit of Asian origin with an exquisite flavor and an attractive reddish color. However, according to recent reports, the consumption of this fruit reduces the levels of blood glucose with adverse effects on human health such as encephalopathy and hypoglycemic. The objective of this work was to determine if the peel, pulp, and seed of "Brewster" lychee fruits harvested at two stages of maturity had antihyperglycemic effect. This effect was determined by an oral glucose tolerance test using Wistar rats. In addition, ultraviolet-visible spectrophotometry and high-resolution liquid chromatography were used to quantify phenolic compounds, flavonoids, organic acids (OAs), sugars, and antioxidant activity. Results indicated that stage I pulp (immature fruits) and stage II peel and seed (export mature fruits) reduced blood glucose levels, and the effects of the former two were synergistic with metformin. The pulp of mature fruits (stage II), however, lacked a hypoglycemic effect. Additionally, the peel and the seeds of these fruits presented a high antioxidant activity (as determined by DPPH [2,2-diphenyl-2-picryl-hydracyl] and ABTS+ [2,2-azino-bis-(3-ethylbenzothiazoline)-6-sulfonic acid] methods), which correlated well with the total content of phenolic compounds. The highest content of polyphenolics, flavonoids, and OAs was found in the extracts of the peel and seeds of both stages of maturity. It was therefore concluded that "Brewster" mature lychees are safe for human consumption, and both the seed and the peel can be useful sources for obtaining new compounds with antihyperglycemic activity.

The Impact of the COVID-19 Pandemic on Food Distribution at Emergency Food Assistance Organizations in the Southwestern United States: A Qualitative Investigation.

This study aimed to identify changes in food distribution operations at emergency food assistance organizations (EFAOs) during the COVID-19 pandemic. EFAOs across the Houston metro area, TX (human service centers and food pantries) as well as the Houston Food Bank (HFB) participated in the qualitative study. Data were collected via individual semi-structured interviews and focus group (December 2020-February 2021), and coded using semi-structured thematic analysis. Categories were pre-identified based on the interview questions. Direct quotes supported subcategories. Directors from 18 EFAOs were interviewed; 8 HFB leadership staff participated in a focus group. Four major categories of change due to COVID-19 included new safety measures, changes in food distribution process, changes in volunteerism and staffing, and changes in amounts of food distributed. This study helps identify susceptibilities in EFAOs' food distribution chain should be addressed to manage future emergency food insecurity crises more effectively. An understanding of the changes/challenges incurred by EFAOs during the COVID-19 pandemic can inform policymakers to ensure local food distribution organizations are prepared to fill the needs during future a crisis of food insecurity.

[Pregnant woman with spontaneous coronary dissection successfully resurrected: case report]. / Embarazada con disección coronaria espontánea resucitada de manera exitosa: reporte de caso.

Background: Spontaneous coronary dissection is a disruption of the arterial wall, with clinical manifestations ranging from unstable angina to sudden cardiac death. It is presented a case of an obstetric patient who is successfully resuscitated after a spontaneous coronary dissection. Clinical case: 37-year-old female patient with a 33-week pregnancy and a history of preeclampsia in the previous pregnancy. She consulted for a 30-min chest pain. After her admission, the patient presented loss of consciousness and cardiorespiratory arrest. Basic and advanced life supports were given and then she was transferred to the intensive care unit where a dissection of the right coronary artery was diagnosed. After 14 days, the patient was discharged from the hospital without neurological sequelae. Conclusions: Spontaneous coronary dissection in the obstetric patient corresponds to a medical emergency, in which pharmacological and surgical measures must be implemented early in order to promote the fetal maternal well-being.

Introducción: La disección coronaria espontánea consiste en la disrupción de la pared arterial, con manifestaciones clínicas que van desde la angina inestable hasta la muerte súbita cardiaca. Se presenta el caso de una paciente obstétrica resucitada exitosamente tras una disección coronaria espontánea. Caso clínico: Mujer de 37 años con embarazo de 33 semanas y antecedente de preeclampsia en el embarazo anterior, quien consultó por dolor torácico de 30 minutos. Posterior a su ingreso presentó pérdida de la consciencia y paro cardiorrespiratorio. Se realizaron maniobras básicas y avanzadas de resucitación, y se trasladó a la unidad de cuidados intensivos donde se diagnosticó disección de arteria coronaria derecha. A los 14 días se dio alta hospitalaria, sin secuelas neurológicas. Conclusiones: La disección coronaria espontánea en la paciente obstétrica corresponde a una urgencia médica, en la cual deben implementarse medidas farmacológicas y quirúrgicas tempranamente con el fin de promover el bienestar del binomio madre-feto.

Subclavian artery aneurysmal rupture and left internal mammary artery extravasation secondary to advanced Marfan syndrome.

This case highlights the unusual life-threatening findings found in a patient with Marfan syndrome (MFS) in the emergency department setting. MFS is a rare autosomal dominant disease that affects 1 in 3000-5000 individuals and has a highly variable range of clinical severity. This case is a 63-year-old male with COPD, scoliosis, aortic and mitral valve replacements on warfarin, and MFS who presented with acute onset hemoptysis, tachypnea, and oxygen saturation of 77% on 4 l nasal cannula. Emergent chest computed tomography angiography (CTA) revealed both a contained rupture of a left subclavian artery aneurysm and active extravasation from his left internal mammary artery (LIMA) into his left chest. The patient was on warfarin and reversed with IV vitamin K and prothrombin complex concentrate. Vascular surgery emergently took the patient to the operating room for embolization of his LIMA and stenting of the contained ruptured left subclavian artery aneurysm. The patient was discharged home one month after admission. This case report illustrates the potential severe sequelae of MFS and the importance of rapid recognition by emergency physicians. An expanded understanding of the pathophysiology of MFS has resulted in great advancement in medical therapies and lifestyle modification and thus has significantly prolonged life expectancy in these patients. Increased awareness and familiarity will facilitate continued high-quality management and treatment by emergency physicians.

A Chloroplast COR413 Protein From Physcomitrella patens Is Required for Growth Regulation Under High Light and ABA Responses.

COR413 genes belong to a poorly characterized group of plant-specific cold-regulated genes initially identified as part of the transcriptional activation machinery of plants during cold acclimation. They encode multispanning transmembrane proteins predicted to target the plasma membrane or the chloroplast inner membrane. Despite being ubiquitous throughout the plant kingdom, little is known about their biological function. In this study, we used reverse genetics to investigate the relevance of a predicted chloroplast localized COR413 protein (PpCOR413im) from the moss Physcomitrella patens in developmental and abiotic stress responses. Expression of PpCOR413im was strongly induced by abscisic acid (ABA) and by various environmental stimuli, including low temperature, hyperosmosis, salinity and high light. In vivo subcellular localization of PpCOR413im-GFP fusion protein revealed that this protein is localized in chloroplasts, confirming the in silico predictions. Loss-of-function mutants of PpCOR413im exhibited growth and developmental alterations such as growth retardation, reduced caulonema formation and hypersensitivity to ABA. Mutants also displayed altered photochemistry under various abiotic stresses, including dehydration and low temperature, and exhibited a dramatic growth inhibition upon exposure to high light. Disruption of PpCOR413im also caused altered chloroplast ultrastructure, increased ROS accumulation, and enhanced starch and sucrose levels under high light or after ABA treatment. In addition, loss of PpCOR413im affected both nuclear and chloroplast gene expression in response to ABA and high light, suggesting a role for this gene downstream of ABA in the regulation of growth and environmental stress responses. Developmental alterations exhibited by PpCOR413im knockout mutants had remarkable similarities to those exhibited by hxk1, a mutant lacking a major chloroplastic hexokinase, an enzyme involved in energy homeostasis. Based on these findings, we propose that PpCOR413im is involved in coordinating energy metabolism with ABA-mediated growth and developmental responses.

Transient synchronisation and quantum coherence in a bio-inspired vibronic dimer.

Synchronisation is a collective phenomenon widely investigated in classical oscillators and, more recently, in quantum systems. However it remains unclear what features distinguish synchronous behaviour in these two scenarios. Recent works have shown that investigating synchronisation dynamics in open quantum systems can give insight into this issue. Here we study transient synchronisation in a bio-inspired vibronic dimer, where electronic excitation dynamics is mediated by coherent interactions with intramolecular vibrational modes. We show that the synchronisation dynamics of local mode displacements exhibit a rich behaviour which arises directly from the distinct time-evolutions of different vibronic quantum coherences. Furthermore, our study shows that coherent energy transport in this bio-inspired system is concomitant with the emergence of positive synchronisation between mode displacements. Our work provides further understanding of the relations between quantum coherence and synchronisation in open quantum systems and suggests an interesting role for coherence in biomolecules, that of promoting synchronisation of vibrational motions driven out of thermal equilibrium.

Strong Quantum Darwinism and Strong Independence are Equivalent to Spectrum Broadcast Structure.

How the objective everyday world emerges from the underlying quantum behavior of its microscopic constituents is an open question at the heart of the foundations of quantum mechanics. Quantum Darwinism and spectrum broadcast structure are two different frameworks providing key insight into this question. Recent works, however, indicate these two frameworks can lead to conflicting predictions on the objectivity of the state of a system interacting with an environment. Here, we provide a resolution to this issue by defining strong quantum Darwinism and proving that it is equivalent to spectrum broadcast structure when combined with strong independence of the subenvironments. We further show that strong quantum Darwinism is sufficient and necessary to signal state objectivity without the requirement of strong independence. Our Letter unveils the deep connection between strong quantum Darwinism and spectrum broadcast structure, thereby making fundamental progress toward understanding and solving the emergence of classicality from the quantum world. Together they provide us a sharper understanding of the transition in terms of state structure, geometry, and quantum and classical information.

On the performance of a photosystem II reaction centre-based photocell.

The photosystem II reaction centre is the photosynthetic complex responsible for oxygen production on Earth. Its water splitting function is particularly favoured by the formation of a stable charge separated state via a pathway that starts at an accessory chlorophyll. Here we envision a photovoltaic device that places one of these complexes between electrodes and investigate how the mean current and its fluctuations depend on the microscopic interactions underlying charge separation in the pathway considered. Our results indicate that coupling to well resolved vibrational modes does not necessarily offer an advantage in terms of power output but can lead to photo-currents with suppressed noise levels characterizing a multi-step ordered transport process. Besides giving insight into the suitability of these complexes for molecular-scale photovoltaics, our work suggests a new possible biological function for the vibrational environment of photosynthetic reaction centres, namely, to reduce the intrinsic current noise for regulatory processes.

A complex case of pacemaker lead endocarditis. / Um caso complexo de endocardite de sondas de pacemaker.

Pacemaker lead endocarditis is an uncommon complication after pacemaker implantation, but is associated with high rates of morbidity and mortality. The authors describe the case of a 68-year-old woman with a double-chamber pacemaker since 2007, admitted to an internal medicine department for spondylodiscitis and Staphylococcus aureus bacteremia. During hospitalization, she had an episode of syncope; the 12-lead electrocardiogram showed pacemaker malfunction with ventricular undersensing and loss of capture. A transesophageal echocardiogram showed images compatible with vegetations on the pacemaker leads. After antimicrobial therapy, the patient developed acute renal failure with subsequent multiple organ failure and death. A high index of clinical suspicion is required for early diagnosis and appropriate treatment of cardiac device-related infective endocarditis.

Isolating the chiral contribution in optical two-dimensional chiral spectroscopy using linearly polarized light.

The full development of mono- or multi-dimensional time-resolved spectroscopy techniques incorporating optical activity signals has been strongly hampered by the challenge of identifying the small chiral signals over the large achiral background. Here we propose a new methodology to isolate chiral signals removing the achiral background from two commonly used configurations for performing two-dimensional optical spectroscopy, known as BOXCARS and gradient assisted photon echo spectroscopy (GRAPES). It is found that in both cases an achiral signal from an isotropic system can be completely eliminated by small manipulations of the relative angles between the linear polarizations of the four input laser pulses. Starting from the formulation of a perturbative expansion of the signal in the angle between the beams and the propagation axis, we derive analytic expressions that can be used to estimate how to change the polarization angles of the four pulses to minimize achiral contributions in the studied configurations. The generalization to any other possible experimental configurations has also been discussed.

Using coherence to enhance function in chemical and biophysical systems.

Coherence phenomena arise from interference, or the addition, of wave-like amplitudes with fixed phase differences. Although coherence has been shown to yield transformative ways for improving function, advances have been confined to pristine matter and coherence was considered fragile. However, recent evidence of coherence in chemical and biological systems suggests that the phenomena are robust and can survive in the face of disorder and noise. Here we survey the state of recent discoveries, present viewpoints that suggest that coherence can be used in complex chemical systems, and discuss the role of coherence as a design element in realizing function.

Moss Pathogenesis-Related-10 Protein Enhances Resistance to Pythium irregulare in Physcomitrella patens and Arabidopsis thaliana.

Plants respond to pathogen infection by activating signaling pathways leading to the accumulation of proteins with diverse roles in defense. Here, we addressed the functional role of PpPR-10, a pathogenesis-related (PR)-10 gene, of the moss Physcomitrella patens, in response to biotic stress. PpPR-10 belongs to a multigene family and encodes a protein twice the usual size of PR-10 proteins due to the presence of two Bet v1 domains. Moss PR-10 genes are differentially regulated during development and inoculation with the fungal pathogen Botrytis cinerea. Specifically, PpPR-10 transcript levels increase significantly by treatments with elicitors of Pectobacterium carotovorum subsp. carotovorum, spores of B. cinerea, and the defense hormone salicylic acid. To characterize the role of PpPR-10 in plant defense against pathogens, we conducted overexpression analysis in P. patens and in Arabidopsis thaliana. We demonstrate that constitutive expression of PpPR-10 in moss tissues increased resistance against the oomycete Pythium irregulare. PpPR-10 overexpressing moss plants developed less symptoms and decreased mycelium growth than wild type plants. In addition, PpPR-10 overexpressing plants constitutively produced cell wall depositions in protonemal tissue. Ectopic expression of PpPR-10 in Arabidopsis resulted in increased resistance against P. irregulare as well, evidenced by smaller lesions and less cellular damage compared to wild type plants. These results indicate that PpPR-10 is functionally active in the defense against the pathogen P. irregulare, in both P. patens and Arabidopsis, two evolutionary distant plants. Thus, P. patens can serve as an interesting source of genes to improve resistance against pathogen infection in flowering plants.