Candida lipolytica is an uncommon Candida species causing invasive fungemia. This yeast is mainly associated with the colonisation of intravascular catheters, complicated intra-abdominal infections, ...and infections in the paediatric population. Here, we report a case of C. lipolytica bloodstream infection in a 53-year-old man. He was admitted for an alcohol withdrawal syndrome and mild COVID-19. Among the primary risk factors for candidemia, only the use of broad-spectrum antimicrobials was reported. The empiric treatment was commenced with caspofungin and then targeted with intravenous fluconazole. Infective endocarditis was ruled out using echocardiography, and PET/TC was negative for other deep-seated foci of fungal infection. The patient was discharged after blood culture clearance and clinical healing. To the best of our knowledge, this is the first case of C. lipolytica candidemia in a patient with COVID-19 and alcohol use disorder. We performed a systematic review of bloodstream infections caused by C. lipolytica. Clinicians should be aware of the possibility of C. lipolytica bloodstream infections in patients with alcohol use disorder, especially in a COVID-19 setting.
Post-coronavirus disease 2019 (post-COVID-19) condition, previously referred to as long COVID, includes a post-acute syndrome defined by the presence of non-specific symptoms occurring usually 3 ...months from the onset of the acute phase and lasting at least 2 months. Patients with chronic lymphocytic leukemia (CLL) represent a high-risk population for COVID-19. Moreover, the response to SARS-CoV-2 vaccination is often absent or inadequate. The introduction of monoclonal antibodies (mAbs) in the treatment landscape of COVID-19 allowed to reduce hospitalization and mortality in mild-moderate SARS-CoV-2 infection, but limited data are available in hematological patients. We here report the effective use of casirivimab/imdevimab (CI) in the treatment of two CLL patients with persistent infection and post-COVID-19 condition. Full genome sequencing of viral RNA from nasopharyngeal swabs was performed at the time of COVID-19 diagnosis and before the administration of CI. Both patients experienced persistent SARS-CoV-2 infection with no seroconversion for 8 and 7 months, respectively, associated with COVID symptoms. In both cases after the infusion of CI, we observed a rapid negativization of the nasal swabs, the resolution of post-COVID-19 condition, and the development of both the IgG against the trimeric spike protein and the receptor-binding domain (RBD) of the spike protein. The analysis of the viral genome in the period elapsed from the time of COVID-19 diagnosis and the administration of mAbs showed the development of new mutations, especially in the S gene. The genome variations observed during the time suggest a role of persistent SARS-CoV-2 infection as a possible source for the development of viral variants. The effects observed in these two patients appeared strongly related to passive immunity conferred by CI treatment permitting SARS-CoV-2 clearance and resolution of post-COVID-19 condition. On these grounds, passive anti-SARS-CoV-2 antibody treatment may represent as a possible therapeutic option in some patients with persistent SARS-CoV-2 infection.
Vertical navigation is crucial for safe aircraft separation and has been traditionally based on the pressure altitude provided by barometric altimeters. New aviation operations require robust ...determination of geodetic altitude and are expected to primarily rely on a global navigation satellite system (GNSS). Because deviations between pressure and geodetic altitudes can reach hundreds of meters, an altitude harmonization is needed to use barometers in combination with GNSS. In this paper, we first present a methodology to compute an accurate geodetic altitude from barometer and external weather data. Secondly, we derive error and threat models of this geodetic altitude. Finally, we employ these models within a GNSS integrity monitoring algorithm augmented with the derived altitude. We assess our methodologies against flight test measurements and availability simulations of localizer performance with vertical guidance operations. These analyses illustrate the potential benefits of employing barometers as augmentation or stand-alone systems for geodetic altitude navigation.
Background Atrial fibrillation (AF) driver mechanisms are obscured to clinical multielectrode mapping approaches that provide partial, surface-only visualization of unstable 3-dimensional atrial ...conduction. We hypothesized that transient modulation of refractoriness by pharmacologic challenge during multielectrode mapping improves visualization of hidden paths of reentrant AF drivers for targeted ablation. Methods and Results Pharmacologic challenge with adenosine was tested in ex vivo human hearts with a history of AF and cardiac diseases by multielectrode and high-resolution subsurface near-infrared optical mapping, integrated with 3-dimensional structural imaging and heart-specific computational simulations. Adenosine challenge was also studied on acutely terminated AF drivers in 10 patients with persistent AF. Ex vivo, adenosine stabilized reentrant driver paths within arrhythmogenic fibrotic hubs and improved visualization of reentrant paths, previously seen as focal or unstable breakthrough activation pattern, for targeted AF ablation. Computational simulations suggested that shortening of atrial refractoriness by adenosine may (1) improve driver stability by annihilating spatially unstable functional blocks and tightening reentrant circuits around fibrotic substrates, thus unmasking the common reentrant path; and (2) destabilize already stable reentrant drivers along fibrotic substrates by accelerating competing fibrillatory wavelets or secondary drivers. In patients with persistent AF, adenosine challenge unmasked hidden common reentry paths (9/15 AF drivers, 41±26% to 68±25% visualization), but worsened visualization of previously visible reentry paths (6/15, 74±14% to 34±12%). AF driver ablation led to acute termination of AF. Conclusions Our ex vivo to in vivo human translational study suggests that transiently altering atrial refractoriness can stabilize reentrant paths and unmask arrhythmogenic hubs to guide targeted AF driver ablation treatment.
Background and Purpose. Myofascial pain syndrome (MPS) is a chronic or acute form of musculoskeletal pain that affects nearly three-quarters of the world’s population. It is characterized by muscle ...pain and stiffness, with palpable nodules and hyperirritability areas called myofascial trigger points (MTPs). The temporal muscle is frequently involved in MPS, and four MTPs in the temporal muscle have been described in the literature, but no anatomical description of the MTPs has been reported. The present study described the entry points of deep temporal nerves in the temporal muscle belly and related these points to the MTPs described in the literature. Method. Temporal muscles of 14 adult cadavers were studied. The muscle bellies were divided into six areas, three superior (1.2 and 3) and three inferior areas (4, 5, and 6) lower, according to a Cartesian plane to analyze and describe the entry points of the branches of the deep temporal nerves into the muscle. The branching distribution was analyzed using Poisson log-linear tests with Bonferroni post hoc tests for comparison between groups (sextants) (p<0.05). Results. Deep temporal nerve entry points were found in the temporal muscle in all areas. Most of the branches were observed in areas 2 and 5, which coincide with the muscle fibers responsible for mandible elevation and related to the previously described MTPs. Fewer branches were found in areas 1 and 6, where contraction produces mandible retraction. Conclusion. There is an anatomical correlation between the branching pattern of the deep temporal nerve and temporal muscle trigger points. Adequate knowledge of the innervation of the temporal muscle may help elucidate the pathophysiology of myofascial syndromes and provide a rational basis for interventional or conservative approaches and help surgeons avoid iatrogenic lesions to the deep temporal nerve lesion.
Abstract Communication, Navigation and Surveillance (CNS) technologies are key enablers for future safe operation of drones in urban environments. However, the design of navigation technologies for ...these new applications is more challenging compared to e.g., civil aviation. On the one hand, the use cases and operations in urban environments are expected to have stringent requirements in terms of accuracy, integrity, continuity and availability. On the other hand, airborne sensors may not be based on high-quality equipment as in civil aviation and solutions need to rely on tighter multisensor solutions, whose safety is difficult to assess. In this work, we first provide some initial navigation requirements related to precision approach operations based on recently proposed vertiport designs. Then, we provide an overview of a possible multisensor navigation architecture solution able to support these types of operations and we comment on the challenges of each of the subsystems. Finally, initial proof of concept for some navigation sensor subsystems is presented based on flight trials performed during the German Aerospace Center (DLR) project HorizonUAM.
Communication, Navigation and Surveillance (CNS) technologies are key enablers for future safe operation of drones in urban environments. However, the design of navigation technologies for these new ...applications is more challenging compared to e.g., civil aviation. On the one hand, the use cases and operations in urban environments are expected to have stringent requirements in terms of accuracy, integrity, continuity and availability. On the other hand, airborne sensors may not be based on high-quality equipment as in civil aviation and solutions need to rely on tighter multisensor solutions, whose safety is difficult to assess. In this work, we first provide some initial navigation requirements related to precision approach operations based on recently proposed vertiport designs. Then, we provide an overview of a possible multisensor navigation architecture solution able to support these types of operations and we comment on the challenges of each of the subsystems. Finally, initial proof of concept for some navigation sensor subsystems is presented based on flight trials performed during the German Aerospace Center (DLR) project HorizonUAM.
PDF
