The contamination of ecosystem compartments by microplastics (MPs) is an ubiquitous problem. MPs have been observed in mice tissues, and recently in human blood, stool and placenta. However, two ...aspects remain unclear: whether MPs accumulate in peripheral organs, specifically in the liver, and if liver cirrhosis favours this process. We aimed to examine human liver tissue samples to determine whether MPs accumulate in the liver.
This proof-of-concept case series, conducted in Germany, Europe, analyzed tissue samples of 6 patients with liver cirrhosis and 5 individuals without underlying liver disease. A total of 17 samples (11 liver, 3 kidney and 3 spleen samples) were analyzed according to the final protocol. A reliable method for detection of MP particles from 4 to 30 µm in human tissue was developed. Chemical digestion of tissue samples, staining with Nile red, subsequent fluorescent microscopy and Raman spectroscopy were performed. Morphology, size and composition of MP polymers were assessed.
Considering the limit of detection, all liver, kidney and spleen samples from patients without underlying liver disease tested negative for MPs. In contrast, MP concentrations in cirrhotic liver tissues tested positive and showed significantly higher concentrations compared to liver samples of individuals without underlying liver disease. Six different microplastic polymers ranging from 4 to 30 µm in size were detected.
This proof-of-concept case series assessed the presence of MPs in human liver tissue and found six different MP polymers in the liver of individuals with liver cirrhosis, but not in those without underlying liver disease. Future studies are needed to evaluate whether hepatic MP accumulation represents a potential cause in the pathogenesis of fibrosis, or a consequence of cirrhosis and portal hypertension.
No funding was received for conducting this investigator driven study.
COVID-19 can cause severe neurological symptoms, but the underlying pathophysiological mechanisms are unclear. Here, we interrogated the brain stems and olfactory bulbs in postmortem patients who had ...COVID-19 using imaging mass cytometry to understand the local immune response at a spatially resolved, high-dimensional, single-cell level and compared their immune map to non-COVID respiratory failure, multiple sclerosis, and control patients. We observed substantial immune activation in the central nervous system with pronounced neuropathology (astrocytosis, axonal damage, and blood-brain-barrier leakage) and detected viral antigen in ACE2-receptor-positive cells enriched in the vascular compartment. Microglial nodules and the perivascular compartment represented COVID-19-specific, microanatomic-immune niches with context-specific cellular interactions enriched for activated CD8+ T cells. Altered brain T-cell-microglial interactions were linked to clinical measures of systemic inflammation and disturbed hemostasis. This study identifies profound neuroinflammation with activation of innate and adaptive immune cells as correlates of COVID-19 neuropathology, with implications for potential therapeutic strategies.
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•Performed detailed molecular and spatial analysis of the COVID-19 brain immune response•Pathognomonic microglial nodules and T cell infiltration are present in COVID-19 brains•Altered microglia-T-cell interactions correlate with systemic measures of inflammation•Vascular leakage is linked with immune activation, ACE2 expression, and viral antigen
COVID-19 can cause severe neurological symptoms. By deep spatial analysis of postmortem brain tissue, Schwabenland et al. identify accumulation of distinct microglial and T cell subsets in microglial nodules and the perivasculature. They observe neuroinflammation with axonal damage, virus-associated perivascular inflammation, and compromised blood-brain barrier. This profound neuroinflammation highlights the need for better strategies against this COVID-19 CNS manifestation.
Osteocytes are ramified bone cells distributed throughout the bone matrix within a network of micrometer-scale cavities (lacunae) and numerous nanometer-thick tunnels (canaliculi). The integrity of ...the canalicular network might influence bone quality and reflect its mechanosensory potential. In this study, we applied an acid etching technique to embedded bone specimens that allows 3D observation of the canalicular network across a 2D plane to quantitatively assess the canalicular connections in cortical bone specimens from young and aged individuals. Our results showed a nearly 30% reduction in the number of canaliculi per osteocyte lacuna in aged individuals (N.Ot.Ca/Ot.Lc: 15.92 ± 1.5 in aged vs 22.10 ± 2.82 in young; p < 0.001); moreover, canalicular number was found to be inversely related to the osteonal tissue age represented by Ca/P ratio (p < 0.001). We frequently observed the phenomenon that canaliculi of osteocytes located near the osteon’s periphery did not end at the osteon’s cement line boundary but penetrated through the cement line and spread into the surrounding bone matrix, thus establishing an “external rooting” or “connection”, which might have significant relevance to bone quality. Our findings showed that not only does the aging process diminish the canalicular network within osteons, but it also significantly reduces the probability of external osteonal rooting and connections with the surrounding bone tissue. Deterioration in the canalicular network with age reduces the connectivity between osteocytes and between osteons/interstitial tissue, which affects the supply of nutrients to osteocytes, degrades their mechanosensitivity, and contributes to increased bone fragility in the elderly.
Purpose
Loosening of pedicle screws is one major complication of posterior spinal stabilisation, especially in the patients with osteoporosis. Augmentation of pedicle screws with cement or ...lengthening of the instrumentation is widely used to improve implant stability in these patients. However, it is still unclear from which value of bone mineral density (BMD) the stability of pedicle screws is insufficient and an additional stabilisation should be performed. The aim of this study was to investigate the correlation of bone mineral density and pedicle screw fatigue strength as well as to define a threshold value for BMD below which an additional stabilisation is recommended.
Methods
Twenty-one human T12 vertebral bodies were collected from donors between 19 and 96 years of age and the BMD was measured using quantitative computed tomography. Each vertebral body was instrumented with one pedicle screw and mounted in a servo-hydraulic testing machine. Fatigue testing was performed by implementing a cranio-caudal sinusoidal, cyclic (0.5 Hz) load with stepwise increasing peak force.
Results
A significant correlation between BMD and cycles to failure (
r
= 0.862,
r
2
= 0.743,
p
< 0.001) as well as for the linearly related fatigue load was found. Specimens with BMD below 80 mg/cm
3
only reached 45% of the cycles to failure and only 60% of the fatigue load compared to the specimens with adequate bone quality (BMD > 120 mg/cm
3
).
Conclusions
There is a close correlation between BMD and pedicle screw stability. If the BMD of the thoracolumbar spine is less than 80 mg/cm
3
, stability of pedicle screws might be insufficient and an additional stabilisation should be considered.
In a cohort including individuals with suspected high alcohol consumption, the concentrations of the indirect alcohol biomarkers carbohydrate-deficient transferrin (CDT) and mean corpuscular volume ...(MCV) and the direct alcohol biomarker phosphatidylethanol (PEth) were investigated. Blood alcohol concentration (BAC) was analysed as a marker for acute alcohol ingestion.
In addition to questions about subjective alcohol consumption behaviour, 147 homeless persons underwent a physical examination with blood sampling. BAC, PEth, CDT and MCV were determined in the blood samples. Special focus was on the comparison of PEth and CDT for indicating excessive alcohol consumption.
BAC was measured above 0.1‰ in 39 blood samples (0.1–2.5‰, median 0.75‰). PEth was detected in all of them. Overall, PEth was positive (≥10 ng/ml) in 104 samples (71%) (11–5687 ng/ml, median 650 ng/ml) with 68 (46%) being above the cut-off for excessive alcohol consumption (210 ng/ml). In 26 subjects PEth was the only positive alcohol biomarker. CDT was ≥ 1.7% in 66 cases (47%) (1.8–22.2%, median 4.4%) and ≥ 2.5% in 52 (35%) cases. MCV was elevated (≥95 fl) in 58 subjects (39%). CDT and PEth concentrations showed a significant positive correlation (spearman's correlation coefficient ρ = 0.77, p < 0.001). PEth concentrations were significantly higher in samples that were also CDT positive than solely PEth positive (p = 0.004). PEth did not indicate excessive alcohol consumption (< 210 ng/ml) in eight and two cases in which CDT was ≥ 1.7% and ≥ 2.5%, respectively. On the other hand, CDT was< 1.7% and< 2.5% in ten and 18 cases, respectively, in which PEth was above cut-off for excessive alcohol consumption. Taking the self-reports of the participants into consideration, PEth’s sensitivity for detecting excessive alcohol consumption was 100% (10 ng/ml) and 94% (210 ng/ml) and CDT’s was 88% (1.7%) and 75% (2.5%).
In individuals of the investigated cohort unusually high concentrations of the alcohol consumption markers PEth and CDT were quantified, which proves the assumption of chronic excessive alcohol consumption in parts of the cohort. PEth was the marker that was positive most often and was more sensitive for excessive alcohol consumption than CDT.
•in the cohort of homeless persons very high concentrations of PEth and CDT were found.•PEth and CDT correlated well.•But some discrepancies occurred considering excessive alcohol consumption.•50% stating no/occasional consumption, had PEth/CDT>cut-off for excessive drinking.•PEth’s sensitivity for excessive alcohol consumption was higher than CDT’s.
Since the introduction and widespread acceptance of percutaneous techniques in the intensive care unit (ICU) setting, the number of critically ill patients undergoing tracheostomy has steadily ...increased. However, this procedure can be associated with major complications, including death. The purpose of this study is to estimate the incidence and analyze the causes of lethal complications due to percutaneous dilatational tracheostomy (PDT).
We analyzed cases of lethal outcome due to complications from PDT including cases published between 1985 and April 2013. A systematic literature search was performed and unpublished cases from our own departmental records were retrospectively analyzed.
A total of 71 cases of lethal outcome following PDT were identified including 68 published cases and 3 of our own patients. The incidence of lethal complications was calculated to be 0.17%. Of the fatal complications, 31.0% occurred during the procedure and 49.3% within seven days of the procedure. The main causes of death were: hemorrhage (38.0%), airway complications (29.6%), tracheal perforation (15.5%), and pneumothorax (5.6%). We found specific risk factors for complications in 73.2% of patients, 25.4% of patients had more than one risk factor. Bronchoscopic guidance was used in only 46.5% of cases.
According to this analysis, PDT-related death occurs in 1 out of 600 patients receiving a PDT. Careful patient selection, bronchoscopic guidance, and securing the tracheal cannula with sutures are likely to reduce complication rates.
Analyses of infection chains have demonstrated that severe acute respiratory syndrome coronavirus 2 is highly transmissive. However, data on postmortem stability and infectivity are lacking. Our ...finding of nasopharyngeal viral RNA stability in 79 corpses showed no time-dependent decrease. Maintained infectivity is supported by virus isolation up to 35 hours postmortem.
Zusammenfassung
Mobilität ist auch im höheren Alter maßgeblich für die selbstständige Lebensführung. Ältere Menschen beginnen bei geringerer körperlicher Leistungsfähigkeit (Gebrechlichkeit, engl. ...Frailty) ihren persönlichen Aktionsradius auf das nähere Wohnumfeld und schließlich die unmittelbare Häuslichkeit zu begrenzen. Erkrankungen des Bewegungsapparates, neurologische, psychische, kognitive, Sinnes- oder Kreislaufstörungen können die funktionale Kompetenz (Fähigkeit, unabhängig zu leben) einschränken.
In einer Längsschnittstudie zur Alterung urbaner Kohorten (LUCAS), aus der in diesem Artikel ausgewählte Ergebnisse berichtet werden, wurden die Teilnehmenden mittels des LUCAS-Funktions-Index unterschiedlichen Funktionsklassen zugeordnet (
Robust, postRobust, preFrail
und
Frail
). Die Ergebnisse zeigen, dass zunehmende Verluste funktionaler Kompetenz mit abnehmender Mobilität und weniger häufigem selbstständigen Autofahren verknüpft waren. Beeinträchtigungen der Mobilität engten den Aktionsradius ein.
Das Ziel der gesundheitlichen Versorgung im Alter ist es, Unabhängigkeit und Lebensqualität der Menschen lange zu erhalten. Autofahren ist ein wichtiger Teil der Alltagsaktivitäten älterer Menschen. Deshalb sollte insbesondere hausärztlich auch regelmäßig wiederholt die Frage nach dem Autofahren gestellt werden, denn präventive Maßnahmen zum Erhalt funktionaler Gesundheit dienen auch dem Erhalt der Fahreignung älterer Menschen.
IMPORTANCE: Current recommendations are to avoid tissue for corneal transplant from donors with coronavirus disease 2019 (COVID-19) or those who were recently exposed to COVID-19 owing to the lack of ...knowledge about the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corneal tissues. Evidence of SARS-CoV-2 in corneal tissue would seem to have clinical relevance for corneal transplant. OBJECTIVES: To investigate the presence of viral SARS-CoV-2 RNA in corneal discs of deceased patients with confirmed COVID-19 and assess viral genomic and subgenomic RNA load, possible infectivity, and histologic abnormalities. DESIGN, SETTING, AND PARTICIPANTS: A case series was conducted of 11 deceased patients with COVID-19 who underwent autopsy between March 20 and May 14, 2020. Eleven corneal discs (1 corneal disc per patient) were harvested for molecular detection of viral genomic and subgenomic RNA, virus isolation, and immunohistochemistry. The SARS-CoV-2 RNA loads were compared with RNA loads in the conjunctival and throat swab samples and aqueous humor, vitreous humor, and blood samples. MAIN OUTCOMES AND MEASURES: Evidence of SARS-CoV-2 RNA in human corneas. RESULTS: This study comprised 11 patients (6 women 55%; mean SD age, 68.5 18.8 years). In 6 of 11 eyes (55%), SARS-CoV-2 genomic RNA was detected in the cornea; subgenomic RNA was present in 4 of these 6 eyes (67%). Infectivity or the presence of viral structural proteins could not be confirmed in any eye. However, patients whose corneal disc was positive for SARS-CoV-2 RNA also had positive results for SARS-CoV-2 RNA in 4 of 6 conjunctival swab samples, 1 of 3 aqueous humor samples, 3 of 5 vitreous humor samples, and 4 of 5 blood samples. Overall, conjunctival swab samples had positive results for SARS-CoV-2 RNA in 5 of 11 cases. Postmortem SARS-CoV-2 viremia was detected in 5 of 9 patients. CONCLUSIONS AND RELEVANCE: Viral genomic and subgenomic RNA of SARS-CoV-2 was detected in the cornea of patients with COVID-19 viremia. The risk of COVID-19 infection via corneal transplant is low even in donors with SARS-CoV-2 viremia, but further research is necessary to assess the rate of SARS-CoV-2 transmission via corneal transplant.
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