Background
Barotrauma frequently occurs in coronavirus disease 2019. Previous studies have reported barotrauma to be a mortality-risk factor; however, its time-dependent nature and pathophysiology are not elucidated. To investigate the time-dependent characteristics and the etiology of coronavirus disease 2019-related-barotrauma.
Methods and findings
We retrospectively reviewed intubated patients with coronavirus disease 2019 from March 2020 to May 2021. We compared the 90-day survival between the barotrauma and non-barotrauma groups and performed landmark analyses on days 7, 14, 21, and 28. Barotrauma within seven days before the landmark was defined as the exposure. Additionally, we evaluated surgically treated cases of coronavirus disease 2019-related pneumothorax.
We included 192 patients. Barotrauma developed in 44 patients (22.9%). The barotrauma group’s 90-day survival rate was significantly worse (47.7% vs. 82.4%, p < 0.001). In the 7-day landmark analysis, there was no significant difference (75.0% vs. 75.7%, p = 0.79). Contrastingly, in the 14-, 21-, and 28-day landmark analyses, the barotrauma group’s survival rates were significantly worse (14-day: 41.7% vs. 69.1%, p = 0.044; 21-day: 16.7% vs. 62.5%, p = 0.014; 28-day: 20.0% vs. 66.7%, p = 0.018). Pathological examination revealed a subpleural hematoma and pulmonary cyst with heterogenous lung inflammation.
Conclusions
Barotrauma was a poor prognostic factor for coronavirus disease 2019, especially in the late phase. Heterogenous inflammation may be a key finding in its mechanism. Barotrauma is a potentially important sign of lung destruction.
SRSF4 is one of the members of serine‐/arginine (SR)‐rich protein family involved in both constitutive and alternative splicing. SRSF4 is localized in the nucleus with speckled pattern, but its nuclear localization signal was not determined. Here, we have identified nuclear localization signals (NLSs) of SRSF4 by using a pyruvate kinase fusion system. As expected, arginine‐/serine (RS)‐rich domain of SRSF4 confers nuclear localization activity when it is fused to PK protein. We then further delineated the minimum sequences for nuclear localization in RS domain of SRSF4. Surprisingly, RS‐rich region does not always have a nuclear localization activity. In addition, basic amino acid stretches that resemble to classical‐type NLSs were identified. These results strongly suggest that SRSF4 protein uses two different nuclear import pathways with multiple NLSs in RS domain.
Mucin-producing urothelial-type adenocarcinoma of the prostate (MPUAP) is a very rare disease. MPUAP has been reported to progress faster than the rate at which normal prostate cancer progresses. We report a case of MPUAP with long-term survival. The patient was a 65-year-old man. Computed tomography and magnetic resonance imaging showed a cystic lesion extending from the prostate to the urethra. We performed transrectal prostate biopsy and transurethral resection of the tumor, and the pathological diagnosis was adenocarcinoma. Subsequently, we performed total cystectomy, ureterostomy, and pelvic lymphadenectomy. Based on the pathological and immunostaining findings (prostate-specific antigen negativity, CDX-2 positivity, cytokeratin 20 positivity, 34β-E12 positivity), the patient was diagnosed with MPUAP. Four years after the surgery, recurrence or metastasis was not observed.
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