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This case report comprises studies of four Goeldi ' s monkeys (Callimico goeldii) from the same enclosure. Globe samples from two related C goeldii (the female C goeldii and her male offspring) were available for a histopathological evaluation. Both cases presented histopathologically evident outer retinal degeneration with differences in severity. There was marked outer retinal atrophy characterized by loss of the outer and inner photoreceptor segments, and depletion of the outer retinal nuclear layer. Furthermore, we report a reduction in the thickness of the outer retinal plexiform, inner retinal nuclear layer, and inner retinal plexiform layer in these C goeldii monkeys. To the authors’ knowledge, these findings have not yet been reported in wildor captive-bred population of C goeldii.

In clinical and experimental NASH, the origin of the scar-forming myofibroblast is the HSC. We used foz/foz mice on a Western diet to characterize in detail the phenotypic changes of HSCs in a NASH model.We examined the single-cell expression profiles (scRNA sequencing) of HSCs purified from the normal livers of foz/foz mice on a chow diet, in NASH with fibrosis of foz/foz mice on a Western diet, and in livers during regression of NASH after switching back to a chow diet. Selected genes were analyzed using immunohistochemistry, quantitative real-time PCR, and short hairpin RNA knockdown in primary mouse HSCs. Our analysis of the normal liver identified two distinct clusters of quiescent HSCs that correspond to their acinar position of either pericentral vein or periportal vein. The NASH livers had four distinct HSC clusters, including one representing the classic fibrogenic myofibroblast. The three other HSC clusters consisted of a proliferating cluster, an intermediate activated cluster, and an immune and inflammatory cluster. The livers with NASH regression had one cluster of inactivated HSCs, which was similar to, but distinct from, the quiescent HSCs.Analysis of single-cell RNA sequencing in combination with an interrogation of previous studies revealed an unanticipated heterogeneity of HSC phenotypes under normal and injured states.

Background Anorexia Nervosa has the highest rate of mortality and morbidity of the mental health conditions. Much of this is related to the physical consequences of starvation and can lead to medical admissions. Integrated care pathways have the potential to decrease admission rates, reduce duration of stay, and prevent patients slipping through gaps between services. The Junior MARSIPAN risk assessment guideline is a best practice framework that has potential to enhance integrated decision making between mental health, paediatric and primary care for children and adolescents with eating disorders. Objective To explore the use of Junior MARSIPAN risk guidelines in collaborative decision making in a Regional Tertiary Referral Hospital, and to understand any associated barriers and enabling factors in their implementation. Methods Patients discharged from Cork University Hospital with a diagnosis of Anorexia Nervosa/Eating Disorder were identified using HIPE data, over a 2-year time period. Variables collected included: admission and subsequent number of bloods performed, assessment of cardiovascular stability, contact with Child and Adolescent Mental Health Service (CAMHS), MDT meetings, the presence of psychiatric co-morbidities and evidence of discharge planning. Results Of the 38 patients who presented to hospital, 20 were identified as having been admitted overnight over the time period, involving 16 patients. The mean number of admissions per patient was 4(2–11), mean age 15.1years (9.6–17.8 y) and 14 were female. The majority of admissions (68%) were unplanned and most were self-referrals. A total of 11 physicians were involved in the care in addition to 6 CAMHS teams and 2 GPs. There was inadequate evidence of documentation of physical risk parameters (BMI%, Orthostatic BP), biochemistry for monitoring of refeeding syndrome, and of multidisciplinary approach to care and discharge planning. Conclusions Complexity and delayed communication was a significant barrier to the implementation of junior MARSIPAN across the 17 different teams involved. There is a need to develop MARSIPAN Lead clinician ‘champions’ and to standardised approaches across services, adult, Paediatric and child psychiatry, in order to minimise variability in patient clinical care experience. An integrated care pathway, based on the Junior MARSIPAN Guidelines, is proposed to improve initial assessment, inpatient management of refeeding risks and to plan discharge. It is hoped this will lead to safer, more supportive and seamless care for young people with eating disorders when they become medically unstable.

Background & aim Non-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD) that is responsible for a growing fraction of cirrhosis and liver cancer cases worldwide. Changes in the gut microbiome have been implicated in NASH pathogenesis, but the lack of suitable murine models has been a barrier to progress. We have therefore characterized the microbiome in a well-validated murine NASH model to establish its value in modeling human disease. Methods The composition of intestinal microbiota was monitored in mice on a 12- or 24-week NASH protocol consisting of high fat, high sugar Western Diet (WD) plus once weekly i.p injection of low-dose CCl4. Additional mice were subjected to WD-only or CCl4-only conditions to assess the independent effect of these variables on the microbiome. Results There was substantial remodeling of the intestinal microbiome in NASH mice, characterized by declines in both species diversity and bacterial abundance. Based on changes to beta diversity, microbiota from NASH mice clustered separately from controls in principal coordinate analyses. A comparison between WD-only and CCl4-only controls with the NASH model identified WD as the primary driver of early changes to the microbiome, resulting in loss of diversity within the 1st week. A NASH signature emerged progressively at weeks 6 and 12, including, most notably, a reproducible bloom of the Firmicute order Erysipelotrichales. Conclusions We have established a valuable model to study the role of gut microbes in NASH, enabling us to identify a new NASH gut microbiome signature.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cycle threshold (Ct) has been suggested as an approximate measure of initial viral burden. The relationship of initial Ct at hospitalization and patient mortality has not been thoroughly investigated.Methods and findingsWe conducted a retrospective study of SARS-CoV-2 positive, hospitalized patients from 3/26/2020 to 8/5/2020 who had SARS-CoV-2 Ct data within 48 hours of admission (n=1044). Only patients with complete survival data discharged (n=774) or died in hospital (n=270), were included in our analysis. Laboratory, demographic, and clinical data were extracted from electronic medical records. Multivariable logistic regression was applied to examine the relationship of patient mortality with Ct values while adjusting for established risk factors. Ct was analyzed as continuous variable and subdivided into quartiles to better illustrate its relationship with outcome. Cumulative incidence curves were created to assess whether there was a survival difference in the setting of the competing risks of death versus patient discharge.Mean Ct at admission was higher for survivors (28.6, SD=5.8) compared to non-survivors (24.8, SD=6.0, P32.9) had lower odds of in-hospital death (PConclusionSARS-CoV-2 Ct was found to be an independent predictor of patient mortality. However, further study is needed on how to best clinically utilize such information given the result variation due to specimen quality, phase of disease, and the limited discriminative ability of the test.AUTHOR SUMMARYSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has effected the entire world, with approximately 23 million affected till date. Clinicians, researcher and scientists are making all efforts to identify ways of diagnosis, predicting outcome and treatment modalities. The polymerase chain reaction (rT-PCR) technology, is the standard test being used for the diagnosis and it gives an additional value known as “cycle threshold” (Ct), which is the number of PCR cycles required to cross the designated threshold and termed patient as positive for the infection. This Ct value is inverse of the viral load in the patient and has been studied as indicator of outcome of infection. In this study we have analyzed the Ct value as a predictor for mortality and compared it between different age and gender. We found the Ct value significantly different between those who survived and those who died due to the disease. However proper utilization of the Ct value needs further studies to be utilized in the clinical setting and guide decision making.

An 18-month-old girl presented with multiple soft tissue masses on her hands and feet that had developed over the previous 4 months. She was otherwise well and there was no family history of note. On examination, she was noted to have painless multiple soft tissue swellings, varying in size from 0.5 to 4 cm across her phalanxes and the dorsum of her feet …

Dyslipidaemias refer to abnormal levels of circulating lipids and high cholesterol and is related to cardiovascular death. This paper examines the types and prevalence of dyslipidaemia with specific reference to a military population and describes who to target in screening strategies used to detect people with abnormal lipid profiles. The diagnostic limits for a diagnosis of dyslipidaemia are explored. Finally, medical management of hyperlipidaemia is discussed and how this may affect military medical grading.

IntroductionFocused assessment with sonography in trauma (FAST) is historically an effective method of assessing the patient in the trauma bay in order to aid decision-making and optimise patient outcomes. However, in the UK civilian practice, the use of FAST may decline given a recent change in National Institute for Health and Care Excellence guidance as a result of improvement in CT availability and resuscitation techniques.MethodIn the Role 3 Medical Treatment Facility, Camp Bastion, 187 patients with trauma who received FAST in the trauma bay in 2014 were reviewed to determine the accuracy of FAST in the deployed environment.ResultsThe data demonstrates the sensitivity and specificity of FAST to be 75% and 99.3%, respectively.ConclusionsThis study demonstrates that FAST is accurate on operations. FAST is provided by the integrated radiologist as part of damage control radiology, which gives the team leader rapid diagnostic information to improve decision-making and ultimately patient outcomes. CT is heavily utilised in civilian practice; however, the military operates in a different environment often with multiple casualties and limited access to CT, as a result, portable ultrasound will continue to be a valuable tool on operations if used properly. The next challenge is to develop and maintain this high diagnostic accuracy in future deployments where the memories of our prior success may fade.

This systematic review investigates if interventions adopting the “good lives” approach to offender rehabilitation are effective at reducing recidivism. Keyword searches were executed on electronic databases and online libraries, correctional experts and agencies were contacted, reference harvesting and a Google search were conducted, and two relevant journals were hand-searched, to locate relevant research. The main reviewer screened potential studies for relevance. Two reviewers independently assessed for eligibility. No eligible studies were found; there is yet no high quality evidence that “good lives” type interventions reduce recidivism. However, four excluded studies offer tentative evidence for the potential in improving treatment engagement, enhancing motivation and lowering participant attrition. Pending strong empirical support, interventions that adopt a “good lives” approach should be accompanied by practices with a demonstrated impact on recidivism. Future evaluations should utilize rigorous...

Background CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT ( r = −0.28, p = 0.0001) and SRWA ( r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). Conclusions Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.

Materials Ocular and cutaneous tissues from two Japanese Akita dogs with uveodermatologic syndrome (UVD) were subjected to immunohistochemical analysis. Results Light microscopic examination of the globes confirmed the presence of panuveitis of different severity in each case. The infiltrate was primarily granulomatous with prominent perivascular lymphoid aggregates. Melanophages were present throughout the affected areas, and there were scattered plasma cells. Immunohistochemistry using CD79a, CD3, MAC387 and MHC class II markers indicated that there were relatively few T lymphocytes and that most lymphocytes were of the B-cell lineage. The two skin biopsies examined also appeared to represent different stages of cutaneous pathology. The biopsy from one case was consistent with the reported features of skin lesions of canine UVD syndrome, including granulomatous dermatitis with extensive T-cell infiltration extending into the epidermis. In contrast, the skin lesion from the second case showed less inflammation, more pigmentary incontinence and evidence of dermal fibrosis. There was no immunoglobulin or complement deposition at any level within the cutaneous or ocular lesions. Conclusions The findings of these two cases suggest that the skin lesions of these two dogs with UVD syndrome were mediated by T cells and macrophages (Th1 immunity), whereas the ocular lesions were more consistent with a B cell and macrophage response (Th2 immunity). This is, however, a preliminary investigation and these features may not be the same for all cases of UVD syndrome.

The purpose of this study was to examine the effects of a 2-hour laboratory challenge on heart rate, blood pressure, catecholamines, and cortisol; and investigate the contribution of the physical act of speaking on both neuroendocrine and cardiovascular measures. Using a within-subjects design, 14 subjects were tested individually during two separate laboratory sessions. During one session, subjects engaged in two cognitively demanding tasks for 2 hours. During the other session, subjects executed the verbal demands of the tasks for 2 hours, but cognitive demands were absent. During both sessions, blood pressure and heart rate were measured and arterialized blood samples were obtained for the measurement of epinephrine, norepinephrine, and cortisol. Subjects demonstrated significantly greater increases in systolic blood pressure diastolic blood pressure, heart rate, epinephrine, and cortisol during the cognitively challenging session than during the control session. It is concluded that sustained elevations in cardiovascular and neuroendocrine measures can be achieved in the laboratory, and that the effects of such tasks cannot be attributed solely to the physical demands of speaking. Implications for the measurement of circulating catecholamines and cortisol during laboratory studies are discussed.

In 1896, Robert Jones submitted the first publication reporting a radiograph of a bullet seen inside the human body. A 12-year-old boy shot himself in the left hand ‘‘just above the left palmar arch’’. The bullet, a lead pellet, could not be found on enlarging the wound and it was ‘‘thought injudicious to prolong the search’’ given the ‘‘important structures in the vicinity’’. Professor Oliver Lodge used Roentgen rays to image the wrist and the bullet was clearly identified at the base of the 3rd metacarpal. It was thought to be sitting in the articular surface between the base of the 3rd metacarpal and the capitate, or ‘‘os magnum’’ as it was referred to. At the time it was quoted as being the first radiograph, or photograph, of a bullet embedded in a wrist. Before the Roentgen ray, this child would have either required extensive exploration or the foreign body would have been left in situ. The chosen imaging technique and outcome would not differ between what was published in the Lancet on 22 February 1896 and what happens currently in 2014, 118 years on. The absorbed radiation dose of the Roentgen ray in this case in 1896 was 12,500–25,000 times greater than it is today.

The effect of psychological stress on plasma lipids was studied in 40 law students (20 men and 20 women). Plasma cholesterol, triglyceride, and apolipoprotein concentrations were examined at the beginning of the quarter and during the week before final examinations. Cortisol, blood pressure, and heart rate, and self-reports of stress and workload were also measured to verify that examinations were associated with increased stress levels. Perceived stress, perceived workload, and cortisol increased before examinations. Low density lipoprotein cholesterol (LDL-C) increased 5.8 +/- 13.9 mg/dL, and apolipoprotein B (apo B) increased 2.9 +/- 4.0 mg/dL. High density lipoprotein cholesterol decreased in women only. These changes were not due to changes in dietary intake or indexes of plasma volume. However, changes in cortisol and changes in LDL-C and apo B were associated, suggesting a neuroendocrine component to the effects. These results suggest that episodic, stressful situations may lead to potentially atherogenic changes in lipid and lipoprotein concentrations.

In 1863 the skull and a portion of the skeleton of a large extinct species of Ox (B. primigenius), which had been found in the peat of the Cambridgeshire Fens, and which apparently had been killed by a celt, was placed in the Woodwardian Museum at Cambridge. At the time of its deposition there a portion of the flint remained firmly fixed in a fracture in the frontal bone, being partially retained in sitû by a mass of peat: as, however, this peat gradually dried, it crumbled away, and the celt became loosened and displaced; moreover, some small fragments of bone fell away from the margin of the wound, so that in its present condition the specimen merely exhibits an irregular fracture in the forehead, in which a fragment of a flint implement lies loosely; but it no longer furnishes conclusive and positive evidence to prove that the fracture was actually caused by the celt which occupies it.

In recognition of the application of basic science to clinical medicine, and because the emergency department offers a unique opportunity for this teaching, an educational program was developed especially for the teaching of cardiorespiratory physiology. The method of conducting such an educational program is described, as are the principles to be learned. Testing scores have shown a marked improvement in the students' performance.