Novel Betacoronavirus in Dromedaries of the Middle East, 2013

In 2013, a novel betacoronavirus was identified in fecal samples from dromedaries in Dubai, United Arab Emirates. Antibodies against the recombinant nucleocapsid protein of the virus, which we named dromedary camel coronavirus (DcCoV) UAE-HKU23, were detected in 52% of 59 dromedary serum samples tested. In an analysis of 3 complete DcCoV UAE-HKU23 genomes, we identified the virus as a betacoronavirus in lineage A1. The DcCoV UAE-HKU23 genome has G+C contents; a general preference for G/C in the third position of codons; a cleavage site for spike protein; and a membrane protein of similar length to that of other betacoronavirus A1 members, to which DcCoV UAE-HKU23 is phylogenetically closely related. Along with this coronavirus, viruses of at least 8 other families have been found to infect camels. Because camels have a close association with humans, continuous surveillance should be conducted to understand the potential for virus emergence in camels and for virus transmission to humans.     

Novel Bluetongue Virus in Goats,Corsica, France, 2014

During 2000–2013, 4 genotypes of bluetongue virus (BTV) were detected in Corsica, France. At the end of 2013, a compulsory BTV-1 vaccination campaign was initiated among domestic ruminants; biological samples from goats were tested as part of a corresponding monitoring program. A BTV strain with nucleotide sequences suggestive of a novel serotype was detected.     

Does an Unloader Brace Reduce Knee Loading in Normally Aligned Knees?

Background

Unloading knee braces often are used after tibiofemoral articular cartilage repair. However, the experimental basis for their use in patients with normal tibiofemoral alignment such as those undergoing cartilage repair is lacking.

Questions/purposes

The purpose of this study was to investigate the effect of varus and valgus adjustments to one commercially available unloader knee brace on tibiofemoral joint loading and knee muscle activation in populations with normal knee alignment.

Methods

The gait of 20 healthy participants (mean age 28.3 years; body mass index 22.9 kg/m²) was analyzed with varus and valgus knee brace conditions and without a brace. Spatiotemporal variables were calculated as were knee adduction moments and muscle activation during stance. A directed cocontraction ratio was also calculated to investigate the relative change in the activation of muscles with medial (versus lateral) moment arms about the knee. Group differences were investigated using analysis of variance. The numbers available would have provided 85% power to detect a 0.05 increase or decrease in the knee adduction moment (Nm/kg*m) in the braced condition compared with the no brace condition.

Results

With the numbers available, there were no differences between the braced and nonbraced conditions in kinetic or muscle activity parameters. Both varus (directed cocontraction ratio 0.29, SD 0.21, effect size 0.95, p = 0.315) and valgus (directed cocontraction ratio 0.28, SD 0.24, effect size 0.93, p = 0.315) bracing conditions increased the relative activation of muscles with lateral moment arms compared with no brace (directed cocontraction ratio 0.49, SD 0.21).

Conclusions

Results revealed inconsistencies in knee kinetics and muscle activation strategies after varus and valgus bracing conditions. Although in this pilot study the results were not statistically significant, the magnitudes of the observed effect sizes were moderate to large and represent suitable pilot data for future work. Varus bracing increased knee adduction moments as expected; however, they produced a more laterally directed muscular activation profile. Valgus bracing produced a more laterally directed muscular activation profile; however, it increased knee adduction moments.

Clinical Relevance

When evaluating changes in knee kinetics and muscle activation together, this study demonstrated conflicting outcomes and questions the efficacy for the use of unloader bracing for people with normally aligned knees such as those after articular cartilage repair.     

Risk of molecular recurrence after tyrosine kinase inhibitor discontinuation in chronic myeloid leukaemia patients: a systematic review of literature with a meta-analysis of studies over the last ten years

More than 10 years ago, the first pilot observational study of imatinib discontinuation was reported in chronic myeloid leukaemia (CML) patients in deep molecular response (DMR). Several studies have been published since then, in patients treated with frontline imatinib, or second-generation tyrosine kinase inhibitors (TKI) in first or second line but also on second attempt of TKI discontinuation. Our objective was to estimate, through meta-analyses of the literature data, the probability of molecular recurrence (MolRec) in the time periods of 0–6, 6–12, 12–18 and 18–24 months after a first and second TKI discontinuation and the probability of re-acquisition of DMR after MolRec. The Medline and Scopus databases were searched up to April 2019. The studies were selected by three independent reviewers. Random-effect meta-analyses were conducted using the MetaXL software. The probability of MolRec in the time periods 0–6, 6–12, 12–18 and 18–24 months after the first attempt was respectively 35%, 8%, 3% and 3%, whereas the probability of MolRec in the time periods 0-6, 6-12 and 12-18 after the second attempt was 48%, 27% and 12% respectively. Re-acquisition of a DMR was observed in 90% of patients. Most of the MolRec occur during the first six months in case of a first attempt, whereas the second MolRec occurs over a larger window of time.     

Functional traits explain variation in plant life history strategies

Ecologists seek general explanations for the dramatic variation in species abundances in space and time. An increasingly popular solution is to predict species distributions, dynamics, and responses to environmental change based on easily measured anatomical and morphological traits. Trait-based approaches assume that simple functional traits influence fitness and life history evolution, but rigorous tests of this assumption are lacking, because they require quantitative information about the full lifecycles of many species representing different life histories. Here, we link a global traits database with empirical matrix population models for 222 species and report strong relationships between functional traits and plant life histories. Species with large seeds, long-lived leaves, or dense wood have slow life histories, with mean fitness (i.e., population growth rates) more strongly influenced by survival than by growth or fecundity, compared with fast life history species with small seeds, short-lived leaves, or soft wood. In contrast to measures of demographic contributions to fitness based on whole lifecycles, analyses focused on raw demographic rates may underestimate the strength of association between traits and mean fitness. Our results help establish the physiological basis for plant life history evolution and show the potential for trait-based approaches in population dynamics.Recent evidence for global patterns of functional variation in plants, such as the leaf economics spectrum (1, 2), the wood economics spectrum (3), and the seed size–seed number tradeoff (4, 5), has convinced many ecologists that functional traits offer the best available approach for achieving a general predictive understanding of communities and ecosystems (6, 7). Trait-based approaches are now being used to predict the outcome of community assembly (8–10), global vegetation dynamics (11), and the rate of ecosystem processes (6, 12–14). A central assumption of trait-based ecology is that morphological traits determine physiological performance, which influences vital rates and determines individual fitness and life history evolution (15, 16). However, because of the challenge of quantifying the contribution of traits to fitness, the assumed links between functional traits and life history have not been fully tested.Research in tropical and Mediterranean forests has revealed cross-species relationships between functional traits and the survival and growth rates of individuals (3, 17–24). Although these relationships provide evidence that functional traits influence vital rates, they offer only limited insight into associations between those traits and individual fitness and life history. Vital rates (e.g., survival and fecundity) represent fitness components, but their influence on mean fitness, defined as the population growth rate (λ), is best understood in the context of the full lifecycle of a species (25, 26). A significant negative correlation between wood density and individual growth (18) might not translate into a significant effect on mean fitness if individual growth has little influence on λ. Conversely, a weak relationship between a functional trait and another vital rate could have a significant effect on mean fitness if that vital rate has a strong influence on λ. Perturbation analyses, such as the sensitivities and elasticities frequently applied to matrix projection models (27), address this problem by quantifying the contribution of vital rates to λ (28), making it possible to characterize a species'' overall life history in terms of the relative importance of survival, individual growth, and fecundity to mean fitness. Species with slow life histories have population growth rates with high elasticities to survival, whereas species with fast life histories have relatively higher elasticities to individual growth or fecundity (29, 30).Armed with vital rate elasticities, we can test quantitative hypotheses about whether functional tradeoffs scale up to generate life history tradeoffs. For example, plants can allocate their reproductive effort to provision a few large seeds, which tolerate low light and resource availability and have a high survival probability, or they can spread their reproductive effort among many small seeds, maximizing fitness under high resource availability (31, 32). If this functional tradeoff at the seedling stage translates into a life history tradeoff, seed mass should be positively related to the elasticity of the population growth rate to survival and negatively related to elasticities to individual growth and fecundity. The leaf economics spectrum represents another allocation tradeoff. Species can construct long-lived, well-defended leaves that are often favored in low resource environments or build leaves that assimilate carbon quickly under conditions of high resource availability but are prone to rapid tissue loss (1, 33). Species with slow leaf economics traits, such as long leaf lifespans, low specific leaf area (SLA), and low leaf N, might also lead slow lives, characterized by high elasticities to survival and low elasticities to individual growth and recruitment. A wood economics spectrum also exists: species with dense wood tend to have higher survival but lower relative growth rates than species with soft wood (3, 34). Elasticities to survival should increase with wood density, whereas elasticities to individual growth and fecundity should decrease.The main obstacle in testing these hypotheses is availability of the detailed demographic data necessary to describe a species’ full lifecycle and estimate vital rate elasticities. We overcame this limitation by crossing the TRY Global Plant Traits Database (35) with the COMPADRE Plant Matrix Database (www.compadre-db.org/), a collection of published matrix population models. This approach produced a dataset of 222 plant species spanning a global range of biomes and perennial growth forms (Table S1), for which we have at least one functional trait measurement as well as a matrix population model that we used to calculate the elasticity of the population growth rate to each of the three vital rates: survival, growth, and fecundity (30).Our primary objective was to evaluate the ability of functional traits to explain variation across species in life history, which we quantified with vital rate elasticities. Our secondary objective was to evaluate whether inferences about life history can be drawn directly from the raw vital rates, which would save researchers the considerable time and effort required to parameterize population models and calculate elasticities. We used two statistical approaches to quantify relationships between vital rate elasticities and seed mass, wood density, and leaf economics traits (leaf lifespan, SLA, and leaf N). Dirichlet regression is a multivariate approach that accounts for the fact that the survival, growth, and fecundity elasticities for each species sum to one but does not account for phylogenetic relationships. Phylogenetic generalized least squares (PGLS) regression ignores the nonindependence of the elasticities but accounts for phylogenetic relationships. We repeated both types of regressions with plant growth form and then biome included as covariates to confirm that trait effects did not simply represent differences between trees and herbaceous species or plants adapted to different environments.     

Does Anatomy Explain the Origin of a Leak after Sleeve Gastrectomy?

Background

Sleeve gastrectomy is a bariatric surgical procedure that may result in particular morbidity or mortality due to gastric fistula in the proximal part of the gastric tube. Two theories are currently proposed to explain this specific leak location. The vascular theory attributes the leaks to reduced perfusion in the gastric tube, and the mechanical theory suggests the etiology as gastric tube hyper-pressure due to pyloric conservation. The aim of this study was to map the arterial gastric vascular supply on fresh cadavers after performing sleeve gastrectomy to evaluate the effect of vascular changes on gastric leakage.

Methods

We performed sleeve gastrectomies on 11 cadaveric trunks with a detailed anatomical study of the gastric vascular supply after latex injection in the three branches arising from the celiac trunk.

Results

In 55 % of cases, the sleeve procedure changed the gastric vascular supply. In 9.1 %, it divided the three left gastric artery branches arising from the lesser curvature. Few changes were noted in the antrum or pylorus.

Conclusions

This anatomical study demonstrates that the vascular supply of the proximal part of the gastric tube can be damaged by a sleeve procedure, which can sever one or more of the branches arising from the left gastric artery. Such weakness could be exacerbated by disparities in vascular supply. The uninterrupted vascular supply of the antrum and pylorus may explain the preferential localization of the fistula to the proximal part of the gastric tube.     

Emergency air evacuation of patients with acute respiratory failure due to SARS-CoV-2 from Mayotte to Reunion Island

In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46–65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO₂/FiO₂ ratio was lower on ICU admission (140 [102–192] mmHg) than on departure (165 [150–200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.