A Comparative Kidney Transcriptome Analysis of Bicarbonate-Loaded insrr-Null Mice

The maintenance of plasma pH is critical for life in all organisms. The kidney plays a critical role in acid-base regulation in vertebrates by controlling the plasma concentration of bicarbonate. The receptor tyrosine kinase IRR (insulin receptor-related receptor) is expressed in renal β-intercalated cells and is involved in alkali sensing due to its ability to autophosphorylate under alkalization of extracellular medium (pH > 7.9). In mice with a knockout of the insrr gene, which encodes for IRR, urinary bicarbonate secretion in response to alkali loading is impaired. The specific regulatory mechanisms in the kidney that are under the control of IRR remain unknown. To address this issue, we analyzed and compared the kidney transcriptomes of wild-type and insrr knockout mice under basal or bicarbonate-loaded conditions. Transcriptomic analyses revealed a differential regulation of a number of genes in the kidney. Using TaqMan real-time PCR, we confirmed different expressions of the slc26a4, rps7, slc5a2, aqp6, plcd1, gapdh, rny3, kcnk5, slc6a6 and atp6v1g3 genes in IRR knockout mice. Also, we found that the expression of the kcnk5 gene is increased in wild-type mice after bicarbonate loading but not in knockout mice. Gene set enrichment analysis between the IRR knockout and wild-type samples identified that insrr knockout causes alterations in expression of genes related mostly to the ATP metabolic and electron transport chain processes.

Updating and evaluating the NH3 gas-phase chemical mechanism of MOZART-4 in the WRF-Chem model

The accuracy of determining atmospheric chemical mechanisms is a key factor in air pollution prediction, pollution-cause analysis and the development of control schemes based on air quality model simulations. However, the reaction of NH3 and OH to generate NH2 and its subsequent reactions are often ignored in the MOZART-4 chemical mechanism. To solve this problem, the gas-phase chemical mechanism of NH3 was updated in this study. Response surface methodology (RSM), integrated gas-phase reaction rate (IRR) diagnosis and process analysis (PA) were used to quantify the influence of the updated NH3 chemical mechanism on the O3 simulated concentration, the nonlinear response relationship of O3 and its precursors, the chemical reaction rate of O3 generation and the meteorological transport process. The results show that the updated NH3 chemical mechanism can reduce the error between the simulated and observed O3 concentrations and better simulate the O3 concentration. Compared with the Base scenario (original chemical mechanism simulated), the first-order term of NH3 in the Updated scenario (updated NH3 chemical mechanism simulated) in RSM passed the significance test (p < 0.05), indicating that NH3 emissions have an influence on the O3 simulation, and the effects of the updated NH3 chemical mechanism on NOx-VOC-O3 in different cities are different. In addition, the analysis of chemical reaction rate changes showed that NH3 can affect the generation of O3 by affecting the NOx concentration and NOx circulation with radicals of OH and HO2 in the Updated scenario, and the change of pollutant concentration in the atmosphere leads to the change of meteorological transmission, eventually leading to the reduction of O3 concentration in Beijing. In conclusion, this study highlights the importance of atmospheric chemistry for air quality models to model atmospheric pollutants and should attract more research focus.

Impact of decompensated cirrhosis in children: A population-based study

Background

We describe the proportion of children with compensated cirrhosis who develop decompensation in Ontario, Canada over the past two decades.

Methods

This is a retrospective population-based cohort study using routinely collected health care data from Ontario, Canada held at ICES during 1997-2017. Diagnosis of cirrhosis was made using validated ICES definition, and decompensation events were defined according to validated coding. Rates of decompensation, type of decompensation, and incidence of liver transplantation after decompensation were analyzed. Databases were linked at the individual level and analyzed at ICES-Queen's.

Results

A total of 2,755 children with compensated cirrhosis were included and 9% (253) developed decompensation over a median follow-up of 7 years. Children most likely to suffer decompensation were younger (median age 10 versus 4 years, p < 0.001) and female (45% versus 52%, p = 0.03). Ascites (137/253, 54%) was the most frequent complication. 199/2755 (7%) of children with cirrhosis received liver transplantation, of which 64% (128/199) occurred after a decompensation event. Overall, a total of 132 (4.7%) deaths occurred during the study period, with 55 deaths following a decompensating event.

Conclusion

We present the first study to describe rates of decompensation, type, and rate of liver transplantation after decompensation in pediatric cirrhosis at the population level. To improve the care of children with liver disease, early detection of liver disease, early initiation of specific treatments as well as identification of children who are at risk of becoming decompensated are crucial.

Techno-economic assessment of power generation potential from floating solar photovoltaic systems in Bangladesh

Floating Solar Photovoltaic (FPV) plants, also known as floatovoltaic plants are showing great potential in the renewable energy sector all around the world. They can contribute to the national grid and provide support to the existing hydropower plants. Moreover, they positively impact the environment by reducing evaporation and improving aquatic lives simultaneously. Despite a decade of research, there has been no study on the technical potential of FPV plants on a riverine country like Bangladesh. In Bangladesh, there are several water infrastructures to accommodate FPV plants. In addition, a considerable amount of solar irradiation is available throughout the year because of the country's geographical location, making FPVs a significantly viable option for generating electricity. To this end, this study provides the first technical potential and economic feasibility assessment of some of the important water bodies of Bangladesh. The technical potential study is performed with the help of solar PVGIS and focuses on the contribution these plants can make to the national grid. The economic viability assessment simulations are done in System Advisory Model (SAM). Moreover, a thorough comparison between FPVs and inland solar plants is also conducted. The results show that after the installation, even with a conservative approach, FPV plants will be able to meet 1.1% of the demand of the capital Dhaka, the city with one of the highest population densities. In addition, FPV installation at Kaptai lake, which already has an existing hydropower plant, can meet up to 7% of the demand of the port city Chattogram. Moreover, economic parameters NPV, IRR and LCOE all indicate the projects are profitable and can be deployed in large-scale. This study will open doors to further research into the FPV potential of Bangladesh and help implement FPVs to meet the renewable energy goals of the country.

Effects of chemical boundary conditions on simulated O3 concentrations in China and their chemical mechanisms

Chemical boundary conditions (BCs) are important inputs for regional chemical transport models. In this study, we use the brute-force method (BFM), process analysis (PA) and response surface model (RSM) to quantify the effects of BCs on simulated O₃ concentrations in different regions of China by the weather research and forecasting with chemistry (WRF-Chem) model. We combine the model with an integrated gas-phase reaction rate (IRR) tool to further analyze the changes in the O₃ chemical mechanisms. Our results show that the simulated O₃ concentrations in western cities are significantly affected by the O₃ in the BCs (BC-O₃), which can increase the maximum simulated O₃ concentration, such as in Lanzhou (36.6 μg/m³, 26.3 %), Wuhai (30.1 μg/m³, 25.5 %) and Urumqi (50.7 μg/m³, 41.2 %). In contrast, O₃ generation in the eastern region is dominated by emissions. Subsequently, we compare the reaction rate changes in O₃ generation and consumption under the effects of BC-O₃ in the western city of Urumqi and the eastern city of Beijing. The results show that in Beijing, the O₃ concentration and the related chemical reaction rates undergo little change, while in Urumqi, the concentration and reaction rates have significant differences. The BC-O₃ significantly accelerates the O₃ photochemical reaction process in Urumqi, resulting in increased O₃ generation and consumption reaction rates; additionally, there may be a chemical reaction pathway for the formation of O₃: BC-O₃ + NO → NO₂ + hv → O + O₂ → O₃. BC-O₃ transmission is the main pathway of changes in the simulated O₃ concentration in the study area, and the chemical reactions between BC-O₃ and local pollutants are primarily characterized by O₃ consumption. In conclusion, the study shows the importance of BCs for regional model simulation while providing supporting information for O₃ formation in model studies.

Changes in the Expression of the gapdh Gene in the Organs of insrr Knockout Mice

The most important property of a living organism is the maintenance of optimal acid-base balance and the ionic composition of the internal environment. The kidneys are one of the main pH-regulating organs in the body. Receptor tyrosine kinase IRR (an insulin receptor-related receptor) is an alkaline pH-sensor. In mice (Mus Musculus) with a knockout of the insrr gene encoding the IRR receptor, bicarbonate secretion is impaired under the conditions of alkaline loading, which indicates the role of the receptor tyrosine kinase IRR in the regulation of acid-base balance in the body. In order to search for proteins functionally associated with the receptor tyrosine kinase IRR, we performed a large-scale sequencing of the mouse kidney transcriptome of wild type and insrr knockout mice kept under normal conditions and under alkaline conditions. As a result, we found a decrease in the gapdh gene expression in the kidneys of insrr knockout mice compared to wild type mice. RNA sequencing data were confirmed by TaqMan real-time PCR and Western blotting. Using the TaqMan real-time PCR method, we revealed a decrease in the level of gapdh expression not only in the kidneys, but also in the liver and brain of insrr knockout mice. Thus, the changes in the gapdh gene expression in the kidneys of insrr knockout mice may indicate a functional relationship between genes and a possible role of GAPDH in previously undescribed molecular mechanisms of regulation of acid-base balance in the body.

Economic Feasibility Study of a Carbon Capture and Storage (CCS) Integration Project in an Oil-Driven Economy: The Case of the State of Kuwait

The rapid growth and urbanization rate, coupled with hot climate and scarce rainfall, makes it essential for a country like Kuwait to have several power and desalination plants with high-generating capacity. These plants are entirely reliant on burning fossil fuels as a source of thermal energy. These plants are also universally accepted to be the largest CO₂ emitters; hence, they present a potential for carbon capture and storage (CCS). Having established the suitability of the existing conditions for post-combustion CCS, a techno-economic-based feasibility study, which took into consideration local power generation technologies and economic conditions, was performed. Relying on fifteen case study models and utilizing the concept of levelized cost of electricity (LCOE), the statistical average method (SAM) was used to assess CCS based on realistic and reliable economic indicators. Zour power station, offering the highest potential CO₂ stream, was selected as a good candidate for the analysis at hand. Heavy fuel oil (HFO) was assumed to be the only fuel type used at this station with affixed price of USD 20/barrel. The analysis shows that the internal rate of return (IRR) was about 7%, which could be attributed to fuel prices in Kuwait and governmental support, i.e., waived construction tax and subsidized workforce salaries. Furthermore, the net present value (NPV) was also estimated as USD 47,928 million with a 13-year payback period (PBP). Moreover, 1–3% reductions in the annual operational cost were reflected in increasing the IRR and the NPV to 9–11% and USD 104,085–193,945 million, respectively, and decreasing the PBP to 12–11 years. On the contrary, increasing the annual operational cost by 1% made the project economically unfeasible, while an increase of 3% resulted in negative IRR (−1%), NVP (−USD 185,458 million) and increased PBP to 30 years. Similarly, increasing the HFO barrel price by USD 5 resulted in negative IRR (−10%) and NVP (−USD 590,409); hence, a CCS project was deemed economically unfeasible. While the study considered the conditions in Kuwait, it is expected that similar results could be obtained for other countries with an oil-driven economy. Considering that around 62% of the fossil fuel blend in Kuwait is consumed by electricity and water generation, it is inevitable to consider the possibility and practicality of having a carbon network with neighboring countries where other oil-driven economies, such as Kingdom of Saudi Arabia and Iraq, can utilize a CCS-based mega infrastructure in Kuwait. The choice of Kuwait is also logical due to being a mid-point between both countries and can initiate a trading scheme in oil derivatives with both countries.

Familial Risk of Inflammatory Bowel Disease: A Population-Based Cohort Study in South Korea

BACKGROUND & AIMS

Despite the rapid increase in inflammatory bowel disease (IBD), population-level familial risk estimates of IBDs still are lacking in Asian-Pacific countries. We aimed to quantify the familial risk of incident IBD among first-degree relatives (FDRs) of individuals with IBD according to age, sex, and familial relationship.

METHODS

Using the South Korea National Health Insurance database (2002-2017), which has complete population coverage and confirmed accuracy of both FDR information and IBD diagnoses, we constructed a cohort of 21,940,795 study subjects comprising 12 million distinct families. We calculated incidence risk ratios of ulcerative colitis (UC) or Crohn's disease (CD) in individuals of affected FDRs compared with individuals without affected FDRs.

RESULTS

Of 45,717 individuals with UC and 17,848 individuals with CD, 3.8% and 3.1% represented familial cases, respectively. Overall, there was a 10.2-fold (95% CI, 9.39-11.1) and a 22.1-fold (95% CI, 20.5-24.5) significantly higher adjusted risk of UC and CD among FDRs of individuals with vs without IBD. Familial risk was highest among twins, followed by nontwin siblings, and then offspring of affected parents. Familial risk generally was higher within generations (sibling-sibling) vs between generations (parent-offspring). Familial risk also increased with the increasing number of affected FDRs.

CONCLUSIONS

According to this population-based analysis, there is a substantially increased risk of IBD among FDRs of affected individuals, with the highest risk among siblings and for CD. These findings might help with an earlier diagnosis and appropriate therapeutic intervention in FDRs of individuals with IBD. Dedicated studies are needed to evaluate the contributions of shared early-in-life environmental exposures and genetic factors.

Economic Feasibility of Floating Offshore Wind Farms Considering Near Future Wind Resources: Case Study of Iberian Coast and Bay of Biscay

Wind energy resources are subject to changes in climate, so the use of wind energy density projections in the near future is essential to determine the viability and profitability of wind farms at particular locations. Thus, a step forward in determining the economic assessment of floating offshore wind farms was taken by considering current and near-future wind energy resources in assessing the main parameters that determine the economic viability (net present value, internal rate of return, and levelized cost of energy) of wind farms. This study was carried out along the Atlantic coast from Brest to Cape St. Vincent. Results show that the future reduction in wind energy density (2%–6%) mainly affects the net present value (NPV) of the farm and has little influence on the levelized cost of energy (LCOE). This study provides a good estimate of the economic viability of OWFs (Offshore Wind Farms) by taking into account how wind resources can vary due to climate change over the lifetime of the farm.

Probing Structure and Function of Alkali Sensor IRR with Monoclonal Antibodies

To study the structure and function of the pH-regulated receptor tyrosine kinase insulin receptor-related receptor (IRR), а member of the insulin receptor family, we obtained six mouse monoclonal antibodies against the recombinant IRR ectodomain. These antibodies were characterized in experiments with exogenously expressed full-length IRR by Western blotting, immunoprecipitation, and immunocytochemistry analyses. Utilizing a previously obtained set of IRR/IR chimeras with swapped small structural domains and point amino acid substitutions, we mapped the binding sites of the obtained antibodies in IRR. Five of them showed specific binding to different IRR domains in the extracellular region, while one failed to react with the full-length receptor. Unexpectedly, we found that 4D5 antibody can activate IRR at neutral pH, and 4C2 antibody can inhibit activation of IRR by alkali. Our study is the first description of the instruments of protein nature that can regulate activity of the orphan receptor IRR and confirms that alkali-induced activation is an intrinsic property of this receptor tyrosine kinase.

Economic Aspects of a Concrete Floating Offshore Wind Platform in the Atlantic Arc of Europe

The objective of this paper is to examine the economic aspects of a concrete offshore wind floating platform in the Atlantic Arc of Europe (Portugal and Spain). The life-cycle cost of a concrete floating offshore wind platform is considered to calculate the main economic parameters that will define the economic feasibility of the offshore wind farm. The case of study is the concrete floating offshore wind platform Telwind^®, a spar platform with a revolutionary way of installing using a self-erecting telescopic tower of the wind turbine. In addition, the study analyses thirteen locations in Spain and twenty in Portugal, including the Atlantic islands of both countries. Results indicate that the economically feasible location to install a concrete offshore wind farm composed of concrete platforms is the Canary Islands (Spain) and Flores (Portugal).

Cervical cytology reproducibility and associated clinical and demographic factors

BACKGROUND

Although the Pap test has been the standard screening method for cervical precancer/cancer detection, it has been criticized for having a relatively low sensitivity and a low reproducibility between pathologists. There is limited knowledge about inter-rater agreement and what clinical and demographic factors are associated with disagreements between pathologists reading the same Pap smear.

METHODS

This study aimed to assess inter- and intra- rater agreement of the Pap smear in 1619 cytologic slides with biopsy confirmation, using kappa statistics. Clinical and demographic factors associated with higher odds of inter-rater agreement were also examined and stratified by histologic diagnosis grade.

RESULTS

Using a five grade classification system, the overall kappa statistics for total, inter-rater, and intra-rater samples were 0.62, 0.57, and 0.88 (unweighted) and 0.83, 0.81, and 0.95 (weighted), respectively. In stratified analyses by histologic grade, total kappas ranged from 0.40 (atypia) to 0.64 (human papilloma virus/CIN 1). Factors such as referral for abnormal Pap test (diagnostic vs screening population), recruiting site, and parity were found to be associated with higher agreement between the two cytologic readings.

CONCLUSIONS

We observed relatively higher levels of agreement compared with other studies. However, variability was considerable and agreement was generally moderate, suggesting that cervical screening test accuracy and reproducibility needs to be improved.

A Mathematical Model for the Effect of Low-Dose Radiation on the G2/M Transition

We develop a mathematical model to study the immediate effect of low-dose radiation on the G2 checkpoint and the G2/M transition of the cell cycle via a radiation pathway (the ATM-Chk2 pathway) of an individual mammalian cell. The model consists of a system of nonlinear differential equations describing the dynamics of a network of regulatory proteins that play key roles in the G2/M transition, cell cycle oscillations, and the radiation pathway. We simulate the application of a single pulse of low-dose radiation at different intensities ([Formula: see text] 0-0.4 Gy) and times during the latter part of the G2-phase. We use bifurcation analysis to characterize the effect of radiation on the G2/M transition via the ATM-Chk2 pathway. We show that radiation between 0.1 and 0.3 Gy can delay the G2/M transition, and radiation higher than 0.3 Gy can fully activate the G2 checkpoint. Also, our results show that radiation can be low enough to neither delay the G2/M transition nor activate the G2 checkpoint ([Formula: see text] 0.1 Gy). Our model supports the idea that the cell response to radiation during G2-phase explains hyper-radiosensitivity and increased radioresistance (HRS/IRR) observed at low dose.

Evaluating inter-rater reliability of indicators to assess performance of medicines management in health facilities in Uganda

Background

To build capacity in medicines management, the Uganda Ministry of Health introduced a nationwide supervision, performance assessment and recognition strategy (SPARS) in 2012. Medicines management supervisors (MMS) assess performance using 25 indicators to identify problems, focus supervision, and monitor improvement in medicines stock and storage management, ordering and reporting, and prescribing and dispensing. Although the indicators are well-recognized and used internationally, little was known about the reliability of these indicators. An initial assessment of inter-rater reliability (IRR), which measures agreement among raters (i.e., MMS), showed poor IRR; subsequently, we implemented efforts to improve IRR. The aim of this study was to assess IRR for SPARS indicators at two subsequent time points to determine whether IRR increased following efforts to improve reproducibility.

Methods

IRR was assessed in 2011 and again after efforts to improve IRR in 2012 and 2013. Efforts included targeted training, providing detailed guidelines and job aids, and refining indicator definitions and response categories. In the assessments, teams of three MMS measured 24 SPARS indicators in 26 facilities. We calculated IRR as a team agreement score (i.e., percent of the MMS teams in which all three MMS had the same score). Two sample tests for proportions were used to compare IRR scores for each indicator, domain, and overall for the initial assessment and the following two assessments. We also compared the IRR scores for indicators classified as simple (binary) versus complex (multi-component). Logistic regression was used to identify supervisor group characteristics associated with domain-specific and overall IRR scores.

Results

Initially only five (21%) indicators had acceptable reproducibility, defined as an IRR score ≥ 75%. At the initial assessment, prescribing quality indicators had the lowest and stock management indicators had the highest IRR. By the third IRR assessment, 12 (50%) indicators had acceptable reproducibility, and the overall IRR score improved from 57% to 72%. The IRR of simple indicators was consistently higher than that of complex indicators in the three assessment periods. We found no correlation between IRR scores and MMS experience or professional background.

Conclusions

Assessments of indicator reproducibility are needed to improve IRR. Using simple indicators is recommended.

Energy demand analysis via small scale hydroponic systems in suburban areas - An integrated energy-food nexus solution

The study is a qualitative approach and looks into new ways for the effective energy management of a wind farm (WF) operation in a suburban or near-urban environment in order the generated electricity to be utilised for hydroponic farming purposes as well. Since soilless hydroponic indoor systems gain more and more attention one basic goal, among others, is to take advantage of this not typical electricity demand and by managing it, offering to the grid a less fluctuating electricity generation signal. In this paper, a hybrid business model is presented where the Distributed Energy Resources (DER) producer is participating in the electricity markets under competitive processes (spot market, real-time markets etc.) and at the same time acts as a retailer offering - based on the demand - to the hydroponic units for their mass deployment in an area, putting forward an integrated energy-food nexus approach.

Combination Treatment of Glioblastoma by Low-Dose Radiation and Genistein

PURPOSE

Gioblastoma multiforme as a chemoresistant and radioresistant malignant cell line needs to novel strategies to treatment. Low-dose hyper-radiosensitivity (LDHRS) seems to be an effective phenomenon to irradiation that can save normal brain fibroblasts. Genistein which is a soy isoflavone can be cytotoxic in some tumor cell lines. So we determined to study the effect of combining these two treatment modalities.

MATERIALS AND METHODS

After 30 hours incubation with Genistein in different concentrations on U87MG cell line, proliferation and clonogenicity were conducted by both clonogenic and MTT assays. A conventional 2Gy radiation dose was compared with 10 doses of 0.2Gy gamma irradiation with 3 minutes and 1 hour intervals. Finally, concurrent effect of these modalities was assessed.

RESULTS

Based on acquired cell doubling time (30 hours), one doubling time treatment by Genistein could decrease clonogenicity. U87MG cell line exhibited HRS at low dose irradiations. 2Gy irradiation was more effective than ultra-fractionation methods in comparison with control group. All groups with 50uM concentration of Genistein showed decrease in the survival. This decrease compared with control group, in 10x0.2Gy with 3 minutes intervals plus 50uM Genistein was significant and for groups with the same dose of Genistein but along with continuous 2Gy was more significant.

CONCLUSION

In one day treatment regimen, 10x0.2Gy ultra-fractionation with 3 minutes and 1 hour intervals seems to be less effective than conventional 2Gy irradiation, however adding 50uM Genistein can decrease survival more. Although 2Gy conventional dose plus 50uM Genistein was the most effective regimen.

Longer Withdrawal Time Is Associated With a Reduced Incidence of Interval Cancer After Screening Colonoscopy

BACKGROUND & AIMS

Withdrawal times and adenoma detection rates are widely used quality indicators for screening colonoscopy. More rapid withdrawal times have been associated with undetected adenomas, which can increase risk for interval colorectal cancer.

METHODS

We analyzed records of 76,810 screening colonoscopies performed between 2004 and 2009, by 51 gastroenterologists practicing in Minneapolis and St Paul, MN. Colonoscopy records were linked electronically to the state cancer registry (Minnesota Cancer Surveillance System) to identify incident interval cancers that were diagnosed within 5.5 years after the screening examination.

RESULTS

The physicians' mean ± SD withdrawal time was 8.6 ± 1.7 minutes and adenoma detection rates were 25% ± 9%. Longer mean withdrawal times were associated with higher adenoma detection rates (3.6% per minute; 95% confidence interval: 2.4% to 4.8%; P < .0001). We identified 78 cancers during 410,687 person-years of follow-up, for an annual rate of 0.19/1000 person-years. Physicians' mean annual withdrawal times were inversely associated with cancer incidence (P < .0001). Compared with withdrawal times ≥6 minutes, the adjusted incidence rate ratio for withdrawal times of <6 minutes was 2.3 (95% confidence interval: 1.5-3.4; P < .0001).

CONCLUSIONS

Shorter mean annual withdrawal times during screening colonoscopies were independently associated with lower adenoma detection rates and increased risk of interval colorectal cancer.

ATR signaling cooperates with ATM in the mechanism of low dose hypersensitivity induced by carbon ion beam

Little work has been done on the mechanism of low dose hyper-radiosensitivity (HRS) and later appeared radioresistance (termed induced radioresistance (IRR)) after irradiation with medium and high linear energy transfer (LET) particles. The aim of this study was to find out whether ATR pathway is involved in the mechanism of HRS induced by high LET radiation. GM0639 cells and two ATM deficient/mutant cells, AT5BIVA and AT2KY were irradiated by carbon ion beam. Thymidine block technique was developed to enrich the G2-phase population. Radiation induced early G2/M checkpoint was quantitatively assess with dual-parameter flow cytometry by detecting the cells positive for phospho-histone H3. The involvement of ATR pathway in HRS/IRR response was detected with pretreatment of specific inhibitors prior to carbon ion beam. The link between the early G2/M checkpoint and HRS/IRR under carbon ion beam was first confirmed in GM0639 cells, through the enrichment of cell population in G2-phase or with Aurora kinase inhibitor that attenuates the transition from G2 to M phase. Interestingly, the early G2/M arrest could still be observed in ATM deficient/mutant cells with an effect of ATR signaling, which was discovered to function in an LET-dependent manner, even as low as 0.2Gy for carbon ion radiation. The involvement of ATR pathway in heavy particles induced HRS/IRR was determined with the specific ATR inhibitor in GM0639 cells, which affected the HRS/IRR occurrence similarly as ATM inhibitor. These data demonstrate that ATR pathway may cooperate with ATM in the mechanism of low dose hypersensitivity induced by carbon ion beam.

Hospital-associated venous thromboembolism in children: incidence and clinical characteristics

OBJECTIVE

To determine incidence and clinical characteristics of hospital-associated venous thromboembolism (VTE) in pediatric patients.

STUDY DESIGN

A retrospective analysis of patients with hospital-associated VTE at the Johns Hopkins Hospital from 1994 to 2009 was performed. Clinical characteristics of patients aged 21 years and younger who developed VTE symptoms after 2 days of hospitalization or <90 days after hospital discharge were examined. International Classification of Diseases, Ninth Revision codes were used to categorize patients with complex chronic medical conditions and trauma.

RESULTS

There were 270 episodes of hospital-associated VTE in 90,485 admissions (rate 30 per 10,000 admissions). Young adults (18-21 years) and adolescents (14-17 years) had significantly increased rates of VTE compared with children (2-9 years) (incidence rate ratio [IRR] 7.7, 95% CI 5.1-12.0; IRR 4.3, 95% CI 2.7-6.8, respectively). A central venous catheter (CVC) was present in 50% of patients, and a surgical procedure was performed in 45% of patients before VTE diagnosis. For patients without a CVC, trauma was the most common admitting diagnosis. CVC-related VTE was diagnosed most frequently in infants (<1 year old) and in patients with malignancy. Renal and cardiac diseases were associated with the highest rates of VTE (51 and 48 per 10,000, respectively). Rates were significantly higher among those with ≥ 4 medical conditions compared with those with 1 medical condition (IRR 4.0, 95% CI 1.4-8.9).

CONCLUSION

Older age and multiple medical conditions were associated with increased rates of hospital-associated VTE. These data can contribute to the design of future clinical trials to prevent hospital-associated VTE in high-risk children.

Inflammatory bowel disease is associated with an increased risk of melanoma: a systematic review and meta-analysis

BACKGROUND & AIMS

Inflammatory bowel disease (IBD) has been associated with an increased risk of nonmelanoma skin cancer, particularly among patients treated with thiopurines. It is unclear whether IBD affects risk for melanoma. We performed a systematic review and meta-analysis of cohort studies to determine the risk of melanoma in patients with IBD.

METHODS

We conducted a systematic search of bibliographic databases through March 2013. Cohort studies reporting incident melanoma after IBD diagnosis and an estimate of incidence rate ratio or standardized incidence rate were included in the analysis. Pooled relative risk (RR) estimates with 95% confidence intervals (CIs) were calculated using the random-effects model.

RESULTS

Our analysis included 12 studies, comprising a total of 172,837 patients with IBD; 179 cases of melanoma were reported from 1940 to 2009. The pooled crude incidence rate of melanoma in patients with IBD was 27.5 cases/100,000 person-years (95% CI, 19.9-37.0). Overall, IBD was associated with a 37% increase in risk of melanoma (12 studies: RR, 1.37; 95% CI, 1.10-1.70). The risk was increased among patients with Crohn's disease (7 studies: RR, 1.80; 95% CI, 1.17-2.75) and ulcerative colitis (7 studies: RR, 1.23; 95% CI, 1.01-1.50). The risk of melanoma was higher in studies performed before introduction of biologic therapies (before 1998) (8 studies: RR, 1.52; 95% CI, 1.02-2.25) but not in studies performed after 1998 (2 studies: RR, 1.08; 95% CI, 0.59-1.96).

CONCLUSIONS

Based on a meta-analysis, IBD has been associated with an increased risk of melanoma, independent of the use of biologic therapy. Patients diagnosed with IBD should be counseled on their risk for melanoma.

Early initiation of enzyme replacement therapy for the mucopolysaccharidoses

The mucopolysaccharidoses (MPS), a group of rare genetic disorders caused by defects in glycosaminoglycan (GAG) catabolism, are progressive, multi-systemic diseases with a high burden of morbidity. Enzyme replacement therapy (ERT) is available for MPS I, II, and VI, and may improve walking ability, endurance, and pulmonary function as evidenced by data from pivotal trials and extension studies. Despite these demonstrable benefits, cardiac valve disease, joint disease, and skeletal disease, all of which cause significant morbidity, do not generally improve with ERT if pathological changes are already established. Airway disease improves, but usually does not normalize. These limitations can be well understood by considering the varied functions of GAG in the body. Disruption of GAG catabolism has far-reaching effects due to the triggering of secondary pathogenic cascades. It appears that many of the consequences of these secondary pathogenic events, while they may improve on treatment, cannot be fully corrected even with long-term exposure to enzyme, thereby supporting the treatment of patients with MPS before the onset of clinical disease. This review examines the data from clinical trials and other studies in human patients to explore the limits of ERT as currently used, then discusses the pathophysiology, fetal tissue studies, animal studies, and sibling reports to explore the question of how early to treat an MPS patient with a firm diagnosis. The review is followed by an expert opinion on the rationale for and the benefits of early treatment.

Prevention of interval colorectal cancers: what every clinician needs to know

Colonoscopic screening and surveillance have been very effective tools in the fight against colorectal cancer (CRC). Colonoscopy is more than a cancer screening test; it also can prevent CRC by detecting and removing precancerous lesions. Despite this potential, there has been increasing concern about CRCs that occur after a previous colonoscopy and before the next screening/surveillance examination (interval CRCs). The etiology of interval CRC is thought to be caused mostly by missed or incompletely resected lesions on index colonoscopy with some contribution of rapidly progressive new lesions. If this is true, many interval cancers should be preventable by improving colonoscopy technique. There are a variety of strategies to decrease interval CRC rates including use of a split-dosed bowel preparation, optimizing withdrawal technique, ensuring complete polypectomy, and careful pathologic examination of the tissue removed. Furthermore, there should be an increased emphasis on how endoscopists are trained to cultivate high-quality technique throughout their careers. It is important to inform patients that even high-quality colonoscopy is not perfectly sensitive for the detection of advanced neoplasia. Improving colonoscopy quality can decrease interval CRC rates and further decrease CRC incidence and mortality.

Health care service utilization and associated factors among heroin users in northern Taiwan

Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2 ± 8.3 years) who entered two psychiatric hospitals (N = 83) and a detention center (N = 41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12 months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit.

Association between enhanced access services in pediatric primary care and utilization of emergency departments: a national parent survey

OBJECTIVES

To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization.

STUDY DESIGN

Internet-based survey of a national sample of parents (n = 820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariable negative binomial regression to assess associations between enhanced access services and ED use.

RESULTS

The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Less than one-half of parents reported access to their child's primary care office on weekends (47%), after 5:00 p.m. on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7%-56%, depending on service). Office hours after 5:00 p.m. on ≥ 5 nights a week was the only service significantly associated with ED utilization in multivariable analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]).

CONCLUSIONS

The majority of parents report enhanced access to their child's primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce ED use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.

Molecular cloning and characterization of SL3: a stem cell-specific SL RNA from the planarian Schmidtea mediterranea

Spliced leader (SL) trans-splicing is a biological phenomenon, common among many metazoan taxa, consisting in the transfer of a short leader sequence from a small SL RNA to the 5' end of a subset of pre-mRNAs. While knowledge of the biochemical mechanisms driving this process has accumulated over the years, the functional consequences of such post-transcriptional event at the organismal level remain unclear. In addition, the fact that functional analyses have been undertaken mainly in trypanosomes and nematodes leaves a somehow fragmented picture of the possible biological significance and evolution of SL trans-splicing in eukaryotes. Here, we analyzed the spatial expression of SL RNAs in the planarian flatworm Schmidtea mediterranea, with the goal of identifying novel developmental paradigms for the study of trans-splicing in metazoans. Besides the previously identified SL1 and SL2, S. mediterranea expresses a third SL RNA described here as SL3. While, SL1 and SL2 are collectively expressed in a broad range of planarian cell types, SL3 is highly enriched in a subset of the planarian stem cells engaged in regenerative responses. Our findings provide new opportunities to study how trans-splicing may regulate the phenotype of a cell.

Imaging Plasmodium immunobiology in the liver, brain, and lung

Plasmodium falciparum malaria is responsible for the deaths of over half a million African children annually. Until a decade ago, dynamic analysis of the malaria parasite was limited to in vitro systems with the typical limitations associated with 2D monocultures or entirely artificial surfaces. Due to extremely low parasite densities, the liver was considered a black box in terms of Plasmodium sporozoite invasion, liver stage development, and merozoite release into the blood. Further, nothing was known about the behavior of blood stage parasites in organs such as the brain where clinical signs manifest and the ensuing immune response of the host that may ultimately result in a fatal outcome. The advent of fluorescent parasites, advances in imaging technology, and availability of an ever-increasing number of cellular and molecular probes have helped illuminate many steps along the pathogenetic cascade of this deadly tropical parasite.

Identification of quality of care deficiencies in elderly surgical patients by measuring adherence to process-based quality indicators

BACKGROUND

The ability to measure surgical quality of care is important and can lead to improvements in patient safety. As such, processes should be carried out in an identical fashion for all patients, regardless of how vulnerable or complex they are. Our objectives were to assess quality of surgical care delivered to elderly patients and to determine the association between patient characteristics and quality of care.

STUDY DESIGN

This is a retrospective pilot cohort study, conducted in a single university-affiliated hospital. Using the institution's National Surgical Quality Improvement Program (NSQIP) database (2009 to 2010), 143 consecutive patients 65 years or older, undergoing elective major abdominal surgery, were selected. Adherence to 15 process-based quality indicators (QIs) was measured, and a pass rate was calculated for each individual QI. The association between patient characteristics (age, sex, Charlson Comorbidity Index, functional status, wound class) and patient quality score was assessed using multiple linear regression.

RESULTS

Quality indicators with the lowest pass rates included postoperative delirium screening (0%), level of care documentation (0.7%), cognition and functional assessment at discharge (4.9%), oral intake documentation (12.6%), and pressure ulcer risk assessment (35.0%). The mean patient quality score was 46.8% ± 10.7% (range 16.7% to 75.0%). No association was found between patient characteristics and patient quality score.

CONCLUSIONS

Quality of care delivered to elderly patients undergoing major surgery at our institution was generally poor and independent of patient characteristics. Although quality appears to be uniform across different patients, these results provide targets for quality improvement initiatives.

Evaluating hippocampal internal architecture on MRI: inter-rater reliability of a proposed scoring system

BACKGROUND

Asymmetry of hippocampal internal architecture (HIA) has been reported to be a frequent imaging finding in epilepsy patients with temporal lobe epilepsy (TLE) who exhibit other signs of hippocampal sclerosis. HIA asymmetry may also be an independent predictor of the side of seizure onset in patients with otherwise normal MRI scans. The study of HIA asymmetry and its relationship to the laterality of TLE would benefit from a reliable method of assessing the clarity of HIA in MRI scans. We propose a visual scoring system that rates HIA clarity from 1 (imperceptible) to 4 (excellent) and report the inter-rater reliability (IRR) of this system.

METHODS

In the initial preliminary phase of this study we examined IRR using a kappa statistic (κ) among a mixed group of expert and non-expert reviewers using only a brief description of the scoring system to score single images from a series of patients. In the second phase we explored the effect of training on the use of our HIA scoring system by assessing IRR among neuroimaging experts before and after a brief interactive training session. In this phase, multiple slices from each patient were scored. Separate κ values and intraclass correlation coefficients (ICC) were calculated from the scores given to each hippocampal image and from the asymmetry of scores between left and right for each slice. In the third phase the effect of training on non-expert reviewers was explored using a similar approach as with the expert reviewers.

RESULTS

In the preliminary phase of the study, HIA scoring of single images showed substantial agreement among expert reviewers (κHIA=0.65), fair agreement among non-expert reviewers (κHIA=0.27), and a fair to moderate degree of agreement among all the reviewers as a whole (κHIA=0.40). In the second phase, prior to training there was substantial agreement among expert reviewers in regard to the individual HIA scores (κHIA=0.62; ICCHIA=0.81) but only moderate agreement on the degree of asymmetry (κAsym=0.47; ICCAsym=0.71). Training improved agreement on the individual HIA scores (κHIA=0.58-0.72; ICCHIA=0.76-0.84) and on the degree of asymmetry (κAsym=0.61-0.67; ICCAsym=0.81-0.85). Among non-expert reviewers, scores improved from only a fair degree of agreement pre-training (κHIA=0.25, κAsym=0.25; ICCHIA=0.68, ICCAsym=0.66) to a moderate level of agreement after training (κHIA=0.54, κAsym=0.52; ICCHIA=0.78, ICCAsym=0.81).

CONCLUSIONS

The proposed HIA scoring system has a substantial degree of inter-rater reliability among experienced neuroimaging reviewers. Training improves the detection of asymmetries in HIA score in particular. Non-expert reviewers can employ the system with a moderate degree of reliability, and training has an even greater impact on the improvement of scoring reliability.

Does hepatitis C viremia or genotype predict the risk of mortality in individuals co-infected with HIV?

BACKGROUND & AIMS

The influence of HCV-RNA levels and genotype on HCV disease progression is not well studied. The prognostic value of these markers was investigated in HIV/HCV co-infected individuals from the EuroSIDA cohort.

METHODS

EuroSIDA is a prospective cohort of 18,295 HIV-1 infected patients in 105 centres across Europe, Israel, and Argentina. All subjects with known HCV antibody (HCVAb) status (n=13,025) were enrolled in the present study.

RESULTS

4044 (31.0%) patients had detectable HCVAb. After adjustment, HCVAb+ patients had an increased incidence of liver-related death (LRD) compared to HCVAb- individuals (IRR 8.90; 95% CI 5.60-14.14, p<0.0001). Information on HCV-RNA was available for 2709 (67.0%) HCVAb+ patients and 2010 (74.2%) were HCV-RNA+. Of 1907 patients with measured HCV genotype, 1008 (52.9%), 62 (3.3%), 567 (29.7%), and 270 (14.2%) were infected with genotype 1, 2, 3 and 4, respectively. Patients with detectable HCV-RNA had similar incidence of non-LRD, but higher incidence of LRD compared to HCVAb+ aviremic patients (adjusted IRR 1.18; 95% CI 0.93-1.50, p=0.17) and (adjusted IRR 2.11; 95% CI 1.30-3.42, p=0.0025), respectively. In patients with HCV viremia, HCV-RNA levels and HCV genotype did not influence the risk of non-LRD or LRD.

CONCLUSIONS

HCV seropositive HIV patients had a 9-fold increased risk of LRD compared to patients who were HCV seronegative. Risk of death from any cause or LRD was not influenced by level of HCV viremia or HCV genotype.

Do rehospitalization rates differ among injury severity levels in the NIDRR Traumatic Brain Injury Model Systems program?

OBJECTIVE

To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.

DESIGN

Prospective observational study.

SETTING

Inpatient rehabilitation within TBIMS with annual follow-up.

PARTICIPANTS

Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.

RESULTS

The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.

CONCLUSIONS

Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management.

Can an airway challenge test predict respiratory diseases? A population-based international study

BACKGROUND

Evidence on the longitudinal association of airway responsiveness with respiratory diseases is scarce. The best indicator of responsiveness is still undetermined.

OBJECTIVE

We investigated the association of airway responsiveness with the incidence of asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis.

METHODS

We studied 3851 subjects who underwent spirometry and methacholine challenge tests both at baseline (1991-1993), when they were 20 to 44 years old, and at follow-up (1999-2002) in the European Community Respiratory Health Survey. Airway responsiveness was defined based on the methacholine dose-response slope on both occasions. Incidence rate ratios for the association of airway responsiveness with disease occurrence were computed by using Poisson regression.

RESULTS

With respect to reference (slope of the fourth quintile or greater), subjects with the greatest degree of airway responsiveness (slope less than the first quintile) showed the greatest risk of developing asthma, COPD, and allergic rhinitis (incidence rate ratios of 10.82, 5.53, and 4.84, respectively; all P < .01). A low slope predicted disease occurrence, even in subjects who did not reach a 20% decrease in FEV1 at the cumulative dose of 1 mg of methacholine (PD20 >1 mg). A decrease in slope over time was an independent predictor of disease risk.

CONCLUSION

Airway responsiveness predicted new-onset asthma, COPD, and allergic rhinitis. Our study supports the use of a continuous noncensored indicator of airway responsiveness, such as the slope of the methacholine dose-response curve, in clinical practice and research because it showed clear advantages over PD20.

Deficient Response to Experimentally Induced Alkalosis in Mice with the Inactivated insrr Gene

Currently, the molecular mechanisms of the acid-base equilibrium maintenance in the body remain poorly understood. The development of alkalosis under various pathological conditions poses an immediate threat to human life. Understanding the physiological mechanisms of alkalosis compensation may stimulate the development of new therapeutic approaches and new drugs for treatment. It was previously shown that the orphan insulin receptor-related receptor (IRR) is activated by mildly alkaline media. In this study, we analyzed mutant mice with targeted inactivation of theinsrr gene encoding IRR, and revealed their phenotype related to disorders of the acid-base equilibrium. Higher concentrations of bicarbonate and CO(2)were found in the blood ofinsrr knockout mice in response to metabolic alkalosis.