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Article ; Online: Fatal superior vena cava rupture complicating dialysis catheter exchange.

Ali, Ahmed E / Al-Balas, Alian / Benson, Paul V / Almehmi, Ammar

2024 , Page(s) 11297298231219288

Abstract: Central vein stenosis (CVS) is a common and challenging complication in hemodialysis patients with chronic central venous catheters (CVCs). CVS often remains asymptomatic and is discovered incidentally during follow-up imaging. CVS symptoms include arm ... ...

Abstract	Central vein stenosis (CVS) is a common and challenging complication in hemodialysis patients with chronic central venous catheters (CVCs). CVS often remains asymptomatic and is discovered incidentally during follow-up imaging. CVS symptoms include arm swelling, venous hypertension, impaired dialysis flow rates, and development of collateral veins. However, these symptoms can be nonspecific and overlap with other conditions, making the diagnosis challenging. Timely recognition and appropriate intervention are crucial to prevent complications and optimize patient outcomes. Diagnostic tools commonly used include duplex ultrasonography and venography to assess the degree and location of stenosis. Management strategies for CVS encompass a multidisciplinary approach involving nephrologists, interventional radiologists, and vascular surgeons. Initial conservative measures may include anticoagulation therapy, along with pharmacological interventions such as antiplatelet agents and thrombolytics. The endovascular approach is the first line for managing CVS by using balloon angioplasty either alone or in combination with stent placement, but CVS typically recurs frequently, requiring repeated interventions with an increased risk of complications. Additionally, alternative vascular access options such as arteriovenous fistulas or grafts may be considered. In this report, we describe a case of a 25-year-old woman who presented with an extensive history of multiple dialysis access failure for left internal jugular vein central venous tunneled catheter exchange. The procedure was complicated by a fatal superior vena cava rupture likely related to the dislodgment of the guidewire causing perforation into the pericardium space with subsequent cardiopulmonary collapse. The post-mortem autopsy showed severe organized stenosis of SVC and transmural defect above the SVC/atrial junction.
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298231219288
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Article: Coronary Stent Abscess in the Setting of Arteriovenous Graft Infection following COVID-19: An Autopsy Case Report.

Butler, Jean Thompson / Chellappan, Rajeshwari / Litovsky, Silvio / Leal, Sixto M / Benson, Paul V

Case reports in pathology

2023 Volume 2023, Page(s) 9998749

Abstract: While rare, coronary stent infections present with significant mortality-with most infections and further complications occurring within months of percutaneous coronary intervention (PCI). Here, we discuss a post-COVID-19 patient who presented ... ...

Abstract	While rare, coronary stent infections present with significant mortality-with most infections and further complications occurring within months of percutaneous coronary intervention (PCI). Here, we discuss a post-COVID-19 patient who presented approximately one year after PCI for declotting of an arteriovenous graft (AVG). Upon admission, the patient was found to be bacteremic with multilobar pneumonia and an infection of the AVG. Empiric antibiotics were started, and blood cultures were subsequently positive for MRSA. Removal of the AVG was unsuccessful, and two days after admission, the patient passed. Autopsy revealed a perivascular abscess in the RCA near the origin of the stent with a ground section of the RCA with stent revealing abundant calcific atherosclerosis and marked necrosis of the artery wall. The cause of death was determined to be sepsis complicating coronary artery disease and chronic renal failure.
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Case Reports
ZDB-ID	2648758-5
ISSN	2090-679X ; 2090-6781
ISSN (online)	2090-679X
ISSN	2090-6781
DOI	10.1155/2023/9998749
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Article: De novo

MacGowan, Taylor / McClinchey, Taylor / Parcha, Vibhu / Vatta, Matteo / Litovsky, Silvio / Arora, Pankaj / Benson, Paul V

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1170460

Abstract: Background: Marfan syndrome is a potentially fatal inherited autosomal dominant condition impacting the cardiovascular and the skeletal system with an estimated 25% cases caused by sporadic genetic variations. Given the genetic inheritance pattern, an ... ...

Abstract	Background: Marfan syndrome is a potentially fatal inherited autosomal dominant condition impacting the cardiovascular and the skeletal system with an estimated 25% cases caused by sporadic genetic variations. Given the genetic inheritance pattern, an autopsy of probands with Marfan syndrome-associated mortality is critical to establish the phenotypic expression and clinical implications of the particular genetic variant, especially for first-degree relatives. We present the findings of a Marfan syndrome proband decedent presenting with sudden onset abdominal pain and unexplained retroperitoneal abdominal hemorrhage. Methods: An autopsy was performed to inform the blood relatives of the phenotypic expression and penetrance of the potentially heritable condition. A clinical laboratory improvement amendment (CLIA)-certified clinical grade genetic sequencing was performed to identify pathogenic variants in genes associated with aortopathy. Results: The autopsy showed intra-abdominal and retroperitoneal hemorrhage due to infarction of the right kidney caused by dissection of the right renal artery. Genetic testing identified a heterozygous pathogenic Conclusions: We report a case of a previously undiagnosed Marfan syndrome death due to a
Language	English
Publishing date	2023-06-12
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1170460
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Article: Detection of

Nargan, Kievershen / Naidoo, Threnesan / Msimang, Mpumelelo / Nadeem, Sajid / Wells, Gordon / Hunter, Robert L / Hutton, Anneka / Lumamba, Kapongo / Glasgow, Joel N / Benson, Paul V / Steyn, Adrie Jc

bioRxiv : the preprint server for biology

2023

Abstract: Rationale: Accurate TB diagnosis is hampered by the variable efficacy of the widely-used Ziehl-Neelsen (ZN) staining method to identify : Objectives: To employ RNAscope to determine the spatial distribution of : Methods: We examined ante- and ... ...

Abstract	Rationale: Accurate TB diagnosis is hampered by the variable efficacy of the widely-used Ziehl-Neelsen (ZN) staining method to identify Objectives: To employ RNAscope to determine the spatial distribution of Methods: We examined ante- and postmortem human TB tissue using RNAscope to detect Measurements and main results: We adapted RNAscope for Conclusions: RNAscope has diagnostic potential and can guide therapeutic intervention as it detects
Language	English
Publishing date	2023-10-05
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.10.04.560963
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Article ; Online: Sympathetic innervation of human and porcine spleens: implications for between species variation in function.

Kirkland, Logan G / Garbe, Chloe G / Hadaya, Joseph / Benson, Paul V / Wagener, Brant M / Tankovic, Sanjin / Hoover, Donald B

Bioelectronic medicine

2022 Volume 8, Issue 1, Page(s) 20

Abstract: Background: The vagus nerve affects innate immune responses by activating spleen-projecting sympathetic neurons, which modulate leukocyte function. Recent basic and clinical research investigating vagus nerve stimulation to engage the cholinergic anti- ... ...

Abstract	Background: The vagus nerve affects innate immune responses by activating spleen-projecting sympathetic neurons, which modulate leukocyte function. Recent basic and clinical research investigating vagus nerve stimulation to engage the cholinergic anti-inflammatory pathway (CAP) has shown promising therapeutic results for a variety of inflammatory diseases. Abundant sympathetic innervation occurs in rodent spleens, and use of these species has dominated mechanistic research investigating the CAP. However, previous neuroanatomical studies of human spleen found a more restricted pattern of innervation compared to rodents. Therefore, our primary goal was to establish the full extent of sympathetic innervation of human spleens using donor tissue with the shortest procurement to fixation time. Parallel studies of porcine spleen, a large animal model, were performed as a positive control and for comparison. Methods: Human and porcine spleen tissue were fixed immediately after harvest and prepared for immunohistochemistry. Human heart and porcine spleen were stained in conjunction as positive controls. Several immunohistochemical protocols were compared for best results. Tissue was stained for tyrosine hydroxylase (TH), a noradrenergic marker, using VIP purple chromogen. Consecutive tissue slices were stained for neuropeptide Y (NPY), which often co-localizes with TH, or double-labelled for TH and CD3, a T cell marker. High-magnification images and full scans of the tissue were obtained and analyzed for qualitative differences between species. Results: TH had dominant perivascular localization in human spleen, with negligible innervation of parenchyma, but such nerves were abundant throughout ventricular myocardium. In marked contrast, noradrenergic innervation was abundant in all regions of porcine spleen, with red pulp having more nerves than white pulp. NPY stain results were consistent with this pattern. In human spleen, noradrenergic nerves only ran close to T cells at the boundary of the periarterial lymphatic sheath and arteries. In porcine spleen, noradrenergic nerves were closely associated with T cells in both white and red pulp as well as other leukocytes in red pulp. Conclusion: Sympathetic innervation of the spleen varies between species in both distribution and abundance, with humans and pigs being at opposite extremes. This has important implications for sympathetic regulation of neuroimmune interactions in the spleen of different species and focused targeting of the CAP in humans.
Language	English
Publishing date	2022-12-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2929561-0
ISSN	2332-8886 ; 2332-8886
ISSN (online)	2332-8886
ISSN	2332-8886
DOI	10.1186/s42234-022-00102-1
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Article ; Online: Altered sphingolipid pathway in SARS-CoV-2 infected human lung tissue.

Khan, Rabisa J / Single, Sierra L / Simmons, Christopher S / Athar, Mohammad / Liu, Yuelong / Bodduluri, Sandeep / Benson, Paul V / Goliwas, Kayla F / Deshane, Jessy S

Frontiers in immunology

2023 Volume 14, Page(s) 1216278

Abstract: Introduction: The SARS-CoV-2 mediated COVID-19 pandemic has impacted millions worldwide. Hyper-inflammatory processes, including cytokine storm, contribute to long-standing tissue injury and damage in COVID-19. The metabolism of sphingolipids as ... ...

Abstract	Introduction: The SARS-CoV-2 mediated COVID-19 pandemic has impacted millions worldwide. Hyper-inflammatory processes, including cytokine storm, contribute to long-standing tissue injury and damage in COVID-19. The metabolism of sphingolipids as regulators of cell survival, differentiation, and proliferation has been implicated in inflammatory signaling and cytokine responses. Sphingosine-kinase-1 (SK1) and ceramide-synthase-2 (CERS2) generate metabolites that regulate the anti- and pro-apoptotic processes, respectively. Alterations in SK1 and CERS2 expression may contribute to the inflammation and tissue damage during COVID-19. The central objective of this study is to evaluate structural changes in the lung post-SARS-CoV-2 infection and to investigate whether the sphingolipid rheostat is altered in response to SARS-CoV-2 infection. Methods: Central and peripheral lung tissues from COVID-19+ or control autopsies and resected lung tissue from COVID-19 convalescents were subjected to histologic evaluation of airspace and collagen deposisiton, and immunohistochemical evaluation of SK1 and CERS2. Results: Here, we report significant reduction in air space and increase in collagen deposition in lung autopsy tissues from patients who died from COVID-19 (COVID-19 Discussion: These data suggest an alteration in the sphingolipid rheostat in lung tissue during COVID-19, suggesting a potential contribution to the inflammation and tissue damage associated with viral infection.
MeSH term(s)	Humans ; SARS-CoV-2 ; COVID-19/pathology ; Sphingolipids ; Pandemics ; Lung/pathology ; Inflammation/pathology ; Collagen
Chemical Substances	Sphingolipids ; Collagen (9007-34-5)
Language	English
Publishing date	2023-10-04
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1216278
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Article ; Online: Sympathetic remodeling and altered angiotensin-converting enzyme 2 localization occur in patients with cardiac disease but are not exacerbated by severe COVID-19.

Kellum, Creighton L / Kirkland, Logan G / Nelson, Tasha K / Jewett, Seth M / Rytkin, Eric / Efimov, Igor R / Hoover, Donald B / Benson, Paul V / Wagener, Brant M

Autonomic neuroscience : basic & clinical

2023 Volume 251, Page(s) 103134

Abstract: Purpose: Remodeling of sympathetic nerves and ACE2 has been implicated in cardiac pathology, and ACE2 also serves as a receptor for SARS-CoV-2. However, there is limited histological knowledge about the transmural distribution of sympathetic nerves and ... ...

Abstract	Purpose: Remodeling of sympathetic nerves and ACE2 has been implicated in cardiac pathology, and ACE2 also serves as a receptor for SARS-CoV-2. However, there is limited histological knowledge about the transmural distribution of sympathetic nerves and the cellular localization and distribution of ACE2 in human left ventricles from normal or diseased hearts. Goals of this study were to establish the normal pattern for these parameters and determine changes that occurred in decedents with cardiovascular disease alone compared to those with cardiac pathology and severe COVID-19. Methods: We performed immunohistochemical analysis on sections of left ventricular wall from twenty autopsied human hearts consisting of a control group, a cardiovascular disease group, and COVID-19 ARDS, and COVID-19 non-ARDS groups. Results: Using tyrosine hydroxylase as a noradrenergic marker, we found substantial sympathetic nerve loss in cardiovascular disease samples compared to controls. Additionally, we found heterogeneous nerve loss in both COVID-19 groups. Using an ACE2 antibody, we observed robust transmural staining localized to pericytes in the control group. The cardiovascular disease hearts displayed regional loss of ACE2 in pericytes and regional increases in staining of cardiomyocytes for ACE2. Similar changes were observed in both COVID-19 groups. Conclusions: Heterogeneity of sympathetic innervation, which occurs in cardiac disease and is not increased by severe COVID-19, could contribute to arrhythmogenesis. The dominant localization of ACE2 to pericytes suggests that these cells would be the primary target for potential cardiac infection by SARS-CoV-2. Regional changes in ACE2 staining by myocytes and pericytes could have complex effects on cardiac pathophysiology.
MeSH term(s)	Humans ; COVID-19 ; SARS-CoV-2 ; Angiotensin-Converting Enzyme 2 ; Cardiovascular Diseases ; Peptidyl-Dipeptidase A ; Heart Diseases
Chemical Substances	Angiotensin-Converting Enzyme 2 (EC 3.4.17.23) ; Peptidyl-Dipeptidase A (EC 3.4.15.1)
Language	English
Publishing date	2023-12-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2020105-9
ISSN	1872-7484 ; 1566-0702
ISSN (online)	1872-7484
ISSN	1566-0702
DOI	10.1016/j.autneu.2023.103134
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Article: Use of Telepathology to Facilitate COVID-19 Research and Education through an Online COVID-19 Autopsy Biorepository.

Benson, Paul V / Litovsky, Silvio H / Steyn, Adrie J C / Margaroli, Camilla / Iriabho, Egiebade / Anderson, Peter G

Journal of pathology informatics

2021 Volume 12, Issue 1, Page(s) 48

Abstract: Introduction: The coronavirus disease 2019 (COVID-19) pandemic has increased the use of technology for communication including departmental conferences, working remotely, and distance teaching. Methods to enable these activities should be developed and ... ...

Abstract	Introduction: The coronavirus disease 2019 (COVID-19) pandemic has increased the use of technology for communication including departmental conferences, working remotely, and distance teaching. Methods to enable these activities should be developed and promulgated. Objective: To repurpose a preexisting educational website to enable the development of a COVID-19 autopsy biorepository to support distance teaching and COVID-19 research. Methods: After consent was obtained, autopsies were performed on patients with a confirmed positive severe acute respiratory syndrome coronavirus-2 reverse-transcriptase-polymerase-chain reaction test. Autopsies were performed according to a COVID-19 protocol, and all patients underwent both gross and microscopic examination. The H and E histology slides were scanned using a Leica Biosystems Aperio CS ScanScope whole slide scanner and the digital slide files were converted to deep zoom images that could be uploaded to the University of Alabama at Birmingham (UAB) Pathology Educational Instructional Resource website where virtual microscopy of the slides is available. Results: A total of 551 autopsy slides from 24 UAB COVID-19 cases, 1 influenza H1N1 case and 1 tuberculosis case were scanned and uploaded. Five separate COVID-19 research teams used the digital slides remotely with or without a pathologist on a Zoom call. The scanned slides were used to produce one published case report and one published research project. The digital COVID-19 autopsy biorepository was routinely used for educational conferences and research meetings locally, nationally and internationally. Conclusion: The repurposing of a pre-existing website enabled telepathology consultation for research and education purposes. Combined with other communication technology (Zoom) this achievement highlights what is possible using pre-existing technologies during a global pandemic.
Language	English
Publishing date	2021-12-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2579241-6
ISSN	2153-3539 ; 2229-5089
ISSN (online)	2153-3539
ISSN	2229-5089
DOI	10.4103/jpi.jpi_15_21
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Article: Gastrointestinal Manifestations of COVID-19 Infection: Clinicopathologic Findings in Intestinal Resections Performed at Single Institution.

Burkett, Alison E / Sher, Sophia B / Patel, Chirag R / Ildin-Eltoum, Isam / Dhall, Deepti / Margaroli, Camilla / Peter, Shajan / Lee, Goo / Bajpai, Prachi / Benson, Paul V / Manne, Upender / Al Diffalha, Sameer

Frontiers in medicine

2022 Volume 9, Page(s) 811546

Abstract: It is now known that COVID-19 not only involves the lungs, but other organs as well including the gastrointestinal tract. Although clinic-pathological features are well-described in lungs, the histopathologic features of gastrointestinal involvement in ... ...

Abstract	It is now known that COVID-19 not only involves the lungs, but other organs as well including the gastrointestinal tract. Although clinic-pathological features are well-described in lungs, the histopathologic features of gastrointestinal involvement in resection specimens are not well characterized. Herein, we describe in detail the clinicopathologic features of intestinal resection specimens in four patients with COVID-19 infection. COVID-19 viral particles by
Language	English
Publishing date	2022-02-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.811546
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Article ; Online: Do innovative immersive virtual reality simulation videos have a role to play in teaching non-technical skills and increasing preparedness for clinical placements for medical students?

Pal, Sushil / Benson, Rosalind / Duvall, Paul / Taylor-Jones, Vidhi

MedEdPublish (2016)

2021 Volume 9, Page(s) 164

Abstract: This article was migrated. The article was marked as recommended.: Background: Teaching non-technical skills (NTS) is an important part of the undergraduate medical curriculum. Resource intensive high-fidelity simulation has an established role in ... ...

Abstract	This article was migrated. The article was marked as recommended. Background: Teaching non-technical skills (NTS) is an important part of the undergraduate medical curriculum. Resource intensive high-fidelity simulation has an established role in this. Alternative methods of delivering large scale simulation-based education should be considered to help further improve NTS and preparedness for clinical placements of medical students. Emerging technologies such as immersive virtual reality (VR) may have a role in this. Aim: To assess if a VR simulation-based teaching programme enhances understanding of NTS and preparedness for clinical placements in medical students at the University of Liverpool. Methods: A VR simulation-based teaching programme, consisting of 4 sessions of lecture-based simulation and a hi-fidelity simulation session was delivered to 3
Language	English
Publishing date	2021-09-29
Publishing country	Scotland
Document type	Journal Article
ISSN	2312-7996
ISSN (online)	2312-7996
DOI	10.15694/mep.2020.000164.2
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