Case Series of Percutaneous Mechanical Aspiration of Mitral Valve Endocarditis.

Infective endocarditis of the mitral valve that is refractory to medical therapy requires surgical debridement. However, patients who are high risk for surgery have limited options. We report 3 cases of refractory infective endocarditis involving the mitral valve that were treated with percutaneous mechanical aspiration with an embolic protection system. (Level of Difficulty: Intermediate.).

Novel cetacean morbillivirus in a rare Fraser's dolphin (Lagenodelphis hosei) stranding from Maui, Hawai'i.

Cetacean morbillivirus (CeMV) is a global threat to cetaceans. We report a novel morbillivirus from a Fraser's dolphin (Lagenodelphis hosei) that stranded in Maui, Hawaii in 2018 that is dissimilar to the beaked whale morbillivirus previously identified from Hawaii and to other CeMV strains. Histopathological findings included intranuclear inclusions in bile duct epithelium, lymphoid depletion, rare syncytial cells and non-suppurative meningitis. Cerebellum and lung tissue homogenates were inoculated onto Vero.DogSLAMtag cells for virus isolation and cytopathic effects were observed, resulting in the formation of multinucleated giant cells (i.e., syncytia). Transmission electron microscopy of infected cell cultures also revealed syncytial cells with intracytoplasmic and intranuclear inclusions of viral nucleocapsids, consistent with the ultrastructure of a morbillivirus. Samples of the cerebellum, lung, liver, spleen and lymph nodes were positive for morbillivirus using a reverse transcription-polymerase chain reaction. The resulting 559 bp L gene sequence had the highest nucleotide identity (77.3%) to porpoise morbillivirus from Northern Ireland and the Netherlands. The resulting 248 bp P gene had the highest nucleotide identity to porpoise morbillivirus in Northern Ireland and the Netherlands and to a stranded Guiana dolphin (Sotalia guianensis) in Brazil (66.9%). As Fraser's dolphins are a pelagic species that infrequently strand, a novel strain of CeMV may be circulating in the central Pacific that could have additional population impacts through transmission to other small island-associated cetacean species.

Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users.

OBJECTIVES: A retrospective case series of a percutaneous approach to debulk tricuspid valve endocarditis (TVE) using an 8 French mechanical aspiration system in patients with a history of intravenous drug use (IVDU) was reported. IVDU associated TVE is increasing in the United States and is associated with high mortality despite early surgical debridement. Patients with advanced disease, shock, and respiratory failure may not be candidates for surgical debridement or replacement. These patients have recurrent events despite medical therapy METHODS: About 25 patients with IVDU associated TVE with persistent bacteremia confirmed by repeat blood cultures after 72 hr of sensitivity directed antibiotics and presence of pulmonary emboli confirmed by computed tomographic (CT) scan, who had undergone percutaneous aspiration were included. Patients were all deemed high risk for surgical debridement by a CT surgeon and evaluated by an infectious disease consultant. Procedures were performed under moderate sedation with intracardiac echo and a steerable guide with a CAT8 Penumbra aspiration catheter. RESULTS: There were no intraprocedural deaths or complications. About 36% had septic shock on presentation. Survival of index hospitalization was 88%. Repeat blood cultures showed no growth on all surviving patients. Readmission rate was 4% (n = 1) at 1 month. About 40% (n = 2) patients with septic shock survived at 1 month compared with 100% survival (n = 20) in those without shock. Presence of septic shock was associated with reduced survival at 1 month (p < .01). CONCLUSION: Percutaneous mechanical aspiration with an 8 Fr system is a feasible, minimally invasive alternative to surgical debulking. Mortality remains high in those presenting with septic shock. Further studies are needed to evaluate long-term outcomes.

Broad-scale trophic shift in the pelagic North Pacific revealed by an oceanic seabird.

Human-induced ecological change in the open oceans appears to be accelerating. Fisheries, climate change and elevated nutrient inputs are variously blamed, at least in part, for altering oceanic ecosystems. Yet it is challenging to assess the extent of anthropogenic change in the open oceans, where historical records of ecological conditions are sparse, and the geographical scale is immense. We developed millennial-scale amino acid nitrogen isotope records preserved in ancient animal remains to understand changes in food web structure and nutrient regimes in the oceanic realm of the North Pacific Ocean (NPO). Our millennial-scale isotope records of amino acids in bone collagen in a wide-ranging oceanic seabird, the Hawaiian petrel (Pterodroma sandwichensis), showed that trophic level declined over time. The amino acid records do not support a broad-scale increase in nitrogen fixation in the North Pacific subtropical gyre, rejecting an earlier interpretation based on bulk and amino acid specific δ15N chronologies for Hawaiian deep-sea corals and bulk δ15N chronologies for the Hawaiian petrel. Rather, our work suggests that the food web structure in the NPO has shifted at a broad geographical scale, a phenomenon potentially related to industrial fishing.

Correction: Body Size Regression Formulae, Proximate Composition and Energy Density of Eastern Bering Sea Mesopelagic Fish and Squid.

[This corrects the article DOI: 10.1371/journal.pone.0132289.].

Cellular Endocytosis and Trafficking of Cholera Toxin B-Modified Mesoporous Silica Nanoparticles.

In this study, mesoporous silica nanoparticles (MSNs) were functionalized with Cholera toxin subunit B (CTxB) protein to influence their intracellular trafficking pathways. The CTxB-MSN carrier was synthesized, and its chemical and structural properties were characterized. Endocytic pathway inhibition assays showed that the uptake of CTxB-MSNs in human cervical cancer (HeLa) cells was partially facilitated by both chlatrin- and caveolae-mediated endocytosis mechanisms. Laser scanning confocal microscopy (LSCM) experiments demonstrated that CTxB-MSNs were taken up by the cells and partially trafficked through the trans-Golgi network into to the endoplasmic reticulum in a retrograde fashion. The delivery abilities of CTxB-MSNs were evaluated using propidium iodide, an impermeable cell membrane dye. LSCM images depicted the release of propidium iodide in the endoplasmic reticulum and cell nucleus of HeLa cells.

Body Size Regression Formulae, Proximate Composition and Energy Density of Eastern Bering Sea Mesopelagic Fish and Squid.

The ecological significance of fish and squid of the mesopelagic zone (200 m-1000 m) is evident by their pervasiveness in the diets of a broad spectrum of upper pelagic predators including other fishes and squids, seabirds and marine mammals. As diel vertical migrators, mesopelagic micronekton are recognized as an important trophic link between the deep scattering layer and upper surface waters, yet fundamental aspects of the life history and energetic contribution to the food web for most are undescribed. Here, we present newly derived regression equations for 32 species of mesopelagic fish and squid based on the relationship between body size and the size of hard parts typically used to identify prey species in predator diet studies. We describe the proximate composition and energy density of 31 species collected in the eastern Bering Sea during May 1999 and 2000. Energy values are categorized by body size as a proxy for relative age and can be cross-referenced with the derived regression equations. Data are tabularized to facilitate direct application to predator diet studies and food web models.

Prey and plastic ingestion of Pacific Northern Fulmars (Fulmarus glacialis rogersii) from Monterey Bay, California.

Marine plastic pollution affects seabirds, including Pacific Northern Fulmars (Fulmarus glacialis rodgersii), that feed at the surface and mistake plastic for prey or incidentally ingest it. Direct and indirect health issues can result, including satiety and possibly leading to inefficient foraging. Our objective was to examine fulmar body condition, identify cephalopod diet to species, enumerate and weigh ingested plastic, and determine if prey number and size were correlated with ingested plastics in beach-cast fulmars wintering in Monterey Bay California (2003, n=178: 2007, n=185). Fulmars consumed mostly Gonatus pyros, G. onyx, and G. californiensis of similar size for both years. We found a significant negative correlation between pectoral muscle index and average size of cephalopod beaks per stomach; a significant increase in plastic categories between 2003 and 2007; and no significant correlation between number and mass of plastic compared with number and size of prey for either year.

Primary localized cutaneous nodular amyloidosis successfully treated with cyclophosphamide.

Primary localized cutaneous nodular amyloidosis (PLCNA) is a rare subtype of localized cutaneous amyloidosis and can be associated with various connective tissue disorders. It can be difficult to treat and past therapies include surgical excision, dermabrasion, electrodessication and curettage, cryotherapy and laser therapy. We present a case of a middle-aged woman with PLCNA associated with CREST (calcinosis, Raynaud phenomenon, oesophageal motility disorders, sclerodactyly and telangiectasia) syndrome and Sjögren's syndrome responding to cyclophosphamide with no new amyloid deposits and resolution of skin ulceration after many years of resistance to drug therapy. It is important to monitor these patients for progression into systemic amyloidosis.

Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification.

The purpose of this study was to evaluate whether intracoronal delivery of an apical barrier of mineral trioxide aggregate (MTA) placed ultrasonically, non-ultrasonically, or ultrasonically with the addition of an intracanal composite resin provided a better seal against bacterial leakage. A second purpose was to determine whether intracanal composite resin or gutta-percha and sealer placed against an apical barrier of MTA provided greater resistance to root fracture. In a standardized in vitro open apex model, MTA was placed as an apical barrier at a thickness of 4 mm, with and without ultrasonic vibration. The barriers were challenged with bacteria exposure within a leakage model, and fracture resistance was assessed with increasing forces applied via an Instron machine. After 45 days, the addition of ultrasonics significantly improved the MTA seal, compared with the non-ultrasonics treatment (Kruskal Wallis nonparametric ANOVA with Dunn multiple comparison test p < 0.05). Bacterial leakage occurred in 6 (33%) of 18 in the non-ultrasonic MTA group, 2 (11%) of 18 in the ultrasonic MTA group, and 1 (6%) of 18 in the ultrasonic MTA-composite group. There were no significant differences at 90 days. A 4-mm thickness of MTA followed with an intracanal composite resin demonstrated a significantly greater resistance to root fracture than MTA followed with gutta-percha and sealer (one-way ANOVA with Newman-Keuls multiple comparison test, p < 0.01). The MTA-gutta-percha group was not significantly different than the MTA unrestored positive control.

The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification.

Treatment of the immature pulpless tooth presents both an endodontic and restorative challenge. A more favorable long-term prognosis may be achieved with a mineral trioxide aggregate (MTA) apexification procedure followed by an internal bonding technique. We investigated the efficacy of this treatment option by testing the sealing ability and retention characteristics of MTA when placed as an apical barrier in a standardized in vitro open apex model. MTA was placed as an apical barrier at a thickness of 1 mm or 4 mm, with and without prior calcium hydroxide medication. The barriers were challenged with bacteria exposure within a leakage model and displacement forces on an Instron machine. In the leakage study, 100% of the MTA apical barriers showed bacterial penetration by day 70, compared with 20% of MTA root-end fillings used as controls. The displacement study demonstrated a statistically significant greater resistance to force with a 4-mm thickness of MTA, regardless of calcium hydroxide use. We concluded that it was the intracanal delivery technique and not the MTA that contributed to the leakage observed. MTA shows promise in our proposed treatment option of immature pulpless teeth if the sealing ability can be enhanced by improving the delivery technique.