Indigenous peoples and local communities as partners in the sequencing of global eukaryotic biodiversity.

The aim to sequence, catalog, and characterize the genomes of all of Earth's eukaryotic biodiversity is the shared mission of many ongoing large-scale biodiversity genomics initiatives. Reference genomes of global flora and fauna have the potential to inform a broad range of major issues facing both biodiversity and humanity, such as the impact of climate change, the conservation of endangered species and ecosystems, public health crises, and the preservation and enhancement of ecosystem services. Biodiversity is dramatically declining: 28% of species being assessed by the IUCN are threatened with extinction, and recent reports suggest that a transformative change is needed to conserve and protect what remains. To provide a collective and global genomic response to the biodiversity crisis, many biodiversity genomics initiatives have come together, creating a network of networks under the Earth BioGenome Project. This network seeks to expedite the creation of an openly available, "public good" encyclopedia of high-quality eukaryotic reference genomes, in the hope that by advancing our basic understanding of nature, it can lead to the transformational scientific developments needed to conserve and protect global biodiversity. Key to completing this ambitious encyclopedia of reference genomes, is the ability to responsibly, ethically, legally, and equitably access and use samples from all of the eukaryotic species across the planet, including those that are under the custodianship of Indigenous Peoples and Local Communities. Here, the biodiversity genomics community is subject to the provisions codified in international, national, and local legislations and customary community norms, principles, and protocols. We propose a framework to support biodiversity genomic researchers, projects, and initiatives in building trustworthy and sustainable partnerships with communities, providing minimum recommendations on how to access, utilize, preserve, handle, share, analyze, and communicate samples, genomics data, and associated Traditional Knowledge obtained from, and in partnership with, Indigenous Peoples and Local Communities across the data-lifecycle.

Artificial intelligence to assess body composition on routine abdominal CT scans and predict mortality in pancreatic cancer- A recipe for your local application.

BACKGROUND: Body composition is associated with mortality; however its routine assessment is too time-consuming. PURPOSE: To demonstrate the value of artificial intelligence (AI) to extract body composition measures from routine studies, we aimed to develop a fully automated AI approach to measure fat and muscles masses, to validate its clinical discriminatory value, and to provide the code, training data and workflow solutions to facilitate its integration into local practice. METHODS: We developed a neural network that quantified the tissue components at the L3 vertebral body level using data from the Liver Tumor Challenge (LiTS) and a pancreatic cancer cohort. We classified sarcopenia using accepted skeletal muscle index cut-offs and visceral fat based its median value. We used Kaplan Meier curves and Cox regression analysis to assess the association between these measures and mortality. RESULTS: Applying the algorithm trained on LiTS data to the local cohort yielded good agreement [>0.8 intraclass correlation (ICC)]; when trained on both datasets, it had excellent agreement (>0.9 ICC). The pancreatic cancer cohort had 136 patients (mean age: 67 ± 11 years; 54% women); 15% had sarcopenia; mean visceral fat was 142 cm2. Concurrent with prior research, we found a significant association between sarcopenia and mortality [mean survival of 15 ± 12 vs. 22 ± 12 (p < 0.05), adjusted HR of 1.58 (95% CI: 1.03-3.33)] but no association between visceral fat and mortality. The detector analysis took 1 ± 0.5 s. CONCLUSIONS: AI body composition analysis can provide meaningful imaging biomarkers from routine exams demonstrating AI's ability to further enhance the clinical value of radiology reports.

Use of ring-enhancement and focal necrosis to differentiate pancreatic adenosquamous carcinoma from pancreatic ductal adenocarcinoma on CT and MRI.

PURPOSE: To assess the ability of the ring-enhancing sign and focal necrosis to diagnose adenosquamous carcinoma (ASqC), a variant of pancreatic ductal adenocarcinoma (PDAC), on MRI and CT. METHODS: The following features of ASqC and conventional PDAC were evaluated on CT and MRI: tumor size, location, margins, borders (non-exophytic, exophytic), and T1 signal intensity. Two readers, blinded to histopathology results, rated their confidence in detecting ring-enhancement and focal necrosis (FN) on a 5-point Likert scale on both MRI and CT. Inter-reader agreement was assessed with Cohen's kappa (k). RESULTS: A total of 24 patients were included: eight patients with treatment naïve and histologically proven ASqC (six women, mean age: 63, range: 40-75) and 16 patients with PDAC (eight women, mean age: 67, range: 47-83). Statistically significant differences between ASqC and PDAC were seen in tumor size, location, presence of FN, and ring enhancement (p = 0.01-0.037). The readers were more confident in depicting the key differentiating feature ring-enhancement in ASqC on MRI compared to CT (confidence 1.71 ± 0.49 vs. 0.88 ± 0.35, p = 0.017) with moderate inter-reader agreement (k = 0.46 and 0.5, respectively). FN showed substantial inter-reader agreement on MR and moderate agreement on CT (k = 0.67 and 0.5, respectively). CONCLUSIONS: Compared to CT, MRI depicts ring-enhancement in ASqC with greater reader confidence and FN in ASqC with higher inter-reader agreement. The concurrent presence of these two imaging features should raise high suspicion for ASqC.

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis.

PURPOSE: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute nontraumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic. METHODS: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute nontraumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently, and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control. RESULTS: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). CONCLUSIONS: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

Incidental finding of a supradiaphragmatic caudate lobe on cross-sectional imaging: An exceedingly rare entity.

Intrathoracic accessory lobes of the liver are exceedingly rare and usually found incidentally in asymptomatic patients. Its diagnosis poses a real challenge for radiologists due to its rarity, location and rounded solid mass appearance. Herein, we describe the case of a supradiaphragmatic caudate lobe of the liver in a 43-year-old African American woman presenting to the hospital for evaluation of an inferior vena cava (IVC) thrombus with CT. Final diagnosis was achieved by MRI using intravenous contrast material, showing a 4.7 cm by 2.7 cm oval shaped mass, with similar signal intensity to the main liver on all sequences. Appropriate diagnosis of this intrathoracic mass is important to negate the need for unnecessary procedures and set a proper follow up after clinical diagnosis.

[Diagnosis of a systolic murmur among young asymptomatic patient: An assessment of professional practices for the expertise in military medicine]. / Diagnostic d'un souffle systolique cardiaque chez un jeune patient asymptomatique : une évaluation des pratiques professionnelles en médecine militaire d'expertise.

UNLABELLED: The finding of a systolic heart murmur is common in medical military practice. Albeit often benign among young healthy adults, it can reveal a valvular or a cardiac disease, which could worsen during workout or expose to risk of a sudden death. This study aims to evaluate the diagnostic efficiency of the military general practitioner when discovering a systolic murmur among young asymptomatic patients. MATERIALS AND METHODS: During one year, this study involved all the general practitioners of the medical military centres of Brittany and the cardiologists of the military hospital in Brest. It prospectively enrolled a cohort of all military asymptomatic patients under 40, without any underlying known heart condition. Military general practitioners listed, thanks to an anonymous form, the main features of the systolic murmur and of the ECG and proposed an auscultatory diagnosis: innocent or organic murmur. Then cardiologists did the same and finally performed a transthoracic echocardiography giving the diagnosis. RESULTS: Fifty-eight patients were referred, 5 not meeting the inclusion criteria. Of the 53 patients included, military general practitioners found 46 innocent murmurs and 7 organic ones. Cardiologists found 51 innocent murmurs and 2 organic. Transthoracic echocardiography just took on one organic murmur (linked with a bicuspid aortic valve), spotted by the specialist, though judged innocent by the general practitioner. DISCUSSION: Most of innocent murmurs diagnosed by general practitioners (45/46) were confirmed. Regarding the seven organic murmurs, the main selected criteria (intensity over 3, orthostatic persistence, diffuse irradiation) are mostly in accordance with the literature, proving right medical instincts. Authors propose a practical management of systolic murmurs among asymptomatic young patients. CONCLUSION: Military general practitioners seem to master symptoms of organic murmur. This assessment argues for a promotion of a holistic clinical examination, which will help not only to rationalize the use of transthoracic echocardiography in economic terms but also to value the medical expertise.

La guardia del servicio de salud mental en un hospital polivalente / On-duty mental health service in the polyvalent hospital

TRODUCCIÓN Conocer las problemáticas prevalentes que demandan interconsulta (IC) con el servicio de Salud Mental de un hospital polivalente. OBJETIVOS Caracterizar las demandas de los usuarios asistidos en IC por el servicio de Salud Mental del hospital entre julio de 2013 y julio de 2014. Conocer la prevalencia de los motivos de consulta de los usuarios del servicio de Guardia. Evaluar si el dispositivo de intervención de guardia reduce las derivaciones de usuarios a hospitales monovalentes. MÉTODOS Se realizó un estudio descriptivo, con un diseño transversal y análisis mixto: cuantitativo y cualitativo. La población blanco estuvo conformada por los usuarios del servicio de Salud Mental del Hospital Regional Pasteur, que son asistidos a través del sistema de IC. La investigación se inició con una descripción cuantitativa, y se analizaron los datos de manera cualitativa. RESULTADOS Sobre un total de 293 casos registrados durante el período analizado de IC, el motivo de consulta prevalente fue el intento de suicidio, lo cual coincide con las mediciones extraídas durante el relevamiento que actuó como antecedente de esta investigación. El intento de suicidio fue la problemática prevalente, con una relevancia (29,01%) significativamente mayor a la del resto de los motivos de consulta que requirieron de la intervención del servicio de Guardia. En segundo lugar aparecieron las denominadas crisis de angustia con el 17,41%, seguidas de cerca por el consumo de sustancias psicoactivas (17,06%). DISCUSIÓN Este dispositivo de guardia del servicio de Salud Mental en un hospital general disminuye las derivaciones de usuarios con padecimientos subjetivos a hospitales monovalentes.

Isolation of Pseudobutyrivibrio ruminis and Pseudobutyrivibrio xylanivorans from rumen of Creole goats fed native forage diet.

We isolated and identified functional groups of bacteria in the rumen of Creole goats involved in ruminal fermentation of native forage shrubs. The functional bacterial groups were evaluated by comparing the total viable, total anaerobic, cellulolytic, hemicellulolytic, and amylolytic bacterial counts in the samples taken from fistulated goats fed native forage diet (Atriplex lampa and Prosopis flexuosa). Alfalfa hay and corn were used as control diet. The roll tubes method increased the possibility of isolating and 16S rDNA gene sequencing allowed definitive identification of bacterial species involved in the ruminal fermentation. The starch and fiber contents of the diets influenced the number of total anaerobic bacteria and fibrolytic and amylolytic functional groups. Pseudobutyrivibrio ruminis and Pseudobutyrivibrio xylanivorans were the main species isolated and identified. The identification of bacterial strains involved in the rumen fermentation helps to explain the ability of these animals to digest fiber plant cell wall contained in native forage species.

Proyecto de mejora del Proceso de Atención Continuada domiciliaria en Atención Primaria: rediseño y AMFE / Improving the continuous care process in primary care during weekends and holidays. Redesigning and FMEA

Objetivo. Describir el proyecto de mejora aplicado al proceso de atención continuada (ATC) de sábados y festivos en el Área 4 de Atención Primaria (AP) de Madrid, para garantizar una atención segura y libre de fallos en los cuidados domiciliarios de los fines de semana. Material y método. El proceso de ATC se identificó como de riesgo por la Unidad Funcional de Gestión de Riesgos (UFGR) del Área, además presentaba quejas: de las enfermeras que realizan la atención y de pacientes. En 2009 se realiza un DAFO (debilidades, amenazas, fortalezas y oportunidades) que evidenció problemas. Posteriormente se diseña un proyecto de mejora que se desarrolla en las fases: 1. Rediseño y mejora del proceso. 2. Aplicación AMFE al nuevo proceso. 3. Pilotaje. 4. Formación a las enfermeras. 5. Implantación en todo el Área. 6. Encuesta de satisfacción a las enfermeras de ATC. Resultados. El rediseño del proceso, proporcionó mejoras como la automatización y aumento de la eficiencia. Posteriormente a la implantación de las medidas de mejora, no se han producido nuevas reclamaciones de pacientes y ha mejorado la satisfacción de las enfermeras de ATC medida a través de encuesta. Al aplicar el AMFE se priorizaron fallos y se pusieron en marcha acciones de mejora. Conclusiones. La mejora del proceso y sobre todo su automatización, ha sido un gran avance para mejorar la seguridad. El AMFE nos ha resultado una herramienta útil y práctica que ha permitido implantar importantes acciones, igualmente se ha conseguido mejorar la satisfacción de las enfermeras que realizan la ATC(AU)

Objective. To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. Materials and method. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. Results. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. Results. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. Conclusion. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved(AU)

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA]. / Proyecto de mejora del Proceso de Atención Continuada domiciliaria en Atención Primaria: rediseño y AMFE.

OBJECTIVE: To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. MATERIALS AND METHOD: The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. RESULTS: After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. CONCLUSION: The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved.

[Study on the role of the tubule in renal vasoconstriction induced by cyclosporine]. / Papel del túbulo en la vasoconstricción renal inducida por ciclosporina.

INTRODUCTION: Cyclosporine (CyA) has proved to induce cell apoptosis on cultured proximal tubule cells. However, there is no much data about the in vivo functional consequences of this injury or the long time observed CyA-induced renal vasoconstriction. MATERIAL AND METHODS: In a swine model of subacute CyA nephrotoxicity (10 mg/ Kg. dx 15 days), we performed a right nephrectomy, followed by left renal artery, vein and ureter catheterisati8n. After inducing water diuresis, three clearance periods of 15 minutes were performed before and after a furosemide 1 mg/kg infusion. Plasma and urine electrolytes, blood gas, acid excretion, plasma renin activity and aldosterone concentration, GFR, RPF, RBF, intra-renal vascular resistances, glomerular filtration pressure, distal Cl- delivery, water clearance and TTKG were measured or estimated on 7 control and 7 treated animals. Right kidney was processed for NaKATPase activity and immunostaining. RESULTS: Treated animals presented detaching proximal cells, luminal blebbing and loss of tight junctions. Cortical but not medullar sodium pump was internalised and partially inactive. Treated animals showed much lower fractional excretions of Na+, with significantly higher distal fractional reabsorption of Cl. Distal shift in fluid load resulted in a significant rise in renal O2 consumption, and modifications in the global renal estequiometry of Na+ transport/O2 uptake. Several consequences followed this situation: preglomerular resistances increased 3 times with only minor changes in postglomerular resistances and renal blood and plasma flow were significantly reduced. Furosemide partially reversed these effects. A slight increase in fractional filtration prevented GFR differences to become statistically significant. CONCLUSION: subacute CyA treatment even al doses not modifying GFR, may cause proximal tubule Na+ transport impairment, resulting in increased rates of distal delivery and absorption of fluid load. Renal uptake of O2 may be increased and tubule glomerular feedback should be expected to be activated. Absence of changes of GFR with furosemide is an early sign of CyA renal damage.

Papel del túbulo en la vasoconstricción renal inducida por ciclosporina / Study of the role of the tubule in renal vasoconstriction induced by cyclosporine

Introducción: Ciclosporina es el primero de una familia de potentes inmunosupresores con capacidad anticalcineurínica que, sin embargo, presentan como limitación terapéutica una nefrotoxicidad que puede aparecer desde periodos tempranos. Los primeros datos funcionales sugerían la existencia de vasoconstricción renal, si bien estudios posteriores han mostrado un efecto tóxico directo de ciclosporina sobre el túbulo proximal. Materiales y Métodos: En este artículo se presenta un modelo porcino de nefrotoxicidad por ciclosporina a medio plazo, analizándose los cambios hemodinámicos intrarrenales y las funciones tubulares, así como la relación entre ambos. Resultados: Ciclosporina produce específicamente una internalización e inactivación de la Na+, K+-ATPasa basolateral del túbulo proximal, determinando el desplazamiento axial de la carga filtrada hacia regiones distales (asa de Henle), con transportes activos más intensos y no modificados por ciclosporina. El resultado es un aumento en la reabsorción fraccional distal de cloro que condiciona un estímulo del “feed-back” túbulo glomerular, vasoconstricción aferente pero no eferente, aumento de las resistencias renales y caída de la presión intraglomerular. Furosemida restaura parcialmente la situación basal. La consecuencia inmediata es un aumento en el consumo de O2 por unidad de sodio trasportado. A nivel del túbulo colector no se observan cambios en la secreción de agua libre, pero la secreción de K+ parece limitada, y no se corrige al aumentar la oferta distal de sodio con furosemida, ni con aldosterona, cuyos valores fueron más altos en los animales tratados con ciclosporina. Conclusión: En resumen, el efecto vasoconstrictor de ciclosporina sobre el riñón se debe en parte a una retroalimentación túbulo glomerular activada por el desplazamiento de solutos filtrados de sus sitios de reabsorción proximal a otros sitos más distales. Las dietas con alto contenido en sodio pueden aumentar el efecto deletéreo de ciclosporina sobre el filtrado glomerular

Introduction: Cyclosporine (CyA) has proved to induce cell apoptosis on cultured proximal tubule cells. However, there is no much data about the in vivo functional consequences of this injury or the long time observed CyA-induced renal vasoconstriction. Material and Methods: In a swine model of subacute CyA nephrotoxicity (10 mg/ Kg. d x 15 days), we performed a right nephrectomy, followed by left renal artery, vein and ureter catheterisation. After inducing water diuresis, three clearance periods of 15 minutes were performed before and after a furosemide 1 mg/kg infusion. Plasma and urine electrolytes, blood gas, acid excretion, plasma renin activity and aldosterone concentration, GFR, RPF, RBF, intra-renal vascular resistances, glomerular filtration pressure, distal Cl- delivery, water clearance and TTKG were measured or estimated on 7 control and 7 treated animals. Right kidney was processed for NaKATPase activity and immunostaining. Results: Treated animals presented detaching proximal cells, luminal blebbing and loss of tight junctions. Cortical but not medullar sodium pump was internalised and partially inactive. Treated animals showed much lower fractional excretions of Na+, with significantly higher distal fractional reabsorption of Cl-. Distal shift in fluid load resulted in a significant rise in renal O2 consumption, and modifications in the global renal estequiometry of Na+ transport/O2 uptake. Several consequences followed this situation: preglomerular resistances increased 3 times with only minor changes in postglomerular resistances and renal blood and plasma flow were significantly reduced. Furosemide partially reversed these effects. A slight increase in fractional filtration prevented GFR differences to become statistically significant. Conclusión: subacute CyA treatment even al doses not modifying GFR, may cause proximal tubule Na+ transport impairment, resulting in increased rates of distal delivery and absorption of fluid load. Renal uptake of O2 may be increased and tubule glomerular feedback should be expected to be activated. Absence of changes of GFR with furosemide is an early sign of CyA renal damage

[Histamine food poisoning]. / Les intoxications alimentaires histaminiques.

The authors describe a collective histamine related food-poisoning epidemic that occurred in the Navy due to the consumption of imported smoked swordfish (Xyphias gladius). Twenty cases were detected. The relative risk among consumers of swordfish is at 7.44 (C.I. of 95%: 2.57-21.59) and the doses of histamine were from 2.030 to 4.750 ppm in 9 samples of tested fish (N < 200 ppm). The interest in using a high-resolution chromatographic liquid to ensure a diagnosis, and in using the community norms in force are shown. A recent review of the literature serves to show the variety of fish responsible for this type of accident, to insist on the mildness, elusiveness, variability, and lack of specificity of clinical signs and therefore risks error in diagnoses, treatment and under-reporting of this type of collective food-poisoning.