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OBJECTIVE: The effects of stroke and delirium on postdischarge cognition and patient-centered health outcomes after surgical aortic valve replacement (SAVR) are not well characterized. Here, we assess the impact of postoperative stroke and delirium on these health outcomes in SAVR patients at 90 days. METHODS: Patients (N = 383) undergoing SAVR (41% received concomitant coronary artery bypass graft) enrolled in a randomized trial of embolic protection devices underwent serial neurologic and delirium evaluations at postoperative days 1, 3, and 7 and magnetic resonance imaging at day 7. Outcomes included 90-day functional status, neurocognitive decline from presurgical baseline, and quality of life. RESULTS: By postoperative day 7, 25 (6.6%) patients experienced clinical stroke and 103 (28.5%) manifested delirium. During index hospitalization, time to discharge was longer in patients experiencing stroke (hazard ratio, 0.62; 95% confidence interval [CI], 0.42-0.94; P = .02) and patients experiencing delirium (hazard ratio, 0.68; 95% CI, 0.54-0.86; P = .001). At day 90, patients experiencing stroke were more likely to have a modified Rankin score >2 (odds ratio [OR], 5.9; 95% CI, 1.7-20.1; P = .01), depression (OR, 5.3; 95% CI, 1.6-17.3; P = .006), a lower 12-Item Short Form Survey physical health score (adjusted mean difference -3.3 ± 1.9; P = .08), and neurocognitive decline (OR, 7.8; 95% CI, 2.3-26.4; P = .001). Delirium was associated with depression (OR, 2.2; 95% CI, 0.9-5.3; P = .08), lower 12-Item Short Form Survey physical health (adjusted mean difference -2.3 ± 1.1; P = .03), and neurocognitive decline (OR, 2.2; 95% CI, 1.2-4.0; P = .01). CONCLUSIONS: Stroke and delirium occur more frequently after SAVR than is commonly recognized, and these events are associated with disability, depression, cognitive decline, and poorer quality of life at 90 days postoperatively. These findings support the need for new interventions to reduce these events and improve patient-centered outcomes.

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Here, we report the draft genome of Paraburkholderia sp. XV. This strain was isolated from the rhizosphere of mango (Mangifera indica L.). Its genome consists of 9,189 coding DNA sequences, 60 tRNAs, a single copy of the 16S rRNA, 5S rRNA, and 23S rRNA gene, and 1 tmRNA. The GC content is 62.6%.

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The genus Gastrodynerus is here revised based on external morphology and male genitalia. Bohart (1984) proposed Gastrodynerus as a new genus with three species: G. vanduzeei (Bohart 1948), G. searsi Bohart, 1984, and G. stangei Bohart, 1984. Later, Rodriguez-Palafox (1996) added G. tacubayae (de Saussure, 1857). Herein, we describe four new species from Central America and South America: G. guatemalensis sp. nov.; G. barretti sp. nov.; G. aimara sp. nov. and G. yungaensis sp. nov. After this taxonomic revision, the Gastrodynerus includes eight species widely distributed in the New World. An identification key is provided for all of the species.

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BACKGROUND: Preeclampsia (PE) is a major cause of short and long-term morbidity for affected infants, including consequences of fetal growth restriction and iatrogenic prematurity. In Brazil, this is a special problem as PE accounts for 18% of preterm births (PTB). In the PREPARE (Prematurity REduction by Pre-eclampsia cARE) study, we will test a novel system of integrated care based on risk stratification and knowledge transfer, to safely reduce PTB. METHODS: This is a stepped wedge cluster randomised trial that will include women with suspected or confirmed PE between 20 + 0 and 36 + 6 gestational weeks. All pregnant women presenting with these findings at seven tertiary centres in geographically dispersed sites, throughout Brazil, will be considered eligible and evaluated in terms of risk stratification at admission. At randomly allocated time points, sites will transition to risk stratification performed according to sFlt-1/PlGF (Roche Diagnostics) measurement and fullPIERS score with both results will be revealed to care providers. The healthcare providers of women stratified as low risk for adverse outcomes (sFlt-1/PlGF ≤38 AND fullPIERS< 10% risk) will receive the recommendation to defer delivery. sFlt-1/PlGF will be repeated once and fullPIERS score twice a week. Rates of prematurity due to preeclampsia before and after the intervention will be compared. Additionally, providers will receive an active program of knowledge transfer about WHO recommendations for preeclampsia, including recommendations regarding antenatal corticosteroids for foetal benefits, antihypertensive therapy and magnesium sulphate for seizure prophylaxis. This study will have 90% power to detect a reduction in PTB associated with PE from a population estimate of 1.5 to 1.0%, representing a 33% risk reduction, and 80% power to detect a reduction from 2.0 to 1.5% (25% risk reduction). The necessary number of patients recruited to achieve these results is 750. Adverse events, serious adverse events, both anticipated and unanticipated will be recorded. DISCUSSION: The PREPARE intervention expects to reduce PTB and improve care of women with PE without significant adverse side effects. If successful, this novel pathway of care is designed for rapid translation to healthcare throughout Brazil and may be transferrable to other low and middle income countries. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03073317.

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The male genitalia of 58 species of the New World Polistes are described: 29 of Polistes (Aphanilopterus), 12 of Polistes (Epicnemius), 13 of Polistes (Fuscopolistes), one of Polistes (Onerarius) and three of Polistes (Palisotius). Comments and remarks are also provided.

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Typical chelonians have a rigid carapace and plastron that form a box-like structure that constrains several aspects of their physiology and ecology. The leatherback sea turtle, Dermochelys coriacea, has a flexible bony carapace strengthened by seven longitudinal ridges, whereas the plastron is reduced to an elliptical outer bony structure, so that the ventrum has no bony support. Measurements of the shell were made on adult female leatherbacks studied on the feeding grounds of waters off Nova Scotia (NS) and on breeding beaches of French Guiana (FG) to examine whether foraging and/or breeding turtles alter carapace size and/or shape. NS turtles exhibited greater mass and girth for a given curved carapace length (CCL) than FG turtles. Girth:CCL ratios rose during the feeding season, indicating increased girth. Measurements were made of the direct (straight) and surface (curved) distances between the medial longitudinal ridge and first right-hand longitudinal ridge (at 50% CCL). In NS turtles, the ratio of straight to curved inter-ridge distances was significantly higher than in FG turtles, indicating distension of the upper surfaces of the NS turtles between the ridges. FG females laid 11 clutches in the breeding season; although CCL and curved carapace width remained stable, girth declined between each nesting episode, indicating loss of mass. Straight to curved inter-ridge distance ratios did not change significantly during the breeding season, indicating loss of dorsal blubber before the onset of breeding. The results demonstrate substantial alterations in size and shape of female D. coriacea over periods of weeks to months in response to alterations in nutritional and reproductive status.

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Scytalidoglutamic peptidase (SGP) is the prototype of fungal glutamic peptidases that are characteristically pepstatin insensitive. These enzymes have a unique catalytic dyad comprised of Gln(53) and Glu(136) that activate a bound water molecule for nucleophilic attack on the carbonyl carbon atom of the scissile peptide bond. The hydrolysis by SGP at peptide bonds with proline in the P(1)' position is a rare event among peptidases that we investigated using the series of fluorescence resonance energy transfer peptides, Abz-KLXPSKQ-EDDnp, compared with the series Abz-KLXSSKQ-EDDnp. The preference observed in these two series for Phe and His over Leu, Ile, Val, Arg, and Lys, seems to be related to the structure of the S(1) subsite of SGP. These results and the pH profiles of SGP activity showed that its S(1) subsite can accommodate the benzyl group of Phe at pH 4 as well as the positively charged imidazolium group of His. In the pH range 2 to 7, SGP maintains its structure and activity, but at pH 8 or higher it is irreversibly denatured. The intrinsic fluorescence of the Trp residues of SGP were sensitive to the titration of carboxyl groups having low pK values; this can be attributed to the buried Asp(57) and/or Asp(43) as described in SGP three-dimensional structure. The solvent kinetic isotope effects and the proton inventory experiments support a mechanism for the glutamic peptidase SGP that involves the nucleophilic attack of the general base (Glu(136)) activated water, and establish a fundamental role of the S(1) subsite interactions in promoting catalysis.

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Primary Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disease affecting mainly the exocrine glands. Its physio-pathology is poorly understood and most of the knowledge has been related to the inflammatory component. The aim of this work was to evaluate gene expression profiling in fractions enriched in epithelial cells from labial salivary glands (LSGs) of patients with primary SS and identify chromosomal regions harboring susceptibility genes expressed in epithelial cells. A combined approach of gene expression and genome-wide association study was used. Enriched epithelial cell fractions were obtained from LSGs of patients and controls. Amplified total RNA was labeled and hybridized to 10K cDNA microarrays. Results were normalized and subjected to statistical and functional analysis. A genome-wide microsatellite screen at 10 cM resolution (393 markers) was performed. In salivary gland-epithelial cells from patients 528 genes were expressed differentially in comparison to controls. Pathways not previously linked to disease were found to be altered. Twenty-eight and 15 genes associated with apoptosis were up-regulated and down regulated, respectively. Interferon-related genes, most of which participated in interferon signaling, were also found to be up-regulated. From the genome-wide screen, 6 markers showed evidence of highly significant association with the disease. Of these, five loci harbor genes differentially expressed in patients LSG-epithelial cells. Our results show that in enriched gland-epithelial cells of pSS, both pro-apoptotic/anti-apoptotic and interferon signaling inhibition/stimulation balances may occur. Genes found over-expressed in epithelial cells are candidates for disease susceptibility.

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AIM: We sought to determine the relationship between age, and other clinical characteristics such as parity, oestrogen use, dietary factors and menstrual history on breast density in Jamaican women. METHODS AND MATERIALS: A retrospective study was done of 891 patients who attended the breast imaging unit. The clinical characteristics were extracted from the patient records. Mammograms were assessed independently by two radiologists who were blinded to the patient clinical characteristics. Breast densities were assigned using the American College of Radiology (ACR) classification. RESULTS: The concordance between the ACR classification of breast density between the two independent radiologists was 92% with k = 0.76 (SE = 0.02, P < 0.001). Women with low breast density were heavier (81.3 +/- 15.5 kg vs 68.4 +/- 14.3 kg, P < 0.0001, mean +/- standard deviation (SD)) and more obese (body mass index (BMI), 30.3 +/- 5.8 kg m(-2) vs 26.0 +/- 5.2 kg m(-2), P < 0.0001). Mammographic breast density decreased with age. The age adjusted odds ratios (ORs) for predictors significantly related to high breast density were parity, OR = 0.79 (95%CIratio0.71, 0.88), weight, OR = 0.92 (95% CIratio0.91, 0.95), BMI, OR = 0.83 (95% CIratio0.78, 0.89), menopause, OR = 0.51 (95% CIratio0.36, 0.74) and a history of previous breast surgery, OR 1.6 (95% CIratio1.1, 2.3). CONCLUSION: The rate decline of breast density with age in our population was influenced by parity and body composition.

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