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Infective endocarditis in pregnancy is associated with high maternal and fetal morbidity and mortality and is estimated to complicate approximately 1 in 100,000 pregnancies. We report the case of a 33-year-old patient who presented at 30 weeks and 3 days gestation in her third pregnancy. The patient described a 3 week history of feeling generally unwell, an episode of temporary speech disturbance, right shoulder tip pain, left subscapular pain on inspiration and chest discomfort. Investigations included an echocardiogram, which revealed a large mobile mass on the aortic coronary cusp and a small mass on the non-coronary cusp. There was significant aortic regurgitation. Blood cultures were positive for staphylococcus lugdunensis. A diagnosis of infective endocarditis was made. The patient deteriorated, with worsening cardiac function, and proceeded to have a caesarean section on day 7 of admission. Her baby had multiple limb abnormalities, subsequently diagnosed as arthrogryposis multiplex congenita. Aortic valve replacement with a mechanical valve was then performed on day 3 post partum. The patient recovered well post operatively and was discharged home with her baby on day 45 post partum. The commonest complications of IE are congestive cardiac failure, perivalvular extension and systemic embolization. The management of infective endocarditis in pregnancy is similar to that of the non-pregnant however there is high foetal mortality associated with cardiopulmonary by-pass for cardiac surgery. The patient described here developed staphylococcus lugdunensis infective endocarditis, which is a rare but aggressive causative organism in infective endocarditis. Infective endocarditis in pregnancy is a rare but serious condition with significant fetal and maternal morbidity and mortality. Early diagnosis with a multidisciplinary team approach is essential to improve outcomes. [ABSTRACT FROM AUTHOR]

We present the results from our 12th annual horizon scan of issues likely to impact biological conservation in the future. From a list of 97 topics, our global panel of 25 scientists and practitioners identified the top 15 issues that we believe society may urgently need to address. These issues are either novel in the biological conservation sector or represent a substantial positive or negative step-change in impact at global or regional level. Six issues, such as coral reef deoxygenation and changes in polar coastal productivity, affect marine or coastal ecosystems and seven relate to human and ecosystem-level responses to climate change. Identification of potential forthcoming issues for biological conservation may enable increased preparedness by researchers, practitioners, and decision-makers. Our 12th annual horizon scan identified 15 emerging issues of concern for global biodiversity conservation. A panel of 25 scientists and practitioners submitted a total of 97 topics that were ranked using a Delphi-style technique according to novelty and likelihood of impact on biodiversity conservation. The top 38 issues were discussed at an online meeting held in September 2020 during which issues were ranked according to the same criteria. Six of the 15 issues primarily affect marine or coastal ecosystems and seven are related to human and ecosystem-level responses to anthropogenic climate change. Other emerging issues include complete coverage of Indian states for sustainable farming and the potential for use of self-healing building materials. [ABSTRACT FROM AUTHOR]

In this horizon scan, we highlight 15 emerging issues of potential relevance to global conservation in 2020. Seven relate to potentially extensive changes in vegetation or ecological systems. These changes are either relatively new, for example, conversion of kelp forests to simpler macroalgal systems, or may occur in the future, for example, as a result of the derivation of nanocelluose from wood or the rapid expansion of small hydropower schemes. Other topics highlight potential changes in national legislation that may have global effect on international agreements. Our panel of 23 scientists and practitioners selected these issues using a modified version of the Delphi technique from a long-list of 89 potential topics. We present 15 issues that emerged from our 11th annual horizon scan of global biological conservation. Issues were identified by a diverse group of scientists and practitioners. The group scored the long-list of 89 issues using a Delphi-like process. Issues were ranked according to novelty, relevance, and potential impact on biological conservation. The top-38 ranked issues were debated at a workshop in Cambridge, UK, with each topic scored immediately following the discussion. Emerging themes include changes in national legislation that could affect international agreements; recognising ecocide as an international crime; and the global decline in kelp forests. Other issues include the increasing use of traditional Asian medicine; the spread of the Asian long-horned tick; use of artificial wombs in mammalian conservation; and the impact that the shrinking ozone hole may have on Antarctic sea ice. [ABSTRACT FROM AUTHOR]

We present the results of our tenth annual horizon scan. We identified 15 emerging priority topics that may have major positive or negative effects on the future conservation of global biodiversity, but currently have low awareness within the conservation community. We hope to increase research and policy attention on these areas, improving the capacity of the community to mitigate impacts of potentially negative issues, and maximise the benefits of issues that provide opportunities. Topics include advances in crop breeding, which may affect insects and land use; manipulations of natural water flows and weather systems on the Tibetan Plateau; release of carbon and mercury from melting polar ice and thawing permafrost; new funding schemes and regulations; and land-use changes across Indo-Malaysia. Highlights We present the 15 topics identified in our tenth annual horizon scan for global conservation. Scoring was carried out by a diverse group of experts using a Delphi-like process. Scores were based on the topics' novelty, likelihood, and potential for major impacts on biodiversity. Emerging themes include conservation impacts of biotechnological advances in agriculture. Other issues included climate change-induced release of carbon and mercury from polar ice. [ABSTRACT FROM AUTHOR]

This is our ninth annual horizon scan to identify emerging issues that we believe could affect global biological diversity, natural capital and ecosystem services, and conservation efforts. Our diverse and international team, with expertise in horizon scanning, science communication, as well as conservation science, practice, and policy, reviewed 117 potential issues. We identified the 15 that may have the greatest positive or negative effects but are not yet well recognised by the global conservation community. Themes among these topics include new mechanisms driving the emergence and geographic expansion of diseases, innovative biotechnologies, reassessments of global change, and the development of strategic infrastructure to facilitate global economic priorities. [ABSTRACT FROM AUTHOR]

We present the results of our eighth annual horizon scan of emerging issues likely to affect global biological diversity, the environment, and conservation efforts in the future. The potential effects of these novel issues might not yet be fully recognized or understood by the global conservation community, and the issues can be regarded as both opportunities and risks. A diverse international team with collective expertise in horizon scanning, science communication, and conservation research, practice, and policy reviewed 100 potential issues and identified 15 that qualified as emerging, with potential substantial global effects. These issues include new developments in energy storage and fuel production, sand extraction, potential solutions to combat coral bleaching and invasive marine species, and blockchain technology. [ABSTRACT FROM AUTHOR]

This paper presents the results of our seventh annual horizon scan, in which we aimed to identify issues that could have substantial effects on global biological diversity in the future, but are not currently widely well known or understood within the conservation community. Fifteen issues were identified by a team that included researchers, practitioners, professional horizon scanners, and journalists. The topics include use of managed bees as transporters of biological control agents, artificial superintelligence, electric pulse trawling, testosterone in the aquatic environment, building artificial oceanic islands, and the incorporation of ecological civilization principles into government policies in China. [ABSTRACT FROM AUTHOR]

Despite modern immunosuppressive regimes, acute rejection remains a leading cause of morbidity and mortality in heart transplant recipients. Clinical features are unreliable, and therefore, screening is performed in order to detect rejection, and hence, augment immunosuppressive therapy, at an early stage, with the aim of reducing short- and long-term sequelae. Histological analysis of right ventricular myocardial tissue obtained at endomyocardial biopsy remains the 'gold standard' surveillance technique; however 'biopsynegative' rejection occurs in up to 20% of patients, the procedure is associated with uncommon but potentially serious complications and it is expensive. Non-invasive screening would, conceivably, be safer, more tolerable and cheaper, and could potentially allow more comprehensive monitoring. The evidence for non-invasive methods of diagnosing acute rejection, including assessment of myocardial deformation, myocardial tissue characterisation, electrophysiological monitoring, visualisation of cellular and molecular components of rejection and peripheral monitoring of immune activation, is reviewed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess, at the European level and using digital technology, the inter-pathologist reproducibility of the ISHLT 2004 system and to compare it with the 1990 system We also assessed the reproducibility of the morphologic criteria for diagnosis of antibody-mediated rejection detailed in the 2004 grading system. Methods: The hematoxylin–eosin-stained sections of 20 sets of endomyocardial biopsies were pre-selected and graded by two pathologists (A.A. and M.B.) and digitized using a telepathology digital pathology system (Aperio ImageScope System; for details refer to http://aperio.com/). Their diagnoses were considered the index diagnoses, which covered all grades of acute cellular rejection (ACR), early ischemic lesions, Quilty lesions, late ischemic lesions and (in the 2005 system) antibody-mediated rejection (AMR). Eighteen pathologists from 16 heart transplant centers in 7 European countries participated in the study. Inter-observer reproducibility was assessed using Fleiss''s kappa and Krippendorff''s alpha statistics. Results: The combined kappa value of all grades diagnosed by all 18 pathologists was 0.31 for the 1990 grading system and 0.39 for the 2005 grading system, with alpha statistics at 0.57 and 0.55, respectively. Kappa values by grade for 1990/2005, respectively, were: 0 = 0.52/0.51; 1A/1R = 0.24/0.36; 1B = 0.15; 2 = 0.13; 3A/2R = 0.29/0.29; 3B/3R = 0.13/0.23; and 4 = 0.18. For the 2 cases of AMR, 6 of 18 pathologists correctly suspected AMR on the hematoxylin–eosin slides, whereas, in each of 17 of the 18 AMR-negative cases a small percentage of pathologists (range 5% to 33%) overinterpreted the findings as suggestive for AMR. Conclusions: Reproducibility studies of cardiac biopsies by pathologists in different centers at the international level were feasible using digitized slides rather than conventional histology glass slides. There was a small improvement in interobserver agreement between pathologists of different European centers when moving from the 1990 ISHLT classification to the “new” 2005 ISHLT classification. Morphologic suspicion of AMR in the 2004 system on hematoxylin–eosin-stained slides only was poor, highlighting the need for better standardization of morphologic criteria for AMR. Ongoing educational programs are needed to ensure standardization of diagnosis of both acute cellular and antibody-mediated rejection. [Copyright &y& Elsevier]

Primary pulmonary osteosarcoma is very rare. Most cases are secondary deposits from primaries arising in the appendicular skeleton. Four cases of primary osteogenic sarcoma of the lung are described and the literature reviewed for previously reported cases. These pulmonary tumors occur in patients who are in their fourth to seventh decades, that is, an older age group than their primary bone equivalent. There is a slight male predominance. There appears to be a propensity for the left lung, especially the left upper lobe. The clinical presentation is similar to primary (epithelial) lung cancer. Differentiation from pleomorphic carcinomas and other sarcomas is discussed. We know of no predisposing factor(s) in our cases for the development of this tumor. [ABSTRACT FROM PUBLISHER]

Segmental mediolytic arteriopathy (SMA) is an extremely rare condition of uncertain etiology causing degeneration of arterial media, intramural dissection or the rupture of aneurysms. It is recognized as a rare cause of fatal intra-abdominal bleeding. We report the first case of recurrent intra-abdominal bleeding secondary to SMA in a lung transplant patient, with a further complication of lymphoproliferative disease in the transplanted lung. We discuss the pathogenesis, clinical presentation, imaging characteristics and the complexities of management in this case. [Copyright &y& Elsevier]

Neurosarcoidosis is seen in 5-15% of patients with systemic sarcoidosis. The most common cranial nerve presentations are optic neuropathy and facial nerve palsy. The authors present a case of sarcoidosis presenting with a pupil-involving third nerve palsy. The patient responded to corticosteroid therapy with resolution of investigations her cranial nerve palsy but progressed to develop cerebellar signs. This is the first documented case of a pupil-involving third nerve palsy occurring as the first presentation of neurosarcoidosis. Although typically a pupil-involving third nerve palsy necessitates urgent neuroimaging to rule out a posterior communicating artery aneurysm, it is important to recognise inflammatory causes in the differential diagnosis. [ABSTRACT FROM AUTHOR]