Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury

Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin-fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non-AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p-value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes.

Disrupted Global and Regional Structural Networks and Subnetworks in Children with Localization-Related Epilepsy

BACKGROUND AND PURPOSE

Structural connectivity has been thought to be a less sensitive measure of network changes relative to functional connectivity in children with localization-related epilepsy. The aims of this study were to investigate the structural networks in children with localization-related epilepsy and to assess the relation among structural connectivity, intelligence quotient, and clinical parameters.

MATERIALS AND METHODS

Forty-five children with nonlesional localization-related epilepsy and 28 healthy controls underwent DTI. Global network (network strength, clustering coefficient, characteristic path length, global efficiency, and small-world parameters), regional network (nodal efficiency), and the network-based statistic were compared between patients and controls and correlated with intelligence quotient and clinical parameters.

RESULTS

Patients showed disrupted global network connectivity relative to controls, including reduced network strength, increased characteristic path length and reduced global efficiency, and reduced nodal efficiency in the frontal, temporal, and occipital lobes. Connectivity in multiple subnetworks was reduced in patients, including the frontal-temporal, insula-temporal, temporal-temporal, frontal-occipital, and temporal-occipital lobes. The frontal lobe epilepsy subgroup demonstrated more areas with reduced nodal efficiency and more impaired subnetworks than the temporal lobe epilepsy subgroup. Network parameters were not significantly associated with intelligence quotient, age at seizure onset, or duration of epilepsy.

CONCLUSIONS

We found disruption in global and regional networks and subnetworks in children with localization-related epilepsy. Regional efficiency and subnetworks were more impaired in frontal lobe epilepsy than in temporal lobe epilepsy. Future studies are needed to evaluate the implications of disrupted networks for surgical resection and outcomes for specific epileptogenic zones and the relation of disrupted networks to more complex cognitive function.

Methamphetamine and amphetamine isomer concentrations in human urine following controlled Vicks VapoInhaler administration

Legitimate use of legal intranasal decongestants containing l-methamphetamine may complicate interpretation of urine drug tests positive for amphetamines. Our study hypotheses were that commonly used immunoassays would produce no false-positive results and a recently developed enantiomer-specific gas chromatography-mass spectrometry (GC-MS) procedure would find no d-amphetamine or d-methamphetamine in urine following controlled Vicks VapoInhaler administration at manufacturer's recommended doses. To evaluate these hypotheses, 22 healthy adults were each administered one dose (two inhalations in each nostril) of a Vicks VapoInhaler every 2 h for 10 h on Day 1 (six doses), followed by a single dose on Day 2. Every urine specimen was collected as an individual void for 32 h after the first dose and assayed for d- and l-amphetamines specific isomers with a GC-MS method with >99% purity of R-(-)-α-methoxy-α-(trifluoromethyl)phenylacetyl derivatives and 10 µg/L lower limits of quantification. No d-methamphetamine or d-amphetamine was detected in any urine specimen by GC-MS. The median l-methamphetamine maximum concentration was 62.8 µg/L (range: 11.0-1,440). Only two subjects had detectable l-amphetamine, with maximum concentrations coinciding with l-methamphetamine peak levels, and always ≤ 4% of the parent's maximum. Three commercial immunoassays for amphetamines EMIT(®) II Plus, KIMS(®) II and DRI(®) had sensitivities, specificities and efficiencies of 100, 97.8, 97.8; 100, 99.6, 99.6 and 100, 100, 100%, respectively. The immunoassays had high efficiencies, but our first hypothesis was not affirmed. The EMIT(®) II Plus assay produced 2.2% false-positive results, requiring an enantiomer-specific confirmation.

Evaluation of Three Commercial Backpack Sprayers with Aqualuer® 20-20 Against Caged Adult Aedes Aegypti

Three commercially available backpack sprayers were evaluated with Aqualuer® 20-20 (20.6% permethrin, active ingredient; 20.6% piperonyl butoxide, technical) against caged adult Aedes aegypti in semifield trials in northeastern Florida. Two battery-powered sprayers, Birchmeier and Hudson, were compared with the standard hand-pump SOLO 425 sprayer, which is currently used in pest management operations. Physical characteristics, droplet analysis, and overall ease of use were documented. Multiple dilutions of the insecticide were also evaluated. The results indicated that the Birchmeier sprayer was the preferable machine in terms of its physical characteristics and operator use. There was no significant difference in percent mortality of the test mosquitoes between the sprayers. Multiple dilutions ranging from 1:9 to 1:1050 of the insecticide resulted in greater than 80% mean mortality.

A 3D machine vision method for non-invasive assessment of respiratory function

BACKGROUND

Respiratory function testing is important for detecting and monitoring illness, however, it is difficult for some patients, such as the young and severely ill, to perform conventional tests that require cooperation and/or patient contact.

METHOD

A new method was developed for non-contact breathing measurement, employing photometric stereo to capture the surface topography of the torso of an unconstrained subject. The surface is integrated to calculate time-dependent volume changes during respiration.

RESULTS

The method provides a useful means of continuously measuring volume changes during respiration with high spatial and temporal resolution. The system was tested by comparison with pneumotachometry equipment and a clear periodic signal, of a frequency corresponding to the reference data, was observed.

CONCLUSION

The approach is unique in performing breathing monitoring (with potential diagnostic capability) for unconstrained patients in virtually any lighting conditions (including darkness during sleep) and in a non-contact, unobtrusive (i.e. using imperceptible light) fashion. Copyright © 2015 John Wiley & Sons, Ltd.

Field Evaluation of a Novel Mos-Hole Trap and Naphtha Compared with BG Sentinel Trap and Mosquito Magnet X Trap to Collect Adult Mosquitoes

The novel Mos-Hole trap™ with liquid attractant naphtha™ from Korea was compared with BG Sentinel™ trap and Mosquito Magnet X™ trap for field collection of adult mosquitoes in St. Johns County, northeastern Florida, from May to October 2013. The novel Mos-Hole trap baited with naphtha (liquid attractant) collected similar numbers of mosquitoes, compared with the number of mosquitoes caught by BG Sentinel traps baited with BG Lure™. Both Mos-Hole and BG Sentinel traps collected a significantly greater number of mosquitoes compared with the numbers collected by Mosquito Magnet X traps. In other field evaluations when switching lures, the Mos-Hole traps baited with BG Lure caught more mosquitoes than the BG Sentinel trap baited with liquid naphtha attractant. The results showed that the novel Mos-Hole trap has the potential to be used as an additional effective sampling tool for population surveillance and control of adult mosquitoes.

Evaluation of a new spraying machine for barrier treatment and penetration of bifenthrin on vegetation against mosquitoes

The effectiveness and penetration of a novel, truck-mounted mist sprayer (3WC-30-4P provided by American LongRay) was evaluated with bifenthrin in a large, park-like setting with historic floodwater and woodland mosquito populations. Efficacy evaluations were determined through adult population collections and excised leaf bioassays. Trapping results showed a mean reduction of 77% in mosquito populations in the treated area for 5 sampling events up to 4 wk posttreatment. Leaf bioassays revealed an average mortality of 80% at 2.7 m and 51% at 5.5 m against laboratory-reared Aedes aegypti for 5 posttreatment samples. Leaves collected from the treated areas caused higher mortality at distances closer to the sprayer, though the distance and coverage of bifenthrin application was effective up to 5 m.

Atmospheric hydrogen peroxide and Eoarchean iron formations

It is widely accepted that photosynthetic bacteria played a crucial role in Fe(II) oxidation and the precipitation of iron formations (IF) during the Late Archean-Early Paleoproterozoic (2.7-2.4 Ga). It is less clear whether microbes similarly caused the deposition of the oldest IF at ca. 3.8 Ga, which would imply photosynthesis having already evolved by that time. Abiological alternatives, such as the direct oxidation of dissolved Fe(II) by ultraviolet radiation may have occurred, but its importance has been discounted in environments where the injection of high concentrations of dissolved iron directly into the photic zone led to chemical precipitation reactions that overwhelmed photooxidation rates. However, an outstanding possibility remains with respect to photochemical reactions occurring in the atmosphere that might generate hydrogen peroxide (H2 O2 ), a recognized strong oxidant for ferrous iron. Here, we modeled the amount of H2 O2 that could be produced in an Eoarchean atmosphere using updated solar fluxes and plausible CO2 , O2 , and CH4 mixing ratios. Irrespective of the atmospheric simulations, the upper limit of H2 O2 rainout was calculated to be <10(6) molecules cm(-2) s(-1) . Using conservative Fe(III) sedimentation rates predicted for submarine hydrothermal settings in the Eoarchean, we demonstrate that the flux of H2 O2 was insufficient by several orders of magnitude to account for IF deposition (requiring ~10(11) H2 O2 molecules cm(-2) s(-1) ). This finding further constrains the plausible Fe(II) oxidation mechanisms in Eoarchean seawater, leaving, in our opinion, anoxygenic phototrophic Fe(II)-oxidizing micro-organisms the most likely mechanism responsible for Earth's oldest IF.

Comparison of screw malposition and vertebral artery injury of C2 pedicle and transarticular screws: meta-analysis and review of the literature

STUDY DESIGN

Literature review and meta-analysis.

OBJECTIVES

To compare the incidence of screw malposition and vertebral artery injury (VAI) with transarticular screws (TAS) and C2 pedicle screws (C2PS) using meta-analysis techniques.

SUMMARY OF BACKGROUND DATA

Posterior instrumentation for atlantoaxial fusions can be challenging and risky. Some centers report a higher incidence of VAI with the implantation of TAS compared with C2PS, whereas other data do not support this.

METHODS

Online databases were searched for English language articles between 1994 and April 2011 describing the clinical and radiographic outcomes after insertion of C2PS or TAS. Forty-one studies reporting on 3627 TAS and 33 studies describing 2979 C2PS met inclusion criteria for VAI or clinically significant misplacements (VAI, neurological deficits, or misplacements requiring surgical revision), and 36 studies reporting on 3280 TAS and 28 studies describing 2532 C2PS met inclusion criteria for radiographic misplacement outcomes.

RESULTS

All studies comprised class III evidence. VAI occurred in 26 of 3627 (0.72%) implanted TAS and in 10 of 2979 (0.34%) implanted C2PS (P=0.01). Clinically significant misplacements occurred in 67 TAS (1.84%) and in 10 C2PS (0.34%; P<0.0001). The point estimate of VAI for TAS was 1.68% [confidence interval (CI), 1.23%-2.29%] and was higher than C2PS (1.09%; CI, 0.73%-1.63%; P=0.01). The point estimate of clinically significant screw malposition for TAS was 2.33% (CI, 1.61%-3.37%) and was higher than that of C2PS (1.15%; CI, 0.77%-1.70%; P<0.001).

CONCLUSIONS

With training, experience, and anatomic knowledge, both TAS and C2PS can be inserted accurately and safely. However, improper insertion and VAI can have catastrophic consequences. Our review identified a higher risk of VAI, neurological injury, and clinically significant malpositions with TAS compared with C2PS. These data provide preliminary support for the supposition that C2PS have a lower risk of morbidity.

Genetic variant predicts bevacizumab-induced hypertension in ECOG-5103 and ECOG-2100

BACKGROUND

Bevacizumab has broad anti-tumour activity, but substantial risk of hypertension. No reliable markers are available for predicting bevacizumab-induced hypertension.

METHODS

A genome-wide association study (GWAS) was performed in the phase III bevacizumab-based adjuvant breast cancer trial, ECOG-5103, to evaluate for an association between genotypes and hypertension. GWAS was conducted in those who had experienced systolic blood pressure (SBP) >160 mm Hg during therapy using binary analysis and a cumulative dose model for the total exposure of bevacizumab. Common toxicity criteria (CTC) grade 3-5 hypertension was also assessed. Candidate SNP validation was performed in the randomised phase III trial, ECOG-2100.

RESULTS

When using the phenotype of SBP>160 mm Hg, the most significant association in SV2C (rs6453204) approached and met genome-wide significance in the binary model (P=6.0 × 10(-8); OR=3.3) and in the cumulative dose model (P=4.7 × 10(-8); HR=2.2), respectively. Similar associations with rs6453204 were seen for CTC grade 3-5 hypertension but did not meet genome-wide significance. Validation study from ECOG-2100 demonstrated a statistically significant association between this SNP and grade 3/4 hypertension using the binary model (P-value=0.037; OR=2.4).

CONCLUSIONS

A genetic variant in SV2C predicted clinically relevant bevacizumab-induced hypertension in two independent, randomised phase III trials.

Morphine and codeine concentrations in human urine following controlled poppy seeds administration of known opiate content

Opiates are an important component for drug testing due to their high abuse potential. Proper urine opiate interpretation includes ruling out poppy seed ingestion; however, detailed elimination studies after controlled poppy seed administration with known morphine and codeine doses are not available. Therefore, we investigated urine opiate pharmacokinetics after controlled oral administration of uncooked poppy seeds with known morphine and codeine content. Participants were administered two 45 g oral poppy seed doses 8 h apart, each containing 15.7 mg morphine and 3mg codeine. Urine was collected ad libitum up to 32 h after the first dose. Specimens were analyzed with the Roche Opiates II immunoassay at 2000 and 300 μg/L cutoffs, and the ThermoFisher CEDIA(®) heroin metabolite (6-acetylmorphine, 6-AM) and Lin-Zhi 6-AM immunoassays with 10 μg/L cutoffs to determine if poppy seed ingestion could produce positive results in these heroin marker assays. In addition, all specimens were quantified for morphine and codeine by GC/MS. Participants (N=22) provided 391 urine specimens over 32 h following dosing; 26.6% and 83.4% were positive for morphine at 2000 and 300 μg/L GC/MS cutoffs, respectively. For the 19 subjects who completed the study, morphine concentrations ranged from <300 to 7522 μg/L with a median peak concentration of 5239 μg/L. The median first morphine-positive urine sample at 2000 μg/L cutoff concentration occurred at 6.6 h (1.2-12.1), with the last positive from 2.6 to 18 h after the second dose. No specimens were positive for codeine at a cutoff concentration of 2000 μg/L, but 20.2% exceeded 300 μg/L, with peak concentrations of 658 μg/L (284-1540). The Roche Opiates II immunoassay had efficiencies greater than 96% for the 2000 and 300 μg/L cutoffs. The CEDIA 6-AM immunoassay had a specificity of 91%, while the Lin-Zhi assay had no false positive results. These data provide valuable information for interpreting urine opiate results.

Modern analytical technologies for the detection of drug abuse and doping

Consequences to individuals convicted of abusing prohibited drugs or doping agents can be severe, including loss of employment, child custody, driving privileges, right to compete in international sports and ultimately freedom, when mandatory confinement occurs. In view of these penalties, laboratories charged with providing evidence must maximize testing accuracy. False positive and false negative tests are prevented by combining sensitive immunoassays and specific chromatographic-mass spectrometric detection. In addition, testing different biological matrices offers unique information about the drug-use history of an individual.:

Laboratory evaluation of citronella, picaridin, and deet repellents against Psorophora ciliata and Psorophora howardii

Commercial formulations of 3 repellents: OFF Active (active ingredient [AI] 15% N,N-diethyl-meta-toluamide [deet]), OFF Family Care (AI 5% picaridin), and CVS Pharmacy Fresh Insect Repellent (AI 10% citronella, 2% lauryl sulfate, and 0.2% potassium sorbate) were evaluated to determine the mean protection time provided against the large floodwater mosquitoes, Psorophora ciliata and Ps. howardii. Each of these products contained different active ingredients and displayed different protection times, but repellency was in accordance with each product's label reapplication times/repellency durations. The CVS Pharmacy Fresh Insect Repellent provided the least protection (2 h and 26 min), followed by OFF Family Care (3 h and 46 min). OFF Active afforded the longest protection (5 h and 41 min), which was significantly higher than the other treatments (P < 0.001).

Honey bee sting pain index by body location

The Schmidt Sting Pain Index rates the painfulness of 78 Hymenoptera species, using the honey bee as a reference point. However, the question of how sting painfulness varies depending on body location remains unanswered. This study rated the painfulness of honey bee stings over 25 body locations in one subject (the author). Pain was rated on a 1–10 scale, relative to an internal standard, the forearm. In the single subject, pain ratings were consistent over three repetitions. Sting location was a significant predictor of the pain rating in a linear model (p < 0.0001, DF = 25, 94, F = 27.4). The three least painful locations were the skull, middle toe tip, and upper arm (all scoring a 2.3). The three most painful locations were the nostril, upper lip, and penis shaft (9.0, 8.7, and 7.3, respectively). This study provides an index of how the painfulness of a honey bee sting varies depending on body location.

Multiscale relationships between fibronectin structure and functional properties

Cell behavior is tightly coupled to the properties of the extracellular matrix (ECM) to which they attach. Fibronectin (Fn) forms a supermolecular, fibrillar component of the ECM that is prominent during development, wound healing and the progression of numerous diseases. This indicates that Fn has an important function in controlling cell behavior during dynamic events in vivo. The multiscale architecture of Fn molecules assembled into these fibers determines the ligand density of cell adhesion sites on the surface of the Fn fiber, Fn fiber porosity for cell signaling molecules such as growth factors, the mechanical stiffness of the Fn matrix and the adhesivity of Fn for its numerous soluble ligands. These parameters are altered by mechanical strain applied to the ECM. Recent efforts have attempted to link the molecular properties of Fn with bulk properties of Fn matrix fibers. Studies of isolated Fn fibers have helped to characterize the fiber's material properties and, in combination with models of Fn molecular behavior in the fibers, have begun to provide insights into the Fn molecular arrangement and intermolecular adhesions within the fibers. A review of these studies allows the development of an understanding of the mechanobiological functions of Fn.

Alkamides from Echinacea disrupt the fungal cell wall-membrane complex

We tested the hypothesis that alkamides from Echinacea exert antifungal activity by disrupting the fungal cell wall/membrane complex. Saccharomyces cerevisiae cells were treated separately with each of seven synthetic alkamides found in Echinacea extracts. The resulting cell wall damage and cell viability were assessed by fluorescence microscopy after mild sonication. Membrane disrupting properties of test compounds were studied using liposomes encapsulating carboxyfluorescein. Negative controls included hygromycin and nourseothricin (aminoglycosides that inhibit protein synthesis), and the positive control used was caspofungin (an echinocandin that disrupts fungal cell walls). The results show that yeast cells exposed to sub-inhibitory concentrations of each of the seven alkamides and Echinacea extract exhibit increased frequencies of cell wall damage and death that were comparable to caspofungin and significantly greater than negative controls. Consistent with effects of cell wall damaging agents, the growth inhibition by three representative alkamides tested and caspofungin, but not hygromycin B, were partially reversed in sorbitol protection assays. Membrane disruption assays showed that the Echinacea extract and alkamides have pronounced membrane disruption activity, in contrast to caspofungin and other controls that all had little effect on membrane stability. A Quantitative Structure-Activity Relationship (QSAR) analysis was performed to study the effect of structural substituents on the antifungal activity of the alkamides. Among the set studied, diynoic alkamides showed the greatest antifungal and cell wall disruption activities while an opposite trend was observed in the membrane disruption assay where the dienoic group was more effective. We propose that alkamides found in Echinacea act synergistically to disrupt the fungal cell wall/membrane complex, an excellent target for specific inhibition of fungal pathogens. Structure-function relationships provide opportunities for synthesis of alkamide analogs with improved antifungal activities.

Autonomic composite hydrogels by reactive printing: materials and oscillatory response

Autonomic materials are those that automatically respond to a change in environmental conditions, such as temperature or chemical composition. While such materials hold incredible potential for a wide range of uses, their implementation is limited by the small number of fully-developed material systems. To broaden the number of available systems, we have developed a post-functionalization technique where a reactive Ru catalyst ink is printed onto a non-responsive polymer substrate. Using a succinimide-amine coupling reaction, patterns are printed onto co-polymer or biomacromolecular films containing primary amine functionality, such as polyacrylamide (PAAm) or poly-N-isopropyl acrylamide (PNIPAAm) copolymerized with poly-N-(3-Aminopropyl)methacrylamide (PAPMAAm). When the films are placed in the Belousov-Zhabotinsky (BZ) solution medium, the reaction takes place only inside the printed nodes. In comparison to alternative BZ systems, where Ru-containing monomers are copolymerized with base monomers, reactive printing provides facile tuning of a range of hydrogel compositions, as well as enabling the formation of mechanically robust composite monoliths. The autonomic response of the printed nodes is similar for all matrices in the BZ solution concentrations examined, where the period of oscillation decreases in response to increasing sodium bromate or nitric acid concentration. A temperature increase reduces the period of oscillations and temperature gradients are shown to function as pace-makers, dictating the direction of the autonomic response (chemical waves).

Topographical control of multiple cell adhesion molecules for traction force microscopy

Cellular traction forces are important quantitative measures in cell biology as they have provided much insight into cell behavior in contexts such as cellular migration, differentiation, and disease progression. However, the complex environment in vivo permits application of cell traction forces through multiple types of cell adhesion molecules. Currently available approaches to differentiate traction forces among multiple cell adhesion molecules are limited to specialized approaches to decouple cell-cell from cell-extracellular matrix (ECM) tractions. Here, we present a technique which uses indirect micropatterning onto a polyacrylamide gel to pattern multiple, spatially distinct fluorescently labeled ECM proteins, specifically gelatin and fibronectin (Fn), and confine the area to which cells can adhere. We found that cells interacting with both gelatin and Fn altered their traction forces significantly in comparison to cells on Fn-only substrates. This crosstalk interaction resulted in a decrease in overall traction forces on dual-patterned substrates as compared to cells on Fn-only substrates. This illustrates the unique need to study such interactions and demonstrates great potential in future studies in multi-ligand environments. Current micropatterning techniques on glass can easily be adapted to present other protein classes, such as cadherins, while maintaining control of adhesion spacing, cell spread area, and stiffness, each of which are important regulators of cell mechanobiology.

Field evaluation of truck-mounted thermal fog of DUET and Aqualuer using different solvents against Aedes albopictus

DUET ultra-low volume (ULV) (1% parllethrin, 5% sumithrin) and Aqualuer ULV (20.6% permethrin), applied neat, diluted with mineral oil, and diluted with diesel oil by a truck-mounted thermal fogger (LongRay TS-95 model) was evaluated in the field against caged Aedes albopictus adults. The application of Aqualuer ULV was significantly more effective than DUET ULV (t = 12.1, df = 5, P < 0.001) without dilution. There were no significant differences between the applications of DUET ULV or Aqualuer ULV diluted 1:3 with mineral oil (t = 0.662, df = 5, P = 0.518) or with 1:3 of diesel oil (t = 1.19, df = 5, P = 0.251). The solvents (mineral oil and diesel oil) to dilute DUET and Aqualuer and sprayed by the truck-mounted thermal fogger did not result in significant differences in the mortalities of caged Ae. albopictus.

Partial ovary development is widespread in honey bees and comparable to other eusocial bees and wasps

Honey bee workers have few opportunities for direct reproduction because their ovary development is chemically suppressed by queens and worker-laid eggs are destroyed by workers. While workers with fully developed ovaries are rare in honey bee colonies, we show that partial ovary development is common. Across nine studies, an average of 6% to 43% of workers had partially developed ovaries in queenright colonies with naturally mated queens. This shift by workers toward potential future reproduction is linked to lower productivity, which suggests that even small investments in reproductive physiology by selfish workers reduce cooperation below a theoretical maximum. Furthermore, comparisons across 26 species of bees and wasps revealed that the level of partial ovary development in honey bees is similar to that of other eusocial Hymenoptera where there is reproductive conflict among colony members. Natural variation in the extent of partial ovary development in honey bee colonies calls for an exploration of the genetic and ecological factors that modulate shifts in cooperation within animal societies.

Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy

OBJECTIVES

The physiological changes that occur during pregnancy, including increased blood volume and cardiac output, can affect hemodynamic control, most profoundly with positional changes that affect venous return to the heart. By using Osteopathic Manipulative Treatment (OMT), a body-based modality theorized to affect somatic structures related to nervous and circulatory systems, we hypothesized that OMT acutely improves both autonomic and hemodynamic control during head-up tilt and heel raise in women at 30 weeks gestation.

DESIGN

One hundred subjects were recruited at 30 weeks gestation.

SETTING

The obstetric clinics of UNTHealth in Fort Worth, TX.

INTERVENTION

Subjects were randomized into one of three treatment groups: OMT, placebo ultrasound, or time control. Ninety subjects had complete data (N=25, 31 and 34 in each group respectively).

MAIN OUTCOME MEASURES

Blood pressure and heart rate were recorded during 5 min of head-up tilt followed by 4 min of intermittent heel raising.

RESULTS

No significant differences in blood pressure, heart rate or heart rate variability were observed between groups with tilt before or after treatment (p>0.36), and heart rate variability was not different between treatment groups (p>0.55). However, blood pressure increased significantly (p=0.02) and heart rate decreased (p<0.01) during heel raise after OMT compared to placebo or time control.

CONCLUSIONS

These data suggest that OMT can acutely improve hemodynamic control during engagement of the skeletal muscle pump and this was most likely due to improvement of structural restrictions to venous return.

Abnormal functional network connectivity among resting-state networks in children with frontal lobe epilepsy

BACKGROUND AND PURPOSE

Epilepsy is considered a disorder of neural networks. The aims of this study were to assess functional connectivity within resting-state networks and functional network connectivity across resting-state networks by use of resting-state fMRI in children with frontal lobe epilepsy and to relate changes in resting-state networks with neuropsychological function.

MATERIALS AND METHODS

Fifteen patients with frontal lobe epilepsy and normal MR imaging and 14 healthy control subjects were recruited. Spatial independent component analysis was used to identify the resting-state networks, including frontal, attention, default mode network, sensorimotor, visual, and auditory networks. The Z-maps of resting-state networks were compared between patients and control subjects. The relation between abnormal connectivity and neuropsychological function was assessed. Correlations from all pair-wise combinations of independent components were performed for each group and compared between groups.

RESULTS

The frontal network was the only network that showed reduced connectivity in patients relative to control subjects. The remaining 5 networks demonstrated both reduced and increased functional connectivity within resting-state networks in patients. There was a weak association between connectivity in frontal network and executive function (P = .029) and a significant association between sensorimotor network and fine motor function (P = .004). Control subjects had 79 pair-wise independent components that showed significant temporal coherence across all resting-state networks except for default mode network-auditory network. Patients had 66 pairs of independent components that showed significant temporal coherence across all resting-state networks. Group comparison showed reduced functional network connectivity between default mode network-attention, frontal-sensorimotor, and frontal-visual networks and increased functional network connectivity between frontal-attention, default mode network-sensorimotor, and frontal-visual networks in patients relative to control subjects.

CONCLUSIONS

We found abnormal functional connectivity within and across resting-state networks in children with frontal lobe epilepsy. Impairment in functional connectivity was associated with impaired neuropsychological function.

Medullary thyroid cancer and pseudocirrhosis: case report and literature review

Pseudocirrhosis is a rare form of liver disease that can cause clinical symptoms and radiographic signs of cirrhosis; however, its histologic features suggest a distinct pathologic process. In the setting of cancer, hepatic metastases and systemic chemotherapy are suspected causes of pseudocirrhosis. Here, we present a patient with medullary thyroid carcinoma metastatic to the liver who developed pseudocirrhosis while on maintenance sunitinib after receiving 5-fluorouracil, leucovorin, and oxaliplatin (folfox) in combination with sunitinib. Cirrhotic change in liver morphology was accompanied by diffusely infiltrative carcinomatous disease resembling the primary tumor. We discuss the diagnosis of pseudocirrhosis in this case and review the literature regarding pseudocirrhosis in cancer.