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There is limited evidence regarding the effects of a pre-existing heart failure (HF) on the diagnostic yield of pulmonary embolism (PE) evaluation in the Emergency Department (ED).Electronic medical record of consecutive adults who underwent a computed tomography pulmonary angiogram (CTPA) in the ED at Loma Linda University Medical Center between June 1, 2019 and March 25, 2022 were reviewed. Repeat studies for the same patient and patients with unspecified HF diagnoses or isolated right ventricular HF were excluded. Key demographics, lab values and vital signs, relevant medications were collected. Primary outcome was the incidence of PE on CTPA compared between patients with and without pre-existing HF.A total of 2846 patients were included in the study (602 patients with HF and 2244 without). In total cohort, 11.7% (n = 334) of patients had PE found on CTPA. The incidence of PE on CTPA was lower among patients with a history of HF than patients without a history of HF (12.5% vs 9%). A history of pre-existing HF was associated with a lower odds ratio for a positive PE study (OR 0.13, 95%CI: 0.03-0.57) in multivariable analyses.In this study, we observed that the incidence of PE among patients who undergo CTPA was lower among patients with pre-existing HF compared to those without. Further studies should determine if HF is an important mitigating factor when risk stratifying patients for PE.

We describe a patient who developed bilateral temporal lesions due to a haemorrhagic stroke. One year after onset, he showed marked apperceptive prosopagnosia and could not name people from their voices, although he had spared semantic knowledge about people he could not name and could access this knowledge from people's voice. Importantly, the patient was able to retrieve proper name of persons after their description and was able to name sounds and songs; he could also retrieve proper names of monuments, towns and cartoon characters upon visual presentation. No further relevant cognitive impairment was present. This clinical picture represents the auditory counterpart of prosopanomia and could be defined 'phonoanomia'. This case report suggests that naming people from their voice implies specific retrieval processes, and pose specific constraints to theoretical models of person recognition.

Background There is limited knowledge on the origin and development from CD34+ precursors of the ample spectrum of human natural killer (NK) cells, particularly of specialized NK subsets. Objective This study sought to characterize the NK-cell progeny of CD34+DNAM-1brightCXCR4+ and of other precursors circulating in the peripheral blood of patients with chronic viral infections (eg, HIV, hepatitis C virus, cytomegalovirus reactivation). Methods Highly purified precursors were obtained by flow cytometric sorting and cultured in standard NK-cell differentiation media (ie, SCF, FLT3, IL-7, IL-15). Phenotypic and functional analyses on progenies were performed by multiparametric cytofluorimetric assays. Transcriptional signatures of NK-cell progenies were studied by microarray analysis. Inhibition of cytomegalovirus replication was studied by PCR. Results Unlike conventional CD34+ precursors, Lin−CD34+DNAM-1brightCXCR4+ precursors from patients with chronic infection, rapidly differentiate into cytotoxic, IFN-γ–secreting CD94/NKG2C+KIR+CD57+ NK-cell progenies. An additional novel subset of common lymphocyte precursors was identified among Lin−CD34−CD56−CD16+ cells and characterized by expression of CXCR4 and lack of perforin and CD94. Lin−CD34−CD56−CD16+Perf−CD94−CXCR4+ precursors are also endowed with generation potential toward memory-like NKG2C+NK cells. Maturing NK-cell progenies mediated strong human cytomegalovirus–inhibiting activity. Microarray analysis confirmed a transcriptional signature compatible with NK-cell progenies and with maturing adaptive NK cells. Conclusions During viral infections, precursors of adaptive NK cells are released and circulate in the peripheral blood.

International audience; Group 3 innate lymphoid cells (ILC3) have been detected in both murine and human decidual tissues where they are thought to play a relevant role in the induction and maintenance of pregnancy. However, limited information exists on the molecular mechanisms that regulate these cells, including immune checkpoints. Here, we show that ILC3 express the inhibitory checkpoints programmed cell death (PD-1) and T cell immunoglobulin and mucin domain containing protein 3 (TIM-3) during the first trimester of pregnancy and that these receptors could regulate production of cytokines, including IL-22, IL-8, and TNF-α, induced by IL-23. We also show that the intermediate extravillous trophoblast (iEVT) expresses high levels of the PD-1-ligand PD-L1, suggesting that PD-1/PD-L1 interaction may regulate ILC3 function at the feto-maternal interface. Our present data provide the first evidence that human decidual ILC3 express a functional PD-1. It is possible that an altered expression or function of PD-1 may break the immune-tolerance resulting in pregnancy failure.

Toxoplasmosis is a zoonotic disease with worldwide prevalence in humans and warm-blooded animal populations. In livestock Toxoplasma gondii is the causal agent of significant economic losses since it can cause abortions in goats and sheep. It is estimated that one third of the world population is infected. Although there are effective therapies for acute infection, these are sometimes poorly tolerated, teratogenic, and have a long administration time. Considering the deficiencies that exist related to the prevention and treatment of toxoplasmosis, the development of a safe and effective vaccine would be extremely valuable in fighting against this infection. In the present work, we characterize for the first time the adjuvant and immunogenic potential of a recombinant profilin protein (rTgPF), in a vaccine formulation alone or in combination with the well-known GRA7 antigen candidate in a murine toxoplasmosis model. Since TgPF acts as a ligand for TLR11 and 12 inducing innate immune responses that promote type 1 adaptive responses, we first study the capacity of the mix rGRA7 + rTgPF to initiate an immune response by evaluating dendritic cell activation. Both rTgPF and rGRA7 induces activation of mouse BMDCs more efficiently than the single proteins, evidenced by increased expression of CD80 and CD86 co-stimulatory proteins and secretion of IL-6, IL-10 and IL-12 cytokines after in vitro stimulation. The sum of the effects of rGRA7 and rTgPF on BMDCs maturation led us to assay them in a vaccination protocol. BALB/c mice vaccinated with this mix elicited a Th1-biased immunity via the induction of lymphocyte proliferation, activation of CD4+T cells and increased IFN-γ production that resulted in enhanced protection against chronic Toxoplama gondii infection. Profilin per se induce only cellular immunity but augments the effect of rGRA7 immune responses when used together, thus allowing us to postulate rTgPF as a potential adjuvant in a protein vaccine.

Study objective Sickle cell disease (SCD) is an inherited hematologic disorder that affects approximately 100,000 US individuals and results in greater than 200,000 emergency department (ED) visits annually in the United States, with pain being the most common complaint. The objective of this retrospective study is to determine the effect of implementing individualized pain plans in the treatment of patients with SCD in the ED on time to first opioid, length of stay, and disposition. Methods At The Ohio State University Wexner Medical Center, a multidisciplinary group including hematologists and ED physicians was formed and enacted a protocol for using individualized pain plans, with the goal of decreasing time to treatment for patients with SCD who presented to the ED with chief complaint of pain. In this retrospective study, data from the year before through the year of implementation were gathered. Generalized linear models were fit to compare time to first opioid, length of stay, and disposition before and after protocol implementation. Results Data showed a 48% decrease in time to first opioid and a 22% decrease in length of ED stay after protocol implementation. No significant change was found in disposition or length of inpatient admission before and after protocol initiation. Conclusion The use of individualized pain plans in the treatment of patients with SCD in the ED is a useful method of not only ensuring rapid and adequate treatment but also decreasing use of health care resources.

Anaplasma phagocytophilum is a tick-borne pathogen of sheep and other ruminants, humans, horses and dogs. Current data on the prevalence and diffusion of A. phagocytophilum among domestic animals in Italy are fragmentary, especially those related to sheep, considered a natural domestic reservoir. We investigated the prevalence of A. phagocytophilum infection in dairy sheep from Tuscany (Italy), by testing 624 sera with the immunofluorescent antibody (IFA) test. The sera belonged to 33 different flocks distributed throughout the province of Grosseto (Tuscany). Positive results were found in 21 out of the 33 flocks tested (63.63%, 95% IC 47.22–80.05%) with a prevalence rate within flocks ranging from 3.33% to 59.26%. The seroprevalence against A. phagocytophilum within the sheep population was 8.01% (95% IC 6.13–10.41%), and most of the positive cases showed low antibody titres (1/40-1/80). The multivariate analysis identified "small flock" ( Our results reveal a moderate circulation of A. phagocytophilum among sheep flocks in central Italy.