bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Phase Response in Critically Ill Elderly Burn Patients
Authors: Rehou Sarah , Shahrokhi Shahriar , Thai Joanne , Stanojcic Mile , Jeschke Marc G.
Published: October 2018

Objectives:

Survival of elderly burn patients remains unacceptably poor. The acute phase, defined as the first 96 hours after burn, includes the resuscitation period and influences subsequent outcomes and survival. The aim of this study was to determine if the acute phase response post burn injury is significantly different in elderly patients compared with adult patients and to identify elements contributing to adverse outcomes.

Design:

Cohort study.

Setting:

Tertiary burn center.

Patients:

Adult (< 65 yr old) and elderly (≥ 65 yr old) patients with an acute burn injury.

Interventions:

None.

Measurements and Main Results:

We included all patients with an acute burn injury greater than or equal to 20% total body surface area to our burn center from 2011 to 2016. Clinical and laboratory measures during the acute phase were compared between adult and elderly patients. Outcomes included clinical hemodynamic measurements, organ biomarkers, volume of fluid resuscitation, cardiac agents, and the inflammatory cytokine response in plasma. Data were analyzed using the Student t test, Mann-Whitney U test, and Fisher exact test. A total of 149 patients were included, with 126 adults and 23 elderly. Injury severity was not significantly different among adult and elderly patients. Elderly had significantly lower heart rates (p < 0.05), cardiac index (p < 0.05), mean arterial pressure (p < 0.05), Pao
2/Fio
2 (p < 0.05), and pH (p < 0.05), along with higher lactate (p < 0.05). Organ biomarkers, particularly creatinine and blood urea nitrogen, showed distinct differences between adults and elderly (p < 0.05). Elderly had significantly lower levels of interleukin-6, monocyte chemotactic protein-1, monocyte chemotactic protein-3, and granulocyte-colony stimulating factor during the acute phase (p < 0.05). Overall mortality was significantly higher in elderly patients (5% vs 52%; p < 0.0001).

Conclusions:

Response to the burn injury during the acute phase response after burn is substantially different between elderly and adult burn patients and is characterized by cardiac depression and hypoinflammation.
Environment-Friendly Practices in Operating Rooms in Turkey
Authors: CANDAN DÖNMEZ Yelda , ASLAN Arzu , YAVUZ VAN GIERSBERGEN Meryem
Published: October 2018

Background:

Environment-friendly practices refer to decreasing energy consumption, using resources carefully and sustainably, and reducing environmental pollution. An environment-friendly hospital is defined as a hospital where energy is saved, carbon emissions are decreased, and productivity and quality are increased. Operating rooms (ORs) account for most wastes generated daily by hospitals. Thus, adopting environment-friendly healthcare practices in ORs will have a positive impact on the environment.

Purpose:

The aim of this study was to identify and recommend environment-friendly practices that are feasible for implementation in ORs in Turkey.

Methods:

Data on the environment-friendly practices that are currently being practiced in the ORs of hospitals in Izmir Province were collected using face-to-face interviews with nurses who were in charge of ORs in Izmir Province. The interviews were conducted using an OR identification form and Greening the OR Checklist. The study population included all of the hospitals in Izmir Province, and the study sample included 18 ORs in the 11 hospitals that consented to take part in the research. Permission to conduct this research was obtained from the ethics committee of the nursing school as well as from the participating hospitals where the study was conducted.

Results:

The hospitals included in the study had, on average, 7.44 ± 7.32 ORs, each of which employed an average of 16.83 ± 17.16 nurses. Four fifths (83.3%) of the ORs always monitored their wastes, and 88.9% gave their batteries to recyclers. In addition, 72.2% renewed their surgical sets to reduce excessive use of materials, and 72.2% preferred using reusable materials instead of single-use materials in their surgical sets. However, 66.7% of the ORs had no environmental team, 93% did not use an environmentally safe surface cleaner, 83.3% did not use sensor controls on lights, and 66.7% did not use LED lights.

Conclusions:

Although most hospitals did not have a special team to recommend and enforce environment-friendly procedures, the OR nurses did their best to protect the environment.
Impact of Orthotic Prescription in Pediatric Partial Foot Amputation: A Case Study
Authors: Young Joshua
Published: October 2018

Introduction

There is little information available on outcomes after prosthetic/orthotic management in partial foot amputation (PFA) in children.

Methods

This case study evaluates walking speed, community activity level, and physical function in a child with bilateral PFA after a change from an orthosis finishing distal to the ankle to one finishing proximal to the ankle. Outcome measures used were walking speed (10-meter walk test), the Gillette Functional Assessment Questionnaire (GFAQ), and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical domain.

Results

At 3-month review GFAQ level increased by 3, OxAFQ-C physical domain increased 50 percentage points, and self-selected velocity increased 0.25 m/s.

Conclusions

This case study suggests that improvements in walking speed, community activity level, and physical function are possible in children with bilateral PFA when changing to orthoses, which compensate for mechanical deficits caused by the reduced lever arm of the foot.
Implications of Increased Trait Impulsivity on Psychopathology and Experienced Stress in the Victims of Early Trauma With Suicidality
Authors: Park C. Hyung Keun , Lee Jae Won , Lee Sang Yeol , Shim Se-Hoon , Moon Jung-Joon , Paik Jong-Woo , Cho Seong-Jin , Kim Shin Gyeom , Kim Min-Hyuk , Kim Seokho , Park Jae-Hyun , You Sungeun , Jeon Hong Jin , Ahn Yong Min
Published: October 2018

There is a paucity of research characterizing suicide-related factors in victims of early trauma (ET). This cross-sectional study investigated an increase in trait impulsivity of ET victims with suicidal ideation or behavior and its role in severity of psychopathologies and experienced stress. Using data of 401 Korean suicidal ideators and attempters, trait impulsivity, severity of psychopathologies, and stress levels in addition to sociodemographic and clinical characteristics were compared between the ET group and the no ET group. Three first-order factors of trait impulsivity measured in Barratt Impulsive Scale-11 (cognitive instability, motor, and [lack of] perseverance) as well as depression, anxiety, overall stress level, and stress from social relationships were significantly elevated in the ET group. Owing to the long-lasting neurobiological influences of ET, it is recommended clinically that victims be carefully monitored for the development of mental distress, such as depression and anxiety, even in adulthood.
Dissociation Mediates the Relationship Between Childhood Trauma and Experiences of Seeing Visions in a French Sample
Authors: Bortolon Catherine , Raffard Stéphane
Published: October 2018

Recent research has supported the mediating role of dissociation in the relationship between childhood trauma (CT) and voice hearing in clinical and nonclinical populations. However, this mediating role has not yet been explored with regard to seeing visions (visual hallucinations). This study aimed to explore the mediating effect of dissociation on the relationship between CT and seeing visions. In total, 425 voluntary participants recruited from the general population completed an online survey evaluating CT, dissociative experiences, and the experience of hearing voices and seeing things. The findings showed that defensive dissociation mediated the association between CT and the experience of seeing visions. A similar model in terms of pathways and the model's predictive accuracy was found for hearing voices. Therefore, seeing visions may partly reflect dissociated traumatic events intruding into consciousness. Trauma-based interventions for seeing visions may be beneficial in improving distress associated with these experiences.
Certified Peer Specialists and Older Adults With Serious Mental Illness' Perspectives of the Impact of a Peer-Delivered and Technology-Supported Self-Management Intervention
Authors: Fortuna Karen L. , Storm Marianne , Naslund John A. , Chow Philip , Aschbrenner Kelly A. , Lohman Matthew C. , Bartels Stephen J.
Published: October 2018

We explored the perspectives of certified peer specialists and older adults with serious mental illness on the impact of a peer-delivered medical and psychiatric self-management intervention, “PeerTECH.” Transcripts from interviews with consumers with serious mental illness and a focus group with certified peer specialists who were engaged in PeerTECH were analyzed. Consumer participants (n = 8) had a mean age of 68.8 years (SD = 4.9) and included individuals diagnosed with major depressive disorder (five people), schizophrenia spectrum disorders (two people), and bipolar disorder (one person). Certified peer specialists (n = 3) were aged 55 years or more. Themes included internal and external forces of accountability, confidence, internal and external locus of hope, human bonding, and peer support. This exploratory qualitative study found that human support from peers can potentially influence health behavioral change in a combined peer and technology-based medical and psychiatric illness self-management intervention.
Torsional Anatomy of the Lower Limb: The Appearance of Anatomy in Hemispastic Position
Authors: Cianca John , Dy Rochelle , Chiou-Tan Faye Y. , John Joslyn , Taber Katherine H.
Published: October 2018

Objective

The aim of the study was to determine whether there are relevant anatomical variations to the typical injection sites for antispasticity procedures in the lower limb.

Methods

Sonographic images were obtained at traditional injection locations for spasticity in the lower limb. Images were recorded in neutral and contracted postures. Doppler imaging was obtained for sites that contained vasculature. The images were analyzed, and schematics were created that highlighted relevant findings.

Results

The adductor longus in commonly used injection sites was close to vasculature making accidental injection of the latter a higher risk. The sciatic nerve was vulnerable to injections at the proximal biceps femoris injection side if injected too deeply. Hamstring injection sites can be adjusted to the midline to improve accuracy. The proximity of the tibial nerve to the flexor hallucis longus and the deep fibular nerve to the extensor hallucis longus puts these nerves at risk for accidental injection.

Discussion

Contracted posture results in altered positions of lower extremity muscles that could lead to inadvertent neurovascular injection or decreased efficacy with injections. Findings in this study may be helpful for planning and executing injections to reduce spasticity in the lower extremity.

Conclusions

Sonographic imaging allows a better localization of muscles associated with spasticity and can instruct the clinician to alter usual injection pathways. This article documents visual evidence that previous assumptions for injection strategies require updating.
Asymptomatic Endometrial Thickening of 8 mm or Greater on Postcontrast Computed Tomography in Postmenopausal Women Is a Predictor of Endometrial Cancer
Authors: Franconeri Andrea , Fang Jieming , Brook Alexander , Brook Olga R.
Published: October 2018

Objectives

The aim of this study was to assess the value of opportunistic endometrial thickness measurement on postcontrast computed tomography (CT) as a predictor of endometrial cancer in asymptomatic postmenopausal women.

Methods

For this Health Insurance Portability and Accountability Act–compliant, institutional review board–approved retrospective study with waiver of informed consent, our institution's tumor board database was searched for postmenopausal patients, diagnosed with endometrial cancer between August 2003 and December 2016 and who had a postcontrast pelvic CT within 12 months prior to the cancer diagnosis (while they were asymptomatic)—“cancer group.” Same number of age-matched patients who had postcontrast pelvic CT constituted the noncancer control group. Endometrial thickness was measured on sagittal postcontrast CT images.

Results

After applying exclusion criteria, 22 asymptomatic patients who were diagnosed with endometrial cancer within 1 year after the CT comprised the cancer group, and 22 age-matched patients comprised the control group. Average endometrial thickness was 18.7 ± 14.8 mm (range, 2–70 mm) in the cancer group and 3.6 ± 2.5 mm (range, 1.8–10 mm) in the control group (P < 0.0001). Endometrial thickness 8 mm or greater predicted endometrial cancer with 86% sensitivity and 91% specificity in these asymptomatic patients. Area under the receiver operating characteristic curve for endometrial thickness as a predictor of endometrial cancer was 0.92.

Conclusions

Endometrial thickness 8 mm or greater on sagittal postcontrast CT was shown to have high sensitivity in opportunistic detection of endometrial cancer in asymptomatic postmenopausal women.
Heterogeneous Pulmonary Perfusion on Dual-Energy Computed Tomography: Faulty Postprocessing or New Artifact?
Authors: Borse Riddhi , Homayounieh Fatemeh , Singh Ramandeep , Digumarthy Subba R.
Published: October 2018

Iodine uptake in the lungs and intrathoracic lesions on postcontrast dual-energy computed tomography is used for evaluation of pulmonary embolism–related perfusion defects and pulmonary infarctions. It has been applied in characterization and treatment response assessment of lung and mediastinal abnormalities. We report a new imaging artifact or faulty image postprocessing in a commercially available rapid kV switching technique of dual-energy computed tomography, which can confound its clinical utility for evaluation of iodine uptake.
Navigating the Pulmonary Perfusion Map: Dual-Energy Computed Tomography in Acute Pulmonary Embolism
Authors: Alis Jonathan , Latson Larry A. , Haramati Linda B. , Shmukler Anna
Published: October 2018

Pulmonary embolism is the third most common acute cardiovascular disease. Dual-energy computed tomography perfusion imaging is a promising adjunct in the detection of acute PE providing simultaneous functional assessment of pulmonary perfusion alongside the high-resolution morphological information from computed tomography pulmonary angiography. We review the evidence to date and common causes of perfusion defects including artifacts, parenchymal, and vascular causes, and discuss its potential in furthering our understanding of physiology and pathophysiology in acute pulmonary embolism.
Efficacy of the Rotational Traction Method in the Assessment of Glenohumeral Cartilage Surface Area in Computed Tomography Arthrography
Authors: Polat Gökhan , Oğul Hayri , Yalçin Ahmet , Tuncer Kutsi , Kaya Serhat , Pirimoğlu Berhan , Sade Recep , Kantarci Mecit
Published: October 2018

Objective

We aimed to investigate the efficacy of the rotational traction method in expanding the joint space and enabling the assessment of an extended surface area.

Methods

Sixty patients who underwent computed tomography arthrography were evaluated in the study: 30 with and 30 without the help of rotational traction. The subgroups consisted of patients with adhesive capsulitis, habitual luxation, or labral tears. Areas of obscured joint surface by coalescent cartilages were calculated using computer software, and those belonging to the traction and nontraction groups along with subgroups were compared statistically.

Results

There was a significant difference between the traction and nontraction group regarding the contact surface area (P < 0.001 for both observers). In patients with adhesive capsulitis, the contact surface area was larger compared with the other subgroups (P = 0.002 for observer 1 and P = 0.002 for observer 2). In patients with habitual luxation, the contact surface area was smaller compared with the other subgroups (P = 0.002 for observer 1 and P = 0.001 for observer 2).

Conclusions

Expansion of joint distance is important for assessing the joint cartilage. The rotational traction method provides effective separation of the joint space. For this reason, rotational traction can be used effectively in patients in whom the joint cartilage is to be evaluated.
Effect of Virtual Monoenergetic Images From Spectral Detector Computed Tomography on Coronary Calcium Blooming
Authors: Van Hedent Steven , Große Hokamp Nils , Kessner Rivka , Gilkeson Robert , Ros Pablo R. , Gupta Amit
Published: October 2018

Objective

The aim of this study was to investigate the quantitative and qualitative effects of virtual monoenergetic images (VMI) by spectral detector computed tomography (SDCT) on calcium blooming in coronary computed tomography angiography.

Methods

Coronary computed tomography angiography using SDCT was performed on 42 patients with coronary artery calcifications. Stenosis grading by diameter and area of calcified plaques and free lumen using VMI from 70 to 140 keV was performed and compared with measurements by conventional images. In addition, interobserver reliability and subjective image quality were assessed by 2 experienced readers.

Results

A total of 61 coronary arteries were evaluated. Stenosis grading by diameter and area showed significant incremental decrease, from 48.86% to 22.82% and from 41.18% to 11.33%, respectively, with increasing VMI (P < 0.05). Interobserver reliability was excellent (intraclass correlation coefficient >0.99). Overall image quality was best at 80 keV.

Conclusions

Calcium blooming significantly decreases at higher monoenergetic levels from SDCT, increasing luminal dimensions and decreasing stenotic grading, with best overall subjective image quality using 80-keV VMI.
Spectral Computed Tomography for the Quantitative Assessment of Patients With Carcinoma of the Gastroesophageal Junction: Initial Differentiation Between a Diagnosis of Squamous Cell Carcinoma and Adenocarcinoma
Authors: Zhou Yue , Hou Ping , Zha Kaiji , Liu Dan , Wang Feng , Zhou Kun , Gao Jianbo
Published: October 2018

Objective

This study aimed to distinguish between esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) using spectral computed tomography (CT) and to discuss the accuracy according to an optimal threshold of single and combined parameters.

Methods

In this monoinstitution study, 61 patients, 35 of whom had ESCC and 26 had EAC confirmed by surgery or esophagoscopy, were recruited from August 2016 to March 2017. Enrolled patients underwent dual-phase chest CT enhancement. The spectral CT parameters (NIC, NICD, NICratio, Z
eff, Z
eff-C, K
40–70 keV, K
80–100 keV, and K
110–140 keV) were measured during arterial phase (AP) and venous phase (VP). Binary logistic regression was used to calculate combined predictive probability. Thresholds of quantitative parameters and diagnostic accuracy were calculated using receiver operating characteristic curve.

Results

Compared with ESCC, higher NICAP, NICVP, NICD, Z
eff AP, Z
eff VP, Z
eff-C AP, and Z
eff-C VP were observed for EAC, whereas NICratio was lower for EAC. Higher K
40–70 keV, K
80–100 keV, and K
110–140 keV were exhibited in EAC than in ESCC. Area under the curve (AUC) of NICAP, K
40–70 keV AP, and Zeff AP were 0.720, 0.730, and 0.706, respectively. The area under the curve of new combined predictive value of NICAP and λ40–0 keV AP was 0.804. The sensitivity and specificity were 77.80% and 80.60%, respectively, when the threshold of new predictive value was 0.60.

Conclusion

The diagnostic accuracy obtained by using NICAP and K
40–70 keV AP combined is better than that obtained using a single parameter in differentiation between a diagnosis of squamous cell carcinoma and adenocarcinoma.
Complementary Molecular and Metabolic Characterization of Meningiomas With DOTATATE and FDG-PET
Authors: Dressen Michael S. , Muthukrishnan Ashok , Tragon Tyson R. , Lieberman Frank S. , Mountz James M.
Published: October 2018

68Ga-DOTATATE imaging for meningiomas is gaining clinical use for selecting patients that may benefit from targeted therapy (eg, 177Lu-DOTATATE). We present an image of a 67-year-old man with an intracranial WHO grade III anaplastic meningioma. He underwent tumor resection followed by intensity-modulated radiation therapy but experienced a recurrence 25 months later. He received an 18F-(FDG) and 68Ga-DOTATATE PET/MR to evaluate for the presence of somatostatin receptor expression and guide subsequent treatment. The scans showed both concordant and discordant regions of uptake, indicating that high somatostatin receptor (SSTR2) expression may not coincide with areas of increased metabolic rate.
Visual and Semiquantitative Accuracy in Clinical Baseline 123I-Ioflupane SPECT/CT Imaging
Authors: Werner Rudolf A. , Marcus Charles , Sheikhbahaei Sara , Solnes Lilja B. , Leal Jeffrey P. , Du Yong , Rowe Steven P. , Higuchi Takahiro , Buck Andreas K. , Lapa Constantin , Javadi Mehrbod S.
Published: October 2018

Purpose

We aimed to (a) elucidate the concordance of visual assessment of an initial 123I-ioflupane scan by a human interpreter with comparison to results using a fully automatic semiquantitative method and (b) to assess the accuracy compared to follow-up (f/u) diagnosis established by movement disorder specialists.

Methods

An initial 123I-ioflupane scan was performed in 382 patients with clinically uncertain Parkinsonian syndrome. An experienced reader performed a visual evaluation of all scans independently. The findings of the visual read were compared with semiquantitative evaluation. In addition, available f/u clinical diagnosis (serving as a reference standard) was compared with results of the human read and the software.

Results

When comparing the semiquantitative method with the visual assessment, discordance could be found in 25 (6.5%) of 382 of the cases for the experienced reader (ĸ = 0.868). The human observer indicated region of interest misalignment as the main reason for discordance. With neurology f/u serving as reference, the results of the reader revealed a slightly higher accuracy rate (87.7%, ĸ = 0.75) compared to semiquantification (86.2%, ĸ = 0.719, P < 0.001, respectively). No significant difference in the diagnostic performance of the visual read versus software-based assessment was found.

Conclusions

In comparison with a fully automatic semiquantitative method in 123I-ioflupane interpretation, human assessment obtained an almost perfect agreement rate. However, compared to clinical established diagnosis serving as a reference, visual read seemed to be slightly more accurate as a solely software-based quantitative assessment.
Pericardial Solitary Fibrous Tumor on FDG PET/CT
Authors: Shao Dan , Wang Shu-Xia
Published: October 2018

Solitary fibrous tumor, which can occur in all parts of the body and is more frequently found in the visceral pleura, is a rare mesenchymal tissue-originating spindle cell tumor derived from CD34-positive dendriticmesenchymal cells, but it rarely occurs in the pericardium. We reported the FDG PET/CT findings of a pathologically confirmed benign pericardial solitary fibrous tumor in a 51-year-old woman.
Intense Choline Activity in Renal Cell Carcinoma Without Obvious 18F-FDG Uptake
Authors: Xia Xiaotian , Hu Fan , Qin Chunxia , Liu Fang , Lan Xiaoli
Published: October 2018

A 64-year-old man presented pain over the right kidney region for 1 year. Contrast-enhanced MRI showed a sharply demarcated soft-tissue mass in the lower part of the right kidney. This lesion had no obvious uptake of 18F-FDG on PET/CT imaging, and an unexpected hypermetabolic irregularly shaped nodule was noted in the upper lobe of the right lung. 11C-choline PET was further performed to reveal the pathological property of the kidney lesion, and high uptake was noticed. The patient received surgery for the 2 lesions, and the final pathological diagnoses were chromophobe renal cell carcinoma and synchronous lung adenocarcinoma.
Dual-Phase 18F-FP-CIT PET in Corticobasal Syndrome
Authors: Min Je Hong , Park Dong Gyu , Yoon Jung Han , An Young Sil
Published: October 2018

Corticobasal syndrome is the most common phenotype of corticobasal degeneration (CBD). 18F-FP-CIT PET and MRI are not helpful in distinguishing CBD from idiopathic Parkinson disease. Dual-phase 18F-FP-CIT PET is a recently developed imaging that shows regional cerebral perfusion in the early phase and dopamine transporter density in the late phase. We investigated the usefulness of dual-phase 18F-FP-CIT PET imaging in 3 patients with corticobasal syndrome. This image highlights that the early phases of 18F-FP-CIT PET may reflect regional cerebral perfusion with a pattern very similar to that of regional glucose metabolism in CBD.
Head and Neck Cancer Soft Tissue Radiation Necrosis—Diagnostic Challenge
Authors: Pucar Darko , Groves Michael W. , Biddinger Paul , Figueroa Ramon , Williams Hadyn T.
Published: October 2018

A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no viable tumor, contrasted CT may guide treatment selection in challenging cases.
Perception of Oldest Older Adults About Pain in Performing Daily Activities
Authors: de Andrade Lage Cabral Bárbara Pires , Giacomin Karla Cristina , de Almeida Simone Costa , Pereira Leani Souza Máximo , Assis Marcella Guimarães
Published: October 2018

This is a qualitative study that sought to understand the way in which oldest older adults perceive and deal with pain during activities of daily living. We interviewed 32 Brazilian older adults 80 years and older participating in the international multicenter study of Back Complaints in the Elderly. The following categories emerged from the content analysis: “The constant experience of pain,” “Understanding pain,” and “Performing daily living activities in pain.” Although pain is a constant experience and understood as something inherent to aging and difficult to explain, many older adults continue to perform daily activities while in pain and/or despite pain.
Severe Protein Calorie Malnutrition in the Context of Alcoholic Liver Cirrhosis
Authors: Kaliszewski Elizabeth , Parker Anna
Published: October 2018

Individuals with alcoholic liver cirrhosis are at risk for developing protein calorie malnutrition and often experience concurrent micronutrient deficiencies. Treatment of liver cirrhosis not only requires medical attention via diuretic therapy, fluid management through paracenteses, and routine esophagogastroduodenoscopies but also requires ample attention to nutrition status and nutrition intervention. Malnutrition is often observed in this patient population due to metabolic abnormalities as well as appetite cessation associated with historical alcohol abuse and adverse gastrointestinal symptoms including abdominal pain and loose stools. This case study presents nutrition management of a severely malnourished cirrhotic patient in an acute hospital setting.
Hypercoagulability in End-stage Liver Disease: Review of Epidemiology, Etiology, and Management
Authors: Verbeek Thomas A. , Stine Jonathan G. , Saner Fuat H. , Bezinover Dmitri
Published: October 2018

In this review, we analyze the epidemiology of thromboses related to end-stage liver disease (ESLD), discuss causes of hypercoagulability, describe susceptible populations, and critically evaluate proposed prophylaxis and treatment of thromboses. Classically, ESLD has been regarded as a model for coagulopathy, and patients were deemed to be at high risk for bleeding complications. Patients with ESLD are not auto-anticoagulated, and they do not have a lower risk of portal vein thrombosis, intracardiac thrombus formation, pulmonary embolism or hepatic artery thrombosis. Though the cause of hypercoagulability is multifactorial, endothelial dysfunction likely plays a central role for all patients with ESLD. Some subpopulations, such as patients with nonalcoholic steatohepatitis and autoimmune conditions, are at increased risk of thrombotic events as are patients of Hispanic ethnicity. The science behind prophylaxis of different types of clotting and treatment of thromboses is developing rapidly. A number of medications, including low molecular weight heparin, unfractionated heparin, aspirin, vitamin K antagonists, and direct oral anticoagulants can be used, but clear guidelines are lacking. Acute intraoperative clotting can be associated with high mortality. Routine use of transesophageal echocardiography can be helpful in early recognition and treatment of intraoperative thrombosis. Heparin should be reserved for cases of intracardiac thrombus/pulmonary embolism without hemodynamic instability. In unstable patients, low dose of recombinant tissue plasminogen activator can be used. In this new era of heightened awareness of thrombotic events in ESLD patients, prospective randomized trials are urgently needed to best guide clinical practice.
Energy current and computing
Authors: Yakovlev Alex
Published: October 2018

In his seminal
Electrical papers
, Oliver Heaviside stated ‘We reverse this …' referring to the relationship between energy current and state changes in electrical networks. We explore implications of Heaviside's view upon the state changes in electronic circuits, effectively constituting computational processes. Our vision about energy-modulated computing that can be applicable for electronic systems with energy harvesting is introduced. Examples of analysis of computational circuits as loads on power sources are presented. We also draw inspiration from Heaviside's way of using and advancing mathematical methods from the needs of natural physical phenomena. A vivid example of Heavisidian approach to the use of mathematics is in employing series where they emerge out of the spatio-temporal view upon energy flows. Using
series
expressions, and types of natural discretization in space and time, we explain the processes of discharging a capacitive transmission line, first, through a constant resistor and, second, through a voltage controlled digital circuit. We show that event-based models, such as Petri nets with an explicit notion of causality inherent in them, can be instrumental in creating bridges between electromagnetics and computing.

This article is part of the theme issue ‘Celebrating 125 years of Oliver Heaviside's ‘Electromagnetic Theory’’.
The architecture of cell differentiation in choanoflagellates and sponge choanocytes
Authors: Laundon Davis , Larson Ben , McDonald Kent , King Nicole , Burkhardt Pawel
Published: October 2018

Collar cells are ancient animal cell types which are conserved across the animal kingdom [1] and their closest relatives, the choanoflagellates [2]. However, little is known about their ancestry, their subcellular architecture, or how they differentiate. The choanoflagellateSalpingoeca rosetta[3] expresses genes necessary for animal multicellularity and development [4] and can alternate between unicellular and multicellular states [3,5], making it a powerful model to investigate the origin of animal multicellularity and mechanisms underlying cell differentiation [6,7]. To compare the subcellular architecture of solitary collar cells inS. rosettawith that of multicellular “rosettes” and collar cells in sponges, we reconstructed entire cells in 3D through transmission electron microscopy on serial ultrathin sections. Structural analysis of our 3D reconstructions revealed important differences between single and colonial choanoflagellate cells, with colonial cells exhibiting a more amoeboid morphology consistent with relatively high levels of macropinocytotic activity. Comparison of multiple reconstructed rosette colonies highlighted the variable nature of cell sizes, cell-cell contact networks and colony arrangement. Importantly, we uncovered the presence of elongated cells in some rosette colonies that likely represent a distinct and differentiated cell type. Intercellular bridges within choanoflagellate colonies displayed a variety of morphologies and connected some, but not all, neighbouring cells. Reconstruction of sponge choanocytes revealed both ultrastructural commonalities and differences in comparison to choanoflagellates. Choanocytes and colonial choanoflagellates are typified by high amoeboid cell activity. In both, the number of microvilli and volumetric proportion of the Golgi apparatus are comparable, whereas choanocytes devote less of their cell volume to the nucleus and mitochondria than choanoflagellates and more of their volume to food vacuoles. Together, our comparative reconstructions uncover the architecture of cell differentiation in choanoflagellates and sponge choanocytes and constitute an important step in reconstructing the cell biology of the last common ancestor of the animal kingdom.
Differential Effects of the Menstrual Cycle on Reactive and Proactive Aggression in Borderline Personality Disorder
Authors: Peters Jessica R. , Owens Sarah A. , Schmalenberger Katja M. , Eisenlohr-Moul Tory A.
Published: October 2018

Borderline personality disorder (BPD) is characterized by rapidly shifting symptoms, including intense anger and aggressive behavior. Understanding how fluctuations in ovarian hormones across the menstrual cycle may contribute to symptom instability is key for accurate assessment of BPD symptoms and effective interventions. Reactive and proactive aggression, as well as anger in and out, were assessed daily in 15 physically healthy, unmedicated naturally cycling female individuals without dysmenorrhea meeting criteria for BPD across 35 days. Urine LH surge and salivary progesterone were used to confirm ovulation and verify cycle phase. Cyclical worsening of symptoms was evaluated using multilevel models to evaluate symptom differences between cycle phases. Both forms of aggressive behavior demonstrated marked cycle effects, with reactive aggression highest during perimenstrual cycle phases, co-occurring with increases in anger in and out. In contrast, highest levels of proactive aggression were observed during the follicular and ovulatory phases, when emotional symptoms and anger were otherwise at lowest levels. These findings highlight the importance of identifying the function of aggression when considering potential psychological and biological influences. Naturally cycling individuals with BPD may be at elevated risk for perimenstrual worsening of a range of interpersonally reactive symptoms, including reactive aggression, whereas proactive aggression may occur more in phases characterized by less emotional and cognitive vulnerability and greater reward sensitivity. Research on aggression in this population should consider cycle effects. Cycling individuals with BPD attempting to reduce aggressive behavior may benefit from cycle-tracking to increase awareness of these effects and to develop appropriate strategies.
Impact of mothers’ past experience and early-life stress on aggression and cognition in adult male mice
Authors: Reshetnikov V. , Ryabushkina Yu. , Bondar N.
Published: October 2018

Early life is an important period for brain development and behavioral programming. Both reduced maternal care and stress in early life are risk factors for various psychiatric disorders. Here, we hypothesized that females’ stressful experience in their early life can lead to a disruption of mother-offspring interactions toward their own progeny. The objective of this study is to assess the effects of mothers’ past stressful experience, early-life stress alone or both on behavior in adult male mice. In this study, female mice were allowed to raise their pups either without exposure to stress (normal rearing condition, NC) or with exposure to maternal separation (3h/day, maternal separation, MS) on postnatal days 2–14. Adult F1 female mice who had experienced MS (stressed mothers, SM) or had been reared normally (undisturbed mothers, UM) were used for generating F2 offspring to be or not to be further exposed to early-life stress. We assessed anxiety-like behavior, exploratory activity, locomotor activity, aggression and cognition in four groups of adult F2 males (UM+NC, UM+MS, SM+NC, SM+MS). We found that SM+MS males become more aggressive if agonistic contact is long enough, suggesting a change in their social coping strategy. Moreover, these aggressive males tended to improve longterm spatial memory. Aggressive SM+NC males, in contrast, showed learning impairments. We did not find any significant differences in anxiety-like behavior or exploratory and locomotor activity. Overall, our findings suggest that mothers’ early-life experience may have important implications for the adult behavior of their offspring.
Development of a microfluidic cell culture and monitoring system for intracellular signaling studies
Authors: Ohkubo Tomoki , Kinoshita Haruyuki , Maekawa Toshiro , Kunida Katsuyuki , Kimura Hiroshi , Kuroda Shinya , Fujii Teruo
Published: October 2018

We describe a microfluidic cell culture and monitoring system that temporally controls molecule concentrations around cells cultured in a small space. The simple system consists of three syringe pumps and a microfluidic device with two inlet ports and two outlet ports. Each syringe pump discharges or draws culture medium, solutions containing signal molecules, or cell suspensions through a port in a programmed flow rate sequence. Signal molecule solutions of differing concentration are merged in a microchannel, mixed immediately, and transported into the cell culture chamber. Regulating the flow rate ratio of syringe pumps over time enables dynamic control of the concentration of signal molecules in the cell culture chamber. The system provides various time-dependent waveforms of concentration over cultured cells, including pulse, rectangular, and triangular. The practical performance of the system for concentration control was evaluated using fluorescent dye imaging. The system was also used with CHO-K1 cells to measure intracellular Ca2+ concentrations, which vary with extracellular ATP levels. When a rectangular pulse of ATP was applied to the cells, Ca2+ levels increased quickly. By contrast, several Ca2+ peaks were observed in response to stepwise increases in ATP concentration. Single-cell Ca2+ responses to ATP pulse stimulation were analyzed by quantitative fluorescence imaging. Hierarchical clustering and quantitative analysis of single-cell data revealed the diversity of Ca2+ responses to ATP pulse stimulation. These results demonstrate that the microfluidic cell culture system is useful for studying a variety of cellular responses, including cell signaling.
CBFβ-MYH11 interferes with megakaryocyte differentiation via modulating a gene program that includes GATA2 and KLF1
Authors: Yi Guoqiang , Mandoli Amit , Jussen Laura , Tijchon Esther , Cordonnier Gaëlle , Hansen Marten , Kim Bowon , Nguyen Luan N. , Jansen Pascal , Vermeulen Michiel , van den Akker Emile , Bond Jonathan , Martens Joost H.A.
Published: October 2018

The inv(16) acute myeloid leukemia associated CBFβ-MYH11 fusion is proposed to block normal myeloid differentiation, but whether this subtype of leukemia cells is poised for a unique cell lineage remains unclear. Here, we surveyed the functional consequences ofCBFβ - MYH11in primary inv(16) patient blasts, upon expression during hematopoietic differentiationin vitroand upon knockdown in cell lines by multi-omics profiling. Our results reveal that primary inv(16) AML cells share common transcriptomic signatures and epigenetic determiners with megakaryocytes and erythrocytes. Usingin vitrodifferentiation systems, we reveal that CBFβ-MYH11 knockdown interferes with normal megakaryocyte maturation. Two pivotal regulators, GATA2 and KLF1, are identified to complementally occupy RUNX1 binding sites upon fusion protein knockdown, and overexpression of GATA2 partly restores megakaryocyte directed differentiation suppressed by CBFβ-MYH11. Together, our findings suggest that in inv(16) leukemia, the CBFβ-MYH11 fusion inhibits primed megakaryopoiesis by attenuating expression of GATA2/KLF1 and interfering with a balanced transcriptional program involving these two factors.
Reticulate evolution in eukaryotes: origin and evolution of the nitrate assimilation pathway
Authors: Ocaña-Pallarès Eduard , Najle Sebastián R. , Scazzocchio Claudio , Ruiz-Trillo Iñaki
Published: October 2018

Genes and genomes can evolve through interchanging genetic material, this leading to reticular evolutionary patterns. However, the importance of reticulate evolution in eukaryotes, and in particular of horizontal gene transfer (HGT), remains controversial. Given that metabolic pathways with taxonomically-patchy distributions can be indicative of HGT events, the eukaryotic nitrate assimilation pathway is an ideal object of investigation, as previous results revealed a patchy distribution and suggested one crucial HGT event. We studied the evolution of this pathway through both multi-scale bioinformatic and experimental approaches. Our taxon-rich genomic screening shows this pathway to be present in more lineages than previously proposed and that nitrate assimilation is restricted to autotrophs and to distinct osmotrophic groups. Our phylogenies show a pervasive role of HGT, with three bacterial transfers contributing to the pathway origin, and at least seven well-supported transfers between eukaryotes. Our results, based on a larger dataset, differ from the previously proposed transfer of a nitrate assimilation cluster from Oomycota (Stramenopiles) to Dikarya (Fungi, Opisthokonta). We propose a complex HGT path involving at least two cluster transfers between Stramenopiles and Opisthokonta. We also found that gene fusion played an essential role in this evolutionary history, underlying the origin of the canonical eukaryotic nitrate reductase, and of a novel nitrate reductase in Ichthyosporea (Opisthokonta). We show that the ichthyosporean pathway, including this novel nitrate reductase, is physiologically active and transcriptionally co-regulated, responding to different nitrogen sources; similarly to distant eukaryotes with independent HGT-acquisitions of the pathway. This indicates that this pattern of transcriptional control evolved convergently in eukaryotes, favoring the proper integration of the pathway in the metabolic landscape. Our results highlight the importance of reticulate evolution in eukaryotes, by showing the crucial contribution of HGT and gene fusion in the evolutionary history of the nitrate assimilation pathway.
Simultaneous isotope dilution quantification and metabolic tracing of deoxyribonucleotides by liquid chromatography high resolution mass spectrometry
Authors: Kuskovsky Rostislav , Buj Raquel , Xu Peining , Hofbauer Samuel , Doan Mary T , Jiang Helen , Bostwick Anna , Mesaros Clementina , Aird Katherine M. , Snyder Nathaniel W.
Published: October 2018

Quantification of cellular deoxyribonucleoside mono-(dNMP), di-(dNDP), triphosphates (dNTPs) and related nucleoside metabolites are difficult due to their physiochemical properties and widely varying abundance. Involvement of dNTP metabolism in cellular processes including senescence and pathophysiological processes including cancer and viral infection make dNTP metabolism an important bioanalytical target. We modified a previously developed ion pairing reversed phase chromatography-mass spectrometry method for the simultaneous quantification and 13C isotope tracing of dNTP metabolites. dNMPs, dNDPs, and dNTPs were chromatographically resolved to avoid mis-annotation of in-source fragmentation. We used commercially available 13C15N-stable isotope labeled analogs as internal standards and show that this isotope dilution approach improves analytical figures of merit. At sufficiently high mass resolution achievable on an Orbitrap mass analyzer, stable isotope resolved metabolomics allows simultaneous isotope dilution quantification and 13C isotope tracing from major substrates including 13C-glucose. As a proof of principle, we quantified dNMP, dNDP and dNTP pools from multiple cell lines. We also identified isotopologue enrichment from glucose corresponding to ribose from the pentose-phosphate pathway in dNTP metabolites.
Physiological Synchrony Predicts Observational Threat Learning in Humans
Authors: Pärnamets Philip , Espinosa Lisa , Olsson Andreas
Published: October 2018

Understanding how information about threats in the environment is shared and transmitted between individuals is crucial for explaining adaptive, survival-related behavior in humans and other animals, and for developing treatments for phobias and other anxiety disorders. Research across species has shown that observing a conspecific’s, a “demonstrator’s”, threat responses causes strong and persistent threat memories in the “observer”. Here, we examined if physiological synchrony between demonstrator and observer can serve to predict the strength of observationally acquired conditioned responses. We measured synchrony between demonstrators’ and observers’ phasic electrodermal signals during learning, which directly reflects autonomic nervous system activity. Prior interpersonal synchrony predicted the strength of the observer’s later skin conductance responses to threat predicting stimuli, in the absence of the demonstrator. Dynamic coupling between an observer’s and a demonstrator’s autonomic nervous system activity may reflect experience sharing processes facilitating the formation of observational threat associations.
Criticality between cortical states
Authors: Fontenele Antonio J. , de Vasconcelos Nivaldo A. P. , Feliciano Thaís , Aguiar Leandro A. A. , Soares-Cunha Carina , Coimbra Bárbara , Porta Leonardo Dalla , Ribeiro Sidarta , Rodrigues Ana João , Sousa Nuno , Carelli Pedro V. , Copelli Mauro
Published: October 2018

Since the first measurements of neuronal avalanches [1], the critical brain hypothesis has gained traction [2]. However, if the brain is critical, what is the phase transition? For several decades it has been known that the cerebral cortex operates in a diversity of regimes [3], ranging from highly synchronous states (e.g. slow wave sleep [4], with higher spiking variability) to desynchronized states (e.g. alert waking [5], with lower spiking variability). Here, using independent signatures of criticality, we show that a phase transition occurs in an intermediate value of spiking variability. The critical exponents point to a universality class different from mean-field directed percolation (MF-DP). Importantly, as the cortex hovers around this critical point [6], it follows a linear relation between the avalanche exponents that encompasses previous experimental results from different setups [7, 8] and is reproduced by a model.
Improving the interpretability of species distribution models by using local approximations
Authors: Angelov Boyan
Published: October 2018

Species Distribution Models (SDMs) are used to generate maps of realised and potential ecological niches for a given species. As any other machine learning technique they can be seen as “black boxes”, due to a lack of interpretability. Advances in other areas of applied machine learning can be applied to remedy this problem. In this study we test a new tool relying on Local Interpretable Model-agnostic Explanations (LIME) by comparing its results of other known methods and ecological interpretations from domain experts. The findings confirm that LIME provides consistent and ecologically sound explanations of climate feature importance during the training of SDMs, and that the sdmexplain R package can be used with confidence.