Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery

Background

Acute kidney injury (AKI) following cardiac surgery is a frequent complication and several risk factors increasing its incidence have already been characterized. This study evaluates the influence of preoperative increased serum uric acid (SUA) levels in comparison with other known risk factors on the incidence of AKI following cardiac surgery.

Methods

During a period of 5 month, 247 patients underwent elective coronary artery bypass grafting, valve replacement/ repair or combined bypass and valve surgery. Datas were prospectively analyzed. Primary endpoint was the incidence of AKI as defined by the AKI criteria comparing patients with preoperative serum uric acid (SUA) levels below versus above the median. Multivariate logistic regression analysis was used to identify independent predictors of postoperative AKI.

Results

Thirty (12.1%) of the 247 patients developed postoperative AKI, 24 of 30 (80%) had preoperative SUA- levels above the median (≥373 μmol/l) (OR: 4.680, CI 95% 1.840; 11.904, p = 0.001). In the multivariate analysis SUA levels above the median (OR: 5.497, CI 95% 1.772; 17.054, p = 0.003), cardiopulmonary bypass (CPB) time > 90 min (OR: 4.595, CI 95% 1.587; 13.305, p = 0.005), cardiopulmonary bypass (CPB) > 30 kg/m² (OR: 3.208, CI 95% 1.202; 8.562; p = 0.02), and preoperative elevated serum-creatinine levels (OR: 1.015, CI 95% 1.001; 1.029, p = 0.04) were independently associated with postoperative AKI.

Conclusions

Serum uric acid is an independent risk marker for AKI after cardiac surgery. From all evaluated factors it showed the highest odds ratio.

Quantitative in vivo T2 mapping using fast spin echo techniques - A linear correction procedure

A method is presented for correcting the effects of stimulated and indirect echoes on quantitative T2 mapping data acquired with multiple spin echo techniques, such as turbo spin echo. In contrast to similar correction techniques proposed in the literature, the method does not require a priori knowledge of the radio frequency (RF) pulse profiles. In a first step, for the T2 mapping protocol under investigation, signal decay curves S(TE) are simulated for a range of different RF pulse profiles. The actual signal decay S(TE) is then measured on a phantom with known T2, so the approximate RF pulse profiles can be derived via comparison with the simulated decay curves. In a second step, with the RF pulses obtained from step one, signal decay curves S(TE) are simulated for different T2 values and fitted mono-exponentially, thus allowing to deduce the relationship between true T2 and the apparent T2 (T2app) values. Results show that this relationship is approximately linear, allowing for a direct correction of T2app maps. If the amplitude of the transmitted RF field (B1) does not exceed the nominal value by more than 10%, it is shown that a B1-independent correction of T2app maps yields sufficiently accurate results for T2. A B1-dependent version is also presented. The method is tested in vitro on a phantom with different T2 values and in vivo on healthy subjects.

Protease-activated receptor-1 inhibits proliferation but enhances leukemia stem cell activity in acute myeloid leukemia

Eradication of leukemia stem cells (LSCs) is the ultimate goal of treating acute myeloid leukemia (AML). We recently showed that the combined loss of Runx1/Cbfb inhibited the development of MLL-AF9-induced AML. However, c-Kit+/Gr-1- cells remained viable in Runx1/Cbfb-deleted cells, indicating that suppressing RUNX activity may not eradicate the most immature LSCs. In this study, we found upregulation of several hemostasis-related genes, including the thrombin-activatable receptor PAR-1 (protease-activated receptor-1), in Runx1/Cbfb-deleted MLL-AF9 cells. Similar to the effect of Runx1/Cbfb deletion, PAR-1 overexpression induced CDKN1A/p21 expression and attenuated proliferation in MLL-AF9 cells. To our surprise, PAR-1 deficiency also prevented leukemia development induced by a small number of MLL-AF9 leukemia stem cells (LSCs) in vivo. PAR-1 deficiency also reduced leukemogenicity of AML1-ETO-induced leukemia. Re-expression of PAR-1 in PAR-1-deficient cells combined with a limiting-dilution transplantation assay demonstrated the cell-dose-dependent role of PAR-1 in MLL-AF9 leukemia: PAR-1 inhibited rapid leukemic proliferation when there were a large number of LSCs, while a small number of LSCs required PAR-1 for their efficient growth. Mechanistically, PAR-1 increased the adherence properties of MLL-AF9 cells and promoted their engraftment to bone marrow. Taken together, these data revealed a multifaceted role for PAR-1 in leukemogenesis, and highlight this receptor as a potential target to eradicate primitive LSCs in AML.

Floral colours in a world without birds and bees: the plants of Macquarie Island

We studied biotically pollinated angiosperms on Macquarie Island, a remote site in the Southern Ocean with a predominately or exclusively dipteran pollinator fauna, in an effort to understand how flower colour affects community assembly. We compared a distinctive group of cream-green Macquarie Island flowers to the flora of likely source pools of immigrants and to a continental flora from a high latitude in the northern hemisphere. We used both dipteran and hymenopteran colour models and phylogenetically informed analyses to explore the chromatic component of community assembly. The species with cream-green flowers are very restricted in colour space models of both fly vision and bee vision and represent a distinct group that plays a very minor role in other communities. It is unlikely that such a community could form through random immigration from continental source pools. Our findings suggest that fly pollination has imposed a strong ecological filter on Macquarie Island, favouring floral colours that are rare in continental floras. This is one of the strongest demonstrations that plant-pollinator interactions play an important role in plant community assembly. Future work exploring colour choices by dipteran flower visitors would be valuable.

Three-dimensional echo-planar cine imaging of cerebral blood supply using arterial spin labeling

OBJECTIVE

Echo-planar imaging (EPI) with CYlindrical Center-out spatiaL Encoding (EPICYCLE) is introduced as a novel hybrid three-dimensional (3D) EPI technique. Its suitability for the tracking of a short bolus created by pseudo-continuous arterial spin labeling (pCASL) through the cerebral vasculature is demonstrated.

MATERIALS AND METHODS

EPICYCLE acquires two-dimensional planes of k-space along center-out trajectories. These "spokes" are rotated from shot to shot about a common axis to encode a k-space cylinder. To track a bolus of labeled blood, the same subset of evenly distributed spokes is acquired in a cine fashion after a short period of pCASL. This process is repeated for all subsets to fill the whole 3D k-space of each time frame.

RESULTS

The passage of short pCASL boluses through the vasculature of a 3D imaging slab was successfully imaged using EPICYCLE. By choosing suitable sequence parameters, the impact of slab excitation on the bolus shape could be minimized. Parametric maps of signal amplitude, transit time, and bolus width reflected typical features of blood transport in large vessels.

CONCLUSION

The EPICYCLE technique was successfully applied to track a short bolus of labeled arterial blood during its passage through the cerebral vasculature.

UBASH3B/Sts-1-CBL axis regulates myeloid proliferation in human preleukemia induced by AML1-ETO

The t(8;21) rearrangement, which creates the AML1-ETO fusion protein, represents the most common chromosomal translocation in acute myeloid leukemia (AML). Clinical data suggest that CBL mutations are a frequent event in t(8;21) AML, but the role of CBL in AML1-ETO-induced leukemia has not been investigated. In this study, we demonstrate that CBL mutations collaborate with AML1-ETO to expand human CD34+ cells both in vitro and in a xenograft model. CBL depletion by shRNA also promotes the growth of AML1-ETO cells, demonstrating the inhibitory function of endogenous CBL in t(8;21) AML. Mechanistically, loss of CBL function confers hyper-responsiveness to thrombopoietin and enhances STAT5/AKT/ERK/Src signaling in AML1-ETO cells. Interestingly, we found the protein tyrosine phosphatase UBASH3B/Sts-1, which is known to inhibit CBL function, is upregulated by AML1-ETO through transcriptional and miR-9-mediated regulation. UBASH3B/Sts-1 depletion induces an aberrant pattern of CBL phosphorylation and impairs proliferation in AML1-ETO cells. The growth inhibition caused by UBASH3B/Sts-1 depletion can be rescued by ectopic expression of CBL mutants, suggesting that UBASH3B/Sts-1 supports the growth of AML1-ETO cells partly through modulation of CBL function. Our study reveals a role of CBL in restricting myeloid proliferation of human AML1-ETO-induced leukemia, and identifies UBASH3B/Sts-1 as a potential target for pharmaceutical intervention.