Quality assurance for patients with head injuries admitted to a regional trauma unit.

PubMed

Schwartz, M L; Sharkey, P W; Andersen, J A

1991-07-01

The efficacy of trauma systems in reducing preventable deaths has been established but the methods of auditing care are still evolving. Various "audit filters" to identify which patients' charts should be reviewed have been proposed. An analysis of all patients admitted to the Regional Trauma Unit (RTU) over a 19-month period was conducted. Of 729 patients, 135 were identified as having suffered a traumatic intracranial hemorrhage (TICH). On review, neither delay in transfer from the emergency room to the operating room nor increasing time from the incident to the operating room correlated with increasing mortality. In contrast to delay, the Glasgow Coma Scale (GCS) score on admission correlated well with outcome. The charts of patients with anomalous outcomes based on admission GCS score were reviewed, and two possibly preventable deaths were identified. There were 48 patients with TICH who had no operations but there were no deaths attributable to a missed operation. There were 76 patients for whom the GCS score at the referring hospital and the GCS score on admission to the RTU were available. Seven of 19 patients who worsened on transfer declined because of significant pulmonary injuries. Anomalous outcomes based on admission GCS score and declining GCS scores are recommended as quality assurance filters.

Effect of private versus emergency medical systems transportation in motor vehicle accident victims: Trauma Center Experience in Saudi Arabia.

PubMed

Alshahrani, Mohammed S

2017-01-01

To assess the effect of the mode of transportation of trauma patients (emergency medical service [EMS] vs. non-EMS) on their final clinical outcome in terms of mortality and length of hospital stay. A retrospective study included all patients who were involved in motor vehicle crashes, and who were transferred immediately to an emergency department of a trauma care center from December 2008 to December 2012. Patients were classified into two groups: those brought through EMS and those brought by non-EMS (private transport). Information on demographic characteristics including age and gender was recorded and medical data such as blood pressure, pulse, oxygen saturation, temperature, initial Glasgow Coma Score (GCS), saturation, temperature, initial Glasgow Coma Score (GCS), injury severity score (ISS), and final outcome (discharged or expired) were obtained. Descriptive statistics, mean and standard deviation (SD) were computed for continuous variables and statistical significance was tested by t -test or Mann-Whitney U-test. Categorical variables were described by frequency distribution and percentages; Chi-square or Fisher's exact test as appropriate were employed to test for statistical significance. Logistics regression was performed with mortality as dependent variable and mode of transport and all demographic and prehospital variables as independent variables. A general linear model analysis was performed to test whether the mode of transport was significant to length of hospital stay in EMS and non-EMS clients. Out of 308 patients identified during the study period, 232 were transported through EMS and 76 through non-EMS. The two groups were similar with regard to mortality and length of stay. The crude mortality rate was 30.6% (95% confidence interval [CI]: 24.64-36.53) in the EMS group and 28.9% (95% CI: 18.44-38.76) in the non-EMS group ( p = 0.785). The average length of hospital stay was 9 days (interquartile range [IQR] = 8, 95% CI: 7.3-10.1) for the EMS group and 8 days (IQR = 9.5, 95% CI: 6.7-10.9) for the non-EMS group ( p = 0.803). Multivariate analysis showed that of the study variables, only the injury severity score (ISS) and Glasgow coma score (GCS) were significant to mortality ( p < 0.01), and GCS was more significant to the length of hospital stay ( p < 0.01). There was no significant difference between the EMS and non-EMS groups as they relate to mortality and length of stay in hospital. However, the mortality and length of hospital stay was statistically significant to ISS and GCS.

Effect of Age on Glasgow Coma Scale in Patients with Moderate and Severe Traumatic Brain Injury: An Approach with Propensity Score-Matched Population.

PubMed

Rau, Cheng-Shyuan; Wu, Shao-Chun; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Kuo, Pao-Jen; Hsieh, Ching-Hua

2017-11-13

Background: The most widely used methods of describing traumatic brain injury (TBI) are the Glasgow Coma Scale (GCS) and the Abbreviated Injury Scale (AIS). Recent evidence suggests that presenting GCS in older patients may be higher than that in younger patients for an equivalent anatomical severity of TBI. This study aimed to assess these observations with a propensity-score matching approach using the data from Trauma Registry System in a Level I trauma center. Methods: We included all adult patients (aged ≥20 years old) with moderate to severe TBI from 1 January 2009 to 31 December 2016. Patients were categorized into elderly (aged ≥65 years) and young adults (aged 20-64 years). The severity of TBI was defined by an AIS score in the head (AIS 3‒4 and 5 indicate moderate and severe TBI, respectively). We examined the differences in the GCS scores by age at each head AIS score. Unpaired Student's t - and Mann-Whitney U -tests were used to analyze normally and non-normally distributed continuous data, respectively. Categorical data were compared using either the Pearson chi-square or two-sided Fisher's exact tests. Matched patient populations were allocated in a 1:1 ratio according to the propensity scores calculated using NCSS software with the following covariates: sex, pre-existing chronic obstructive pulmonary disease, systolic blood pressure, hemoglobin, sodium, glucose, and alcohol level. Logistic regression was used to evaluate the effects of age on the GCS score in each head AIS stratum. Results: The study population included 2081 adult patients with moderate to severe TBI. These patients were categorized into elderly ( n = 847) and young adults ( n = 1234): each was exclusively further divided into three groups of patients with head AIS of 3, 4, or 5. In the 162 well-balanced pairs of TBI patients with head AIS of 3, the elderly demonstrated a significantly higher GCS score than the young adults (14.1 ± 2.2 vs. 13.1 ± 3.3, respectively; p = 0.002). In the 362 well-balanced pairs of TBI patients with head AIS of 4, the elderly showed a significantly higher GCS score than the young adults (13.1 ± 3.3 vs. 12.2 ± 3.8, respectively; p = 0.002). In the 89 well-balance pairs of TBI patients with head AIS of 5, no significant differences were observed for the GCS scores. Conclusions: This study demonstrated that elderly patients with moderate TBI present higher GCS score than younger patients. This study underscores the importance of determining of TBI severity in this group of elderly patients based on the GCS score alone. A lower threshold of GCS cutoff should be adopted in the management of the elderly patients with TBI.

The 90-day prognostic value of serum cyclophilin A in traumatic brain injury.

PubMed

Jin, Hang-Huang; Mao, Tian-Ming; Bai, Zhi-Qiang; Chen, Yuan; Ji, Hai-Long; Jin, Yong

2018-06-07

Cyclophilin A is involved in many inflammatory diseases and its expression is up-regulated after brain injury. We determined if serum cyclophilin A could be used as a marker for severity and 90-day outcome in patients with traumatic brain injury (TBI). Serum cyclophilin A concentrations were quantified in 105 severe TBI patients and 105 healthy individuals. Its association with Glasgow Coma Scale (GCS) score, 90-day mortality and 90-day poor outcome (Glasgow Outcome Scale score of 1-3) were investigated. Serum cyclophilin A concentrations were significantly higher in TBI patients than in healthy individuals. Cyclophilin A concentrations had a close relation to GCS scores and showed a high discriminatory ability for 90-day mortality and poor outcome according to area under receiver operating characteristic curve (AUC). Its AUC was in the range of GCS scores. Moreover, its combination with GCS scores significantly improved the predictive performance of GCS scores alone. In addition, serum cyclophilin A emerged as an independent predictor for 90-day mortality, overall survival and poor outcome. Increased serum cyclophilin A concentrations could reflect trauma severity and unfavorable outcome after head trauma, substantializing cyclophilin A as a potential biomarker for prognostic prediction of TBI. Copyright © 2018 Elsevier B.V. All rights reserved.

Traumatic acute subdural haematomas of the posterior fossa: clinicoradiological analysis of 24 patients.

PubMed

d'Avella, D; Servadei, F; Scerrati, M; Tomei, G; Brambilla, G; Massaro, F; Stefini, R; Cristofori, L; Conti, A; Cardali, S; Tomasello, F

2003-12-01

We report 24 patients with a traumatic acute subdural haematoma of the posterior fossa managed between 1997 and 1999 at 8 Italian neurosurgical centres. Each centre provided data about patients' clinico-radiological findings, management, and outcomes, which were retrospectively reviewed. A poor result occurred in 14 patients (58.3%). Ten patients (41.7%) had favourable results. Patients were divided into two groups according to their admission Glasgow Coma Scale (GCS) scores. In Group 1 (12/24 cases; GCS score, > or =8), the outcome was favourable in 75% of cases. In Group 2 (12/12 cases; GCS score, <8), the outcome was poor in 91.6% of cases. Nineteen patients underwent posterior fossa surgery. Factors correlating to outcome were GCS score, status of the basal cisterns and the fourth ventricle, and the presence of supratentorial hydrocephalus. Multivariate analysis showed significant independent prognostic effect only for GCS score (P<0.05). acute posterior fossa subdural haematomas can be divided into two distinct groups: those patients admitted in a comatose state and those with a moderate/mild head injury on admission. Comatose patients present usually with signs of posterior fossa mass effect and have a high percentage of bad outcomes. On the contrary, patients admitted with a GCS of 8 or higher are expected to recover. In these patients the thickness of the haematoma (<1 cm) seems to be a guide to indicate surgical evacuation of the haematoma.

Disclosing genetic risk for coronary heart disease: effects on perceived personal control and genetic counseling satisfaction.

PubMed

Robinson, C L; Jouni, H; Kruisselbrink, T M; Austin, E E; Christensen, K D; Green, R C; Kullo, I J

2016-02-01

We investigated whether disclosure of coronary heart disease (CHD) genetic risk influences perceived personal control (PPC) and genetic counseling satisfaction (GCS). Participants (n = 207, age: 45-65 years) were randomized to receive estimated 10-year risk of CHD based on a conventional risk score (CRS) with or without a genetic risk score (GRS). Risk estimates were disclosed by a genetic counselor who also reviewed how GRS altered risk in those randomized to CRS+GRS. Each participant subsequently met with a physician and then completed surveys to assess PPC and GCS. Participants who received CRS+GRS had higher PPC than those who received CRS alone although the absolute difference was small (25.2 ± 2.7 vs 24.1 ± 3.8, p = 0.04). A greater proportion of CRS+GRS participants had higher GCS scores (17.3 ± 5.3 vs 15.9 ± 6.3, p = 0.06). In the CRS+GRS group, PPC and GCS scores were not correlated with GRS. Within both groups, PPC and GCS scores were similar in patients with or without family history (p = NS). In conclusion, patients who received their genetic risk of CHD had higher PPC and tended to have higher GCS. Our findings suggest that disclosure of genetic risk of CHD together with conventional risk estimates is appreciated by patients. Whether this results in improved outcomes needs additional investigation. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury.

PubMed

Nyam, Tee-Tau Eric; Ao, Kam-Hou; Hung, Shu-Yu; Shen, Mei-Li; Yu, Tzu-Chieh; Kuo, Jinn-Rung

2017-04-01

The aim of the study was to determine whether the Full Outline of UnResponsiveness (FOUR) score, which includes eyes opening (E), motor function (M), brainstem reflex (B), and respiratory pattern (R), can be used as an alternate method to the Glasgow Coma Scale (GCS) in predicting intensive care unit (ICU) mortality in traumatic brain injury (TBI) patients. From January 2015 to June 2015, patients with isolated TBI admitted to the ICU were enrolled. Three advanced practice nurses administered the FOUR score, GCS, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Therapeutic Intervention Scoring System (TISS) concurrently from ICU admissions. The endpoint of observation was mortality when the patients left the ICU. Data are presented as frequency with percentages, mean with standard deviation, or median with interquartile range. Each measurement tool used area under the receiver operating characteristic curve to compare the predictive power between these four tools. In addition, the difference between survival and death was estimated using the Wilcoxon rank sum test. From 55 TBI patients, males (72.73 %) were represented more than females, the mean age was 63.1 ± 17.9, and 19 of 55 observations (35 %) had a maximum FOUR score of 16. The overall mortality rate was 14.6 %. The area under the receiver operating characteristic curve was 74.47 % for the FOUR score, 74.73 % for the GCS, 81.78 % for the APACHE II, and 53.32 % for the TISS. The FOUR score has similar predictive power of mortality compared to the GCS and APACHE II. Each of the parameters-E, M, B, and R-of the FOUR score showed a significant difference between mortality and survival group, while the verbal and eye-opening components of the GCS did not. Having similar predictive power of mortality compared to the GCS and APACHE II, the FOUR score can be used as an alternative in the prediction of early mortality in TBI patients in the ICU.

Validation of the Chinese version of the FOUR score in the assessment of neurosurgical patients with different level of consciousness.

PubMed

Peng, Juan; Deng, Yingying; Chen, Fangyao; Zhang, Xiaomei; Wang, Xiaoyan; Zhou, Ying; Zhou, Hongzhen; Qiu, Binghui

2015-12-10

The Glasgow Coma Scale (GCS) is currently the most widely used scoring system for comatose patients. A decade ago, the Full Outline of Unresponsiveness (FOUR) score was devised to better capture four functional aspects of consciousness (eye, motor responses, brainstem reflexes, and respiration). This study aimed to validate the Chinese version of the FOUR score in patients with different levels of consciousness. The study had two phases: (1) translation of the FOUR score, and (2) assessment of its reliability and validity. The Chinese version of the FOUR score was developed according to a standardized protocol. One hundred-twenty consecutive patients with acute brain damage, admitted to Nanfang Hospital (Southern Medical University, Guangdong, China) from November 2014 to February 2015, were enrolled. The inter-rater agreement for the FOUR score and GCS was evaluated using intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were established to determine the scales' abilities to predict outcome. The rater agreement was excellent both for FOUR (ICC = 0.970; p < 0.001) and GCS (ICC = 0.958; p < 0.001). The FOUR score yielded an excellent test-retest reliability (ICC = 0.930; p < 0.001). Spearman's correlation coefficients between GCS and the FOUR score were high: r = 0.932, first rating; r = 0.887, second rating (all p < 0.001). Areas under the curve (AUC) for mortality were 0.834 (95 % CI, 0.740-0.928) and 0.815 (95 % CI, 0.723-0.908) for the FOUR score and GCS, respectively. The Chinese version of the FOUR score is a reliable scale for evaluating the level of consciousness in patients with acute brain injury.

Fish passage and abundance around grade control structures on incised streams

USGS Publications Warehouse

Thomas, J.T.; Papanicolaou, A.N.; Pierce, C.L.; Dermisis, D.C.; Litvan, M.E.; Larson, C.J.

2009-01-01

This paper summarizes research from separate studies of fish passage over weirs (Larson et al., 2004; Litvan, 2006; Litvan, et al., 2008a-c) and weir hydraulics (Papanicolaou and Dermisis, 2006; Papanicolaou and Dermisis, in press). Channel incision in the deep loess region of western Iowa has caused decreased biodiversity because streams have high sediment loads, altered flow regimes, lost habitat, and lost lateral connectivity with their former floodplains. In-stream grade control structures (GCS) are built to prevent further erosion, protect infrastructure, and reduce sediment loads. However, GCS can have a detrimental impact on fisheries abundance and migration, biodiversity, and longitudinal connectivity. Fish mark-recapture studies were performed on stretches of streams with and without GCS. GCS with vertical or 1:4 (rise/run) downstream slopes did not allow fish migration, but GCS with slopes ??? 1:15 did. GCS sites were characterized by greater proportions of pool habitat, maximum depths, fish biomass, slightly higher index of biotic integrity (IBI) scores, and greater macroinvertebrate abundance and diversity than non-GCS sites. After modification of three GCS, IBI scores increased and fish species exhibiting truncated distributions before were found throughout the study area. Another study examined the hydraulic performance of GCS to facilitate unimpeded fish passage by determining the mean and turbulent flow characteristics in the vicinity of the GCS via detailed, non-intrusive field tests. Mean flow depth (Y) and velocity (V) atop the GCS were critical for evaluating GCS performance. Turbulent flow measurements illustrated that certain GCS designs cause sudden constrictions which form eddies large enough to disorient fish. GCS with slopes ??? 1:15 best met the minimum requirements to allow catfish passage of a flow depth of ??? 0.31 m and a mean flow velocity of ??? 1.22 m/s. ?? 2009 ASCE.

A comparison of "life threatening injury" concept in the Turkish Penal Code and trauma scoring systems.

PubMed

Fedakar, Recep; Aydiner, Ahmet Hüsamettin; Ercan, Ilker

2007-07-01

To compare accuracy and to check the suitability of the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS) and the Trauma and Injury Severity Score (TRISS), the scoring systems widely used in international trauma studies, in the evaluation of the "life threatening injury" concept established by the Turkish Penal Code. The age, sex, type of trauma, type and localizations of wounds, GCS, RTS, ISS, NISS and TRISS values, the decision of life threatening injury of 627 trauma patients admitted to Emergency Department of the Uludag University Medical School Hospital in year 2003 were examined. A life-threatening injury was present in 35.2% of the cases examined. GCS, RTS, ISS, NISS and TRISS confirmed the decision of life threatening injury with percentages of 74.8%, 76.9%, 88.7%, 86.6% and 68.6%, respectively. The best cut-off point 14 was determined in the ISS system with 79.6% sensitivity and 93.6% specificity. All of the cases with sole linear skull fracture officially decided as life threatening injury had an ISS of 5, a NISS of 6 and the best scores of GCS (15), RTS (7.8408) and TRISS (100%). ISS and NISS appeared to be the best trauma scoring systems that can be used for the decision of life threatening injury, compared with GCS, RTS and TRISS. Thus, ISS and NISS can be acceptable for using the evaluation of the life threatening injury concept established by the Turkish Penal Code.

Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis.

PubMed

Pietraszek-Grzywaczewska, Iwona; Bernas, Szymon; Łojko, Piotr; Piechota, Anna; Piechota, Mariusz

2016-01-01

Scoring systems in critical care patients are essential for predicting of the patient outcome and evaluating the therapy. In this study, we determined the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scoring systems in the prediction of mortality in adult patients admitted to the intensive care unit (ICU) with severe purulent bacterial meningitis. We retrospectively analysed data from 98 adult patients with severe purulent bacterial meningitis who were admitted to the single ICU between March 2006 and September 2015. Univariate logistic regression identified the following risk factors of death in patients with severe purulent bacterial meningitis: APACHE II, SAPS II, SOFA, and GCS scores, and the lengths of ICU stay and hospital stay. The independent risk factors of patient death in multivariate analysis were the SAPS II score, the length of ICU stay and the length of hospital stay. In the prediction of mortality according to the area under the curve, the SAPS II score had the highest accuracy followed by the APACHE II, GCS and SOFA scores. For the prediction of mortality in a patient with severe purulent bacterial meningitis, SAPS II had the highest accuracy.

Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome.

PubMed

Skandsen, Toril; Kvistad, Kjell Arne; Solheim, Ole; Strand, Ingrid Haavde; Folvik, Mari; Vik, Anne

2010-09-01

In this prospective cohort study the authors examined patients with moderate to severe head injuries using MR imaging in the early phase. The objective was to explore the occurrence of diffuse axonal injury (DAI) and determine whether DAI was related to level of consciousness and patient outcome. One hundred and fifty-nine patients (age range 5-65 years) with traumatic brain injury, who survived the acute phase, and who had a Glasgow Coma Scale (GCS) score of 3-13 were admitted between October 2004 and August 2008. Of these 159 patients, 106 were examined using MR imaging within 4 weeks postinjury. Patients were classified into 1 of 3 stages of DAI: Stage 1, in which lesions were confined to the lobar white matter; Stage 2, in which there were callosal lesions; and Stage 3, in which lesions occurred in the dorsolateral brainstem. The outcome measure used 12 months postinjury was the Glasgow Outcome Scale-Extended (GOSE). Diffuse axonal injury was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS score was significantly lower in patients with "pure DAI" (median GCS Score 9) than in patients without DAI (median GCS Score 12; p < 0.001). The GCS score was related to outcome only in those patients with DAI (r = 0.47; p = 0.001). Patients with DAI had a median GOSE score of 7, and patients without DAI had a median GOSE score of 8 (p = 0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; p < 0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). Diffuse axonal injury was found in almost three-quarters of the patients with moderate and severe head injury who survived the acute phase. Diffuse axonal injury influenced the level of consciousness, and only in patients with DAI was GCS score related to outcome. Finally, DAI was a negative prognostic sign only when located in the brainstem.

Accuracy in identifying patients with loss of consciousness in a police-operated emergency call centre - first step in the chain of survival.

PubMed

Bach, A; Christensen, E F

2007-07-01

The first link in the 'chain of survival' is the activation of Emergency Medical Services (EMS). In the major part of Denmark, police officers operate the alarm 1-1-2 centre, including calls for EMS. Our aim was to study the police 1-1-2 operators' accuracy in identifying calls concerning patients with loss of consciousness as a key symptom of life-threatening conditions. 'Unconsciousness' was defined as patients with a Glasgow Coma Scale (GCS) score of < 9, scored by the on-scene anaesthesiologist from the Mobile Emergency Care Unit (MECU). This study was an observational cohort study based on data from the Police 1-1-2 Database and the Aarhus County Pre-hospital Database containing data from MECU cases during 6 months in 2004-05. Two thousand, three hundred and forty-three emergency calls with MECU dispatch were identified. In 1655 cases, both 1-1-2 data and the GCS score were recorded. Two hundred and ninety-five patients were found with a GCS score of < 9 at MECU arrival, 243 of whom were reported 'unconscious' by 1-1-2, giving a sensitivity of 82%. One thousand, three hundred and sixty patients were found with a GCS score of > or = 9, 972 of whom were reported 'awake', giving a specificity of 72%. The positive predictive value (percentage of patients found with a GCS score of < 9 at MECU arrival amongst patients reported as 'unconscious') was 39%. The accuracy was moderate with room for improvement. The positive predictive value was low, indicating over-triage of MECU.

Effects of grade control structures on fish passage, biological assemblages, and hydraulic environments in western Iowa streams: a multidisciplinary review

USGS Publications Warehouse

Thomas, J.T.; Culler, M.E.; Dermisis, D.C.; Pierce, Clay; Papanicolaou, A.N.; Stewart, T.W.; Larson, C.J.

2011-01-01

Land use changes and channelization of streams in the deep loess region of western Iowa have led to stream channel incision, altered flow regimes, increased sediment inputs, decreased habitat diversity and reduced lateral connectivity of streams and floodplains. Grade control structures (GCSs) are built in streams to prevent further erosion, protect infrastructure and reduce sediment loads. However, GCS can have a detrimental impact on fisheries and biological communities. We review three complementary biological and hydraulic studies on the effects of GCS in these streams. GCS with steep (≥1:4 rise : run) downstream slopes severely limited fish passage, but GCS with gentle slopes (≤1:15) allowed greater passage. Fish assemblages were dominated by species tolerant of degradation, and Index of Biotic Integrity (IBI) scores were indicative of fair or poor biotic integrity. More than 50% of fish species had truncated distributions. After modification of GCS to reduce slopes and permit increased passage, IBI scores increased and several species were detected further upstream than before modification. Total macroinvertebrate density, biomass and taxonomic diversity and abundance of ecologically sensitive taxa were greater at GCS than in reaches immediately upstream, downstream or ≥1 km from GCS. A hydraulic study confirmed results from fish passage studies; minimum depths and maximum current velocities at GCS with gentle slopes (≤1:15) were more likely to meet minimum criteria for catfish passage than GCS with steeper slopes. Multidisciplinary approaches such as ours will increase understanding of GCS-associated factors influencing fish passage, biological assemblage structure and other ecological relationships in streams.

Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries.

PubMed

Demetriades, Demetrios; Kuncir, Eric; Murray, James; Velmahos, George C; Rhee, Peter; Chan, Linda

2004-08-01

We assessed the prognostic value and limitations of Glasgow Coma Scale (GCS) and head Abbreviated Injury Score (AIS) and correlated head AIS with GCS. We studied 7,764 patients with head injuries. Bivariate analysis was performed to examine the relationship of GCS, head AIS, age, gender, and mechanism of injury with mortality. Stepwise logistic regression analysis was used to identify the independent risk factors associated with mortality. The overall mortality in the group of head injury patients with no other major extracranial injuries and no hypotension on admission was 9.3%. Logistic regression analysis identified head AIS, GCS, age, and mechanism of injury as significant independent risk factors of death. The prognostic value of GCS and head AIS was significantly affected by the mechanism of injury and the age of the patient. Patients with similar GCS or head AIS but different mechanisms of injury or ages had significantly different outcomes. The adjusted odds ratio of death in penetrating trauma was 5.2 (3.9, 7.0), p < 0.0001, and in the age group > or = 55 years the adjusted odds ratio was 3.4 (2.6, 4.6), p < 0.0001. There was no correlation between head AIS and GCS (correlation coefficient -0.31). Mechanism of injury and age have a major effect in the predictive value of GCS and head AIS. There is no good correlation between GCS and head AIS.

Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning.

PubMed

Sam, Kishore Gnana; Kondabolu, Krishnakanth; Pati, Dipanwita; Kamath, Asha; Pradeep Kumar, G; Rao, Padma G M

2009-07-01

Self-poisoning with organophosphorus (OP) compounds is a major cause of morbidity and mortality across South Asian countries. To develop uniform and effective management guidelines, the severity of acute OP poisoning should be assessed through scientific methods and a clinical database should be maintained. A prospective descriptive survey was carried out to assess the utility of severity scales in predicting the outcome of 71 organophosphate (OP) and carbamate poisoning patients admitted during a one year period at the Kasturba Hospital, Manipal, India. The Glasgow coma scale (GCS) scores, acute physiology and chronic health evaluation II (APACHE II) scores, predicted mortality rate (PMR) and Poisoning severity score (PSS) were estimated within 24h of admission. Significant correlation (P<0.05) between PSS and GCS and APACHE II and PMR scores were observed with the PSS scores predicting mortality significantly (P< or =0.001). A total of 84.5% patients improved after treatment while 8.5% of the patients were discharged with severe morbidity. The mortality rate was 7.0%. Suicidal poisoning was observed to be the major cause (80.2%), while other reasons attributed were occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%) reasons. This study highlights the application of clinical indices like GCS, APACHE, PMR and severity scores in predicting mortality and may be considered for planning standard treatment guidelines.

Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda.

PubMed

Krebs, Elizabeth; Gerardo, Charles J; Park, Lawrence P; Nickenig Vissoci, Joao Ricardo; Byiringiro, Jean Claude; Byiringiro, Fidele; Rulisa, Stephen; Thielman, Nathan M; Staton, Catherine A

2017-06-01

Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with mortality for patients with TBI at University Teaching Hospital of Kigali, Kigali, Rwanda. A prospective consecutive sampling of patients with TBI presenting to University Teaching Hospital of Kigali Accident and Emergency Department was screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, and visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, and repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in a multivariate logistic regression model and refined via backward elimination. Between October 7, 2013, and April 6, 2014, 684 patients were enrolled; 14 (2%) were excluded because of incomplete data. Of patients, 81% were male with mean age of 31 years (range, 10-89 years; SD 11.8). Most patients (80%) had mild TBI (Glasgow Coma Scale [GCS] score 13-15); 10% had moderate (GCS score 9-12) and 10% had severe (GCS score 3-8) TBI. Multivariate logistic regression determined that GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were significantly associated with death. GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

Fish assemblages in a western Iowa stream modified by grade control structures

USGS Publications Warehouse

Litvan, M.E.; Pierce, C.L.; Stewart, T.W.; Larson, C.J.

2008-01-01

Over 400 riprap grade control structures (GCSs) have been built in streams of western Iowa to reduce erosion and protect bridges, roads, and farmland. In conjunction with a companion study evaluating fish passage over GCSs in Turkey Creek, we evaluated the differences in fish assemblage and habitat characteristics in reaches immediately downstream from GCSs (GCS sites) and reaches at least 1 km from any GCS (non-GCS sites). The GCS sites were characterized by greater proportions of pool habitat, maximum depths, fish biomass, and abundance of juvenile largemouth bass Micropterus salmoides than were non-GCS sites. Index of biotic integrity (IBI) scores were poor or fair (<43 on a 0-100 scale) and not significantly different between the GCS and non-GCS sites. Additionally, we investigated both the longitudinal changes in fish assemblages in this GCS-fragmented stream and the changes in fish assemblages after slope modifications of three GCSs to facilitate fish passage. Thirteen fish species were present throughout the study area, whereas another 15 species exhibited truncated distributions not extending to the most upstream sampling location. After modification of the GCSs, IBI scores increased at seven of nine sites (mean increase =4.6 points). Also, channel catfish Ictalurus punctatus were detected 7.3 km upstream at sites where, 2 years before GCS modification, they had been absent from collections. Given the number and distribution of GCSs in western Iowa streams, understanding the effects of these structures is vital to the conservation and management of fish assemblages in this and other regions where GCSs or similar structures are used. ?? Copyright by the American Fisheries Society 2008.

Simplifying the use of prognostic information in traumatic brain injury. Part 2: Graphical presentation of probabilities.

PubMed

Murray, Gordon D; Brennan, Paul M; Teasdale, Graham M

2018-06-01

OBJECTIVE Clinical features such as those included in the Glasgow Coma Scale (GCS) score, pupil reactivity, and patient age, as well as CT findings, have clear established relationships with patient outcomes due to neurotrauma. Nevertheless, predictions made from combining these features in probabilistic models have not found a role in clinical practice. In this study, the authors aimed to develop a method of displaying probabilities graphically that would be simple and easy to use, thus improving the usefulness of prognostic information in neurotrauma. This work builds on a companion paper describing the GCS-Pupils score (GCS-P) as a tool for assessing the clinical severity of neurotrauma. METHODS Information about early GCS score, pupil response, patient age, CT findings, late outcome according to the Glasgow Outcome Scale, and mortality were obtained at the individual adult patient level from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9045) and IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) databases. These data were combined into a pooled data set for the main analysis. Logistic regression was first used to model the combined association between the GCS-P and patient age and outcome, following which CT findings were added to the models. The proportion of variability in outcomes "explained" by each model was assessed using Nagelkerke's R 2 . RESULTS The authors observed that patient age and GCS-P have an additive effect on outcome. The probability of mortality 6 months after neurotrauma is greater with increasing age, and for all age groups the probability of death is greater with decreasing GCS-P. Conversely, the probability of favorable recovery becomes lower with increasing age and lessens with decreasing GCS-P. The effect of combining the GCS-P with patient age was substantially more informative than the GCS-P, age, GCS score, or pupil reactivity alone. Two-dimensional charts were produced displaying outcome probabilities, as percentages, for 5-year increments in age between 15 and 85 years, and for GCS-Ps ranging from 1 to 15; it is readily seen that the movement toward combinations at the top right of the charts reflects a decreasing likelihood of mortality and an increasing likelihood of favorable outcome. Analysis of CT findings showed that differences in outcome are very similar between patients with or without a hematoma, absent cisterns, or subarachnoid hemorrhage. Taken in combination, there is a gradation in risk that aligns with increasing numbers of any of these abnormalities. This information provides added value over age and GCS-P alone, supporting a simple extension of the earlier prognostic charts by stratifying the original charts in the following 3 CT groupings: none, only 1, and 2 or more CT abnormalities. CONCLUSIONS The important prognostic features in neurotrauma can be brought together to display graphically their combined effects on risks of death or on prospects for independent recovery. This approach can support decision making and improve communication of risk among health care professionals, patients, and their relatives. These charts will not replace clinical judgment, but they will reduce the risk of influences from biases.

The effects of a documentary film on public stigma related to mental illness among genetic counselors

PubMed Central

Anderson, Kelly; Austin, Jehannine C.

2013-01-01

Many people, including genetic counselors (GCs), have been found to hold stigmatizing attitudes towards people with mental illnesses. We aimed to determine whether these attitudes could be changed by exposing GCs/GC students to a documentary film about people with mental illness. We screened the documentary at the 2010 North American conferences for GCs. Immediately before (T1), immediately after (T2), and one month after (T3) watching the documentary, participants self-rated their comfort with asking patients about mental illness, and completed scales measuring two aspects of stigma: stereotype endorsement (SE) and desire for social distance (SD). A total of 87 T1 and T2 questionnaires, and 39 T3 questionnaires were returned. At T2 and T3, 34.5% and 48.7% respectively reported feeling more comfortable to ask patients about mental illness. Scores on SD and SE scales decreased significantly from T1 to T2, but returned to initial levels at T3. The documentary increased GC/GC students’ comfort with asking about mental illness and temporarily decreased stigmatizing attitudes. PMID:22037897

Which score should be used in intubated patients’ Glasgow coma scale or full outline of unresponsiveness?

PubMed Central

Gorji, Mohammad Ali Heidari; Gorji, Ali Morad Heidari; Hosseini, Seyed Hossein

2015-01-01

Background and Aims: Today Glasgow coma scale (GCS) is the most well-known and common score for evaluation of the level of consciousness and outcome predict after traumatic brain injuries in the world. Regarding to some advantages of the full outline of unresponsiveness (FOUR) score over GCS in intubated patients, we’re going to compare the precision of these two scores in predicting the outcome predict in intubated patients. Methods: This research was a diagnostic-based study, which was conducted prospectively on 80 patients with Traumatic brain injury who were intubated and admitted to Intensive Care Unit (ICU) of Educational Hospitals of Mazandaran University of Medical Science during February 2013 to August 2013. The scores of FOUR and GCS were measured by the researcher in the first 24 h of admission in ICU. The information's recorded in the check list including the mortality rate of early and late inside of the hospital interred to excel. The findings were analyzed using SPSS software, through descriptive statistics and regression logistic. Results: The results showed of 80 patients 21 patients (20%) were female and 59 patients (80%) were male. The age average of the samples was 33.80 ± 12.60 ranging from 16 to 60 years old. 21 patients (26.2%) died during treatment. Of 21 patients, 15 patients died during first 14 days (18.7%) and 6 patients died after 14 years (7.5%). The area under curve (AUC) of FOUR score in early mortality was 0.90 (C1 = 0.95, 0.88–0.90). The amount AUC for GCS was 0.80 (C1 = 0.95, 0.78–0.84), which in delayed mortality it was ordered as 0.86 (C1 = 0.95, 0.84–0.90) and 0.89 (C1 = 0.95, 0.78–0.88). Conclusion: The research results indicated that FOUR score is more exact and more practical in intubated patients regarding lack of verbal response factor in early mortality prediction in GCS. Hence, it is recommended for health professionals to use the FOUR score to predict the early outcome of intubated patients with traumatic brain injuries. PMID:26097814

Effect of the Modified Glasgow Coma Scale Score Criteria for Mild Traumatic Brain Injury on Mortality Prediction: Comparing Classic and Modified Glasgow Coma Scale Score Model Scores of 13

PubMed Central

Mena, Jorge Humberto; Sanchez, Alvaro Ignacio; Rubiano, Andres M.; Peitzman, Andrew B.; Sperry, Jason L.; Gutierrez, Maria Isabel; Puyana, Juan Carlos

2011-01-01

Objective The Glasgow Coma Scale (GCS) classifies Traumatic Brain Injuries (TBI) as Mild (14–15); Moderate (9–13) or Severe (3–8). The ATLS modified this classification so that a GCS score of 13 is categorized as mild TBI. We investigated the effect of this modification on mortality prediction, comparing patients with a GCS of 13 classified as moderate TBI (Classic Model) to patients with GCS of 13 classified as mild TBI (Modified Model). Methods We selected adult TBI patients from the Pennsylvania Outcome Study database (PTOS). Logistic regressions adjusting for age, sex, cause, severity, trauma center level, comorbidities, and isolated TBI were performed. A second evaluation included the time trend of mortality. A third evaluation also included hypothermia, hypotension, mechanical ventilation, screening for drugs, and severity of TBI. Discrimination of the models was evaluated using the area under receiver operating characteristic curve (AUC). Calibration was evaluated using the Hoslmer-Lemershow goodness of fit (GOF) test. Results In the first evaluation, the AUCs were 0.922 (95 %CI, 0.917–0.926) and 0.908 (95 %CI, 0.903–0.912) for classic and modified models, respectively. Both models showed poor calibration (p<0.001). In the third evaluation, the AUCs were 0.946 (95 %CI, 0.943 – 0.949) and 0.938 (95 %CI, 0.934 –0.940) for the classic and modified models, respectively, with improvements in calibration (p=0.30 and p=0.02 for the classic and modified models, respectively). Conclusion The lack of overlap between ROC curves of both models reveals a statistically significant difference in their ability to predict mortality. The classic model demonstrated better GOF than the modified model. A GCS of 13 classified as moderate TBI in a multivariate logistic regression model performed better than a GCS of 13 classified as mild. PMID:22071923

Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge.

PubMed

Kesinger, Matthew Ryan; Kumar, Raj G; Wagner, Amy K; Puyana, Juan Carlos; Peitzman, Andrew P; Billiar, Timothy R; Sperry, Jason L

2015-02-01

Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI. This study involved data from the merger of an institutional trauma registry and the Traumatic Brain Injury Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale [AIS] score ≥ 4) who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into low (GOSE score < 6) and high (GOSE score ≥ 6). Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up (1 year: odds ratio [OR], 6.39; 95% confidence interval [CI], 1.76-23.14; p = 0.005) (2 years: OR, 7.30; 95% CI, 1.87-27.89; p = 0.004) (5-years: OR, 6.89; 95% CI, 1.42-33.39; p = 0.017). Stratifying by GCS score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an independent predictor of low GOSE score (OR, 4.59; 95% CI, 1.82-11.60; p = 0.001). HAP is independently associated with poor outcomes in severe TBI extending 5 years after injury. This suggests that precautions should be taken to reduce the risk of HAP in individuals with severe TBI. Prognostic study, level III.

Hematoma Shape, Hematoma Size, Glasgow Coma Scale Score and ICH Score: Which Predicts the 30-Day Mortality Better for Intracerebral Hematoma?

PubMed Central

Wang, Chih-Wei; Liu, Yi-Jui; Lee, Yi-Hsiung; Hueng, Dueng-Yuan; Fan, Hueng-Chuen; Yang, Fu-Chi; Hsueh, Chun-Jen; Kao, Hung-Wen; Juan, Chun-Jung; Hsu, Hsian-He

2014-01-01

Purpose To investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS) score, and intracerebral hematoma (ICH) score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality. Materials and Methods This retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA) and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC) were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant. Results The overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018), 0.715 (P = 0.0008) (by ABC/2) to 0.738 (P = 0.0002) (by CAVA), 0.877 (P<0.0001) (by ABC/2) to 0.882 (P<0.0001) (by CAVA), and 0.912 (P<0.0001), respectively. Conclusion Our study shows that hematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score. PMID:25029592

Prognostic value of continuous electroencephalography monitoring in children with severe brain damage.

PubMed

Lan, Yan-huai; Zhu, Xiao-mei; Zhou, Yuan-feng; Qiu, Peng-ling; Lu, Guo-ping; Sun, Dao-kai; Wang, Yi

2015-06-01

The purpose of this study is to determine whether there is a relationship between continuous electroencephalography (EEG) monitoring patterns and prognosis for children with severe brain damage. Patients and The different patterns of EEG were analyzed for 103 children (Glasgow Coma Scale [GCS] score < 8) who were monitored with continuous video-EEG (CVEEG) within 72 hours after the onset of coma. The clinical outcomes were scored and evaluated at hospital discharge by the modified Pediatric Cerebral and Overall Performance Category Scale (PCOPCS). EEG parameters of the different prognosis groups were compared and risk factors for prognosis were identified. Of the 103 children, 36 were in the good prognosis group (PCOPCS scores 1 and 2) and 67 were in the poor prognosis group (PCOPCS scores 3-6). The poor prognosis group had the lower proportion of events in reactive EEG patterns and sleep architecture, and a higher proportion of low-voltage events. Multivariate analyses showed that the lower GCS score and no sleep architecture were significantly associated with poor prognosis. Comatose children with higher GCS score and sleep architecture have better clinical outcomes in terms of morbidity and mortality. Georg Thieme Verlag KG Stuttgart · New York.

A pediatric FOUR score coma scale: interrater reliability and predictive validity.

PubMed

Czaikowski, Brianna L; Liang, Hong; Stewart, C Todd

2014-04-01

The Full Outline of UnResponsiveness (FOUR) Score is a coma scale that consists of four components (eye and motor response, brainstem reflexes, and respiration). It was originally validated among the adult population and recently in a pediatric population. To enhance clinical assessment of pediatric intensive care unit patients, including those intubated and/or sedated, at our children's hospital, we modified the FOUR Score Scale for this population. This modified scale would provide many of the same advantages as the original, such as interrater reliability, simplicity, and elimination of the verbal component that is not compatible with the Glasgow Coma Scale (GCS), creating a more valuable neurological assessment tool for the nursing community. Our goal was to potentially provide greater information than the formally used GCS when assessing critically ill, neurologically impaired patients, including those sedated and/or intubated. Experienced pediatric intensive care unit nurses were trained as "expert raters." Two different nurses assessed each subject using the Pediatric FOUR Score Scale (PFSS), GCS, and Richmond Agitation Sedation Scale at three different time points. Data were compared with the Pediatric Cerebral Performance Category (PCPC) assessed by another nurse. Our hypothesis was that the PFSS and PCPC should highly correlate and the GCS and PCPC should correlate lower. Study results show that the PFSS is excellent for interrater reliability for trained nurse-rater pairs and prediction of poor outcome and in-hospital mortality, under various situations, but there were no statistically significant differences between the PFSS and the GCS. However, the PFSS does have the potential to provide greater neurological assessment in the intubated and/or sedated patient based on the outcomes of our study.

A comparison of the diagnostic power of the Full Outline of Unresponsiveness scale and the Glasgow coma scale in the discharge outcome prediction of patients with traumatic brain injury admitted to the intensive care unit

PubMed Central

Gorji, Mohammad Ali Heidari; Hoseini, Seyed Hosein; Gholipur, Afshin; Mohammadpur, Reza Ali

2014-01-01

Background and Aim: This study aimed to determine whether the Full Outline of Unresponsiveness (FOUR) score is an accurate predictorof discharge outcome in traumatic brain injury (TBI) patients and to compare its performanceto Glasgow coma scale (GCS). Materials and Methods: Thisis diagnostic study conducted prospectively on 53 TBI patients admitted to ICU of education hospitals of Medical Science University of Mazandaran during February 2013 to June 2013. Data collection was done with a checklist including biographic, clinical information and outcome. The FOUR score and GCS were determined by the researcher in the first 24 hours. Outcomes considered as in-hospital mortality and poor neurologic outcome (Glasgow Outcome Scale (GOS) 1-3) in discharge time from the hospital. Results: In terms of predictive power for in-hospital mortality, the area under the receiver operating characteristic (ROC) curve was 0/92 (95% CI. 0/81-0/97) for FOUR score and 0/96 (95% CI. 0/87-0/99) for GCS. In terms of predictive power of poor neurologic outcome, the area under the ROC curve was 0/95 (95% CI. 0/86-0/99) for FOUR score and 0/90 (95% CI.0/79-0/96) for GCS as evidenced by GOS 1-3. The cut-off of 6 showed sensitivity and specificity of total four score predicting poor outcome at 0/86 and 0/87 while the cut-off of 4 showed the value of in hospital mortality at 0/90 and 0/90. The total GCS score showed sensitivity and specificity 0/100 and 0/61 at cut-off 7 in predicting poor outcome while in predicting mortality at cut-off of 4 this range was 0/100 and 0/92. Conclusion: The FOUR score is an accurate predictor of discharge outcome in TBI patients. Thus, researchers recommend for therapeutic Schematizationto use in neurosurgical patients at admission day. PMID:24843331

Somatic cells initiate primordial follicle activation and govern the development of dormant oocytes in mice.

PubMed

Zhang, Hua; Risal, Sanjiv; Gorre, Nagaraju; Busayavalasa, Kiran; Li, Xin; Shen, Yan; Bosbach, Benedikt; Brännström, Mats; Liu, Kui

2014-11-03

The majority of oocytes in the mammalian ovary are dormant oocytes that are enclosed in primordial follicles by several somatic cells, which we refer to as primordial follicle granulosa cells (pfGCs). Very little is known, however, about how the pfGCs control the activation of primordial follicles and the developmental fates of dormant oocytes. By targeting molecules in pfGCs with several mutant mouse models, we demonstrate that the somatic pfGCs initiate the activation of primordial follicles and govern the quiescence or awakening of dormant oocytes. Inhibition of mTORC1 signaling in pfGCs prevents the differentiation of pfGCs into granulosa cells, and this arrests the dormant oocytes in their quiescent states, leading to oocyte death. Overactivation of mTORC1 signaling in pfGCs accelerates the differentiation of pfGCs into granulosa cells and causes premature activation of all dormant oocytes and primordial follicles. We further show that pfGCs trigger the awakening of dormant oocytes through KIT ligand (KITL), and we present an essential communication network between the somatic cells and germ cells that is based on signaling between the mTORC1-KITL cascade in pfGCs and KIT-PI3K signaling in oocytes. Our findings provide a relatively complete picture of how mammalian primordial follicles are activated. The microenvironment surrounding primordial follicles can activate mTORC1-KITL signaling in pfGCs, and these cells trigger the awakening of dormant oocytes and complete the process of follicular activation. Such communication between the microenvironment, somatic cells, and germ cells is essential to maintaining the proper reproductive lifespan in mammals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges.

PubMed

Cowen, T D; Meythaler, J M; DeVivo, M J; Ivie, C S; Lebow, J; Novack, T A

1995-09-01

To determine the relationship between early variables (initial Glasgow Coma Scale [GCS] scores, computed tomography [CT] findings, presence of skeletal trauma, age, length of acute hospitalization) and outcome variables (Functional Independence Measure [FIM] scores, rehabilitation length of stay [LOS], rehabilitation charges) in traumatic brain injury (TBI). Inception cohort. University tertiary care rehabilitation center. 91 patients with TBI. Inpatient rehabilitation. FIM, rehabilitation LOS, and rehabilitation charges. Patients in the severely impaired (GCS = 3 to 7) group showed significantly lower (p = .01) mean admission and discharge motor scores (21.26, 39.83) than patients in the mildly impaired (GCS = 13 to 15) group (38.86, 55.29). Cognitive scores were also significantly lower (p < .01) in the severely impaired group on admission (26.73 vs 54.14) and discharge (42.28 vs 66.48). These findings continued to be statistically significant (p < .01) after regression analysis accounted for the other early variables previously listed. Regression analysis also illustrated that longer acute hospitalization LOS was independently associated with significantly lower admission motor (p < .01) and cognitive (p = .05) scores, and significantly higher (p = .01) rehabilitation charges. Patients with CT findings of intracranial bleed with skull fracture had longer total LOS (70.88 vs 43.08 days; p < .05), rehabilitation LOS (30.01 vs 19.68 days; p < .10), and higher rehabilitation charges ($43,346 vs $25,780; p < .05). Paradoxically, those patients in a motor vehicle crash with an extremity bone fracture had significantly higher (p = .002; p = .04 after regression analysis) FIM cognitive scores on admission (48.30 vs 27.28) and discharge (64.74 vs 45.78) than those without a fracture. Finally, data available on rehabilitation admission were used to predict discharge outcomes. The percentage of explained variance for each outcome variable is as follows: discharge FIM motor score, 69.5%; discharge FIM cognitive score, 71.2%; rehabilitation LOS, 54.1%; rehabilitation charges, 61.1%. The most powerful predictor of LOS and charges was the admission FIM motor score (p < .001), followed by CT findings (p = .02) and age (p = .04). Information readily available on rehabilitation admission, particularly the FIM motor score, may be useful in predicting discharge FIM scores as well as utilization of medical rehabilitation resources. Earlier transfer to rehabilitation may result in higher functional status and lower rehabilitation charges, as well as lower acute hospitalization charges. The presence of extremity fractures encountered during a motor vehicle crash is associated with a more favorable outcome in TBI as evidenced by higher discharge FIM cognitive scores.

Psychological well-being and the dyadic relationship of Chinese menopausal women (and their spouses) attending hormone replacement clinics.

PubMed

Lam, P M; Cheung, G W Y; Shek, D T L; Lee, D T S; Haines, C; Chung, T K H

2004-04-01

This survey examined the general health and the marital relationship of 122 Chinese menopausal women and their spouses attending hormone replacement clinics. Climacteric symptoms of the participants were assessed by the modified Greene Climacteric Scale (GCS). The psychological well-being of the participants and their spouses was assessed by the 12-item Chinese General Health Questionnaire (GHQ), and their marital quality was assessed by the Chinese Dyadic Adjustment Scale (DAS). The GCS scores of our cohort were significantly higher than that of a community-based sample of menopausal Chinese women. About one-third of the participants and one-fifth of their spouses suffered from reduced psychological well-being. Although the DAS total scores of the participants and their spouses were comparable to those of the adjusted couples in a younger population, the affectional DAS subscores were significantly lower. The GCS scores of the menopausal women were significantly positively correlated with their GHQ scores but negatively correlated with their DAS scores. In summary, the menopausal women attending the hormonal replacement clinics, especially those with more dimacteric symptoms, suffered from significant psychiatric morbidity and marital maladjustment. The psychological dimension of the menopause should never be neglected.

Will Neuroimaging Reveal a Severe Intracranial Injury in This Adult With Minor Head Trauma?: The Rational Clinical Examination Systematic Review.

PubMed

Easter, Joshua S; Haukoos, Jason S; Meehan, William P; Novack, Victor; Edlow, Jonathan A

Adults with apparently minor head trauma (Glasgow Coma Scale [GCS] scores ≥13 who appear well on examination) may have severe intracranial injuries requiring prompt intervention. Findings from clinical examination can aid in determining which adults with minor trauma have severe intracranial injuries visible on computed tomography (CT). To assess systematically the accuracy of symptoms and signs in adults with minor head trauma in order to identify those with severe intracranial injuries. We performed a systematic search of MEDLINE (1966-2015) and the Cochrane Library to identify studies assessing the diagnosis of intracranial injuries. Studies were included that measured the performance of findings for identifying intracranial injury with a reference standard of neuroimaging or follow-up evaluation. Fourteen studies (range, 431-7955 patients) met inclusion criteria with patients having GCS scores between 13 and 15 and 50% or more older than 18 years. Three authors independently performed critical appraisal and data extraction. The prevalence of severe intracranial injury (requiring prompt intervention) among the 23,079 patients with minor head trauma was 7.1% (95% CI, 6.8%-7.4%) and the prevalence of injuries leading to death or requiring neurosurgical intervention was 0.9% (95% CI, 0.78%-1.0%). The presence of physical examination findings suggestive of skull fracture (likelihood ratio [LR], 16; 95% CI, 3.1-59; specificity, 99%), GCS score of 13 (LR, 4.9; 95% CI, 2.8-8.5; specificity, 97%), 2 or more vomiting episodes (LR, 3.6; 95% CI, 3.1-4.1; specificity, 92%), any decline in GCS score (LR range, 3.4-16; specificity range, 91%-99%;), and pedestrians struck by motor vehicles (LR range, 3.0-4.3; specificity range, 96%-97%) were associated with severe intracranial injury on CT. Among patients with apparent minor head trauma, the absence of any of the features of the Canadian CT Head Rule (≥65 years; ≥2 vomiting episodes, amnesia >30 minutes, pedestrian struck, ejected from vehicle, fall >1 m, suspected skull fracture, or GCS score <15 at 2 hours) had an LR of 0.04 (95% CI, 0-0.65), lowering the probability of severe injury to 0.31% (95% CI, 0%-4.7%). The absence of all the New Orleans Criteria findings (>60 years, intoxication, headache, vomiting, amnesia, seizure, or trauma above the clavicle) had an LR of 0.08 (95% CI, 0.01-0.84), lowering the probability of severe intracranial injury to 0.61% (95% CI, 0.08%-6.0%). Combinations of history and physical examination features in clinical decision rules can identify patients with minor head trauma at low risk of severe intracranial injuries. Certain findings, including signs of skull fracture, GCS score of 13, 2 or more vomiting episodes, decrease in GCS score, and pedestrians struck by motor vehicles, may help identify patients at increased risk of severe intracranial injuries.

Effects of severity of traumatic brain injury and brain reserve on cognitive-control related brain activation.

PubMed

Scheibel, Randall S; Newsome, Mary R; Troyanskaya, Maya; Steinberg, Joel L; Goldstein, Felicia C; Mao, Hui; Levin, Harvey S

2009-09-01

Functional magnetic resonance imaging (fMRI) has revealed more extensive cognitive-control related brain activation following traumatic brain injury (TBI), but little is known about how activation varies with TBI severity. Thirty patients with moderate to severe TBI and 10 with orthopedic injury (OI) underwent fMRI at 3 months post-injury using a stimulus response compatibility task. Regression analyses indicated that lower total Glasgow Coma Scale (GCS) and GCS verbal component scores were associated with higher levels of brain activation. Brain-injured patients were also divided into three groups based upon their total GCS score (3-4, 5-8, or 9-15), and patients with a total GCS score of 8 or less produced increased, diffuse activation that included structures thought to mediate visual attention and cognitive control. The cingulate gyrus and thalamus were among the areas showing greatest increases, and this is consistent with vulnerability of these midline structures in severe, diffuse TBI. Better task performance was associated with higher activation, and there were differences in the over-activation pattern that varied with TBI severity, including greater reliance upon left-lateralized brain structures in patients with the most severe injuries. These findings suggest that over-activation is at least partially effective for improving performance and may be compensatory.

Application of the FOUR Score in Intracerebral Hemorrhage Risk Analysis.

PubMed

Braksick, Sherri A; Hemphill, J Claude; Mandrekar, Jay; Wijdicks, Eelco F M; Fugate, Jennifer E

2018-06-01

The Full Outline of Unresponsiveness (FOUR) Score is a validated scale describing the essentials of a coma examination, including motor response, eye opening and eye movements, brainstem reflexes, and respiratory pattern. We incorporated the FOUR Score into the existing ICH Score and evaluated its accuracy of risk assessment in spontaneous intracerebral hemorrhage (ICH). Consecutive patients admitted to our institution from 2009 to 2012 with spontaneous ICH were reviewed. The ICH Score was calculated using patient age, hemorrhage location, hemorrhage volume, evidence of intraventricular extension, and Glasgow Coma Scale (GCS). The FOUR Score was then incorporated into the ICH Score as a substitute for the GCS (ICH Score FS ). The ability of the 2 scores to predict mortality at 1 month was then compared. In total, 274 patients met the inclusion criteria. The median age was 73 years (interquartile range 60-82) and 138 (50.4%) were male. Overall mortality at 1 month was 28.8% (n = 79). The area under the receiver operating characteristic curve was .91 for the ICH Score and .89 for the ICH Score FS . For ICH Scores of 1, 2, 3, 4, and 5, 1-month mortality was 4.2%, 29.9%, 62.5%, 95.0%, and 100%. In the ICH Score FS model, mortality was 10.7%, 26.5%, 64.5%, 88.9%, and 100% for scores of 1, 2, 3, 4, and 5, respectively. The ICH Score and the ICH Score FS predict 1-month mortality with comparable accuracy. As the FOUR Score provides additional clinical information regarding patient status, it may be a reasonable substitute for the GCS into the ICH Score. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

The reliability of the Glasgow Coma Scale: a systematic review.

PubMed

Reith, Florence C M; Van den Brande, Ruben; Synnot, Anneliese; Gruen, Russell; Maas, Andrew I R

2016-01-01

The Glasgow Coma Scale (GCS) provides a structured method for assessment of the level of consciousness. Its derived sum score is applied in research and adopted in intensive care unit scoring systems. Controversy exists on the reliability of the GCS. The aim of this systematic review was to summarize evidence on the reliability of the GCS. A literature search was undertaken in MEDLINE, EMBASE and CINAHL. Observational studies that assessed the reliability of the GCS, expressed by a statistical measure, were included. Methodological quality was evaluated with the consensus-based standards for the selection of health measurement instruments checklist and its influence on results considered. Reliability estimates were synthesized narratively. We identified 52 relevant studies that showed significant heterogeneity in the type of reliability estimates used, patients studied, setting and characteristics of observers. Methodological quality was good (n = 7), fair (n = 18) or poor (n = 27). In good quality studies, kappa values were ≥0.6 in 85%, and all intraclass correlation coefficients indicated excellent reliability. Poor quality studies showed lower reliability estimates. Reliability for the GCS components was higher than for the sum score. Factors that may influence reliability include education and training, the level of consciousness and type of stimuli used. Only 13% of studies were of good quality and inconsistency in reported reliability estimates was found. Although the reliability was adequate in good quality studies, further improvement is desirable. From a methodological perspective, the quality of reliability studies needs to be improved. From a clinical perspective, a renewed focus on training/education and standardization of assessment is required.

Combat Casualties and Severe Shock: Risk Factors for Death at Role 3 Military Facilities.

PubMed

Buehner, Michelle F; Eastridge, Brian J; Aden, James K; DuBose, Joseph J; Blackbourne, Lorne H; Cestero, Ramon F

2017-09-01

Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90. Transfers from role 2 facilities were excluded. Data captured included demographics, admission vital signs, laboratory values, blood products, and mortality. Relationships between admission physiology, blood product utilization, and mortality were developed. Independent associations between variables were determined by logistic regression analysis. 1,703 patients were identified who met our inclusion criteria and composite mortality was 23%. Mortality in those receiving a balanced transfusion ratio was 18% versus 27% (p < 0.0001). Hypotensive casualties who survived were significantly more likely to have a higher presenting Glasgow Coma Score (GCS), temperature, SBP, shock index, and pH. In addition, this group was also more likely to have a lower international normalized ratio, pCO2, and base deficit (p < 0.001). Age, heart rate, and pulse pressure were not significantly different between groups. Independent predictors of mortality included Injury Severity Score, presentation GCS, and initial pH value (p < 0.0001). In contrast, independent predictors of survival included those with above-knee amputation and a balanced transfusion (p < 0.0001). Combat casualties hypotensive on arrival to surgical facilities have a significant expected mortality. Those receiving balanced transfusions demonstrated improved survival. Of the five independent risk factors, pH, GCS, and the presence of above-knee amputation are typically available during initial evaluation. These factors may be helpful in determining resource allocation and mortality risk, especially in triage or mass casualty settings. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Prevalence of seizures in cats after head trauma.

PubMed

Grohmann, Kristina S; Schmidt, Martin J; Moritz, Andreas; Kramer, Martin

2012-12-01

To determine the prevalence of seizures in cats after head trauma. Retrospective cross-sectional study. 52 cats with head trauma. Information was obtained from medical records of cats with head trauma and via telephone interviews of owners at least 2 years after cats had head trauma. Severity of head trauma in cats was classified with the modified Glasgow coma scale (mGCS), and the association between scores and development of seizures was determined. 9 cats had moderate head trauma (mGCS score, 9 to 14), and 43 cats had mild head trauma (mGCS score, 15 to 18). None of the cats developed seizures during the follow-up period (≥ 2 years after head injury). The calculated 95% confidence interval for prevalence of seizures in cats after head injury was 0% to 5.6%. There was no significant relationship between severity of head trauma and the risk of seizures in cats. Results indicated the probability that cats with mild to moderate head trauma would develop posttraumatic seizures was low. However, clinicians should monitor cats with a history of head trauma for development of secondary epilepsy.

Performance of Glial Fibrillary Acidic Protein (GFAP) in Detecting Traumatic Intracranial Lesions on Computed Tomography in Children and Youth with Mild Head Trauma

PubMed Central

Papa, Linda; Zonfrillo, Mark; Ramirez, Jose; Silvestri, Salvatore; Giordano, Philip; Braga, Carolina F.; Tan, Ciara N.; Ameli, Neema J.; Lopez, Marco; Mittal, Manoj K.

2015-01-01

Objectives This study examined the performance of serum glial fibrillary acidic protein (GFAP) in detecting traumatic intracranial lesions on computed tomography (CT) scan in children and youth with mild and moderate traumatic brain injury (TBI), and assessed its performance in trauma control patients without head trauma. Methods This prospective cohort study enrolled children and youth presenting to three Level I trauma centers following blunt head trauma with Glasgow Coma Scale (GCS) scores of 9 to 15, as well as trauma control patients with GCS scores of 15 who did not have blunt head trauma. The primary outcome measure was the presence of intracranial lesions on initial CT scan. Blood samples were obtained in all patients within six hours of injury and measured by ELISA for GFAP (ng/ml). Results A total of 257 children and youth were enrolled in the study and had serum samples drawn within 6 hours of injury for analysis: 197 had blunt head trauma and 60 were trauma controls. CT scan of the head was performed in 152 patients and traumatic intracranial lesions on CT scan were evident in 18 (11%), all of whom had GCS scores of 13 to 15. When serum levels of GFAP were compared in children and youth with traumatic intracranial lesions on CT scan to those without CT lesions, median GFAP levels were significantly higher in those with intracranial lesions (1.01, IQR 0.59 to 1.48) than those without lesions (0.18, IQR 0.06 to 0.47). The area under the receiver operating characteristic (ROC) curve (AUC) for GFAP in detecting children and youth with traumatic intracranial lesions on CT was 0.82 (95% CI = 0.71 to 0.93). In those presenting with GCS scores of 15, the AUC for detecting lesions was 0.80 (95% CI = 0.68 to 0.92). Similarly, in children under five years old the AUC was 0.83 (95% CI = 0.56 to 1.00). Performance for detecting intracranial lesions at a GFAP cutoff level of 0.15 ng/ml yielded a sensitivity of 94%, a specificity of 47%, and a negative predictive value of 98%. Conclusions In children and youth of all ages, GFAP measured within 6 hours of injury was associated with traumatic intracranial lesions on CT and with severity of TBI. Further study is required to validate these findings before clinical application. PMID:26469937

Total and ionized plasma magnesium concentrations in children after traumatic brain injury.

PubMed

Mendez, Donna Reyes; Corbett, Ronald; Macias, Charles; Laptook, Abbot

2005-03-01

This study examined 1) whether plasma total Mg (TMg) and ionized Mg (IMg) concentrations in children are reduced by traumatic brain injury (TBI) and 2) whether the extent of reduction correlates with severity of trauma assessed by the Glasgow Coma Scale (GSC) score. This was a prospective cohort study of 98 pediatric patients who had TBI and were admitted through the emergency department. A GCS score was assigned and blood was obtained upon presentation and 24 h later. Plasma was analyzed for TMg and IMg. Patients were grouped into three categories-GCS scores 13-15, 8-12, and <8-to designate mild (n=21), moderate (n=37), and severe (n=40) TBI, respectively. Blood was obtained from 50 healthy children before elective surgery as controls. Control subjects had a TMg and an IMg of 0.94 +/- 0.08 and 0.550 +/- 0.06 mM. TBI patients had an initial TMg and IMg of 0.83 +/- 0.09 and 0.520 +/- 0.05 mM, respectively. Initial TMg for mild, moderate, and severe TBI subgroups (0.87 +/- 0.16, 0.81 +/- 0.15, and 0.83 +/- 0.14 mM, respectively) was reduced from control subjects (p <0.01). IMg was reduced only in the severe TBI subgroup (0.516 +/- 0.07 mM; p=0.016). Twenty-four hours later, TMg remained lower than in control subjects for all subgroups of TBI; however, IMg normalized. TBI in children is associated with a reduction in TMg, whereas IMg decreased only with severe TBI. IMg returned to control values by 24 h despite a continued lower TMg, suggesting mechanisms to maintain IMg. Changes in plasma IMg may serve as a marker for TBI but only over a limited time interval.

Factors influencing pediatric Injury Severity Score and Glasgow Coma Scale in pediatric automobile crashes: results from the Crash Injury Research Engineering Network.

PubMed

Ehrlich, Peter F; Brown, J Kristine; Sochor, Mark R; Wang, Stewart C; Eichelberger, Martin E

2006-11-01

Motor vehicle crashes account for more than 50% of pediatric injuries. Triage of pediatric patients to appropriate centers can be based on the crash/injury characteristics. Pediatric motor vehicle crash/injury characteristics can be determined from an in vitro laboratory using child crash dummies. However, to date, no detailed data with respect to outcomes and crash mechanism have been presented with a pediatric in vivo model. The Crash Injury Research Engineering Network is comprised of 10 level 1 trauma centers. Crashes were examined with regard to age, crash severity (DeltaV), crash direction, restraint use, and airbag deployment. Multiple logistic regression analysis was performed with Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) as outcomes. Standard age groupings (0-4, 5-9, 10-14, and 15-18) were used. The database is biases toward a survivor population with few fatalities. Four hundred sixty-one motor vehicle crashes with 2500 injuries were analyzed (242 boys, 219 girls). Irrespective of age, DeltaV > 30 mph resulted in increased ISS and decreased GCS (eg, for 0-4 years, DeltaV < 30: ISS = 10, GCS = 13.5 vs DeltaV > 30: ISS = 19.5, GCS = 10.6; P < .007, < .002, respectively). Controlling for DeltaV, children in lateral crashes had increased ISS and decreased GCS versus those in frontal crashes. Airbag deployment was protective for children 15 to 18 years old and resulted in a lower ISS and higher GCS (odds ratio, 2.1; 95% confidence interval, 0.9-4.6). Front-seat passengers suffered more severe (ISS > 15) injuries than did backseat passengers (odds ratio, 1.7; 95% confidence interval, 0.7-3.4). A trend was noted for children younger than 12 years sitting in the front seat to have increased ISS and decreased GCS with airbag deployment but was limited by case number. A reproducible pattern of increased ISS and lower GCS characterized by high severity, lateral crashes in children was noted. Further analysis of the specific injuries as a function and the crash characteristic can help guide management and prevention strategies.

Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.

PubMed

Susman, Mark; DiRusso, Stephen M; Sullivan, Thomas; Risucci, Donald; Nealon, Peter; Cuff, Sara; Haider, Adil; Benzil, Deborah

2002-08-01

The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and < 65 years) with similar injuries. The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the chi2 test and Mann-Whitney U test, with p < 0.05 considered significant. There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the nonelderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. Elderly traumatic brain injury patients have a worse mortality and functional outcome than nonelderly patients who present with head injury even though their head injury and overall injuries are seemingly less severe.

Can focused trauma education initiatives reduce mortality or improve resource utilization in a low-resource setting?

PubMed

Petroze, Robin T; Byiringiro, Jean Claude; Ntakiyiruta, Georges; Briggs, Susan M; Deckelbaum, Dan L; Razek, Tarek; Riviello, Robert; Kyamanywa, Patrick; Reid, Jennifer; Sawyer, Robert G; Calland, J Forrest

2015-04-01

Over 90% of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using χ(2) and Fisher's exact test. A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3%, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5% (n = 55) to 37.1% (n = 23), (p = 0.009, OR 0.42, 95% CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multi-factorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.

Self and near relative ratings of functional level one year after traumatic brain injury.

PubMed

Sandhaug, Maria; Andelic, Nada; Berntsen, Svein A; Seiler, Stephen; Mygland, Aase

2012-01-01

To quantify traumatic brain injury (TBI) patients' perceptions of own function by the Patient Competency Rating Scale (PCRS) one year after injury, and to examine self-awareness of functional deficits by comparing PCRS ratings from patients (PCRS-P) and PCRS ratings from near relatives (PCRS-R), and to identify predictors of awareness deficits. A cohort of 50 severe (n = 33) and moderate (n = 17) TBI patients. Awareness of deficits was investigated by subtracting PCRS relative ratings from PCRS patient ratings. Predictors of PCRS ratings and differences were assessed by stepwise multiple regression analyses. The average patient PCRS sum score was 122/150 (95% CI = 115; 129) as compared to a sum score of 117/150 (95% CI = 110; 125), given by their relatives (p = 0.93). The patients scored themselves slightly higher than their relatives in the domains of activities of daily living (ADL) and cognitive function (p < 0.001, p < 0.001). Regression analyses showed that Glasgow Coma Scale (GCS)score at admission to rehabilitation was the strongest predictor of patient PCRS (B = 3.314, p = 0.008). The strongest predictor of differences between patient and relative PCRS was GCS acute (B = -3.530, p = 0.001). TBI patients demonstrated a slight "awareness gap" in ADL and cognitive function. Low GCS in the acute phase and high age were the strongest predictors of self- awareness deficits.

Injury severity at presentation is not associated with long-term vocational outcome in British Military brain injury.

PubMed

Bahadur, Sardar; McGilloway, E; Etherington, J

2016-04-01

Injury Severity Score (ISS) and GCS can be retrospective markers of injury severity, but if used by clinicians to decide on the treatment of acutely brain-injured casualties at the point of injury may potentially limit interventions on people who may ultimately survive with good functional outcomes. ISS/GCS and long-term outcomes were reviewed by assessing all UK military neurorehabilitation patients with an operational/combat brain injury treated over 4 years (February 2008-July 2012) at Defence Medical Rehabilitation Centre (Headley Court). 34 participants from 9 operational tours of Iraq and Afghanistan were analysed. Overall, 44% of injuries were due to improvised explosive devices (IEDs) and 41% from gunshot wounds; 70.9% of injuries were penetrating wounds with the remainder due to blast/blunt trauma or combined injury. The primary injury was head/neck in 76.5%, although eight patients (23.4%) requiring neurorehabilitation were initially 'non-head injury'. Eight patients (26.5%) sustained more than 10 injuries, and 18 had between three and nine injuries. Eleven patients (32%) had an initial GCS of 3, and 16 (47%) had ISS of 75 (deemed 'unsurvivable'). All patients with ISS of 75 were long-term survivors. At 4 months after discharge, 47% (16) were fully independent, and a further 41% (14) were independent in own homes, but needed assistance with some activities, such as paying bills. Over three-quarters (27 patients, 79%) returned to full/part-time work, 11 of whom returned to military duties; 93% of 'unsurvivable' ISS, and 91% of patients with GCS of 3 were capable of returning/returned to work. In total, 7/11 casualties returning to military duties had major trauma ISS, and two were 'unsurvivable'. All seven casualties with both GCS 3 and ISS 75 survived and returned to independence (help with some activities). ISS/GCS at the point of injury does not reflect eventual outcome. IEDs/gunshots cause the greatest number of injuries and the highest incidence of brain injury. Brain injury should be considered in every battlefield casualty, irrespective of whether the head/neck/spinal cord was avoided. ISS should not be considered indicative or predictive of long-term prognosis/quality of life/employability as brain injury in this small cohort is both survivable and recoverable. It should not be used as a retrospective guide to alter treatment pathways, as there is poor correlation with long-term outcome. Subsequent neurorehabilitation should always be considered because survival, return to independence and full employment are very likely. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Globular cluster formation and evolution in the context of cosmological galaxy assembly: open questions

NASA Astrophysics Data System (ADS)

Forbes, Duncan A.; Bastian, Nate; Gieles, Mark; Crain, Robert A.; Kruijssen, J. M. Diederik; Larsen, Søren S.; Ploeckinger, Sylvia; Agertz, Oscar; Trenti, Michele; Ferguson, Annette M. N.; Pfeffer, Joel; Gnedin, Oleg Y.

2018-02-01

We discuss some of the key open questions regarding the formation and evolution of globular clusters (GCs) during galaxy formation and assembly within a cosmological framework. The current state of the art for both observations and simulations is described, and we briefly mention directions for future research. The oldest GCs have ages greater than or equal to 12.5 Gyr and formed around the time of reionization. Resolved colour-magnitude diagrams of Milky Way GCs and direct imaging of lensed proto-GCs at z˜6 with the James Webb Space Telescope (JWST) promise further insight. GCs are known to host multiple populations of stars with variations in their chemical abundances. Recently, such multiple populations have been detected in ˜2 Gyr old compact, massive star clusters. This suggests a common, single pathway for the formation of GCs at high and low redshift. The shape of the initial mass function for GCs remains unknown; however, for massive galaxies a power-law mass function is favoured. Significant progress has been made recently modelling GC formation in the context of galaxy formation, with success in reproducing many of the observed GC-galaxy scaling relations.

Globular cluster formation and evolution in the context of cosmological galaxy assembly: open questions.

PubMed

Forbes, Duncan A; Bastian, Nate; Gieles, Mark; Crain, Robert A; Kruijssen, J M Diederik; Larsen, Søren S; Ploeckinger, Sylvia; Agertz, Oscar; Trenti, Michele; Ferguson, Annette M N; Pfeffer, Joel; Gnedin, Oleg Y

2018-02-01

We discuss some of the key open questions regarding the formation and evolution of globular clusters (GCs) during galaxy formation and assembly within a cosmological framework. The current state of the art for both observations and simulations is described, and we briefly mention directions for future research. The oldest GCs have ages greater than or equal to 12.5 Gyr and formed around the time of reionization. Resolved colour-magnitude diagrams of Milky Way GCs and direct imaging of lensed proto-GCs at z ∼6 with the James Webb Space Telescope (JWST) promise further insight. GCs are known to host multiple populations of stars with variations in their chemical abundances. Recently, such multiple populations have been detected in ∼2 Gyr old compact, massive star clusters. This suggests a common, single pathway for the formation of GCs at high and low redshift. The shape of the initial mass function for GCs remains unknown; however, for massive galaxies a power-law mass function is favoured. Significant progress has been made recently modelling GC formation in the context of galaxy formation, with success in reproducing many of the observed GC-galaxy scaling relations.

Globular cluster formation and evolution in the context of cosmological galaxy assembly: open questions

PubMed Central

Bastian, Nate; Gieles, Mark; Crain, Robert A.; Kruijssen, J. M. Diederik; Larsen, Søren S.; Ploeckinger, Sylvia; Agertz, Oscar; Trenti, Michele; Ferguson, Annette M. N.; Pfeffer, Joel; Gnedin, Oleg Y.

2018-01-01

We discuss some of the key open questions regarding the formation and evolution of globular clusters (GCs) during galaxy formation and assembly within a cosmological framework. The current state of the art for both observations and simulations is described, and we briefly mention directions for future research. The oldest GCs have ages greater than or equal to 12.5 Gyr and formed around the time of reionization. Resolved colour-magnitude diagrams of Milky Way GCs and direct imaging of lensed proto-GCs at z∼6 with the James Webb Space Telescope (JWST) promise further insight. GCs are known to host multiple populations of stars with variations in their chemical abundances. Recently, such multiple populations have been detected in ∼2 Gyr old compact, massive star clusters. This suggests a common, single pathway for the formation of GCs at high and low redshift. The shape of the initial mass function for GCs remains unknown; however, for massive galaxies a power-law mass function is favoured. Significant progress has been made recently modelling GC formation in the context of galaxy formation, with success in reproducing many of the observed GC-galaxy scaling relations. PMID:29507511

Multivariate outcome prediction in traumatic brain injury with focus on laboratory values.

PubMed

Nelson, David W; Rudehill, Anders; MacCallum, Robert M; Holst, Anders; Wanecek, Michael; Weitzberg, Eddie; Bellander, Bo-Michael

2012-11-20

Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Identifying factors relevant to outcome can provide a better understanding of TBI pathophysiology, in addition to aiding prognostication. Many common laboratory variables have been related to outcome but may not be independent predictors in a multivariate setting. In this study, 757 patients were identified in the Karolinska TBI database who had retrievable early laboratory variables. These were analyzed towards a dichotomized Glasgow Outcome Scale (GOS) with logistic regression and relevance vector machines, a non-linear machine learning method, univariately and controlled for the known important predictors in TBI outcome: age, Glasgow Coma Score (GCS), pupil response, and computed tomography (CT) score. Accuracy was assessed with Nagelkerke's pseudo R². Of the 18 investigated laboratory variables, 15 were found significant (p<0.05) towards outcome in univariate analyses. In contrast, when adjusting for other predictors, few remained significant. Creatinine was found an independent predictor of TBI outcome. Glucose, albumin, and osmolarity levels were also identified as predictors, depending on analysis method. A worse outcome related to increasing osmolarity may warrant further study. Importantly, hemoglobin was not found significant when adjusted for post-resuscitation GCS as opposed to an admission GCS, and timing of GCS can thus have a major impact on conclusions. In total, laboratory variables added an additional 1.3-4.4% to pseudo R².

Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage.

PubMed

Yu, S-X; Zhang, Q-S; Yin, Y; Liu, Z; Wu, J-M; Yang, M-X

2016-11-01

This study evaluates the value of continuous dynamic monitoring of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage to predict early postoperative complications. Data from 80 patients treated in our hospital from February 2014 to February 2015 were analyzed. The patients all underwent decompressive craniectomies, and their ICP changes were monitored invasively and continuously for 1 to 7 days after surgery. The average blood loss during surgery for the group of patients was 65.3 ± 12.4 ml and the mean GCS score 8.7 ± 2.4. Cases were divided into three groups according to ICP values to compare early postoperative complications of the groups: a normal and mildly increased group (51 cases), a moderately increased group (19 cases) and a severely increased group (10 cases). To validate the analysis we first showed that comparisons among groups based on gender, age, systolic pressure, diastolic pressure, bleeding time, blood loss, operation time, craniectomy localization, and preoperative mannitol dosage yielded no statistically significant differences. In contrast, the following comparisons produced statistically significant differences: the comparison of postoperative Glasgow Coma Scale (GCS) scores showing that the lower intracranial pressure, the higher the GCS score; the postoperative rehemorrhage, cerebral edema and death ratios showing the higher the intracranial pressure, the higher the rehemorrhage ratio; the average ICP and the time to occurrence of rehemorrhage, cerebral edema or cerebral infarction, showing the relationship between the average ICP and the time to a complication. Patients with higher ICP averages suffered a complication of rehemorrhage within the first 9.6 ± 2.5 hours on average. Nevertheless, the comparison of GCS scores in those patients and the others showed no significant differences. Based on the findings, the dynamic monitoring of intracranial pressure can early and sensitively predict postoperative complications of patients with hypertensive cerebral hemorrhage, and guide the clinical intervention actively to improve the surgery outcome.

Airway Management Strategies for Brain-injured Patients Meeting Standard Criteria to Consider Extubation. A Prospective Cohort Study.

PubMed

McCredie, Victoria A; Ferguson, Niall D; Pinto, Ruxandra L; Adhikari, Neill K J; Fowler, Robert A; Chapman, Martin G; Burrell, Althea; Baker, Andrew J; Cook, Deborah J; Meade, Maureen O; Scales, Damon C

2017-01-01

Patients with acute brain injury are frequently capable of breathing spontaneously with minimal ventilatory support despite persistent neurological impairment. We sought to describe factors associated with extubation timing, success, and primary tracheostomy in these patients. We conducted a prospective multicenter observational cohort study in three academic hospitals in Toronto, Canada. Consecutive brain-injured adults receiving mechanical ventilation for at least 24 hours in three intensive care units were screened by study personnel daily for extubation consideration criteria. We monitored all patients until hospital discharge and used logistic regression models to examine associations with extubation failure and delayed extubation. Of 192 patients included, 152 (79%) were extubated and 40 (21%) received a tracheostomy without an extubation attempt. The rate of extubation failure within 72 hours was 32 of 152 (21%), which did not vary significantly between those extubated before (early; 6 of 37; 16.2%), within 24 hours (timely; 14 of 70; 20.0%), or more than 24 hours after meeting criteria to consider extubation (delayed; 12 of 45; 26.7%; P = 0.49). Delayed extubation was associated with lower a Glasgow Coma Scale (GCS) score at the time of consideration of extubation, absence of cough, and new positive sputum cultures. Factors independently associated with successful extubation were presence of cough (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.42-9.09), fluid balance in prior 24 hours (OR, 0.75 per 1-L increase; 95% CI, 0.57-0.98), and age (OR, 0.97 per 10-yr increase; 95% CI, 0.95-0.99). A higher GCS score was not associated with successful extubation. Extubation success was predicted by younger age, presence of cough, and negative fluid balance, rather than GCS score at extubation. These results do not support prolonging intubation solely for low GCS score in brain-injured patients.

[Spanish versions of the Simplified Motor Score and the Glasgow Coma Scale in out-of-hospital treatment of head injury in adults: a preliminary study of each scale's ability to predict adverse events].

PubMed

Roca, Guillem; Mayol, Sergi; García, Esteban; Casajuana, Edgar; Quintana, Salvador

2015-06-01

To determine the ability of the modified (Spanish) version of the Simplified Motor Score (mSMS) to predict adverse events during hospitalization and to compare its predictive ability to that of the Glasgow Coma Scale (GCS) in adults with head injuries treated outside the hospital. Observational study of retrospective cohorts including all patients over the age of 14 years attended for head injuries occurring within 24 hours of treatment by an advanced life-support unit staffed by nurses between May 1, 2013, and May 1, 2014. The mSMS was a translation of the English original, created through a process of discussions of direct and back translations to arrive at consensus. Out-of-hospital patient records were searched to find GCS and mSMS scores. To predict the ability of each scale to predict brain injuries, neurosurgery, intubation, and/or inhospital death, we calculated the area under the receiving operator characteristic curves (AUCs). Of the total of 115 head-injury patients attended, 64 met the inclusion criteria. The mean (SD) age was 47 (24) years. Twelve (18.8%) patients developed some form of adverse event during hospitalization; 91.6% had brain damage, 58.3% required intubation, 8.3% required surgery, and 41.6% died. The AUC for the GCS was 0.907 (95% CI, 0.81-1.00; P<.001); the AUC for the mSMS was 0.796 (95% CI, 0.64-0.95; P=.001). Although the ability of the mSMS to predict in-hospital adverse outcomes is good, it is inferior to the GCS in adults with head injuries attended outside the hospital.

Outcome and prognostic factors of malaria-associated acute kidney injury requiring hemodialysis: A single center experience

PubMed Central

Kute, V. B.; Shah, P. R.; Munjappa, B. C.; Gumber, M. R.; Patel, H. V.; Jain, S. H.; Engineer, D. P.; Naresh, V. V. Sai; Vanikar, A. V.; Trivedi, H. L.

2012-01-01

Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. We carried out prospective study in 2010, to describe clinical characteristics, laboratory parameters, prognostic factors, and outcome in 59 (44 males, 15 females) smear-positive malaria patients with AKI. The severity of illness was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, Multiple Organ Dysfunction Score (MODS), and Glasgow Coma Scale (GCS) scores. All patients received artesunate and hemodialysis (HD). Mean age of patients was 33.63 ± 14 years. Plasmodium falciparum malaria was seen in 76.3% (n = 45), Plasmodium vivax in 16.9% (n = 10), and mixed infection in 6.8% (n = 4) patients. Presenting clinical features were fever (100%), nausea-vomiting (85%), oliguria (61%), abdominal pain/tenderness (50.8%), and jaundice (74.5%). Mean APACHE II, SOFA, MODS, and GCS scores were 18.1 ± 3, 10.16 ± 3.09, 9.71 ± 2.69, and 14.15 ± 1.67, respectively, all were higher among patients who died than among those who survived. APACHE II ≥20, SOFA and MODS scores ≥12 were associated with higher mortality (P < 0.05). 34% patients received blood component transfusion and exchange transfusion was done in 15%. Mean number of HD sessions required was 4.59 ± 3.03. Renal biopsies were performed in five patients (three with patchy cortical necrosis and two with acute tubular necrosis). 81.3% of patients had complete renal recovery and 11.8% succumbed to malaria. Prompt diagnosis, timely HD, and supportive therapy were associated with improved survival and recovery of kidney functions in malarial with AKI. Mortality was associated with higher APACHE II, SOFA, MODS, GCS scores, requirement of inotrope, and ventilator support. PMID:22279340

A case report on near manual strangulation and glasgow coma scale.

PubMed

Meel Banwari, L

2015-09-01

Glasgow Coma Scale (GCS) is considered as a gold standard in estimating the prognosis of the comatose patient. The management of the patient relies heavily on this scale. The mechanism of injury must also be included in scoring of the GCS. Survival from strangulation is uncommon, and if it occurs, it is often associated with various complications such as neurological consequences. To highlight a poor correlation with low GCS and ultimate outcome in cases of manual strangulation. This is a case report of young female adult who was raped and manually strangulated by a colleague during a training course for traditional healers. She was admitted with very low (3/15) Glasgow Coma Scale (GCS) and presumed to have a poor prognosis. She was rigorously ventilated in Intensive Care Unit (ICU), and was discharged from hospital after a week without any complications. The neck and genital injuries are described. This report discusses. A low Glasgow Coma Scale is not a predictive of poor prognosis in cases of manual strangulation.

[The evaluation of the suitability of our cases for referral to a level I trauma center].

PubMed

Taviloğlu, K; Aydin, A; Cuhali, B D; Demiralp, T; Güloğlu, R; Ertekin, C

2001-07-01

This study was performed on 200 patients with a prospective method, between July and October 1998. The aim of the study was to analyze the patients who were admitted directly or referred from another hospital, if they were suitable with the transfer criteria to a level I trauma center. One hundred and seven patients (53.5%) were admitted without ambulance and 93 patients (46.5%) by ambulance to our center. 34% of those patients applied directly and 66% of them were sent from other hospitals. Private ambulances consisted 70%, and 30% the belonged to the national health service. Only 26% of the ambulances had doctor as staff. The most common trauma etiologies were: traffic accidents (42.5%), falling from a height (37.5%) and assaults (11.5%). The mean Glasgow coma score (GCS) of the patients was calculated as 13.9 and mean revised trauma score was 11.7. The Glasgow coma score, revised trauma score and appropriateness to the transfer criteria of the American College of Surgeons were statistically analyzed according to the Fischer Exact test. The results revealed that 96% of the patients with RTS, 86% of the patients with GCS and 60% of the patients with ACS were not appropriate to the transfer criteria to a level I trauma center. In conclusion; we believe that GCS will predict better results in the triage of trauma patients with head trauma in our country.

The geriatric polytrauma: Risk profile and prognostic factors.

PubMed

Rupprecht, Holger; Heppner, Hans Jürgen; Wohlfart, Kristina; Türkoglu, Alp

2017-03-01

In the German population, the percentage of elderly patients is increasing, and consequently there are more elderly patients among trauma cases, and particularly cases of polytrauma. The aim of this study was to present clinical results and a risk profile for geriatric polytrauma patients. Review of 140 geriatric (over 65 years of age) polytrauma patients who received prehospital treatment was performed. Severity of trauma was retrospectively assessed with Hannover Polytrauma Score (HPTS). Age, hemoglobin (Hb) level, systolic blood pressure (BP), Glasgow Coma Scale (GCS) score, timing of and necessity for intubation were analyzed in relation to mortality and in comparison with younger patients. Geriatric polytrauma patients (n=140) had overall mortality rate of 65%, whereas younger patients (n=1468) had mortality rate of 15.9%. Despite equivalent severity of injury (HPTS less age points) in geriatric and non-geriatric groups, mortality rate was 4 times higher in geriatric group. Major blood loss with Hb <8 g/dL was revealed to be 3 times more fatal than moderate or minor blood loss (Hb ≥8 g/dL). GCS score <12 corresponded to double mortality rate (39% vs 83%). Age by itself is significant risk factor and predictor of increased mortality in polytrauma patients. Additional risk factors include very low GCS score and systolic BP <80 mm Hg, for instance, as potential clinical indicators of massive bleeding and traumatic brain injury. Such parameters demand early and rapid treatment at prehospital stage and on admission.

Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning.

PubMed

Cha, Y S; Kim, H; Do, H H; Kim, H I; Kim, O H; Cha, K-C; Lee, K H; Hwang, S O

2018-03-01

Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). To date, there have been no studies on the utility of serum neuron-specific enolase (NSE), a marker of neuronal cell damage, as a predictive marker of DNS in acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 9-month period. Serum NSE was measured after emergency department arrival, and patients were divided into two groups. The DNS group comprised patients with delayed sequelae, while the non-DNS group included patients with none of these sequelae. A total of 98 patients with acute CO poisoning were enrolled in this study. DNS developed in eight patients. The median NSE value was significantly higher in the DNS group than in the non-DNS group. There was a statistical difference between the non-DNS group and the DNS group in terms of CO exposure time, Glasgow Coma Scale (GCS), loss of consciousness, creatinine kinase, and troponin I. GCS and NSE were the early predictors of development of DNS. The area under the curve according to the receiver operating characteristic curves of GCS, serum NSE, and GCS combined with serum NSE were 0.922, 0.836, and 0.969, respectively. In conclusion, initial GCS and NSE served as early predictors of development of DNS. Also, NSE might be a useful additional parameter that could improve the prediction accuracy of initial GCS.

Selective vulnerability of dentate granule cells prior to amyloid deposition in PDAPP mice: digital morphometric analyses.

PubMed

Wu, Chi-Cheng; Chawla, Faisal; Games, Dora; Rydel, Russell E; Freedman, Stephen; Schenk, Dale; Young, Warren G; Morrison, John H; Bloom, Floyd E

2004-05-04

Increasing evidence from mouse models of Alzheimer's disease shows that overexpression of a mutant form of the amyloid precursor protein (APP) and its product, beta-amyloid peptide, initiate pathological changes before amyloid deposition. To evaluate the cytological basis for one of these early changes, namely reduced volume of the dentate gyrus (DG), we have used high-throughput diOlistic cell loading and 3D neuronal reconstruction to investigate potential dendritic pathology of granule cells (GCs) in 90-day-old PDAPP mice. Labeled GCs from fixed hippocampal slices were selected randomly and imaged digitally by using confocal laser-scanning microscopy. The dendritic complexity of GCs was quantified according to subordinate morphological parameters, including soma position within the granule cell layer (superficial versus deep) and topographic location within the DG (dorsal versus ventral blade) along the anterior-posterior hippocampal axis. Initial analysis, which included all sampled GC types, revealed a 12% reduction of total dendritic length in PDAPP mice compared with littermate controls. Further analysis, performed with refined subgroups, found that superficially located GCs in the dorsal blade were profoundly altered, exhibiting a 23% loss in total dendritic length, whereas neurons in the ventral blade were unaffected. Superficial GCs were particularly vulnerable (a 32% reduction) in the posterior region of the DG. Furthermore, the dendritic reductions of this select group were uniformly localized within middle-to-outer portions of the dentate molecular layer. We conclude that substantial dendritic pathology is evident in 90-day-old PDAPP mice for a spatially defined subset of GCs well before amyloid accumulation occurs.

Selective vulnerability of dentate granule cells prior to amyloid deposition in PDAPP mice: Digital morphometric analyses

PubMed Central

Wu, Chi-Cheng; Chawla, Faisal; Games, Dora; Rydel, Russell E.; Freedman, Stephen; Schenk, Dale; Young, Warren G.; Morrison, John H.; Bloom, Floyd E.

2004-01-01

Increasing evidence from mouse models of Alzheimer's disease shows that overexpression of a mutant form of the amyloid precursor protein (APP) and its product, β-amyloid peptide, initiate pathological changes before amyloid deposition. To evaluate the cytological basis for one of these early changes, namely reduced volume of the dentate gyrus (DG), we have used high-throughput diOlistic cell loading and 3D neuronal reconstruction to investigate potential dendritic pathology of granule cells (GCs) in 90-day-old PDAPP mice. Labeled GCs from fixed hippocampal slices were selected randomly and imaged digitally by using confocal laser-scanning microscopy. The dendritic complexity of GCs was quantified according to subordinate morphological parameters, including soma position within the granule cell layer (superficial versus deep) and topographic location within the DG (dorsal versus ventral blade) along the anterior-posterior hippocampal axis. Initial analysis, which included all sampled GC types, revealed a 12% reduction of total dendritic length in PDAPP mice compared with littermate controls. Further analysis, performed with refined subgroups, found that superficially located GCs in the dorsal blade were profoundly altered, exhibiting a 23% loss in total dendritic length, whereas neurons in the ventral blade were unaffected. Superficial GCs were particularly vulnerable (a 32% reduction) in the posterior region of the DG. Furthermore, the dendritic reductions of this select group were uniformly localized within middle-to-outer portions of the dentate molecular layer. We conclude that substantial dendritic pathology is evident in 90-day-old PDAPP mice for a spatially defined subset of GCs well before amyloid accumulation occurs. PMID:15118092

Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran.

PubMed

Khalili, Hosseinali; Sadraei, Nazanin; Niakan, Amin; Ghaffarpasand, Fariborz; Sadraei, Amin

2016-10-01

To determine the role of intracranial pressure (ICP) monitoring in management of patients with severe traumatic brain injury (TBI) admitted to a large level I trauma center in Southern Iran. This was a cohort study performed during a 2-year period in a level I trauma center in Southern Iran including all adult patients (>16 years) with severe TBI (Glasgow Coma Scale [GCS] score, 3-8) who underwent ICP monitoring through ventriculostomy. The management was based on the recorded ICP values with threshold of 20 mm Hg. Decompressive craniectomy was performed in patients with intractable intracranial hypertension (persistent ICP ≥25 mm Hg). In unresponsive patients, barbiturate coma was induced. Patients were followed for 6 months and Glasgow Outcome Scale Extended was recorded. The determinants of favorable and unfavorable outcome were also determined. Overall, we included 248 patients with mean age of 34.6 ± 16.6 years, among whom there were 216 men (87.1%) and 32 women (12.9%). Eighty-five patients (34.2%) had favorable and 163 (65.8%) unfavorable outcomes. Those with favorable outcome had significantly lower age (P = 0.004), higher GCS score on admission (P < 0.001), lower Rotterdam score (P = 0.035), fewer episodes of intracranial hypertension (P < 0.001), and lower maximum recorded ICP (P = 0.041). These factors remained statistically significant after elimination of confounders by multivariate logistic regression model. Age, GCS score on admission, Rotterdam score, intracranial hypertension, and maximum recorded ICP are important determinants of outcome in patients with severe TBI. ICP monitoring assisted us in targeted therapy and management of patients with severe TBI. Copyright © 2016 Elsevier Inc. All rights reserved.

Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

PubMed

Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

2015-11-06

Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in system performance with some paediatric drowning cases subsequently not identified for P-HEMS response being transported to adult hospitals.

Missile injury to the pediatric brain in conflict zones.

PubMed

Wani, Abrar A; Ramzan, Altaf U; Malik, Nayil K; Qayoom, Abdul; Nizami, Furqan A; Kirmani, Altaf R; Wani, M Afzal

2011-03-01

This study was conducted both prospectively and retrospectively at one center over a period of 8 years. The population consisted of all patients with both an age 18 years or younger and a diagnosed penetrating missile injury (PMI) during the study interval. The authors analyzed factors determining outcome and demographic trends in this population, and they compared them with those in the more developed world. Fifty-one patients were the victims of armed conflict, although no one was directly a party to any battle. This mechanism of injury is in strong opposition to data in the literature from developed countries, in which most missile injuries are the result of suicide or homicide or are even sports related. Moreover, all previous studies on the pediatric population have considered only injuries from gunshots, but authors of the current study have included injuries from other penetrating missiles as well. On cross tabulation analysis using the chi-square test, the factors shown to correlate with outcome included the Glasgow Coma Scale (GCS) score, pupillary abnormalities, patient age, hemodynamic status, and bihemispheric damage. On multinomial regression analysis, the two strongest predictors of death were GCS score and pupillary abnormalities. The GCS score and hemodynamic status were the strongest predictors of disability. There was no difference in the prognostic factors for PMI between developing or more developed countries. Glasgow Coma Scale score, pupillary abnormalities, and hemodynamic status were the strongest predictors of outcome. In conflict zones in developing countries the victims were mostly innocent bystanders, whereas in the more developed countries homicides and suicides were the leading etiological factors.

Traumatic Brain Injury Caused by Missile Wounds in the North of Palestine: A Single Institution's Experience with 520 Consecutive Civilian Patients.

PubMed

Darwazeh, Rami; Darwazeh, Mazhar; Sbeih, Ibrahim; Yan, Yi; Wang, Jianmin; Sun, Xiaochuan

2018-05-05

Literature about traumatic brain injury caused by missile wounds is scanty. We shed some light on this field. This retrospective study was carried out, between September 2000 and September 2010, on 520 civilian patients who sustained traumatic brain injury from missiles in the north of Palestine. Thorough detailed analyses were made of patients' admission Glasgow Coma Scale (GCS) scores, pupillary reactivity to light, site and mode of injuries, type of injurious agents, missile trajectory, method of treatment, radiologic manifestations, complications, and outcome. The GCS score was used to assess the level of consciousness, whereas the Glasgow Outcome Scale score was used to evaluate the outcome. Patients' age ranged from 6 months to 75 years. Only 50 (9.6%) patients were female. Patients injured by metallic bullets, rubber bullets, and shrapnel from bomb explosions numbered 351, 139, and 30, respectively. Of 384 patients who were treated conservatively, no mortality was detected, whereas of 136 surgically treated patients, 66 (48.5%) died of their injuries. Although our management of patients was not optimal because of many factors, the overall mortality was 12.7% (n = 66). The promptness of transport to hospital was a decisive factor with a major bearing on decreasing mortality. Brain computed tomography was invaluable in the diagnosis and follow-up of our patients. In addition, age, pupillary reactivity, admission GCS score, missile trajectory, ventricular involvement, and site and mode of injury were important prognostic factors. Copyright © 2018 Elsevier Inc. All rights reserved.

Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients.

PubMed

El-Gamasy, Mohamed Abd El-Aziz; Elezz, Ahmed Abd El Basset Abo; Basuni, Ahmed Sobhy Mohamed; Elrazek, Mohamed El Sayed Ali Abd

2016-11-01

Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS) in Tanta University Emergency Hospital. The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR), Base Excess (BE), and Glasgow Coma Scale (GCS) values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS.

Frontal assessment battery (FAB) performance following traumatic brain injury hospitalized in an acute care setting.

PubMed

Rojas, Natalia; Laguë-Beauvais, Maude; Belisle, Arielle; Lamoureux, Julie; AlSideiri, Ghusn; Marcoux, Judith; Maleki, Mohammed; Alturki, Abdulrahman Y; Anchouche, Sonia; Alquraini, Hanan; Feyz, Mitra; Guise, Elaine de

2018-01-19

The Frontal Assessment Battery (FAB) has been shown to be useful in several clinical settings. The aim of the present study was to examine the performance of patients with traumatic brain injury (TBI) on the FAB and to predict their acute outcome. The FAB was administered to 89 patients with mild (27 = uncomplicated and 39 = complicated) and moderate (n = 23) TBI during hospitalization in an acute care setting. The length of stay in days (LOS), Glasgow Outcome Scale-Revised score (GOSE) and Disability Rating Scale (DRS) score were collected. Results showed no significant differences between the three groups on the FAB score, but age and education were significantly associated with the FAB score. Parietal lesions were associated with lower total FAB score, and with the Similarities, Motor series and Conflicting instructions subscales, while frontal lesions were associated with lower performance on the Motor series and Conflicting instructions subscales. Total FAB score was significantly correlated with all outcome measures, and together the FAB total score and the Glasgow Coma Scale (GCS) score explained 30.8% of the variance in the DRS score. The FAB may be useful clinically to acutely assess frontal and parietal lobe functions at bedside in patients with TBI and, in combination with the GCS score to measure TBI severity, can enable clinicians to predict early outcome.

Level of consciousness in dying patients. The role of palliative sedation: a longitudinal prospective study.

PubMed

Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

2012-05-01

Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise. A prospective longitudinal and descriptive design was used. Each patient admitted in one of the 8 participating units was included if they met the inclusion criteria and gave written informed consent. 266 patients were included. The incidence of palliative sedation was 7;5%. For the group of sedated patients results show that 90% entered the palliative care unit being fully conscious. Two patients were comatose upon arrival. 90% of the patients remained fully conscious up to the day palliative sedation was started. When looking at the effect of palliative sedation on the level of consciousness the analysis strongly suggest that the palliative sedation - as expected- has an impact on the GCS score. Irrespective of the dichotomization of the score the probability of having a lower GCS increases substantially once sedation is initiated. Additionally, results show that once palliative sedation is administered, the level of consciousness gradually goes down up until the day of death. Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportional way when refractory suffering occurs. It occurs in extraordinary situations and at the very end of the dying process.

Glucocorticoids and Metabolic Control.

PubMed

Magomedova, Lilia; Cummins, Carolyn L

2016-01-01

In response to stress, the central nervous system initiates a signaling cascade, which leads to the production of glucocorticoids (GCs). GCs act through the glucocorticoid receptor (GR) to coordinate the appropriate cellular response with the primary goal of mobilizing the storage forms of carbon precursors to generate a continuous glucose supply for the brain. Although GCs are critical for maintaining energy homeostasis, excessive GC stimulation leads to a number of undesirable side effects, including hyperglycemia, insulin resistance, fatty liver, obesity, and muscle wasting leading to severe metabolic dysfunction. Summarized below are the diverse metabolic roles of glucocorticoids in energy homeostasis and dysregulation, focusing specifically on glucose, lipid, and protein metabolism.

Histochemical Characterization of Oocytes in the Pink Cuskeel (Genypterus blacodes).

PubMed

Cohen, Stefanía; Petcoff, Gladys; Freijo, Roberto O; Portiansky, Enrique L; Barbeito, Claudio G; Macchi, Gustavo J; Díaz, Alcira O

2015-08-01

In the present study we histochemically and lectinhistochemically characterized the growing oocytes of the pink cuskeel (Genypterus blacodes). We used histochemical methods for the localization and characterization of glycoconjugates (GCs) and lectin histochemical techniques for the identification of specific sugar residues. We analyzed presence and distribution of GCs in the different structures of the growing follicles (cortical alveoli, globules, yolk granules and zona radiata). During the initial stage of vitellogenesis, the oocytes presented small yolk granules composed of GCs that gradually increased during exogenous vitellogenesis. These GCs contained moderate quantities of α-D-mannose, D-glucose, N-acetylglucosamine and N-acetyl-neuraminic acid. The cortical alveoli contained both neutral and carboxylated GCs, and lectin techniques detected N-acetylgalactosamine, galactose and L-fucose. The zona radiata showed a strong positive reaction to PAS and it reacted weakly with more specific techniques, such as KOH/PA*S and PA/Bh/KOH/PAS. This structure showed GCs with oxidizable vicinal diols, O-acyl sugars and sialic acid residues with different substitution types and presented N-acetylgalactosamine and L-fucose specific residues. The oocytes follicular envelope evidenced neutral and acidic non-sulfated GCs and high concentrations of α-D-mannose, D-glucose, galactose and N-acetylgalactosamine. The intergranular cytoplasmic GCs were mainly rich in α-D-mannose, D-glucose, N-acetylgalactosamine, N-acetylglucosamine and N-acetyl-neuraminic acid. These results enhance the comprehension of the structure and functionality of the pink cuskeel ovarian follicles, and provide a useful tool for the study of this tissue in other teleost species.

The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients.

PubMed

Helling, Thomas S; Nelson, Paul W; Shook, John W; Lainhart, Kathy; Kintigh, Denise

2003-07-01

The presence of a surgeon at the initial assessment and care of the trauma patient has been the focal point of trauma center designation. However, for Level I verification, the American College of Surgeons Committee on Trauma currently does not require the presence of an attending trauma surgeon in the hospital (IH), provided senior surgical residents are immediately available. Likewise, the state of Missouri does not mandate an IH presence of the attending trauma surgeon but requires senior (postgraduate year 4 or 5) level surgical residents to immediately respond, with a 20-minute response time mandated for the attending surgeon if IH or out of the hospital (OH). Nevertheless, some claim that IH coverage by attending surgeons provides better care for seriously injured patients. This retrospective study assessed patient care parameters over the past 10 years on critically injured patients to detect any difference in outcome whether the surgeon was IH or OH at the time of the trauma team activation (cardiopulmonary instability, Glasgow Coma Scale [GCS] score < 9, penetrating truncal injury). Patients were subcategorized into blunt/penetrating, shock (systolic blood pressure < 90 mm Hg) on arrival, GCS score < 9, Injury Severity Score (ISS) > 15, or ISS > 25. Response was examined from 8 am to 6 pm weekdays (IH) or 6 pm to 8 am weekdays and all weekends (OH). Patient care parameters examined were mortality, complications, time in the emergency department, time to the operating room, time to computed tomographic scanning, intensive care unit length of stay (LOS), and hospital LOS. For all patients (n = 766), there was no significant difference in any parameters except intensive care unit LOS (IH, 4.90 +/- 7.96 days; OH, 3.58 +/- 7.69 days; p < 0.05). For blunt trauma (n = 369), emergency department time was shorter (99.71 +/- 88.26 minutes vs. 126.51 +/- 96.68 minutes, p < 0.01) and hospital LOS was shorter (8.04 +/- 1.02 days vs. 11.08 +/- 1.15 days, p < 0.05) for OH response. For penetrating trauma (n = 377), shock (n = 187), GCS score < 9 (n = 248), ISS > 15 (n = 363), and ISS > 25 (n = 230), there were no statistically significant differences in any patient care parameter between IH and OH response. For those in most need of urgent operation-penetrating injuries and shock-there were no differences in time to operating room or mortality for OH or IH response. As long as initial assessment and care is provided by senior level IH surgical residents and as long as the attending surgeon responds in a defined period of time (if OH) to guide critical decision-making, the IH presence of an attending surgeon has not been shown in this retrospective study to improve care of the critically injured patient.

Effect of Massage Therapy on Vital Signs and GCS Scores of ICU Patients: A Randomized Controlled Clinical Trial

PubMed Central

Vahedian-Azimi, Amir; Ebadi, Abbas; Asghari Jafarabadi, Mohammad; Saadat, Soheil; Ahmadi, Fazlollah

2014-01-01

Background: Unalleviated complications related to hospitalization, including stress, anxiety, and pain, can easily influence different structures, like the neural system, by enhancing the stimulation of sympathetic nervous pathways and causing unstable vital signs and deterioration in the level of consciousness. Objectives: The purpose of this study was to determine the effects of massage therapy by family members on vital signs and Glasgow Coma Scale Score (GCS) of patients hospitalized in the Intensive Care Unit (ICU). Patients and Methods: This randomized controlled clinical trial was conducted at the ICU of the Shariati Hospital during 2012; 45 ICU patients and 45 family members in the experimental group and the same number of patients and family members in the control group were consecutively selected . The data collection instrument consisted of two parts. The first part included demographic data (age, marital status and Body Mass Index) and the second part included a checklist to record the patient’s vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR)) and GCS. All measurements were done at the same time in both groups before the intervention (full body massage therapy), and 1 hour, 2 hours, 3 hours, and 4 hours after intervention. The patients were provided with a 60-minute full body massage The massage protocol included static, surface tension, stretching, superficial lymph unload, transverse friction, and myofacial releasing techniques. Results: Significant differences were observed between experimental and control groups in the SBP at 1 hour, SBP 2 hours, and SBP 3 hours, and also in GCS at 1 hour to GCS at 4 hours (P < 0.05). Multivariate analysis revealed a significant difference between experimental and control groups in SBP at all time points (P < 0.05). Conclusions: Massage via family members had several positive effects on the patients’ clinical conditions, and therefore, it should be recognized as one of the most important clinical considerations in hospitalized patients. PMID:25337518

Effect of Massage Therapy on Vital Signs and GCS Scores of ICU Patients: A Randomized Controlled Clinical Trial.

PubMed

Vahedian-Azimi, Amir; Ebadi, Abbas; Asghari Jafarabadi, Mohammad; Saadat, Soheil; Ahmadi, Fazlollah

2014-08-01

Unalleviated complications related to hospitalization, including stress, anxiety, and pain, can easily influence different structures, like the neural system, by enhancing the stimulation of sympathetic nervous pathways and causing unstable vital signs and deterioration in the level of consciousness. The purpose of this study was to determine the effects of massage therapy by family members on vital signs and Glasgow Coma Scale Score (GCS) of patients hospitalized in the Intensive Care Unit (ICU). This randomized controlled clinical trial was conducted at the ICU of the Shariati Hospital during 2012; 45 ICU patients and 45 family members in the experimental group and the same number of patients and family members in the control group were consecutively selected . The data collection instrument consisted of two parts. The first part included demographic data (age, marital status and Body Mass Index) and the second part included a checklist to record the patient's vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR)) and GCS. All measurements were done at the same time in both groups before the intervention (full body massage therapy), and 1 hour, 2 hours, 3 hours, and 4 hours after intervention. The patients were provided with a 60-minute full body massage The massage protocol included static, surface tension, stretching, superficial lymph unload, transverse friction, and myofacial releasing techniques. Significant differences were observed between experimental and control groups in the SBP at 1 hour, SBP 2 hours, and SBP 3 hours, and also in GCS at 1 hour to GCS at 4 hours (P < 0.05). Multivariate analysis revealed a significant difference between experimental and control groups in SBP at all time points (P < 0.05). Massage via family members had several positive effects on the patients' clinical conditions, and therefore, it should be recognized as one of the most important clinical considerations in hospitalized patients.

Patients with Moderate and Severe Traumatic Brain Injury: Impact of Preinjury Platelet Inhibitor or Warfarin Treatment.

PubMed

Tollefsen, Marie Hexeberg; Vik, Anne; Skandsen, Toril; Sandrød, Oddrun; Deane, Susan Frances; Rao, Vidar; Moen, Kent Gøran

2018-06-01

We aimed to examine the effect of preinjury antithrombotic medication on clinical and radiologic neuroworsening in traumatic brain injury (TBI) and study the effect on outcome. A total of 184 consecutive patients ≥50 years old with moderate and severe TBI admitted to a level 1 trauma center were included. Neuroworsening was assessed clinically by using the Glasgow Coma Scale (GCS) score and radiologically by using the Rotterdam CT score on repeated time points. Functional outcome was assessed with the Glasgow Outcome Scale Extended 6 months after injury. The platelet inhibitor group (mean age, 77.3 years; n = 43) and the warfarin group (mean age, 73.2 years; n = 20) were significantly older than the nonuser group (mean age, 63.7 years; n = 121; P ≤ 0.001). In the platelet inhibitor group 74% and in the warfarin group, 85% were injured by falls. Platelet inhibitors were not significantly associated with clinical or radiologic neuroworsening (P = 0.37-1.00), whereas warfarin increased the frequency of worsening in GCS score (P = 0.001-0.028) and Rotterdam CT score (P = 0.004). In-hospital mortality was higher in the platelet inhibitor group (28%; P = 0.030) and the warfarin group (50%; P < 0.001) compared with the nonuser group (13%). Platelet inhibitors did not predict mortality or worse outcome after adjustment for age, preinjury disability, GCS score, and Rotterdam CT score, whereas warfarin predicted both mortality and worse outcome. In this study of patients with moderate and severe TBI, preinjury platelet inhibitors did not cause neuroworsening or predict higher mortality or worse outcome. In contrast, preinjury warfarin caused neuroworsening and was an independent risk factor for mortality and worse outcome at 6 months. Hence, fall prevention and liberal use of computed tomography examinations is important in this patient group. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients.

PubMed

Moon, Byeong Hoo; Park, Sang Kyu; Jang, Dong Kyu; Jang, Kyoung Sool; Kim, Jong Tae; Han, Yong Min

2015-01-01

We studied the applicability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in patients admitted to the intensive care unit (ICU) with acute stroke and compared the results with the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). We also conducted a comparative study of accuracy for predicting hemorrhagic and ischemic stroke mortality. Between January 2011 and December 2012, ischemic or hemorrhagic stroke patients admitted to the ICU were included in the study. APACHE II and SAPS II-predicted mortalities were compared using a calibration curve, the Hosmer-Lemeshow goodness-of-fit test, and the receiver operating characteristic (ROC) curve, and the results were compared with the GCS and NIHSS. Overall 498 patients were included in this study. The observed mortality was 26.3%, whereas APACHE II and SAPS II-predicted mortalities were 35.12% and 35.34%, respectively. The mean GCS and NIHSS scores were 9.43 and 21.63, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients. The GCS and NIHSS were inferior in predicting mortality in both patient groups. Although both the APACHE II and SAPS II systems can be used to measure performance in the neurosurgical ICU setting, the accuracy of APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients was superior. Copyright © 2014 Elsevier Ltd. All rights reserved.

Civilian Penetrating Gunshot Injury to the Neurocranium in Enugu

PubMed Central

Onyia, Ephraim Eziechina; Chikani, Mark C; Mezue, Wilfred C; Uche, Enoch O; Iloabachie, Izuchukwu; Mesi, Matthew; Ejembi, Sunday; Agunwa, Chuka

2017-01-01

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Conclusions: Admitting GCS and bullet trajectory were predictive of outcome. PMID:28584512

Civilian Penetrating Gunshot Injury to the Neurocranium in Enugu.

PubMed

Onyia, Ephraim Eziechina; Chikani, Mark C; Mezue, Wilfred C; Uche, Enoch O; Iloabachie, Izuchukwu; Mesi, Matthew; Ejembi, Sunday; Agunwa, Chuka

2017-01-01

Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004-2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Admitting GCS and bullet trajectory were predictive of outcome.

Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury

PubMed Central

Brezova, Veronika; G⊘ran Moen, Kent; Skandsen, Toril; Vik, Anne; Brewer, James B.; Salvesen, Øyvind; Håberg, Asta K.

2014-01-01

The objectives of this prospective study in 62 moderate–severe TBI patients were to investigate volume change in cortical gray matter (GM), hippocampus, lenticular nucleus, lobar white matter (WM), brainstem and ventricles using a within subject design and repeated MRI in the early phase (1–26 days) and 3 and 12 months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact of Glasgow Coma Scale (GCS) score at admission, duration of post-traumatic amnesia (PTA), and diffusion axonal injury (DAI) grade on brain volumes and ADC values over time was assessed. Lastly, we determined if MRI-derived brain volumes from the 3-month scans provided additional, significant predictive value to 12-month outcome classified with the Glasgow Outcome Scale—Extended after adjusting for GCS, PTA and age. Cortical GM loss was rapid, largely finished by 3 months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3 months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12 months. Slopes of volume reduction over time for the cortical and subcortical GGM were significantly different. Hippocampal volume loss was most pronounced and rapid in individuals with PTA > 2 weeks. The 3-month volumes of the hippocampus and lentiform nucleus were the best independent predictors of 12-month outcome after adjusting for GCS, PTA and age. In the brainstem, volume loss was significant at both 3 and 12 months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12 months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3 months, and was strongly associated with volume changes in the brainstem and cortical GM, but not lobar WM volume. Higher ADC values were detected in the cortex in individuals with severe TBI, DAI and PTA > 2 weeks, from 3 months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome. PMID:25068105

Total Intravenous Anesthesia Including Ketamine versus Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury

DTIC Science & Technology

2008-07-01

receiving VGA with regard to Injury Severity Score, Glasgow Coma Scale score, base deficit, Head Abbreviated Injury Score, and craniectomy or craniotomy ...1, 2, or 3. Craniectomy or craniotomy was performed at the discretion of the neurosurgeon based on type of skull injury, severity of injury, and...perfectly on GCS ( 8, 8), base deficit ( 6, 6), Head Abbreviated Injury Score ( 3, 3) and craniectomy versus craniotomy . From these, subsets

Prevalence of graduated compression stocking-associated pressure injuries in surgical intensive care units.

PubMed

Hobson, Deborah B; Chang, Tracy Y; Aboagye, Jonathan K; Lau, Brandyn D; Shihab, Hasan M; Fisher, Betsy; Young, Samantha; Sujeta, Nancy; Shaffer, Dauryne L; Popoola, Victor O; Kraus, Peggy S; Knorr, Gina; Farrow, Norma E; Streiff, Michael B; Haut, Elliott R

2017-08-01

This study aimed to determine the prevalence of static graduated compression stocking (sGCS)-associated pressure injury among patients in surgical intensive care units (ICUs). We retrospectively reviewed data from wound care rounds between April 2011 and June 2012 at 3 surgical ICUs at an urban, tertiary care hospital. Patients with sGCS-associated pressure injury were identified and descriptive analysis was performed on their demographic, perioperative, and postoperative characteristics. We examined 1787 individual patients during 2391 patient encounters. A total of 129 (7.2%) of patients developed pressure injuries. Forty patients (2.2%) developed sGCS-associated pressure injury. Static GCS-associated pressure injury accounted for 31% (40/129) of all pressure injuries and 74% (40/54) of all medical device-related pressure injury. Eighteen (45%) and 6 (15%) developed stage 1 and 2 pressure injury, respectively, and 16 (40%) developed deep tissue injuries. The mean age of our patients was 64.7 years, about half (47.5%) were male, and their mean Acute Physiology and Chronic Health Evaluation II score was 18.8. Many had comorbid conditions, including obesity (44.5%) and diabetes (42.5%), and required mechanical ventilation (45%). Pressure injuries are a notable complication of sGCS in surgical ICU patients. Appropriate measures are required to help avoid this potentially preventable harm. Copyright © 2017 Elsevier Inc. All rights reserved.

Characterization of Unconventional Reservoirs: CO2 Induced Petrophysics

NASA Astrophysics Data System (ADS)

Verba, C.; Goral, J.; Washburn, A.; Crandall, D.; Moore, J.

2017-12-01

As concerns about human-driven CO2 emissions grow, it is critical to develop economically and environmentally effective strategies to mitigate impacts associated with fossil energy. Geologic carbon storage (GCS) is a potentially promising technique which involves the injection of captured CO2 into subsurface formations. Unconventional shale formations are attractive targets for GCS while concurrently improving gas recovery. However, shales are inherently heterogeneous, and minor differences can impact the ability of the shale to effectively adsorb and store CO2. Understanding GCS capacity from such endemic heterogeneities is further complicated by the complex geochemical processes which can dynamically alter shale petrophysics. We investigated the size distribution, connectivity, and type (intraparticle, interparticle, and organic) of pores in shale; the mineralogy of cores from unconventional shale (e.g. Bakken); and the changes to these properties under simulated GCS conditions. Electron microscopy and dual beam focused ion beam scanning electron microscopy were used to reconstruct 2D/3D digital matrix and pore structures. Comparison of pre and post-reacted samples gives insights into CO2-shale interactions - such as the mechanism of CO2 sorption in shales- intended for enhanced oil recovery and GCS initiatives. These comparisons also show how geochemical processes proceed differently across shales based on their initial diagenesis. Results show that most shale pore sizes fall within meso-macro pore classification (> 2 nm), but have variable porosity and organic content. The formation of secondary minerals (calcite, gypsum, and halite) may play a role in the infilling of fractures and pore spaces in the shale, which may reduce permeability and inhibit the flow of fluids.

[Clinical predictors correlated to outcome of war missile penetrating brain injury].

PubMed

Splavski, Bruno; Vranković, Duro; Saftić, Robert; Muzević, Dario; Kosuta, Maja; Gmajnić, Rudika

2006-09-01

The purpose of this retrospective study was to review and discuss the outcome of surgical management and other clinical predictors influencing the prognosis of war missile penetrating brain injuries. To determine clinical predictors that influence the prognosis of war missile penetrating brain injury, 126 surgically treated patients who had sustained such an injury during the two-year period of war in Croatia (1991-1993) were retrospectively analyzed. Investigated clinical features were: Glasgow Coma Scale (GCS) score on admission; extent of brain injury; time between injury and hospital admission; presence of intracranially retained foreign bodies or bone fragments; development of postinjury and posttraumatic complications; and Glasgow Outcome Score (GOS) at six-month follow up. The data were statistically analyzed. Sixty-seven patients survived penetrating missile brain injury, in most of them with GCS score above 8 on admission. The mean time interval to hospital admission in this group of patients was less than two hours. Twelve of 67 patients developed different complications. All patients recovered well according to GOS (GOS 5 and 4) at six-month follow up. Fifty-nine patients died. The wounded who were in moribund state on the hospital admission (n = 11), and those who died during surgery (n = 8) were excluded from the analysis. The remaining 40 patients who did not survive were analyzed. The majority of them had GCS score 3-8 on admission. They mostly sustained bilateral hemispheric lesion, and/or ventricular lesion, and developed brain edema. The mean time interval between injury and hospital admission was over two hours in this group of patients. Postoperative complication developed in 9 of 40 patients. The patients with GCS score exceeding 8 had by far more favorable outcome in comparison to those with GCS score less than 8. Considering the extent of injury, patients suffering unihemispheric brain wounds had a more favorable outcome than those with lesions of both hemispheres, and particularly those with transventricular lesions. The time between injury and hospital admission proved to be another important prognostic factor. The majority of patients admitted up to one hour of injury survived, while two thirds of those admitted between one and three hours of injury succumbed. The presence of intracranially retained foreign bodies and bone fragments, and postinjury and postoperative complications implied worse outcome in comparison with their absence. The state of consciousness on admission was the most sensitive criterion as far as the prognosis is concerned. The outcome also depended on the extent of brain damage since the wounds associated with a high mortality rate were predominantly bihemispheric. Concerning survival, the time between injury and hospital admission also appeared to be important, as well as intracranially retained foreign bodies and bone fragments, and development of complications. There was no relationship between the presence of retained fragments and development of infection, suggesting that it is not necessary to reoperate for retained fragments. We assume that early surgery is essential for treatment outcome, although it is not necessary to reoperate for retained fragments.

A realistic bi-hemispheric model of the cerebellum uncovers the purpose of the abundant granule cells during motor control.

PubMed

Pinzon-Morales, Ruben-Dario; Hirata, Yutaka

2015-01-01

The cerebellar granule cells (GCs) have been proposed to perform lossless, adaptive spatio-temporal coding of incoming sensory/motor information required by downstream cerebellar circuits to support motor learning, motor coordination, and cognition. Here we use a physio-anatomically inspired bi-hemispheric cerebellar neuronal network (biCNN) to selectively enable/disable the output of GCs and evaluate the behavioral and neural consequences during three different control scenarios. The control scenarios are a simple direct current motor (1 degree of freedom: DOF), an unstable two-wheel balancing robot (2 DOFs), and a simulation model of a quadcopter (6 DOFs). Results showed that adequate control was maintained with a relatively small number of GCs (< 200) in all the control scenarios. However, the minimum number of GCs required to successfully govern each control plant increased with their complexity (i.e., DOFs). It was also shown that increasing the number of GCs resulted in higher robustness against changes in the initialization parameters of the biCNN model (i.e., synaptic connections and synaptic weights). Therefore, we suggest that the abundant GCs in the cerebellar cortex provide the computational power during the large repertoire of motor activities and motor plants the cerebellum is involved with, and bring robustness against changes in the cerebellar microcircuit (e.g., neuronal connections).

Ethnographic analysis of traumatic brain injury patients in the national Model Systems database.

PubMed

Burnett, Derek M; Kolakowsky-Hayner, Stephanie A; Slater, Dan; Stringer, Anthony; Bushnik, Tamara; Zafonte, Ross; Cifu, David X

2003-02-01

To compare demographics, injury characteristics, therapy service and intensity, and outcome in minority versus nonminority patients with traumatic brain injury (TBI). Retrospective analysis. Twenty medical centers. Two thousand twenty patients (men, n=1,518; women, n=502; nonminority, n=1,168; minority, n=852) with TBI enrolled in the Traumatic Brain Injury Model Systems database. Not applicable. Age, gender, marital status, education, employment status, injury severity (based on Glasgow Coma Scale [GCS] admission score, length of posttraumatic amnesia, duration of unconsciousness), intensity (hours) of therapy rendered, rehabilitation length of stay (LOS), rehabilitation charges, discharge disposition, postinjury employment status, FIM instrument change scores, and FIM efficiency scores. Independent sample t tests were used to analyze continuous variables; chi-square analyses were used to evaluate categorical data. overall, minorities were found to be mostly young men who were single, unemployed, and less well educated, with a longer work week if employed when injured. motor vehicle crashes (MVCs) predominated as the cause of injury for both groups; however, minorities were more likely to sustain injury from acts of violence and auto-versus-pedestrian crashes. Minorities also had higher GCS scores on admission and shorter LOS. Rehabilitation services: significant differences were found in the types and intensity of rehabilitation services provided; these included physical therapy, occupational therapy, and speech-language pathology, but not psychology. Minority patients who sustain TBI generally tend to be young men with less social responsibility. Although MVCs predominate as the primary etiology, acts of violence and auto-versus-pedestrian incidents are more common in the minority population. Minorities tend to have higher GCS scores at admission. Also, the type and intensity of rehabilitation services provided differed significantly for the various interdisciplinary subspecialties. Rehabilitation charges, discharge disposition, and postinjury employment status were similar for the 2 groups, even though LOS is typically 3 to 4 days shorter for the minority group. A more detailed investigation is warranted to explain these findings.

Postoperative surveillance in neurosurgical patients - usefulness of neurological assessment scores and bispectral index.

PubMed

Herrero, Silvia; Carrero, Enrique; Valero, Ricard; Rios, Jose; Fábregas, Neus

We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS). In the CG (n=70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p<0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p=0.002; OR=7.15, 95% CI=2.1-24.7 vs. p=0.002; OR=9.5, 95% CI=2.3-39.4). In the NCG (n=46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p<0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p=0.048; OR=7.28, 95% CI=1.021-52.006). Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Postoperative surveillance in neurosurgical patients - usefulness of neurological assessment scores and bispectral index].

PubMed

Herrero, Silvia; Carrero, Enrique; Valero, Ricard; Rios, Jose; Fábregas, Neus

We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS). In the CG (n=70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p<0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p=0.002; OR=7.15, 95% CI=2.1-24.7 vs. p=0.002; OR=9.5, 95% CI=2.3-39.4). In the NCG (n=46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p<0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p=0.048; OR=7.28, 95% CI=1.021-52.006). Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Necrotizing soft tissue infections caused by Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis of groups C and G in western Norway.

PubMed

Bruun, T; Kittang, B R; de Hoog, B J; Aardal, S; Flaatten, H K; Langeland, N; Mylvaganam, H; Vindenes, H A; Skrede, S

2013-12-01

Streptococcus pyogenes (group A streptococcus, GAS) is a major cause of necrotizing soft tissue infection (NSTI). On rare occasions, other β-haemolytic streptococci may also cause NSTI, but the significance and nature of these infections has not been thoroughly investigated. In this study, clinical and molecular characteristics of NSTI caused by GAS and β-haemolytic Streptococcus dysgalactiae subsp. equisimilis of groups C and G (GCS/GGS) in western Norway during 2000-09 are presented. Clinical data were included retrospectively. The bacterial isolates were subsequently emm typed and screened for the presence of genes encoding streptococcal superantigens. Seventy cases were identified, corresponding to a mean annual incidence rate of 1.4 per 100 000. Sixty-one of the cases were associated with GAS, whereas GCS/GGS accounted for the remaining nine cases. The in-hospital case fatality rates of GAS and GCS/GGS disease were 11% and 33%, respectively. The GCS/GGS patients were older, had comorbidities more often and had anatomically more superficial disease than the GAS patients. High age and toxic shock syndrome were associated with mortality. The Laboratory Risk Indicator for Necrotizing Fasciitis laboratory score showed high values (≥6) in only 31 of 67 cases. Among the available 42 GAS isolates, the most predominant emm types were emm1, emm3 and emm4. The virulence gene profiles were strongly correlated to emm type. The number of superantigen genes was low in the four available GCS/GGS isolates. Our findings indicate a high frequency of streptococcal necrotizing fasciitis in our community. GCS/GGS infections contribute to the disease burden, but differ from GAS cases in frequency and predisposing factors. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Cerebrospinal Fluid Markers of Macrophage and Lymphocyte Activation after Traumatic Brain Injury in Children

PubMed Central

Newell, Elizabeth; Shellington, David K.; Simon, Dennis W.; Bell, Michael J.; Kochanek, Patrick M.; Feldman, Keri; Bayır, Hülya; Aneja, Rajesh K.; Carcillo, Joseph A.; Clark, Robert S. B.

2015-01-01

Objective The magnitude and role of the cellular immune response following pediatric traumatic brain injury (TBI) remains unknown. We tested the hypothesis that macrophage/microglia and T-cell activation occurs following pediatric TBI by measuring cerebrospinal fluid (CSF) levels of sCD163 and ferritin, and sIL-2Rα, respectively, and determined whether these biomarkers were associated with relevant clinical variables and outcome. Design Retrospective analysis of samples from an established, single-center CSF bank. Setting Pediatric Intensive Care Unit (PICU) in a tertiary Children’s Hospital Patients Sixty-six pediatric patients after severe TBI (Glasgow coma scale score [GCS]<8) age 1 mo-16 y and 17 control patients age 1 mo-14 y. Measurements and Main Results CSF levels of sCD163, ferritin, and sIL-2Rα were determined by ELISA at 2 time points (t1=17±10, t2=72±15 h) for each TBI patient. CSF sCD163, ferritin, and sIL2Rα levels after TBI were compared with controls and analyzed for associations with age, patient sex, initial GCS, diagnosis of abusive head trauma (AHT), the presence of hemorrhage on computerized tomography scan, and Glasgow outcome scale score (GOS). CSF sCD163 was increased in TBI patients at t2 vs. t1 and controls (95.4[21.8–134.0] vs. 31.0[5.7–77.7] and 27.8[19.1–43.1] ng/ml, respectively; median[IQ]; P<0.05). CSF ferritin was increased in TBI patients at t2 and t1 vs. controls (8.3[7.5–19.8] and 8.9[7.5–26.7] vs. [7.5[0.0–0.0] ng/ml, respectively; P<0.05). CSF sIL-2Rα in TBI patients at t2 and t1 were not different vs. controls. Multivariate regression revealed associations between high ferritin and age ≤ 4 y, lower GCS, AHT, and unfavorable GOS. Conclusions Children with TBI demonstrate evidence for macrophage activation after TBI, and in terms of CSF ferritin, this appears more prominent with young age, initial injury severity, AHT, and unfavorable outcome. Further study is needed to determine whether biomarkers of macrophage activation may be used to discriminate between aberrant and adaptive immune responses, and whether inflammation represents a therapeutic target after TBI. PMID:25850867

MicroRNAs and Glucocorticoid-Induced Apoptosis in Lymphoid Malignancies

PubMed Central

Sionov, Ronit Vogt

2013-01-01

The initial response of lymphoid malignancies to glucocorticoids (GCs) is a critical parameter predicting successful treatment. Although being known as a strong inducer of apoptosis in lymphoid cells for almost a century, the signaling pathways regulating the susceptibility of the cells to GCs are only partly revealed. There is still a need to develop clinical tests that can predict the outcome of GC therapy. In this paper, I discuss important parameters modulating the pro-apoptotic effects of GCs, with a specific emphasis on the microRNA world comprised of small players with big impacts. The journey through the multifaceted complexity of GC-induced apoptosis brings forth explanations for the differential treatment response and raises potential strategies for overcoming drug resistance. PMID:23431463

Are third-generation cephalosporins still the empirical antibiotic treatment of community-acquired spontaneous bacterial peritonitis? A systematic review and meta-analysis.

PubMed

Fiore, Marco; Gentile, Ivan; Maraolo, Alberto E; Leone, Sebastiano; Simeon, Vittorio; Chiodini, Paolo; Pace, Maria C; Gustot, Thierry; Taccone, Fabio S

2018-03-01

Spontaneous bacterial peritonitis (SBP) is a common complication among cirrhotic patients. Guidelines recommend third-generation cephalosporins (3GCs) as empiric antibiotic therapy (EAT) of SBP. Recently, a broad-spectrum EAT was shown to be more effective than cephalosporins in the treatment of nosocomial spontaneous bacterial peritonitis (N-SBP); however, the prevalence of 3GCs-resistant bacteria is high in the nosocomial setting and broad-spectrum EAT cannot be used in all cases of SBP. The aim of this study was to evaluate the 3GCs resistance distribution between N-SBP and community-acquired spontaneous bacterial peritonitis (CA-SBP) to clarify whether 3GCs are still an effective therapeutic intervention for CA-SBP. We searched for studies that reported the aetiology of SBP and the resistance profile of both gram-positive and gram-negative bacteria in MEDLINE and Google Scholar databases (since 1 January 2000 to 30 April 2017). A meta-analysis was carried out to estimate the risk difference [relative risk (RR) and 95% confidence intervals (CIs)] for 3GCs resistance in N-SBP and CA-SBP. Heterogeneity was assessed using the I-test. A total of eight studies were included, including 1074 positive cultures of ascitic fluid in cirrhotic patients; 462 positive cultures were from N-SBP and, among these, 251 (54.3%) were 3GCs resistant. Six hundred and twelve positive cultures were from CA-SBP and, among these, 207 (33.8%) were 3GCs-resistant SBP. A pooled RR of 3GCs resistance in N-SBP compared with CA-SBP showed a significant difference (RR=1.67, 95% CI: 1.14-2.44; P=0.008). We carried out two subgroup analyses: the first according to the median year of study observation (before vs. since 2008) and the second according to the country of the study (China vs. others). The studies carried out before 2008 (327 SBP-positive culture) showed a significantly higher risk for 3GCs-resistant strains in N-SBP compared with CA-SBP (RR=2.36, 95% CI: 1.39-3.99; P=0.001), whereas this was not found in SBP acquired after 2008 (RR=1.24, 95% CI: 0.83-1.84; P=0.29). N-SBP occurring in China had no significantly higher risk for 3GCs-resistant strains compared with CA-SBP (RR=1.44, 95% CI: 0.87-2.37; P=0.16). Our findings suggest that although the pooled RR of 3GCs resistance in N-SBP compared with CA-SBP show that 3GCs are still an effective option for the treatment of CA-SBP, the subanalysis of studies that enroled patients in the last decade did not show a significant higher RR of 3GCs resistance in N-SBP compared with CA-SBP. Therefore, in centres where local patterns of antimicrobial susceptibility (with low rates of 3GCs resistance) are not available, 3GCs should not be used initially for CA-SBP treatment. Future studies are needed to confirm this trend of 3GCs resistance.

Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care.

PubMed

Feng, Zhihong; Wang, Tao; Liu, Ping; Chen, Sipeng; Xiao, Han; Xia, Ning; Luo, Zhiming; Wei, Bing; Nie, Xiuhong

2017-01-01

We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients). Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age ( P < 0.05 for all). With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II ( P = 1.519). Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

GCS component development cycle

NASA Astrophysics Data System (ADS)

Rodríguez, Jose A.; Macias, Rosa; Molgo, Jordi; Guerra, Dailos; Pi, Marti

2012-09-01

The GTC1 is an optical-infrared 10-meter segmented mirror telescope at the ORM observatory in Canary Islands (Spain). First light was at 13/07/2007 and since them it is in the operation phase. The GTC control system (GCS) is a distributed object & component oriented system based on RT-CORBA8 and it is responsible for the management and operation of the telescope, including its instrumentation. GCS has used the Rational Unified process (RUP9) in its development. RUP is an iterative software development process framework. After analysing (use cases) and designing (UML10) any of GCS subsystems, an initial component description of its interface is obtained and from that information a component specification is written. In order to improve the code productivity, GCS has adopted the code generation to transform this component specification into the skeleton of component classes based on a software framework, called Device Component Framework. Using the GCS development tools, based on javadoc and gcc, in only one step, the component is generated, compiled and deployed to be tested for the first time through our GUI inspector. The main advantages of this approach are the following: It reduces the learning curve of new developers and the development error rate, allows a systematic use of design patterns in the development and software reuse, speeds up the deliverables of the software product and massively increase the timescale, design consistency and design quality, and eliminates the future refactoring process required for the code.

Differential release and phagocytosis of tegument glycoconjugates in neurocysticercosis: implications for immune evasion strategies.

PubMed

Alvarez, Jorge I; Rivera, Jennifer; Teale, Judy M

2008-04-09

Neurocysticercosis (NCC) is an infection of the central nervous system (CNS) by the metacestode of the helminth Taenia solium. The severity of the symptoms is associated with the intensity of the immune response. First, there is a long asymptomatic period where host immunity seems incapable of resolving the infection, followed by a chronic hypersensitivity reaction. Since little is known about the initial response to this infection, a murine model using the cestode Mesocestoides corti (syn. Mesocestoides vogae) was employed to analyze morphological changes in the parasite early in the infection. It was found that M. corti material is released from the tegument making close contact with the nervous tissue. These results were confirmed by infecting murine CNS with ex vivo-labeled parasites. Because more than 95% of NCC patients exhibit humoral responses against carbohydrate-based antigens, and the tegument is known to be rich in glycoconjugates (GCs), the expression of these types of molecules was analyzed in human, porcine, and murine NCC specimens. To determine the GCs present in the tegument, fluorochrome-labeled hydrazides as well as fluorochrome-labeled lectins with specificity to different carbohydrates were used. All the lectins utilized labeled the tegument. GCs bound by isolectinB4 were shed in the first days of infection and not resynthesized by the parasite, whereas GCs bound by wheat germ agglutinin and concavalinA were continuously released throughout the infectious process. GCs bound by these three lectins were taken up by host cells. Peanut lectin-binding GCs, in contrast, remained on the parasite and were not detected in host cells. The parasitic origin of the lectin-binding GCs found in host cells was confirmed using antibodies against T. solium and M. corti. We propose that both the rapid and persistent release of tegumental GCs plays a key role in the well-known immunomodulatory effects of helminths, including immune evasion and life-long inflammatory sequelae seen in many NCC patients.

Short-term, high-dose glucocorticoid treatment does not contribute to reduced bone mineral density in patients with multiple sclerosis.

PubMed

Olsson, A; Oturai, D B; Sørensen, P S; Oturai, P S; Oturai, A B

2015-10-01

Patients with multiple sclerosis (MS) are at increased risk of reduced bone mineral density (BMD). A contributing factor might be treatment with high-dose glucocorticoids (GCs). The objective of this paper is to assess bone mass in patients with MS and evaluate the importance of short-term, high-dose GC treatment and other risk factors that affect BMD in patients with MS. A total of 260 patients with MS received short-term high-dose GC treatment and had their BMD measured by dual x-ray absorptiometry. BMD was compared to a healthy age-matched reference population (Z-scores). Data regarding GCs, age, body mass index (BMI), serum 25(OH)D, disease duration and severity were collected retrospectively and analysed in a multiple linear regression analysis to evaluate the association between each risk factor and BMD. Osteopenia was present in 38% and osteoporosis in 7% of the study population. Mean Z-score was significantly below zero, indicating a decreased BMD in our MS patients. Multiple linear regression analysis showed no significant association between GCs and BMD. In contrast, age, BMI and disease severity were independently associated with both lumbar and femoral BMD. Reduced BMD was prevalent in patients with MS. GC treatment appears not to be the primary underlying cause of secondary osteoporosis in MS patients. © The Author(s), 2015.

Prognostic accuracy of five simple scales in childhood bacterial meningitis.

PubMed

Pelkonen, Tuula; Roine, Irmeli; Monteiro, Lurdes; Cruzeiro, Manuel Leite; Pitkäranta, Anne; Kataja, Matti; Peltola, Heikki

2012-08-01

In childhood acute bacterial meningitis, the level of consciousness, measured with the Glasgow coma scale (GCS) or the Blantyre coma scale (BCS), is the most important predictor of outcome. The Herson-Todd scale (HTS) was developed for Haemophilus influenzae meningitis. Our objective was to identify prognostic factors, to form a simple scale, and to compare the predictive accuracy of these scales. Seven hundred and twenty-three children with bacterial meningitis in Luanda were scored by GCS, BCS, and HTS. The simple Luanda scale (SLS), based on our entire database, comprised domestic electricity, days of illness, convulsions, consciousness, and dyspnoea at presentation. The Bayesian Luanda scale (BLS) added blood glucose concentration. The accuracy of the 5 scales was determined for 491 children without an underlying condition, against the outcomes of death, severe neurological sequelae or death, or a poor outcome (severe neurological sequelae, death, or deafness), at hospital discharge. The highest accuracy was achieved with the BLS, whose area under the curve (AUC) for death was 0.83, for severe neurological sequelae or death was 0.84, and for poor outcome was 0.82. Overall, the AUCs for SLS were ≥0.79, for GCS were ≥0.76, for BCS were ≥0.74, and for HTS were ≥0.68. Adding laboratory parameters to a simple scoring system, such as the SLS, improves the prognostic accuracy only little in bacterial meningitis.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morscher, Meagan; Pattabiraman, Bharath; Rodriguez, Carl

Our current understanding of the stellar initial mass function and massive star evolution suggests that young globular clusters (GCs) may have formed hundreds to thousands of stellar-mass black holes (BHs), the remnants of stars with initial masses from ∼20-100 M {sub ☉}. Birth kicks from supernova explosions may eject some BHs from their birth clusters, but most should be retained. Using a Monte Carlo method we investigate the long-term dynamical evolution of GCs containing large numbers of stellar BHs. We describe numerical results for 42 models, covering a broad range of realistic initial conditions, including up to 1.6 × 10{supmore » 6} stars. In almost all models we find that significant numbers of BHs (up to ∼10{sup 3}) are retained all the way to the present. This is in contrast to previous theoretical expectations that most BHs should be ejected dynamically within a few gigayears The main reason for this difference is that core collapse driven by BHs (through the Spitzer {sup m}ass segregation instability{sup )} is easily reverted through three-body processes, and involves only a small number of the most massive BHs, while lower-mass BHs remain well-mixed with ordinary stars far from the central cusp. Thus the rapid segregation of stellar BHs does not lead to a long-term physical separation of most BHs into a dynamically decoupled inner core, as often assumed previously. Combined with the recent detections of several BH X-ray binary candidates in Galactic GCs, our results suggest that stellar BHs could still be present in large numbers in many GCs today, and that they may play a significant role in shaping the long-term dynamical evolution and the present-day dynamical structure of many clusters.« less

Dynamical evolution of stellar mass black holes in dense stellar clusters: estimate for merger rate of binary black holes originating from globular clusters

NASA Astrophysics Data System (ADS)

Tanikawa, A.

2013-10-01

We have performed N-body simulations of globular clusters (GCs) in order to estimate a detection rate of mergers of binary stellar mass black holes (BBHs) by means of gravitational wave (GW) observatories. For our estimate, we have only considered mergers of BBHs which escape from GCs (BBH escapers). BBH escapers merge more quickly than BBHs inside GCs because of their small semimajor axes. N-body simulation cannot deal with a GC with the number of stars N ˜ 106 due to its high calculation cost. We have simulated dynamical evolution of small N clusters (104 ≲ N ≲ 105), and have extrapolated our simulation results to large N clusters. From our simulation results, we have found the following dependence of BBH properties on N. BBHs escape from a cluster at each two-body relaxation time at a rate proportional to N. Semimajor axes of BBH escapers are inversely proportional to N, if initial mass densities of clusters are fixed. Eccentricities, primary masses and mass ratios of BBH escapers are independent of N. Using this dependence of BBH properties, we have artificially generated a population of BBH escapers from a GC with N ˜ 106, and have estimated a detection rate of mergers of BBH escapers by next-generation GW observatories. We have assumed that all the GCs are formed 10 or 12 Gyr ago with their initial numbers of stars Ni = 5 × 105-2 × 106 and their initial stellar mass densities inside their half-mass radii ρh,i = 6 × 103-106 M⊙ pc-3. Then, the detection rate of BBH escapers is 0.5-20 yr-1 for a BH retention fraction RBH = 0.5. A few BBH escapers are components of hierarchical triple systems, although we do not consider secular perturbation on such BBH escapers for our estimate. Our simulations have shown that BHs are still inside some of GCs at the present day. These BHs may marginally contribute to BBH detection.

The effect of brain tomography findings on mortality in sniper shot head injuries.

PubMed

Can, Çağdaş; Bolatkale, M; Sarıhan, A; Savran, Y; Acara, A Ç; Bulut, M

2017-06-01

Penetrating gunshot head injuries have a poor prognosis and require prompt care. Brain CT is a routine component of the standard evaluation of head wounds and suspected brain injury. We aimed to investigate the effect of brain CT findings on mortality in gunshot head injury patients who were admitted to our emergency department (ED) from the Syrian Civil War. The study group comprised patients who were admitted to the ED with gunshot brain injury. Patients' GCS scores, prehospital intubations and brain CT findings were examined. 104 patients were included (92% male, mean age 25 years). Pneumocephalus, midline shift, penetrating head injury, patients with GCS scores ≤6 and patients who had to be intubated in the prehospital period were associated with higher mortality (p<0.05). The results of this study demonstrated that pneumocephalus, midline shift, a penetrating head injury, GCS scores ≤6 and prehospital intubation are associated with high mortality, whereas patients with temporal bone fracture, perforating or single cerebral lobe head injury had a higher survival rates. The temporal bone has a relatively thin and smooth shape compared with the other skull bones so a bullet is less fragmented when it has penetrated the temporal bone, which could be a reason for the reduced cavitation effect. In perforating head injury, the bullet makes a second hole and so will have deposited less energy than a retained bullet with a consequent reduction in intracranial injury and mortality. Further studies are required to reach definitive conclusions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The role of early surgical intervention in civilian gunshot wounds to the head.

PubMed

Helling, T S; McNabney, W K; Whittaker, C K; Schultz, C C; Watkins, M

1992-03-01

Surgical management of gunshot wounds of the head has remained a controversial issue in the care of civilian patients. In an attempt to determine who might benefit from aggressive surgical intervention, we examined 89 patients over a 3-year period who had suffered cranial gunshot wounds and had at least one computed tomographic scan of the head after admission. Patients were divided into those receiving early (less than 24 hours) surgical intervention (ES, n = 27), late (greater than 24 hours) surgical intervention (LS, n = 6) or no surgical intervention (NS, n = 56). Overall mortality was 63%. Ten of 27 patients (37%) in the ES group died compared with 46 of 56 patients (82%) in the NS group (p less than 0.0001). Glasgow Coma Scale (GCS) scores in the ES group averaged 7.86 +/- 4.72 and in the NS group 5.59 +/- 4.42 (p less than 0.05). The GCS scores in the LS group (all of whom survived) were significantly higher than those of the other two groups, 12.17 +/- 4.10. The number of patients with GCS scores of 3 or 4 on admission was significantly less in the ES (41%) than in the NS group (66%, p = 0.035) and survival was better with surgery (36%) than without (3%, p = 0.007). Patients with mass lesions (clot, ventricular blood) were more often found in the ES group (17/27) than in the NS group (18/56) (p = 0.008). Patients with bihemispheric injuries fared better with surgery (7 of 14 survivors) than without (2 of 33 survivors, p = 0.0003). Only one infectious complication (brain abscess) was encountered in the LS group. No delayed intracranial complications in survivors in the NS group were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Diurnal salivary cortisol measurement in the neurosurgical-surgical intensive care unit in critically ill acute trauma patients.

PubMed

Bartanusz, Viktor; Corneille, Michael G; Sordo, Salvador; Gildea, Marianne; Michalek, Joel E; Nair, Prakash V; Stewart, Ronald M; Jezova, Daniela

2014-12-01

Acute trauma patients represent a specific subgroup of the critically ill population due to sudden and dramatic changes in homeostasis and consequently extreme demands on the activity of the hypothalamic-pituitary-adrenocortical (HPA) axis. Salivary cortisol is an accepted surrogate for serum free cortisol in the assessment of HPA axis function. The purpose of this study was (1) to establish the feasibility of salivary cortisol measurement in acute trauma patients in the neurosurgical-surgical intensive care unit (NSICU), and (2) to determine the diurnal pattern of salivary cortisol in the acute phase after injury. Saliva from 50 acute trauma patients was prospectively collected twice a day at 6AM and 4PM during the first week after injury in the NSICU. Mean PM cortisol concentrations were significantly higher in subjects versus controls (p<0.001). Subjects failed to develop the expected PM versus AM decrease in cortisol concentration seen in controls (p=0.005). Salivary cortisol did not vary significantly with baseline Glasgow Coma Scale (GCS), Injury Severity Score, sex, injury type, ethnicity, or age. When comparing mean AM and PM salivary cortisol by GCS severity category (GCS ⩽8 and GCS >8) the AM salivary cortisol was significantly higher in patients with GCS ⩽8 (p=0.002). The results show a loss of diurnal cortisol variation in acute trauma patient in the NSICU during the first week of hospitalization. Patients with severe brain injury had higher morning cortisol levels than those with mild/moderate brain injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Alcohol-related hospitalisations of trauma patients in Southern Taiwan: a cross-sectional study based on a trauma registry system

PubMed Central

Rau, Cheng-Shyuan; Liu, Hang-Tsung; Hsu, Shiun-Yuan; Cho, Tzu-Yu; Hsieh, Ching-Hua

2014-01-01

Objectives To provide an overview of the demographic characteristics of patients with positive blood alcohol concentration (BAC) and to investigate the performance of brain CT scans in these patients. Design Cross-sectional study. Setting Taiwan. Participants 2192 patients who had undergone a test for blood alcohol of 13 233 patients registered in the Trauma Registry System between 1 January 2009 and 31 December 2012. A BAC level of 50 mg/dL was defined as the cut-off value. Detailed information was retrieved from the patients with positive BAC (n=793) and was compared with information from those with a negative BAC (n=1399). Main outcome measures Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) as well as the performance and findings of obtained brain CT scans. Results Patients with positive BAC had a higher rate of face injury, but a lower GCS score, a lower rate of head and neck injury, a lower ISS and New Injury Severity Score. Alcohol use was associated with a shorter length of hospital stay (8.6 vs 11.4 days, p=0.000) in patients with an ISS of <16. Of 496 patients with positive BAC who underwent brain CT, 164 (33.1%) showed positive findings on CT scan. In contrast, of 891 patients with negative BAC who underwent brain CT, 389 (43.7%) had positive findings on CT scan. The lower percentage of positive CT scan findings in patients with positive BAC was particularly evident in patients with an ISS <16 (18.0% vs 28.8%, p=0.001). Conclusions Patients who consumed alcohol tended to have a low GCS score and injuries that were less severe. However, given the significantly low percentage of positive findings, brain CT might be overused in these patients with less severe injuries. PMID:25361838

Medication reconciliation in a rural trauma population.

PubMed

Miller, S Lee; Miller, Stephanie; Balon, Jennifer; Helling, Thomas S

2008-11-01

Medication errors during hospitalization can lead to adverse drug events. Because of preoccupation by health care providers with life-threatening injuries, trauma patients may be particularly prone to medication errors. Medication reconciliation on admission can result in decreased medication errors and adverse drug events in this patient population. The purpose of this study is to determine the accuracy of medication histories obtained on trauma patients by initial health care providers compared to a medication reconciliation process by a designated clinical pharmacist after the patient's admission and secondarily to determine whether trauma-associated factors affected medication accuracy. This was a prospective enrollment study during 13 months in which trauma patients admitted to a Level I trauma center were enrolled in a stepwise medication reconciliation process by the clinical pharmacist. The setting was a rural Level I trauma center. Patients admitted to the trauma service were studied. The intervention was medication reconciliation by a clinical pharmacist. The main outcome measure was accuracy of medication history by initial trauma health care providers compared to a medication reconciliation process by a clinical pharmacist who compared all sources, including telephone calls to pharmacies. Patients taking no medications (whether correctly identified as such or not) were not analyzed in these results. Variables examined included admission medication list accuracy, age, trauma team activation mode, Injury Severity Score, and Glasgow Coma Scale (GCS) score. Two hundred thirty-four patients were enrolled. Eighty-four of 234 patients (36%) had an Injury Severity Score greater than 15. Medications were reconciled within an average of 3 days of admission (range 1 to 8) by the clinical pharmacist. Overall, medications as reconciled by the clinical pharmacist were recorded correctly for 15% of patients. Admission trauma team medication lists were inaccurate in 224 of 234 cases (96%). Admitting nurses' lists were more accurate than the trauma team's (11% versus 4%; 95% confidence interval 2.5% to 11.2%). Errors were found by the clinical pharmacist in medication name, strength, route, and frequency. No patients (0/20) with admission GCS less than 13 had accurate medication lists. Seventy of 84 patients (83%) with an Injury Severity Score greater than 15 had inaccurate medication lists. Ten of 234 patients (4%) were ordered wrong medications, and 1 adverse drug event (hypoglycemia) occurred. The median duration of the reconciliation process was 2 days. Only 12% of cases were completed in 1 day, and almost 25% required 3 or more (maximum 8) days. This study showed that medication history recorded on admission was inaccurate. This patient population overall was susceptible to medication inaccuracies from multiple sources, even with duplication of medication histories by initial health care providers. Medication reconciliation for trauma patients by a clinical pharmacist may improve safety and prevent adverse drug events but did not occur quickly in this setting.

Methods to isolate a large amount of generative cells, sperm cells and vegetative nuclei from tomato pollen for "omics" analysis.

PubMed

Lu, Yunlong; Wei, Liqin; Wang, Tai

2015-01-01

The development of sperm cells (SCs) from microspores involves a set of finely regulated molecular and cellular events and the coordination of these events. The mechanisms underlying these events and their interconnections remain a major challenge. Systems analysis of genome-wide molecular networks and functional modules with high-throughput "omics" approaches is crucial for understanding the mechanisms; however, this study is hindered because of the difficulty in isolating a large amount of cells of different types, especially generative cells (GCs), from the pollen. Here, we optimized the conditions of tomato pollen germination and pollen tube growth to allow for long-term growth of pollen tubes in vitro with SCs generated in the tube. Using this culture system, we developed methods for isolating GCs, SCs and vegetative cell nuclei (VN) from just-germinated tomato pollen grains and growing pollen tubes and their purification by Percoll density gradient centrifugation. The purity and viability of isolated GCs and SCs were confirmed by microscopy examination and fluorescein diacetate staining, respectively, and the integrity of VN was confirmed by propidium iodide staining. We could obtain about 1.5 million GCs and 2.0 million SCs each from 180 mg initiated pollen grains, and 10 million VN from 270 mg initiated pollen grains germinated in vitro in each experiment. These methods provide the necessary preconditions for systematic biology studies of SC development and differentiation in higher plants.

20 years of trauma documentation in Germany--actual trends and developments.

PubMed

2014-10-01

The TraumaRegister DGU(®) has been founded 20 years ago. Although initially supported by larger hospitals and universities, it has recently become a representative registry for the care of severely injured patients in Germany. Based on the registry data some important trends and developments of the recent decades are presented. German trauma patients with an Injury Severity Score (ISS)≥ 16 were eligible if primary admitted from the scene. All cases documented between 1993 and 2012 (20 years) were eligible. For selected variables, an average change per years was calculated using linear regression analysis. A total of 49,801 patients was analysed. The mean age was 46.3 years, and 72% were males. The following relevant trends could be observed: The average age increased dramatically from 38 to 50 years. Pre-hospital intubation rate was halfed in patients with Glasgow Coma Scale (GCS)>8 but remained constant in unconscious patients (GCS ≤ 8; 90% intubation rate). Pre-hospital volume administration decreased as well, which led to less blood transfusions (from 45% to 16%). The use of helicopters for transportation into a trauma centre decreased as well but today still 27% of all cases are transported by air. Whole-body CT was performed in about 80% of patients; this value is stable in the last four years. Hospital mortality could be reduced and was 2-3% lower than expected in recent years. The Revised Injury Severity Classification (RISC) score used as a reference here was based on TR-DGU data from the 1990s. Standardised prospective registration of severely injured patients over 20years allows to empirically monitor trends and developments in acute trauma care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Predictors of outcome in myxoedema coma: a study from a tertiary care centre.

PubMed

Dutta, Pinaki; Bhansali, Anil; Masoodi, Shriq Rashid; Bhadada, Sanjay; Sharma, Navneet; Rajput, Rajesh

2008-01-01

With the easy availability of thyroid hormone assays, thyroid disorders are now recognised even in a subclinical state. However, patients are still seen with advanced manifestations of the disease, particularly in developing countries. This observational study analysed the predictors of outcome in patients with myxoedema coma and tested the validity of different modules to define morbidity and mortality in these patients. Twenty-three consecutive patients with myxoedema coma who presented from January 1999 to August 2006 were studied. The thyroid function test and random serum cortisol were measured in all patients at the time of admission. Patients were given oral or intravenous (i.v.) thyroxine with intention to treat with the latter according to availability. Various modules that predict outcome, including Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score, were analysed. SOFA score was repeated every 2 days until the time of discharge or demise. Twenty-three patients (20 women; 87%) of 59.5 +/- 14.4 years of age (range, 30 to 89 years) were seen during the study period. Nine (39%) patients were diagnosed with hypothyroidism for the first time at the time of presentation of myxoedema coma, whereas 14 (70%) were diagnosed with hypothyroidism previously. However, the treatment defaulters presented early to the hospital and had more severe manifestations than de novo subjects. Nineteen (82%) had thyroprivic (primary) and 4 (17%) had trophoprivic (secondary) hypothyroidism. Fifteen (65%) patients presented in the winter and in 17 (74%) sepsis was the major accompanying comorbidity. Twelve (52%) had a history of diuretic use, thereby delaying the initial diagnosis. Patients who received oral L-thyroxine had no difference in outcome from those receiving i.v. thyroxine. Twelve (52%) subjects died and sepsis was the predominant cause of death. Various predictors of mortality included hypotension (p = 0.01) and bradycardia (p = 0.03) at presentation, need for mechanical ventilation (p = 0.00), hypothermia unresponsive to treatment (p = 0.01), sepsis (p = 0.01), intake of sedative drugs (p = 0.02), lower GCS (p = 0.03), high APACHE II score (p = 0.04), and high SOFA score (p = 0.00). However, SOFA score was more effective than other predictive models as baseline and day 3 SOFA scores of more than 6 were highly predictive of poor outcome. L-Thyroxine treatment defaulters had more severe manifestations compared with de novo subjects. Outcome was not influenced by either aetiology or route of administration of L-thyroxine, and SOFA score was the best outcome predictor model.

Thermodynamic properties of gas-condensate system with abnormally high content of heavy hydrocarbons

NASA Astrophysics Data System (ADS)

Zanochuev, S. A.; Shabarov, A. B.; Podorozhnikov, S. Yu; Zakharov, A. A.

2018-05-01

Gas-condensate systems (GCS) with an abnormally high content of heavy hydrocarbons are characterized by a sharp change in both phase and component compositions with an insignificant decrease in pressure below the start pressure of the phase transitions (the beginning of condensation). Calculation methods for describing the phase behavior of such systems are very sensitive to the quality of the initial information. The uncertainty of the input data leads not only to significant errors in the forecast of phase compositions, but also to an incorrect phase state estimation of the whole system. The research presents the experimental thermodynamic parameters of the GCS of the BT reservoirs on the Beregovoye field, obtained at the phase equilibrium facility. The data contribute to the adaptation of the calculated models of the phase behavior of the GCS with a change in pressure.

The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only

PubMed Central

Garner, Alan A; Mann, Kristy P; Fearnside, Michael; Poynter, Elwyn; Gebski, Val

2015-01-01

Background Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Methods Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score <9 (original definition), or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 (modified definition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. Results 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), p<0.01, Number needed to treat =6. 338 patients met the modified definition, of which 182 were allocated to physician care. The 6-month GOS scores were not significantly different on intention-to-treat analysis (OR 1.14, 95% CI 0.73 to 1.75, p=0.56) nor was the 30-day mortality (OR 1.05, 95% CI 0.66 to 1.66, p=0.84). As-treated analyses were also not significantly different. Conclusions This trial suggests a potential mortality reduction in patients with blunt trauma with GCS<9 receiving additional physician care (original definition only). Confirmatory studies which also address non-compliance issues are needed. Trial registration number NCT00112398. PMID:25795741

Antithrombotic agents intake prior to injury does not affect outcome after a traumatic brain injury in hospitalized elderly patients.

PubMed

Julien, Jessica; Alsideiri, Ghusn; Marcoux, Judith; Hasen, Mohammed; Correa, José A; Feyz, Mitra; Maleki, Mohammed; de Guise, Elaine

2017-04-01

The purpose of this study is to investigate the effect of risk factors including International Normalized Ratio (INR) as well as the Partial Thromboplastin Time (PTT) scores on several outcomes, including hospital length of stay (LOS) and The Extended Glasgow Outcome Scale (GOSE) following TBI in the elderly population. Data were retrospectively collected on patients (n=982) aged 65 and above who were admitted post TBI to the McGill University Health Centre-Montreal General Hospital from 2000 to 2011. Age, Injury Severity Score (ISS), Glasgow Coma Scale score (GCS), type of trauma (isolated TBI vs polytrauma including TBI), initial CT scan results according to the Marshall Classification and the INR and PTT scores and prescriptions of antiplatelet or anticoagulant agents (AP/AC) were collected. Results also indicated that age, ISS and GSC score have an effect on the GOSE score. We also found that taking AC/AP has an effect on GOSE outcome, but that this effects depends on PTT, with lower odds of a worse outcome for those taking AC/AP agents as the PTT value goes up. However, this effect only becomes significant as the PTT value reaches 60 and above. Age and injury severity rather than antithrombotic agent intake are associated with adverse acute outcome such as GOSE in hospitalized elderly TBI patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Acute seizures in cerebral venous sinus thrombosis: What predicts it?

PubMed

Mahale, Rohan; Mehta, Anish; John, Aju Abraham; Buddaraju, Kiran; Shankar, Abhinandan K; Javali, Mahendra; Srinivasa, Rangasetty

2016-07-01

Seizures are the presenting feature of cerebral venous sinus thrombosis (CVST) in 12-31.9% of patients. 44.3% of patients have seizures in the early stage of the disease. Acute seizures (AS), refers to seizures which take place before the diagnosis or during the first 2 weeks afterward. To report the predictors of acute seizures in cerebral venous sinus thrombosis (CVST). 100 patients with CVST were included in the study. The occurrence of acute seizures was noted. The predictors of acute seizure were evaluated by univariate analysis including the demographic (gender, age), clinical (headache, focal neurological deficit, papilloedema, GCS score), type and number of risk factors, MRI findings (Type of lesion: hemorrhagic infarction or hematoma, location of lesion) and MRV findings (superficial or deep sinus, cortical veins). A total of 46 patients had acute seizures. On univariate analysis, altered mental status (p<0.001), paresis (p=0.03), GCS score <8 (p=0.009), hemorrhagic infarct on imaging (p=0.04), involvement of frontal lobe (p=0.02), superior sagittal sinus (p=0.008), and high D-dimer levels (p=0.03) were significantly associated with acute seizure. On multivariate analysis, the hemorrhagic infarct on MRI and high D-dimer was independently predictive for early seizure. The predictive factors for the acute seizures are altered mental status (GCS<8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels. Copyright © 2016 Elsevier B.V. All rights reserved.

Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures.

PubMed

Lionte, C; Sorodoc, V; Tuchilus, C; Cimpoiesu, D; Jaba, E

2017-07-01

Acute exposure to systemic poisons represents an important challenge in clinical toxicology. We aimed to analyze the potential role of cardiac biomarkers, routine laboratory tests, and clinical scores as morbidity and in-hospital mortality predictors in patients intoxicated with various systemic poisons. We conducted a prospective study on adults acutely exposed to systemic poisons. We determined the PSS, Glasgow Coma Scale (GCS), and we performed electrocardiogram, laboratory tests, lactate and cardiac biomarkers (which were reassessed 4 h, respectively 6 h later). Of 120 patients included, 45% developed complications, 19.2% had a poor outcome, and 5% died. Multivariate logistic regression sustained lactate (odds ratio (OR) 1.58; confidence interval (CI) 95%: 0.97-2.59; p 0.066), MB isoenzyme of creatine kinase (6h-CKMB; OR 1.08; CI 95%: 1.02-1.16; p 0.018) as predictors for a poor outcome. A GCS < 10 (OR 0.113; CI 95%: 0.019-0.658; p 0.015) and 4h-lactate (OR 4.87; CI 95%: 0.79-29.82; p 0.087) predicted mortality after systemic poisons exposure. Receiver operating characteristic analysis showed that brain natriuretic peptide (area under the curve (AUC), 0.96; CI 95%: 0.92-0.99; p < 0.001), lactate (AUC, 0.91; CI 95%: 0.85-0.97; p < 0.001), and 6h-CKMB have good discriminatory capacity for predicting a poor outcome. In conclusion, these biomarkers, lactate, and GCS can be used to predict morbidity and mortality after systemic poisons exposure.

Traumatic brain injury: It is all about definition.

PubMed

Savitsky, B; Givon, A; Rozenfeld, M; Radomislensky, I; Peleg, K

2016-01-01

TBI may be defined by different methods. Some may be most useful for immediate clinical purposes, however less optimal for epidemiologic research. Other methods, such as the Abbreviated Injury Score (AIS), may prove more beneficial for this task, if the cut-off-points for their categories are defined correctly. To reveal the optimal cut-off-points for AIS in definition of severity of TBI in order to ensure uniformity between future studies of TBI. Mortality of patients with TBI AIS 3, 4 was 1.9% and 2.9% respectively, comparing with 31.1% among TBI AIS 5+. Predictive discrimination ability of the model with cut-off-points of 5+ for TBI AIS (in comparison with other cut-off-points) was better. Patients with missing Glasgow Coma Scale (GCS) in the ED had an in-hospital mortality rate of 11.5%. In this group, 25% had critical TBI according to AIS. Normal GCS didn't indicate an absence of head injury, as, among patients with GCS 15 in the ED, 26% had serious/critical TBI injury. Moreover, 7% of patients with multiple injury and GCS 3-8 had another reason than head injury for unconsciousness. This study recommends the adoption of an AIS cut-off ≥ 5 as a valid definition of severe TBI in epidemiological studies, while AIS 3-4 may be defined as 'moderate' TBI and AIS 1-2 as 'mild'.

[The efficiency of emergency therapy in patients with head-brain, multiple injury. Quality assurance in emergency medicine].

PubMed

Schüttler, J; Schmitz, B; Bartsch, A C; Fischer, M

1995-12-01

For cardio-pulmonary resuscitation there are standardized treatment concepts, but there have been few prospective investigations examining the efficacy of prehospital advanced trauma life support and its effect on the outcome in patients with severe head injury and multiple trauma treated within the German emergency system. The results of this study underline the importance of intensive prehospital treatment and highlight some problems that should be taken into account in future in the training of emergency physicians. METHODS. A total of 179 patients with cerebral trauma were investigated. Data obtained included demographic and logistic data of the patients and the emergency physicians, diagnoses and treatment at the scene of the accident and state of the patient on admission in each case. Having divided the patients into three groups by severity of the trauma, we distinguished between sufficient and insufficient treatment and assessed infusion therapy, ventilatory support, positioning and immobilization, and analgesic and sedative therapy. For statistical analysis of the data we used chi 2-test and Fisher's exact test. P < 0.05 was considered significant. RESULTS. There were 102 patients who had sustained a cerebral trauma without other life-threatening lesions (score 1), 40 with multiple trauma (score 2) and 37 with multiple trauma (score 3). On average 2.4 IV lines were established and the patients received 1186 +/- 765 cc of crystalloid in addition to 801 +/- 411 cc of colloid fluids. In all groups, patients who received adequate infusion therapy had a better outcome; even in the group with score 1 significantly fewer had a fatal outcome. In all, 167 (93%) patients had endotracheal tubes placed, and in 150 cases (84%) ventilatory therapy was considered sufficient. The proportion of score 1 patients with sufficient ventilatory support who had a fatal outcome was significantly lower than that in the group with insufficient treatment. In patients with multiple trauma we could not separate the benefits of sufficient respiratory therapy and infusion therapy. In only 54% of the cases a vacuum mattress was used and in only 41% the patients were positioned with the upper part of the body elevated by 30 degrees. These were 28 patients (16%) who received neither analgesics nor sedatives. Regardless of the quality of prehospital treatment of isolated head injury, a Glasgow Coma Scale (GCS) score lower than 5 involved a very high mortality and all patients with a GCS score of 9 or more survived. In the group with GCS scores between 5 and 8, however, significantly more of the patients who received adequate treatment survived (82.5% vs 40%). CONCLUSIONS. The present study confirms that sufficient advanced trauma life support can improve the outcome of trauma victims with cerebral trauma. Adequate infusion and respiratory therapy reduce the mortality among such patients significantly. In patients with multiple trauma a clear positive effect of generous infusion therapy also is evident. The clearest effect of sufficient prehospital treatment is seen in patients with isolated cerebral trauma and a GCS score between 5 and 8. These results demonstrate the importance of advanced trauma life support and show emphatically that the so-called scoop-and-run strategy should be abandoned when resources are available for extended preclinical emergency treatment. On the other hand, we detected some problem areas in the prehospital treatment of trauma victims, such as positioning, immobilization and drug therapy with analgesics and sedatives. These findings allow us to pinpoint specific points that should be stressed in the training of emergency physicians and paramedics.

Diagnostic and Prognostic Capability of Newer Magnetic Resonance Imaging Brain Sequences in Diffuse Axonal Injury Patient.

PubMed

Bansal, Mayank; Sinha, Virendra Deo; Bansal, Juhi

2018-01-01

Diffuse axonal injury is one of the major causes of unconsciousness, profound neurologic deficits and persistent vegetative state after head trauma. In recent years, MR imaging has been gaining popularity as an adjunctive imaging method in patients with DAI. Our study aims to assess the relative diagnostic and prognostic capability of various MRI sequences. Retrospective observational study done in 1 year duration on 30 DAI patients. Clinical assessment done with GCS at admission and GOS at 6 month. MRI Brain FLAIR, DWI, T2*GRE AND SWI sequences taken. DAI grade were evaluated for different MRI sequences. Prognosis was correlated to total number of lesion/locations and DAI grade of patients. Statistical analysis was done using SPSS Statistical software (ver.20.0.0) and XL-Stat and ANOVA one way test, post hoc test (Turkey test) and Chi square test. We studied 30 male patients, mean age 32.57±8.72 ranges. The commonest mode of injury is RTA-80%, fall-16% followed by assault-3.33%. Out of 30 patients, 17 patients (56.67%) had GCS <=8, 13 patients (43.33%) had GCS between 9 and 12 and no patient had a GCS score between 13 and 15. The mean GCS score was 8.47±1.50. At a 6 month follow up, out of a total of 30 patients, 2 patients (6.66%) expired (GOS-1), 3 patients (10%) remained in persistent vegetative state (GOS-2), 11 patients (36.67%) and 10 patients (33.33%) were found to be severely (GOS-3) and moderately (GOS-4) disabled respectively and 4 patients (13.33%) showed good recovery (GOS-5). Mean GOS is 3.37+/-1.06. Newer imaging -SWI able to detects lesion better (diagnosis of DAI) as compared to other older sequences like FLAIR,DWI,T2*GRE. But no statistically significant found between total number of lesion/locations to the outcome and also newer imaging do not change the grade of DAI patients. Although advanced imaging in head injury, SWI helps in diagnosing the diffuse axonal injury more efficiently than other imaging sequences, but it is the grade of patients at admission that predicts the outcome best.

Prohibitin (PHB) inhibits apoptosis in rat granulosa cells (GCs) through the extracellular signal-regulated kinase 1/2 (ERK1/2) and the Bcl family of proteins.

PubMed

Chowdhury, Indrajit; Thompson, Winston E; Welch, Crystal; Thomas, Kelwyn; Matthews, Roland

2013-12-01

Mammalian ovarian follicular development is tightly regulated by crosstalk between cell death and survival signals, which include both endocrine and intra-ovarian regulators. Whether the follicle ultimately ovulates or undergoes atresia is dependent on the expression and actions of factors promoting follicular cell proliferation, differentiation or apoptosis. Prohibitin (PHB) is a highly conserved, ubiquitous protein that is abundantly expressed in granulosa cells (GCs) and associated with GC differentiation and apoptosis. The current study was designed to characterize the regulation of anti-apoptotic and pro-apoptotic factors in undifferentiated rat GCs (gonadotropin independent phase) governed by PHB. Microarray technology was initially employed to identify potential apoptosis-related genes, whose expression levels within GCs were altered by either staurosporine (STS) alone or STS in presence of ectopically over-expressed PHB. Next, immunoblot studies were performed to examine the expression patterns of selective Bcl-2 family members identified by the microarray analysis, which are commonly regulated in the intrinsic-apoptotic pathway. These studies were designed to measure protein levels of Bcl2 family in relation to expression of the acidic isoform (phosphorylated) PHB and the components of MEK-Erk1/2 pathway. These studies indicated that over-expression of PHB in undifferentiated GCs inhibit apoptosis which concomitantly results in an increased level of the anti-apoptotic proteins Bcl2 and Bclxl, reduced release of cytochrome c from mitochondria and inhibition of caspase-3 activity. In contrast, silencing of PHB expression resulted in change of mitochondrial morphology from the regular reticular network to a fragmented form, which enhanced sensitization of these GCs to the induction of apoptosis. Collectively, these studies have provided new insights on the PHB-mediated anti-apoptotic mechanism, which occurs in undifferentiated GCs through a PHB → Mek-Erk1/2 → Bcl/Bcl-xL pathway and may have important clinical implications.

Effect of Memantine on Serum Levels of Neuron-Specific Enolase and on the Glasgow Coma Scale in Patients With Moderate Traumatic Brain Injury.

PubMed

Mokhtari, Majid; Nayeb-Aghaei, Hossein; Kouchek, Mehran; Miri, Mir Mohammad; Goharani, Reza; Amoozandeh, Arash; Akhavan Salamat, Sina; Sistanizad, Mohammad

2018-01-01

Traumatic brain injury (TBI) is a major cause of disability and death globally. Despite significant progress in neuromonitoring and neuroprotection, pharmacological interventions have failed to generate favorable results. We examined the effect of memantine on serum levels of neuron-specific enolase (NSE), a marker of neuronal damage, and the Glasgow Coma Scale (GCS) in patients with moderate TBI. Patients were randomly assigned to the control group (who received standard TBI management) and the treatment group (who, alongside their standard management, received enteral memantine 30 mg twice daily for 7 days). Patients' clinical data, GCS, findings of head computed tomography, and serum NSE levels were collected during the study. Forty-one patients were randomized into the control and treatment groups, 19 and 22 patients respectively. Baseline characteristics and serum NSE levels were not significantly different between the 2 groups. The mean serum NSE levels for the memantine and the control groups on day 3 were 7.95 ± 2.86 and 12.33 ± 7.09 ng/mL, respectively (P = .05), and on day 7 were 5.03 ± 3.25 and 10.04 ± 5.72 ng/mL, respectively (P = .003). The mean GCS on day 3 was 12.3 ± 2.0 and 10.9 ± 1.9 in the memantine and control groups, respectively (P = .03). Serum NSE levels and GCS changes were negatively correlated (r = -0.368, P = .02). Patients with moderate TBI who received memantine had significantly reduced serum NSE levels by day 7 and marked improvement in their GCS scores on day 3 of the study. © 2017, The American College of Clinical Pharmacology.

Assessment of Myocardial Infarct Size by Three-Dimensional and Two-Dimensional Speckle Tracking Echocardiography: A Comparative Study to Single Photon Emission Computed Tomography.

PubMed

Wang, Qiushuang; Huang, Dangsheng; Zhang, Liwei; Shen, Dong; Ouyang, Qiaohong; Duan, Zhongxiang; An, Xiuzhi; Zhang, Meiqing; Zhang, Chunhong; Yang, Feifei; Zhi, Guang

2015-10-01

To compare three-dimensional (3D) and two-dimensional (2D) speckle tracking echocardiography (STE) techniques in the assessment of left ventricular function and myocardial infarct size (MIS). Thirty-two patients diagnosed with ST elevation myocardial infarction and 18 healthy control patients underwent 2D echocardiography, 3D echocardiography, and single photon emission computed tomography (SPECT). 3D left ventricular global area strain (GAS), 2D and 3D global longitudinal strain (GLS), global radial strain (GRS) as well as global circumferential strain (GCS) were analyzed to correlate with myocardial infarct size detected by SPECT. 2D and 3D left ventricular ejection fraction (LVEF) as well as 2D and 3D wall motion score index (WMSI) also were measured using conventional echocardiography. The 2D-GLS values were significantly higher than that of 3D-GLS, while 2D-GCS and GRS were significantly lower than 3D-GCS and GRS, respectively. However, no significant differences in LVEF and WMSI could be observed between 2D and 3D echocardiography. Myocardial strain indices, LVEF, and WMSI using 2D and 3D echocardiography also had good correlations with MIS as measured by SPECT. ROC curve analysis showed that the 3D and 2D myocardial indices, LVEF, and WMSI could distinguish between small and large MIS, while 2D-GLS had the highest AUC. The 2D and 3D myocardial strain indices correlated well with MIS by SPECT. Among them, the 2D-GLS showed the highest diagnostic value, while 3D-GRS and GCS had better diagnostic value than 2D-GRS and GCS. © 2015, Wiley Periodicals, Inc.

Cooperation of international Research Infrastructures to address environmental global challenges

NASA Astrophysics Data System (ADS)

Bonet García, Francisco J.; Suárez-Muñoz, María; Conchubhair, Diarmuid O.; Dohna, Tina; Lo Bue, Nadia

2017-04-01

Human impact on the planet is causing a set of global environmental problems that threaten the wellbeing of current and future generations. Examples of these environmental problems include climate change, decline of biodiversity, alteration of biogeochemical cycles, ocean acidification, etc. These environmental Global Challenges (GCs) are transnational and complex, combining elements of both natural and social factors. Providing solutions for these challenges can be significantly enhanced through the collaboration of various related institutions, governments and stakeholders. A deeper understanding of the causes and consequences of GCs, as well as the processes which control them is required. Environmental Research Infrastructures (DANUBIUS-RI) are key players in this learning process. Covering many fields of research, it is through RIs collaboration that GCs can be more fully addressed. However, the collaboration among environmental RIs is still limited nationally as well as internationally. Although contact is encouraged and interactions are common practice, there are few cases where RI managers initiate and foster transnational collaborations in order to address specific problems. The COOP+ project aims to explore and strengthen cooperation among global RIs by bringing various RIs together and working on the identification of requirements, strengths, knowledge gaps and other relevant items in regard to the selected GCs. For this purpose, 13 GCs have been selected: coral bleaching, marine debris, noise impact on marine fauna, Arctic sea ice melting, pollinators decline, threatened species, agriculture pollutants, nitrogen cycle, carbon and GHG, geohazards and extreme events, estuaries, global urbanization process, and ozone depletion. These GCs are being analysed and described by multidisciplinary teams of experts composed of scientists, RIs operators and other stakeholders. This assessment will derive a list of tasks and requirements to be fulfilled by the participating RIs regarding each GC. Moreover, it is expected that the outcomes of this work will encourage and promote project participants and stakeholders, as well as the general public to take action with regard to the challenges and solutions outlined by the GC descriptions. This task of describing GCs is an open initiative: all input is welcome. To input with any suggestions, please send an email to info@coop-plus.eu. This contribution presents the preliminary results obtained during the description of the selected GC's under the point of view of RIs: - Template used to describe all GC in a standardized way. It contains several sections regarding topics such as: rationale of the challenge, identification of scientific/technical/social needs, role of RIs in the GC, tasks to be done (data collection, experimental research, modelling, dissemination), etc. - Configuration of working teams designed to describe the GCs. Each GC has a person in charge who is responsible of coordinating the writing process. The working team is composed by scientists experts in each challenge, experts in thematic RIs (within EU and abroad), policy makers and other stakeholders. The results obtained by this description task will be published in a special issue in a Geoscience journal. The writing teams are expected to become project consortia willing to participate in specific calls to address GCs.

NASA's UAS Integration into the NAS: A Report on the Human Systems Integration Phase 1 Simulation Activities

NASA Technical Reports Server (NTRS)

Fern, Lisa; Rorie, R. Conrad; Shively, R. Jay

2014-01-01

In 2011 the National Aeronautics and Space Administration (NASA) began a five-year Project to address the technical barriers related to routine access of Unmanned Aerial Systems (UAS) in the National Airspace System (NAS). Planned in two phases, the goal of the first phase was to lay the foundations for the Project by identifying those barriers and key issues to be addressed to achieve integration. Phase 1 activities were completed two years into the five-year Project. The purpose of this paper is to review activities within the Human Systems Integration (HSI) subproject in Phase 1 toward its two objectives: 1) develop GCS guidelines for routine UAS access to the NAS, and 2) develop a prototype display suite within an existing Ground Control Station (GCS). The first objective directly addresses a critical barrier for UAS integration into the NAS - a lack of GCS design standards or requirements. First, the paper describes the initial development of a prototype GCS display suite and supporting simulation software capabilities. Then, three simulation experiments utilizing this simulation architecture are summarized. The first experiment sought to determine a baseline performance of UAS pilots operating in civil airspace under current instrument flight rules for manned aircraft. The second experiment examined the effect of currently employed UAS contingency procedures on Air Traffic Control (ATC) participants. The third experiment compared three GCS command and control interfaces on UAS pilot response times in compliance with ATC clearances. The authors discuss how the results of these and future simulation and flight-testing activities contribute to the development of GCS guidelines to support the safe integration of UAS into the NAS. Finally, the planned activities for Phase 2, including an integrated human-in-the-loop simulation and two flight tests are briefly described.

Natural oil slicks fuel surface water microbial activities in the northern Gulf of Mexico

PubMed Central

Ziervogel, Kai; D'souza, Nigel; Sweet, Julia; Yan, Beizhan; Passow, Uta

2014-01-01

We conducted a series of roller tank incubations with surface seawater from the Green Canyon oil reservoir, northern Gulf of Mexico, amended with either a natural oil slick (GCS-oil) or pristine oil. The goal was to test whether bacterial activities of natural surface water communities facilitate the formation of oil-rich marine snow (oil snow). Although oil snow did not form during any of our experiments, we found specific bacterial metabolic responses to the addition of GCS-oil that profoundly affected carbon cycling within our 4-days incubations. Peptidase and β-glucosidase activities indicative of bacterial enzymatic hydrolysis of peptides and carbohydrates, respectively, were suppressed upon the addition of GCS-oil relative to the non-oil treatment, suggesting that ascending oil and gas initially inhibits bacterial metabolism in surface water. Biodegradation of physically dispersed GCS-oil components, indicated by the degradation of lower molecular weight n-alkanes as well as the rapid transformation of particulate oil-carbon (C: N >40) into the DOC pool, led to the production of carbohydrate- and peptide-rich degradation byproducts and bacterial metabolites such as transparent exopolymer particles (TEP). TEP formation was highest at day 4 in the presence of GCS-oil; in contrast, TEP levels in the non-oil treatment already peaked at day 2. Cell-specific enzymatic activities closely followed TEP concentrations in the presence and absence of GCS-oil. These results demonstrate that the formation of oil slicks and activities of oil-degrading bacteria result in a temporal offset of microbial cycling of organic matter, affecting food web interactions and carbon cycling in surface waters over cold seeps. PMID:24847314

Natural oil slicks fuel surface water microbial activities in the northern Gulf of Mexico.

PubMed

Ziervogel, Kai; D'Souza, Nigel; Sweet, Julia; Yan, Beizhan; Passow, Uta

2014-01-01

We conducted a series of roller tank incubations with surface seawater from the Green Canyon oil reservoir, northern Gulf of Mexico, amended with either a natural oil slick (GCS-oil) or pristine oil. The goal was to test whether bacterial activities of natural surface water communities facilitate the formation of oil-rich marine snow (oil snow). Although oil snow did not form during any of our experiments, we found specific bacterial metabolic responses to the addition of GCS-oil that profoundly affected carbon cycling within our 4-days incubations. Peptidase and β-glucosidase activities indicative of bacterial enzymatic hydrolysis of peptides and carbohydrates, respectively, were suppressed upon the addition of GCS-oil relative to the non-oil treatment, suggesting that ascending oil and gas initially inhibits bacterial metabolism in surface water. Biodegradation of physically dispersed GCS-oil components, indicated by the degradation of lower molecular weight n-alkanes as well as the rapid transformation of particulate oil-carbon (C: N >40) into the DOC pool, led to the production of carbohydrate- and peptide-rich degradation byproducts and bacterial metabolites such as transparent exopolymer particles (TEP). TEP formation was highest at day 4 in the presence of GCS-oil; in contrast, TEP levels in the non-oil treatment already peaked at day 2. Cell-specific enzymatic activities closely followed TEP concentrations in the presence and absence of GCS-oil. These results demonstrate that the formation of oil slicks and activities of oil-degrading bacteria result in a temporal offset of microbial cycling of organic matter, affecting food web interactions and carbon cycling in surface waters over cold seeps.

Globular cluster formation with multiple stellar populations: self-enrichment in fractal massive molecular clouds

NASA Astrophysics Data System (ADS)

Bekki, Kenji

2017-08-01

Internal chemical abundance spreads are one of fundamental properties of globular clusters (GCs) in the Galaxy. In order to understand the origin of such abundance spreads, we numerically investigate GC formation from massive molecular clouds (MCs) with fractal structures using our new hydrodynamical simulations with star formation and feedback effects of core-collapse supernovae (SNe) and asymptotic giant branch (AGB) stars. We particularly investigate star formation from gas chemically contaminated by SNe and AGB stars ('self-enrichment') in forming GCs within MCs with different initial conditions and environments. The principal results are as follows. GCs with multiple generations of stars can be formed from merging of hierarchical star cluster complexes that are developed from high-density regions of fractal MCs. Feedback effects of SNe and AGB stars can control the formation efficiencies of stars formed from original gas of MCs and from gas ejected from AGB stars. The simulated GCs have strong radial gradients of helium abundances within the central 3 pc. The original MC masses need to be as large as 107 M⊙ for a canonical initial stellar mass function (IMF) so that the final masses of stars formed from AGB ejecta can be ˜105 M⊙. Since star formation from AGB ejecta is rather prolonged (˜108 yr), their formation can be strongly suppressed by SNe of the stars themselves. This result implies that the so-called mass budget problem is much more severe than ever thought in the self-enrichment scenario of GC formation and thus that IMF for the second generation of stars should be 'top-light'.

Grave prognosis on spontaneous intracerebral haemorrhage: GP on STAGE score.

PubMed

Poungvarin, Niphon; Suwanwela, Nijasri C; Venketasubramanian, Narayanaswamy; Wong, Lawrence K S; Navarro, Jose C; Bitanga, Ester; Yoon, Byung Woo; Chang, Hui M; Alam, Sardar M

2006-11-01

Spontaneous intracerebral haemorrhage (ICH) is more common in Asia than in western countries, and has a high mortality rate. A simple prognostic score for predicting grave prognosis of ICH is lacking. Our objective was to develop a simple and reliable score for most physicians. ICH patients from seven Asian countries were enrolled between May 2000 and April 2002 for a prospective study. Clinical features such as headache and vomiting, vascular risk factors, Glasgow coma scale (GCS), body temperature (BT), blood pressure on arrival, location and size of haematoma, intraventricular haemorrhage (IVH), hydrocephalus, need for surgical treatment, medical treatment, length of hospital stay and other complications were analyzed to determine the outcome using a modified Rankin scale (MRS). Grave prognosis (defined as MRS of 5-6) was judged on the discharge date. 995 patients, mean age 59.5 +/- 14.3 years were analyzed, after exclusion of incomplete data in 87 patients. 402 patients (40.4%) were in the grave prognosis group (MRS 5-6). Univariable analysis and then multivariable analysis showed only four statistically significant predictors for grave outcome of ICH. They were fever (BT > or = 37.8 degrees c), low GCS, large haematoma and IVH. The grave prognosis on spontaneous intracerebral haemorrhage (GP on STAGE) score was derived from these four factors using a multiple logistic model. A simple and pragmatic prognostic score for ICH outcome has been developed with high sensitivity (82%) and specificity (82%). Furthermore, it can be administered by most general practitioners. Validation in other populations is now required.

Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward.

PubMed

Ikenaga, Yasunori; Nakayama, Sayaka; Taniguchi, Hiroki; Ohori, Isao; Komatsu, Nahoko; Nishimura, Hitoshi; Katsuki, Yasuo

2017-05-01

Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Development of a Streamlined Work Flow for Handling Patients' Genetic Testing Insurance Authorizations.

PubMed

Uhlmann, Wendy R; Schwalm, Katie; Raymond, Victoria M

2017-08-01

Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients' genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.

[Process indicators: tools for monitoring the management of severe trauma cases in Catalonia].

PubMed

Prat, Salvi; Muñoz-Ortiz, Laura; Navarro, Salvador; Koo, Maylin; Jiménez-Fábrega, Xavier; Martínez-Cruz, Olga; Espallargues, Mireia

2016-10-01

Process indicators have been widely used to monitor the way trauma care is provided. We aimed to analyze whether data from a hospital's severe trauma register could facilitate the evaluation of aspects of the initial management of severe injuries. Observational, retrospective population-based study. A working group of experts selected a set of trauma care process indicators relevant to some aspects of initial care, diagnosis, and treatment of severely injured patients. Four of the indicators referred to prehospital care and 5 to hospital care. We calculated the observed and expected compliance rates for all the indicators. A total of 1526 cases (44.4%) were analyzed for 2013; 1908 (55.6%) were analyzed for 2014. We were able to evaluate 3 of the 4 prehospital process indicators: endotracheal intubation in patients with a score of 8 on the Glasgow coma scale (GCS) (84% compliance), venous access established before hospital arrival (83.4%), and placement of a neck collar to immobilize the cervical spine (72.7%). Compliance for the hospital-phase indicators were as follows: performance of a computed tomography scan of the head within 60 minutes in cases with a GCS of 13 (5.3% compliance, craniotomy in candidate patients within 2 hours of diagnosis (65%), diagnostic examination for abdominal injuries within 60 minutes in patients with systolic blood pressure 90 mm Hg (89.3%), and therapeutic laparotomy or angiography within 4 hours of abdominal injury in candidate patients with systolic blood pressure 90 mm Hg (51.7%). Compliance was 69.9% for the last process indicator: surgical treatment of open fractures within 8 hours of an accident. Our findings show that a hospital trauma register provides data about care process indicators that can allow us to monitor the quality of care of severely injured patients.

Emergency airway management in critically injured patients: a survey of U.S. aero-medical transport programs.

PubMed

James, Dorsha N; Voskresensky, Igor V; Jack, Meg; Cotton, Bryan A

2009-06-01

Pre-hospital airway management represents the intervention most likely to impact outcomes in critically injured patients. As such, airway management issues dominate quality improvement (QI) reviews of aero-medical programs. The purpose of this study was to evaluate current practice patterns of airway management in trauma among U.S. aero-medical service (AMS) programs. The Association of Air Medical Services (AAMS) Resource Guide from 2005 to 2006 was utilized to identify the e-mail addresses of all directors of U.S. aero-medical transport programs. Program directors from 182 U.S. aero-medical programs were asked to participate in an anonymous, web-based survey of emergency airway management protocols and practices. Non-responders to the initial request were contacted a second time by e-mail. 89 programs responded. 98.9% have rapid sequence intubation (RSI) protocols. 90% use succinylcholine, 70% use long-acting neuromuscular blockers (NMB) within their RSI protocol. 77% have protocols for mandatory in-flight sedation but only 13% have similar protocols for maintenance paralytics. 60% administer long-acting NMB immediately after RSI, 13% after confirmation of neurological activity. Given clinical scenarios, however, 97% administer long-acting NMB to patients with scene and in-flight Glasgow Coma Scale (GCS) of 3, even for brief transport times. The majority of AMS programs have well defined RSI and in-flight sedation protocols, while protocols for in-flight NMB are uncommon. Despite this, nearly all programs administer long-acting NMB following RSI, irrespective of GCS or flight time. Given the impact of in-flight NMB on initial assessment, early intervention, and injury severity scoring, a critical appraisal of current AMS airway management practices appears warranted.

ON THE BIRTH MASSES OF THE ANCIENT GLOBULAR CLUSTERS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Conroy, Charlie; Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA

All globular clusters (GCs) studied to date show evidence for internal (star-to-star) variation in their light-element abundances (including Li, C, N, O, F, Na, Mg, Al, and probably He). These variations have been interpreted as evidence for multiple star formation episodes within GCs, with secondary episodes fueled, at least in part, by the ejecta of asymptotic giant branch (AGB) stars from a first generation of stars. A major puzzle emerging from this otherwise plausible scenario is that the fraction of stars associated with the second episode of star formation is observed to be much larger than expected for a standardmore » initial mass function. The present work investigates this tension by modeling the observed anti-correlation between [Na/Fe] and [O/Fe] for 20 Galactic GCs. If the abundance pattern of the retained AGB ejecta does not depend on GC mass at fixed [Fe/H], then a strong correlation is found between the fraction of current GC stellar mass composed of pure AGB ejecta, f{sub p} , and GC mass. This fraction varies from 0.20 at low masses (10{sup 4.5} M{sub Sun }) to 0.45 at high masses (10{sup 6.5} M{sub Sun }). The fraction of mass associated with pure AGB ejecta is directly related to the total mass of the cluster at birth; the ratio between the initial and present mass in stars can therefore be derived. Assuming a star formation efficiency of 50%, the observed Na-O anti-correlations imply that GCs were at least 10-20 times more massive at birth, a conclusion that is in qualitative agreement with previous work. These factors are lower limits because any mass-loss mechanism that removes first- and second-generation stars equally will leave f{sub p} unchanged. The mass dependence of f{sub p} probably arises because lower mass GCs are unable to retain all of the AGB ejecta from the first stellar generation. Recent observations of elemental abundances in intermediate-age Large Magellanic Cloud clusters are re-interpreted and shown to be consistent with this basic scenario. The small scatter in f{sub p} at fixed GC mass argues strongly that the process responsible for the large mass loss is internal to GCs. A satisfactory explanation of these trends is currently lacking.« less

Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war.

PubMed

Aras, M; Altaş, M; Yilmaz, A; Serarslan, Y; Yilmaz, N; Yengil, E; Urfali, B

2014-10-01

Toward the end of 2010, the Arab spring, the waves of revolutionary demonstrations and protests influenced also Syria, where violent clashes turned into a civil war. Hundreds of thousands of people became refugees. The use of excessive force unfortunately culminated in numerous deaths and injuries in many cities. Being the closest city to Aleppo, Damascus and Homs, the biggest cities of Syria, Antioch/Hatay has been the city where initial emergency treatments were performed. For this reason, we examined and retrospectively analyzed the medical records of the patients treated in the clinics of our hospital due to cranial gunshot wounds during the war. The medical records of 186 patients who were injured in the Syrian War and brought to, followed up and treated in the Neurosurgery Clinic of Mustafa Kemal University, Faculty of Medicine in Hatay, a Turkish city on the Syrian border, between April 2011 and June 2013. A total of 186 patients were evaluated in a period of more than 2 years. Of all 91.4% of the patients were adults (male/female: 152/18) and 8.6% of them were pediatric patients (male/female: 14/2). The average age of the patients was 31 years, with an age range of between 2 months and 67 years. According to Glasgow coma score (GCS) of the patients at the time of admission, GCS was 3 in 32 patients (17.2%), between 4 and 7 in 70 patients (37.6%), and between 8 and 15 in 84 patients (45.1%). We observed that the patients with GCS of 4-7 had a significantly lower mortality among the 56 patients treated surgically compared with the 14 patients treated medically. Cranial gunshot wounds are responsible for high mortality and morbidity. A multiplicity of factors plays a role on morbidity and mortality. These are the duration of transport, the injury pattern, the velocities of the weapons used, and the Glasgow Coma Scales of the patients at the time of admission. The authors recommend that the patients with cranial gunshot wounds who has GCS of 4-7 should be aggressively treated including surgery as well. We do not recommend surgical treatment for patients with GCS of 3. All our experiences show that treatment of gunshot wounds will continue to be a matter of debate, about which there is more to learn. The data presented in this study will once again demonstrate the seriousness of the event, and will, perhaps, contribute to the peace negotiations to end the war. Copyright © 2014 Elsevier B.V. All rights reserved.

Predictors and clinical implications of shivering during therapeutic normothermia.

PubMed

Badjatia, Neeraj; Kowalski, Robert G; Schmidt, J Michael; Voorhees, Marc E; Claassen, Jan; Ostapkovich, Noeleen D; Presciutti, Mary; Connolly, E Sander; Palestrant, David; Parra, Augusto; Mayer, Stephan A

2007-01-01

Shivering during induced normothermia (IN) remains a therapeutic limitation. We investigated potential risk factors and clinical implications of shivering during IN. Post hoc analysis was performed on 24 patients enrolled in a clinical trial of an automated surface cooling system to achieve IN. Hyponatremia was defined as serum levels <136 mmol/L and hypomagnesaemia as levels <1.5 mg/dL. Continuous heat energy transfer (kcal/h) was averaged hourly. Glasgow Coma Scale (GCS) scores were recorded every 2 h. Shivering status was documented hourly. Mixed effects modeling was used to determine clinical measures associated with shivering. Generalized estimating equation (GEE) models were used to compare baseline-adjusted repeated-measures GCS scores. About of 24 (39%) patients demonstrated shivering. Shivering was associated with men (67% vs. 21%, P = 0.03), hyponatremia (44% vs. 7%, P = 0.03), and hypomagnesaemia (56% vs. 7%, P = 0.02). The average kcal/h (158 +/- 645 kcal/h vs. 493 +/- 645 kcal/h, P = 0.03) was greater in shivering patients. Shivering was positively associated with increases in heart rate (P < 0.001), respiratory rate (P < 0.001), and kcal/h (P < 0.001). Non-shivering patients showed a greater increase from baseline GCS (GEE, P = 0.02) at 24 h. No differences in sedative doses or fever burden were noted between shiverers and non-shiverers. Men, hyponatremia, and hypomagnesaemia may predispose febrile patients treated with IN to shivering. Shivering dramatically increases the amount of heat transfer required to maintain normothermia, and may be associated with adverse effects on level of consciousness.

Procalcitonin as a Diagnostic and Prognostic Factor for Tuberculosis Meningitis

PubMed Central

Kim, Jinseung; Kim, Si Eun; Park, Bong Soo; Shin, Kyong Jin; Ha, Sam Yeol; Park, JinSe; Kim, Sung Eun

2016-01-01

Background and Purpose We investigated the potential role of serum procalcitonin in differentiating tuberculosis meningitis from bacterial and viral meningitis, and in predicting the prognosis of tuberculosis meningitis. Methods This was a retrospective study of 26 patients with tuberculosis meningitis. In addition, 70 patients with bacterial meningitis and 49 patients with viral meningitis were included as the disease control groups for comparison. The serum procalcitonin level was measured in all patients at admission. Differences in demographic and laboratory data, including the procalcitonin level, were analyzed among the three groups. In addition, we analyzed the predictive factors for a prognosis of tuberculosis meningitis using the Glasgow Coma Scale (GCS) at discharge, and the correlation between the level of procalcitonin and the GCS score at discharge. Results Multiple logistic regression analysis showed that a low level of procalcitonin (≤1.27 ng/mL) independently distinguished tuberculosis meningitis from bacterial meningitis. The sensitivity and specificity for distinguishing tuberculosis meningitis from bacterial meningitis were 96.2% and 62.9%, respectively. However, the level of procalcitonin in patients with tuberculosis meningitis did not differ significantly from that in patients with viral meningitis. In patients with tuberculosis meningitis, a high level of procalcitonin (>0.4 ng/mL) was a predictor of a poor prognosis, and the level of procalcitonin was negatively correlated with the GCS score at discharge (r=-0.437, p=0.026). Conclusions We found that serum procalcitonin is a useful marker for differentiating tuberculosis meningitis from bacterial meningitis and is also valuable for predicting the prognosis of tuberculosis meningitis. PMID:27165424

Comparative endoscopic evaluation of normal and ulcerated gastric mucosae in Thoroughbred foals

PubMed Central

OKAI, Kazuhiko; TAHARAGUCHI, Sadao; ORITA, Yasuhiro; YOKOTA, Hiroshi; TANIYAMA, Hiroyuki

2015-01-01

To contribute to early diagnosis and treatment of gastric ulcer of foals, we examined the gastric mucosa of healthy and affected foals using an endoscope. In healthy foals, the characteristic changes in the development of the squamous mucosa were seen mainly in the squamous mucosa, and maturation of the squamous mucosa in the greater curvature (GC-S) occurred more slowly than that of the squamous mucosa in the lesser curvature (LC-S). Epithelial desquamation in the LC-S and GC-S was observed between 6 and 90 days but was not observed in the LC-S at about 60 days, whereas it was observed in the GC-S until 90 days old. These findings suggest that there is a difference in the development of the gastric mucosa by region and that desquamation continues over a term longer than studies have reported in the past. In the affected foals, the minimum age at which gastric ulcer was observed was 4 days old. Gastric ulcers formed predominantly in the squamous mucosa (LC-S and GC-S) of foals with an immature mucosa before the weaning period, and the peak incidence occurred between 61 and 90 days old. The differences in the ulceration sites were considered to depend on the difference in the development (maturation) stage of the squamous mucosa. The grading score of the gastric ulcer increased with the growth of the affected foals. The gastric ulcer might be enhanced greatly by stress in the weaning period. PMID:25648790

Patient volume per surgeon does not predict survival in adult level I trauma centers.

PubMed

Margulies, D R; Cryer, H G; McArthur, D L; Lee, S S; Bongard, F S; Fleming, A W

2001-04-01

The 1999 American College of Surgeons resources for optimal care document added the requirement that Level I trauma centers admit over 240 patients with Injury Severity Score (ISS) > 15 per year or that trauma surgeons care for at least 35 patients per year. The purpose of this study was to test the hypothesis that high volume of patients with ISS > 15 per individual trauma surgeon is associated with improved outcome. Data were obtained from the trauma registry of the five American College of Surgeons-verified adult Level I trauma centers in our mature trauma system between January 1, 1998, and March 31, 1999. Data abstracted included age, sex, Glasgow Coma Scale (GCS) score, intensive care unit length of stay, hospital length of stay, probability of survival (Ps), mechanism of injury, number of patients per each trauma surgeon and institution, and mortality. Multiple logistic regression was performed to select independent variables for modeling of survival. From the five Level I centers there were 11,932 trauma patients in this time interval; of these, 1,754 patients (14.7%) with ISS > 15 were identified and used for analysis. Patients with ISS > 15 varied from 173 to 625 per institution; trauma surgeons varied from 8 to 25 per institution; per-surgeon patient volume varied from 0.8 to 96 per year. Logistic regression analysis revealed that the best independent predictors of survival were Ps, GCS score, age, mechanism of injury, and institutional volume (p < 0.01). Age and institutional volume correlated negatively with survival. Analysis of per-surgeon patient caseload added no additional predictive value (p = 0.44). The significant independent predictors of survival in severely injured trauma patients are Ps, GCS score, age, mechanism of injury, and institutional volume. We found no statistically meaningful contribution to the prediction of survival on the basis of per-surgeon patient volume. Since this volume criterion for surgeon enpanelment and trauma center designation would not be expected to improve outcome, such a requirement should be justified by other measures or abandoned.

Patient perceptions of glucocorticoid side effects: a cross-sectional survey of users in an online health community.

PubMed

Costello, Ruth; Patel, Rikesh; Humphreys, Jennifer; McBeth, John; Dixon, William G

2017-04-03

To identify the side effects most important to glucocorticoid (GC) users through a survey of a UK online health community (Healthunlocked.com). Online cross-sectional survey. Participants were recruited through Healthunlocked.com, an online social network for health. Adults who were currently taking GCs, or had taken GCs in the past month. Responders scored the importance of listed side effects from 1 to 10, with 10 being of high importance to them. For each side effect, histograms were plotted, and the median rating and IQR were determined. Side effects were ranked by median ranking (largest to smallest) and then IQR (smallest to largest). The scores were categorised as low (scores 1-3), medium (scores 4-7) and high (scores 8-10) importance. 604 responders completed the survey. Histograms of side effect scores showed a skew towards high importance for weight gain, a U-shaped distribution for cardiovascular disease (CVD), diabetes, eye disease and infections, and a skew towards low importance for acne. When ranked, the side effect of most importance to responders was weight gain (median score=9, IQR 6-10) followed by insomnia and moon face with equal median score (8) and IQR (5-10). Three serious side effects, CVD, diabetes and infections, were ranked of lower importance overall but had wide ranging scores (median score=8, IQR 1-10). The three most highly rated side effects were not clinically serious but remained important to patients, perhaps reflecting their impact on quality of life and high prevalence. This should be taken into consideration when discussing treatment options and planning future GC safety studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Which pediatric blunt trauma patients do not require pelvic imaging?

PubMed

Haasz, Maya; Simone, Laura A; Wales, Paul W; Stimec, Jennifer; Stephens, Derek; Beno, Suzanne; Schuh, Suzanne

2015-11-01

This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%. This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture. Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs. Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging. Therapeutic study, level IV.

THE OPTICAL COLORS OF GIANT ELLIPTICAL GALAXIES AND THEIR METAL-RICH GLOBULAR CLUSTERS INDICATE A BOTTOM-HEAVY INITIAL MASS FUNCTION

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goudfrooij, Paul; Diederik Kruijssen, J. M., E-mail: goudfroo@stsci.edu, E-mail: kruijssen@mpa-garching.mpg.de

2013-01-10

We report a systematic and statistically significant offset between the optical (g - z or B - I) colors of seven massive elliptical galaxies and the mean colors of their associated massive metal-rich globular clusters (GCs) in the sense that the parent galaxies are redder by {approx}0.12-0.20 mag at a given galactocentric distance. However, spectroscopic indices in the blue indicate that the luminosity-weighted ages and metallicities of such galaxies are equal to that of their averaged massive metal-rich GCs at a given galactocentric distance, to within small uncertainties. The observed color differences between the red GC systems and their parentmore » galaxies cannot be explained by the presence of multiple stellar generations in massive metal-rich GCs, as the impact of the latter to the populations' integrated g - z or B - I colors is found to be negligible. However, we show that this paradox can be explained if the stellar initial mass function (IMF) in these massive elliptical galaxies was significantly steeper at subsolar masses than canonical IMFs derived from star counts in the solar neighborhood, with the GC colors having become bluer due to dynamical evolution, causing a significant flattening of the stellar MF of the average surviving GC.« less

Predictors of shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage: a pilot study in a single Egyptian institute.

PubMed

Aboul-Ela, Hashem M; Salah El-Din, Ahmed M; Zaater, Ahmed A; Shehab, Mohamed; El Shahawy, Ossama A

2018-01-01

Acute hydrocephalus can cause neurological deterioration after aneurysmal subarachnoid hemorrhage (aSAH). Predicting which patient would require shunting is challenging. This prospective study was conducted upon twenty patients who suffered acute hydrocephalus due to subarachnoid hemorrhage of ruptured aneurysms. Surgical or non-surgical management of hydrocephalus was conducted. Glasgow Coma scale (GCS) was assessed, and hydrocephalus was graded by bicaudate index. Fisher grade was determined from CT scan. Aneurysm site was determined by conventional or CT angiography. Either surgical clipping or endovascular coiling of aneurysms was performed. Initially, 3 (15%) patients had emergency CSF diversion on admission due to poor GCS on arrival. Initially, the remaining 17 patients were managed conservatively. Five patients did not require any intervention. Twelve patients had external ventricular drainage placement, 4 were weaned, and 8 failed weaning. High bicaudate index (> 0.2) correlated with shunting. Aneurysm site correlated well with shunting (ACoA or PCoA). Patients with fair GCS can be managed conservatively. Any deterioration warrants shifting to CSF diversion. Higher bicaudate index will usually need CSF diversion. The value of Fisher carries no significant value. Aneurysm location (ACoA or PCoA) correlates with an increased incidence of ventriculoperitoneal shunt placement.

Evidence for top-heavy stellar initial mass functions with increasing density and decreasing metallicity

NASA Astrophysics Data System (ADS)

Marks, Michael; Kroupa, Pavel; Dabringhausen, Jörg; Pawlowski, Marcel S.

2012-05-01

Residual-gas expulsion after cluster formation has recently been shown to leave an imprint in the low-mass present-day stellar mass function (PDMF) which allowed the estimation of birth conditions of some Galactic globular clusters (GCs) such as mass, radius and star formation efficiency. We show that in order to explain their characteristics (masses, radii, metallicity and PDMF) their stellar initial mass function (IMF) must have been top heavy. It is found that the IMF is required to become more top heavy the lower the cluster metallicity and the larger the pre-GC cloud-core density are. The deduced trends are in qualitative agreement with theoretical expectation. The results are consistent with estimates of the shape of the high-mass end of the IMF in the Arches cluster, Westerlund 1, R136 and NGC 3603, as well as with the IMF independently constrained for ultra-compact dwarf galaxies (UCDs). The latter suggests that GCs and UCDs might have formed along the same channel or that UCDs formed via mergers of GCs. A Fundamental Plane is found which describes the variation of the IMF with density and metallicity of the pre-GC cloud cores. The implications for the evolution of galaxies and chemical enrichment over cosmological times are expected to be major.

Evidence for participation of GCS1 in fertilization of the starlet sea anemone Nematostella vectensis: Implication of a common mechanism of sperm–egg fusion in plants and animals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ebchuqin, Eerdundagula; Yokota, Naoto; Yamada, Lixy

Highlights: • GCS1 is a sperm transmembrane protein that is essential for gamete fusion in flowering plants. • The GCS1 gene is present not only in angiosperms but also in unicellular organisms and animals. • NvGCS1 gene is expressed in the testis and GCS1 protein exists in sperm of a sea anemone. • Anti-GCS1 antibodies inhibited the fertilization, showing the participation in fertilization. - Abstract: It has been reported that GCS1 (Generative Cell Specific 1) is a transmembrane protein that is exclusively expressed in sperm cells and is essential for gamete fusion in flowering plants. The GCS1 gene is presentmore » not only in angiosperms but also in unicellular organisms and animals, implying the occurrence of a common or ancestral mechanism of GCS1-mediated gamete fusion. In order to elucidate the common mechanism, we investigated the role of GCS1 in animal fertilization using a sea anemone (Cnidaria), Nematostella vectensis. Although the existence of the GCS1 gene in N. vectensis has been reported, the expression of GCS1 in sperm and the role of GCS1 in fertilization are not known. In this study, we showed that the GCS1 gene is expressed in the testis and that GCS1 protein exists in sperm by in situ hybridization and proteomic analysis, respectively. Then we made four peptide antibodies against the N-terminal extracellular region of NvGCS1. These antibodies specifically reacted to NvGCS1 among sperm proteins on the basis of Western analysis and potently inhibited fertilization in a concentration-dependent manner. These results indicate that sperm GCS1 plays a pivotal role in fertilization, most probably in sperm–egg fusion, in a starlet sea anemone, suggesting a common gamete-fusion mechanism shared by eukaryotic organisms.« less

Predictors of outcome in myxoedema coma: a study from a tertiary care centre

PubMed Central

Dutta, Pinaki; Bhansali, Anil; Masoodi, Shriq Rashid; Bhadada, Sanjay; Sharma, Navneet; Rajput, Rajesh

2008-01-01

Background With the easy availability of thyroid hormone assays, thyroid disorders are now recognised even in a subclinical state. However, patients are still seen with advanced manifestations of the disease, particularly in developing countries. This observational study analysed the predictors of outcome in patients with myxoedema coma and tested the validity of different modules to define morbidity and mortality in these patients. Methods Twenty-three consecutive patients with myxoedema coma who presented from January 1999 to August 2006 were studied. The thyroid function test and random serum cortisol were measured in all patients at the time of admission. Patients were given oral or intravenous (IV) thyroxine with intention to treat with the latter according to availability. Various modules that predict outcome, including Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score, were analysed. SOFA score was repeated every 2 days until the time of discharge or demise. Results Twenty-three patients (20 women; 87%) of 59.5 ± 14.4 years of age (range, 30 to 89 years) were seen during the study period. Nine (39%) patients were diagnosed with hypothyroidism for the first time at the time of presentation of myxoedema coma, whereas 14 (70%) were diagnosed with hypothyroidism previously. However, the treatment defaulters presented early to the hospital and had more severe manifestations than de novo subjects. Nineteen (82%) had thyroprivic (primary) and 4 (17%) had trophoprivic (secondary) hypothyroidism. Fifteen (65%) patients presented in the winter and in 17 (74%) sepsis was the major accompanying comorbidity. Twelve (52%) had a history of diuretic use, thereby delaying the initial diagnosis. Patients who received oral L-thyroxine had no difference in outcome from those receiving IV thyroxine. Twelve (52%) subjects died and sepsis was the predominant cause of death. Various predictors of mortality included hypotension (p = 0.01) and bradycardia (p = 0.03) at presentation, need for mechanical ventilation (p = 0.00), hypothermia unresponsive to treatment (p = 0.01), sepsis (p = 0.01), intake of sedative drugs (p = 0.02), lower GCS (p = 0.03), high APACHE II score (p = 0.04), and high SOFA score (p = 0.00). However, SOFA score was more effective than other predictive models as baseline and day 3 SOFA scores of more than 6 were highly predictive of poor outcome. Conclusion L-Thyroxine treatment defaulters had more severe manifestations compared with de novo subjects. Outcome was not influenced by either aetiology or route of administration of L-thyroxine, and SOFA score was the best outcome predictor model. PMID:18173846

The Arabidopsis arc5 and arc6 mutations differentially affect plastid morphology in pavement and guard cells in the leaf epidermis.

PubMed

Fujiwara, Makoto T; Yasuzawa, Mana; Kojo, Kei H; Niwa, Yasuo; Abe, Tomoko; Yoshida, Shigeo; Nakano, Takeshi; Itoh, Ryuuichi D

2018-01-01

Chloroplasts, or photosynthetic plastids, multiply by binary fission, forming a homogeneous population in plant cells. In Arabidopsis thaliana, the division apparatus (or division ring) of mesophyll chloroplasts includes an inner envelope transmembrane protein ARC6, a cytoplasmic dynamin-related protein ARC5 (DRP5B), and members of the FtsZ1 and FtsZ2 families of proteins, which co-assemble in the stromal mid-plastid division ring (FtsZ ring). FtsZ ring placement is controlled by several proteins, including a stromal factor MinE (AtMinE1). During leaf mesophyll development, ARC6 and AtMinE1 are necessary for FtsZ ring formation and thus plastid division initiation, while ARC5 is essential for a later stage of plastid division. Here, we examined plastid morphology in leaf epidermal pavement cells (PCs) and stomatal guard cells (GCs) in the arc5 and arc6 mutants using stroma-targeted fluorescent proteins. The arc5 PC plastids were generally a bit larger than those of the wild type, but most had normal shapes and were division-competent, unlike mutant mesophyll chloroplasts. The arc6 PC plastids were heterogeneous in size and shape, including the formation of giant and mini-plastids, plastids with highly developed stromules, and grape-like plastid clusters, which varied on a cell-by-cell basis. Moreover, unique plastid phenotypes for stomatal GCs were observed in both mutants. The arc5 GCs rarely lacked chlorophyll-bearing plastids (chloroplasts), while they accumulated minute chlorophyll-less plastids, whereas most GCs developed wild type-like chloroplasts. The arc6 GCs produced large chloroplasts and/or chlorophyll-less plastids, as previously observed, but unexpectedly, their chloroplasts/plastids exhibited marked morphological variations. We quantitatively analyzed plastid morphology and partitioning in paired GCs from wild-type, arc5, arc6, and atminE1 plants. Collectively, our results support the notion that ARC5 is dispensable in the process of equal division of epidermal plastids, and indicate that dysfunctions in ARC5 and ARC6 differentially affect plastid replication among mesophyll cells, PCs, and GCs within a single leaf.

[Prognostic factors after cardiac arrest. Usefulness of early video-electroencephalogram].

PubMed

Arméstar, Fernando; Becerra Cuñat, Juan Luis; León Chan, Yariela; Mesalles Sanjuan, Eduard; Moreno, José Antonio; Jiménez González, Marta; Roca, Josep

2015-05-08

Predictors of unfavorable outcome in patients after cardiopulmonary arrest (CPA) are important to make decisions about the limitation of therapeutic efforts. The aim was to analyze the clinical variables in the prognosis of patients recovered after CPA. Retrospective study on comatose patients with recovered CPA. The variables were: age, sex, Glasgow Coma Score (GCS), pupillary light reflex, other variables related to CPA (cause, duration, witnessed or not witnessed), myoclonic status and electroencephalographic (EEG) patterns. Fifty patients were studied. The variables associated with mortality were the absence of pupillary light reflex (hazard ratio [HR] 0.277, 95% confidence interval [95% CI] 0.103-0.741, P=.01), a low GCS (HR 0.701, 95% CI 0.542-0.908, P=.007) and myoclonic state (HR 0.38, 95% CI 0.176-0.854, P=.01). We evaluated the EEG patterns in 22 patients. No statistical significance was observed. The absence of pupillary light reflex, a low GCS and myoclonic state are prognostic factors in patients recovered after a CPA. The EEG patterns showed a nonsignificant association with prognosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Community integration 2 years after moderate and severe traumatic brain injury.

PubMed

Sandhaug, Maria; Andelic, Nada; Langhammer, Birgitta; Mygland, Aase

2015-01-01

The aim of this study was to examine community integration by the Community Integration Questionnaire (CIQ) 2 years after injury in a divided TBI sample of moderately and severely injured patients. The second aim was to identify social-demographic, injury-related and rehabilitation associated predictors of CIQ. A cohort study. Outpatient follow-up. Fifty-seven patients with moderate (n = 21) or severe (n = 36) TBI were examined with the Community Integration Questionnaire (CIQ) at 2 years after injury. Possible predictors were analysed in a regression model using CIQ total score at 2 years as the outcome measure. The Community Integration Questionnaire. At 2 years follow-up, there was significant difference between the moderately and severely injured patients in the productivity scores (p < 0.003), while difference in the total CIQ scores approached the significance level (p = 0.074). Significant predictors of a higher CIQ score were living with a spouse, higher Glasgow Coma Scale (GCS) in the acute phase, shorter Post-Traumatic Amnesia (PTA), longer rehabilitation stay (LOS) and use of rehabilitation service. Use of rehabilitation service (B = 7.766) and living with a spouse (B = 4.251) had the largest influence. This means that living with a spouse, better score on the GCS scale, shorter PTA, longer LOS and use of rehabilitation service after discharge equated to better community integration 2 years after TBI Conclusions: Two years after TBI the moderately injured patients have a higher productivity level than the severely injured patients. Marital status, injury severity and rehabilitation after injury were associated with community integration 2 years after TBI.

Thai venous stroke prognostic score: TV-SPSS.

PubMed

Poungvarin, Niphon; Prayoonwiwat, Naraporn; Ratanakorn, Disya; Towanabut, Somchai; Tantirittisak, Tassanee; Suwanwela, Nijasri; Phanthumchinda, Kamman; Tiamkoa, Somsak; Chankrachang, Siwaporn; Nidhinandana, Samart; Laptikultham, Somsak; Limsoontarakul, Sansern; Udomphanthuruk, Suthipol

2009-11-01

Prognosis of cerebral venous sinus thrombosis (CVST) has never been studied in Thailand. A simple prognostic score to predict poor prognosis of CVST has also never been reported. The authors are aiming to establish a simple and reliable prognostic score for this condition. The medical records of CVST patients from eight neurological training centers in Thailand who received between April 1993 and September 2005 were reviewed as part of this retrospective study. Clinical features included headache, seizure, stroke risk factors, Glasgow coma scale (GCS), blood pressure on arrival, papilledema, hemiparesis, meningeal irritation sign, location of occluded venous sinuses, hemorrhagic infarction, cerebrospinal fluid opening pressure, treatment options, length of stay, and other complications were analyzed to determine the outcome using modified Rankin scale (mRS). Poor prognosis (defined as mRS of 3-6) was determined on the discharge date. One hundred ninety four patients' records, 127 females (65.5%) and mean age of 36.6 +/- 14.4 years, were analyzed Fifty-one patients (26.3%) were in the poor outcome group (mRS 3-6). Overall mortality was 8.4%. Univariate analysis and then multivariate analysis using SPSS version 11.5 revealed only four statistically significant predictors influencing outcome of CVST They were underlying malignancy, low GCS, presence of hemorrhagic infarction (for poor outcome), and involvement of lateral sinus (for good outcome). Thai venous stroke prognostic score (TV-SPSS) was derived from these four factors using a multiple logistic model. A simple and pragmatic prognostic score for CVST outcome has been developed with high sensitivity (93%), yet low specificity (33%). The next study should focus on the validation of this score in other prospective populations.

Predictors of successful weaning from prolonged mechanical ventilation in Taiwan.

PubMed

Wu, Yao-Kuang; Kao, Kuo-Chin; Hsu, Kuang-Hung; Hsieh, Meng-Jer; Tsai, Ying-Huang

2009-08-01

For adult patients on prolonged mechanical ventilation (PMV, >/=21 days), successful weaning has been attributed to various factors. The purpose of this study was to describe patient outcomes, weaning rates and factors in successful weaning at a hospital-based respiratory care center (RCC) in Taiwan. This was a retrospective observational study performed in a 24-bed RCC over six years. A total of 1307 patients on PMV were included in the study. The overall survival rate was 62%. Fifty-six percent of patients were successfully weaned. Unsuccessfully weaned patients had higher MICU transfer rates, higher Acute Physiology and Chronic Health Evaluation II scores, longer duration of RCC stay, higher rates of being bed-ridden prior to admission, increased hemodialysis rates, higher modified Glasgow Coma Scale scores, higher rapid shallow breathing index, lower inspiratory pressure at residual volume (PImax) and lower blood urea nitrogen (BUN) and creatinine levels. Factors found to be associated with unsuccessful weaning were length of RCC stay (OR=1.04, P<0.001), modified GCS score (OR=0.93, P<0.046), PImax (OR=0.97, P<0.001), serum albumin concentration (OR=0.62, P<0.023) and BUN level (OR=1.01, P<0.002). High rates of ventilator independence can be achieved in an RCC setting as an alternative to ICU care. Factors associated with unsuccessful weaning included longer duration of RCC stay, elevated BUN levels and lower modified GCS scores, serum albumin and PImax levels.

The predictive value of resting heart rate following osmotherapy in brain injury: back to basics.

PubMed

Hasanpour Mir, Mahsa; Yousefshahi, Fardin; Abdollahi, Mohammad; Ahmadi, Arezoo; Nadjafi, Atabak; Mojtahedzadeh, Mojtaba

2012-12-30

The importance of resting heart rate as a prognostic factor was described in several studies. An elevated heart rate is an independent risk factor for adverse cardiovascular events and total mortality in patients with coronary artery disease, chronic heart failure, and the general population. Also heart rate is elevated in the Multi Organ Dysfunction Syndrome (MODS) and the mortality due to MODS is highly correlated with inadequate sinus tachycardia.To evaluate the value of resting heart rate in predicting mortality in patients with traumatic brain injury along scoring systems like Acute Physiology and Chronic Health Evaluation(APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Score (GCS). By analyzing data which was collected from an open labeled randomized clinical trial that compared the different means of osmotherapy (mannitol vs bolus or infusion hypertonic saline), heart rate, GCS, APACHE II and SOFA score were measured at baseline and daily for 7 days up to 60 days and the relationship between elevated heart rate and mortality during the first 7 days and 60th day were assessed. After adjustments for confounding factors, although there was no difference in mean heart rate between either groups of alive and expired patients, however, we have found a relative correlation between 60th day mortality rate and resting heart rate (P=0.07). Heart rate can be a prognostic factor for estimating mortality rate in brain injury patients along with APACHE II and SOFA scores in patients with brain injury.

Association between Hyperglycaemia with Neurological Outcomes Following Severe Head Trauma.

PubMed

Khajavikhan, Javaher; Vasigh, Aminolah; Kokhazade, Taleb; Khani, Ali

2016-04-01

Head Trauma (HT) is a major cause of death, disability and important public health problem. HT is also the main cause of hyperglycaemia that can increase mortality. The aim of this study was to assess the correlation between hyperglycaemia with neurological outcomes following severe Traumatic Brain Injury (TBI). This is a descriptive and correlation study that was carried out at the Imam Khomeini Hospital affiliated with Ilam University of Medical Sciences, Ilam, IR, during March 2014-March 2015 on patients with severe TBI. Data were collected from the patient records on mortality, Intensive Care Unit (ICU) length of stay, hospital length of stay, admission GCS score, Injury Severity Score (ISS), mechanical ventilation, Ventilation Associated Pneumonia (VAP) and Acute Respiratory Distress Syndrome (ARDS). Random Blood Sugar (RBS) level on admission was recorded. Patients with diabetes mellitus (to minimize the overlap between acute stress hyperglycaemia and diabetic hyperglycaemia) were excluded. About 34(40%) of patients were admitted with hyperglycaemia (RBS ≥ 200 mg/dl) over the study period. The mortality rate, length of ICU stay, hospital stay, ISS and VAP & ARDS in patients with RBS levels ≥ 200 mg was significantly higher than patients with RBS levels below ≤ 200mg (p<0.05, p<0.001). A significant correlation was found between RBS with GCS arrival, length of ICU stay, length of hospital stay, ISS, mechanical ventilation and VAP & ARDS (p<0.05, p< 0.001). RBS is a predicate factor for ISS (p <0.05, OR : 1.36), GCS (p <0.001, OR : 1.69), mechanical ventilation (p< 0.05, OR : 1.27), VAP & ARDS (p <0.001, OR : 1.68), length of ICU stay (p <0.001, OR : 1.87) and length of hospital stay (p <0.05, OR : 1.24). Hyperglycaemia after severe TBI (RBS ≥ 200) is associated with poor outcome. It can be a predictive factor for mortality rate, ICU stay, GCS arrival, VAP & RDS, hospital stay and ISS. Management of hyperglycaemia with insulin protocol in cases with value >200mg/dl, is critical in improving the outcome of patients with TBI.

Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).

PubMed

Ely, E Wesley; Truman, Brenda; Shintani, Ayumi; Thomason, Jason W W; Wheeler, Arthur P; Gordon, Sharon; Francis, Joseph; Speroff, Theodore; Gautam, Shiva; Margolin, Richard; Sessler, Curtis N; Dittus, Robert S; Bernard, Gordon R

2003-06-11

Goal-directed delivery of sedative and analgesic medications is recommended as standard care in intensive care units (ICUs) because of the impact these medications have on ventilator weaning and ICU length of stay, but few of the available sedation scales have been appropriately tested for reliability and validity. To test the reliability and validity of the Richmond Agitation-Sedation Scale (RASS). Prospective cohort study. Adult medical and coronary ICUs of a university-based medical center. Thirty-eight medical ICU patients enrolled for reliability testing (46% receiving mechanical ventilation) from July 21, 1999, to September 7, 1999, and an independent cohort of 275 patients receiving mechanical ventilation were enrolled for validity testing from February 1, 2000, to May 3, 2001. Interrater reliability of the RASS, Glasgow Coma Scale (GCS), and Ramsay Scale (RS); validity of the RASS correlated with reference standard ratings, assessments of content of consciousness, GCS scores, doses of sedatives and analgesics, and bispectral electroencephalography. In 290-paired observations by nurses, results of both the RASS and RS demonstrated excellent interrater reliability (weighted kappa, 0.91 and 0.94, respectively), which were both superior to the GCS (weighted kappa, 0.64; P<.001 for both comparisons). Criterion validity was tested in 411-paired observations in the first 96 patients of the validation cohort, in whom the RASS showed significant differences between levels of consciousness (P<.001 for all) and correctly identified fluctuations within patients over time (P<.001). In addition, 5 methods were used to test the construct validity of the RASS, including correlation with an attention screening examination (r = 0.78, P<.001), GCS scores (r = 0.91, P<.001), quantity of different psychoactive medication dosages 8 hours prior to assessment (eg, lorazepam: r = - 0.31, P<.001), successful extubation (P =.07), and bispectral electroencephalography (r = 0.63, P<.001). Face validity was demonstrated via a survey of 26 critical care nurses, which the results showed that 92% agreed or strongly agreed with the RASS scoring scheme, and 81% agreed or strongly agreed that the instrument provided a consensus for goal-directed delivery of medications. The RASS demonstrated excellent interrater reliability and criterion, construct, and face validity. This is the first sedation scale to be validated for its ability to detect changes in sedation status over consecutive days of ICU care, against constructs of level of consciousness and delirium, and correlated with the administered dose of sedative and analgesic medications.

Comparing traditional and novel injury scoring systems in a US level-I trauma center: an opportunity for improved injury surveillance in low- and middle-income countries.

PubMed

Laytin, Adam D; Dicker, Rochelle A; Gerdin, Martin; Roy, Nobhojit; Sarang, Bhakti; Kumar, Vineet; Juillard, Catherine

2017-07-01

In most low- and middle-income countries (LMICs), the resources to accurately quantify injury severity using traditional injury scoring systems are limited. Novel injury scoring systems appear to have adequate discrimination for mortality in LMIC contexts, but they have not been rigorously compared where traditional injury scores can be accurately calculated. To determine whether novel injury scoring systems perform as well as traditional ones in a HIC with complete and comprehensive data collection. Data from an American level-I trauma registry collected 2008-2013 were used to compare three traditional injury scoring systems: Injury Severity Score (ISS); Revised Trauma Score (RTS); and Trauma Injury Severity Score (TRISS); and three novel injury scoring systems: Kampala Trauma Score (KTS); Mechanism, GCS, Age and Pressure (MGAP) score; and GCS, Age and Pressure (GAP) score. Logistic regression was used to assess the association between each scoring system and mortality. Standardized regression coefficients (β 2 ), Akaike information criteria, area under the receiver operating characteristics curve, and the calibration line intercept and slope were used to evaluate the discrimination and calibration of each model. Among 18,746 patients, all six scores were associated with hospital mortality. GAP had the highest effect size, and KTS had the lowest median Akaike information criteria. Although TRISS discriminated best, the discrimination of KTS approached that of TRISS and outperformed GAP, MGAP, RTS, and ISS. MGAP was best calibrated, and KTS was better calibrated than RTS, GAP, ISS, or TRISS. The novel injury scoring systems (KTS, MGAP, and GAP), which are more feasible to calculate in low-resource settings, discriminated hospital mortality as well as traditional injury scoring systems (ISS and RTS) and approached the discrimination of a sophisticated, data-intensive injury scoring system (TRISS) in a high-resource setting. Two novel injury scoring systems (KTS and MGAP) surpassed the calibration of TRISS. These novel injury scoring systems should be considered when clinicians and researchers wish to accurately account for injury severity. Implementation of these resource-appropriate tools in LMICs can improve injury surveillance, guiding quality improvement efforts, and supporting advocacy for resource allocation commensurate with the volume and severity of trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

The inter-rater reliability and prognostic value of coma scales in Nepali children with acute encephalitis syndrome.

PubMed

Ray, Stephen; Rayamajhi, Ajit; Bonnett, Laura J; Solomon, Tom; Kneen, Rachel; Griffiths, Michael J

2018-02-01

Background Acute encephalitis syndrome (AES) is a common cause of coma in Nepali children. The Glasgow coma scale (GCS) is used to assess the level of coma in these patients and predict outcome. Alternative coma scales may have better inter-rater reliability and prognostic value in encephalitis in Nepali children, but this has not been studied. The Adelaide coma scale (ACS), Blantyre coma scale (BCS) and the Alert, Verbal, Pain, Unresponsive scale (AVPU) are alternatives to the GCS which can be used. Methods Children aged 1-14 years who presented to Kanti Children's Hospital, Kathmandu with AES between September 2010 and November 2011 were recruited. All four coma scales (GCS, ACS, BCS and AVPU) were applied on admission, 48 h later and on discharge. Inter-rater reliability (unweighted kappa) was measured for each. Correlation and agreement between total coma score and outcome (Liverpool outcome score) was measured by Spearman's rank and Bland-Altman plot. The prognostic value of coma scales alone and in combination with physiological variables was investigated in a subgroup (n = 22). A multivariable logistic regression model was fitted by backward stepwise. Results Fifty children were recruited. Inter-rater reliability using the variables scales was fair to moderate. However, the scales poorly predicted clinical outcome. Combining the scales with physiological parameters such as systolic blood pressure improved outcome prediction. Conclusion This is the first study to compare four coma scales in Nepali children with AES. The scales exhibited fair to moderate inter-rater reliability. However, the study is inadequately powered to answer the question on the relationship between coma scales and outcome. Further larger studies are required.

An analysis of the predictors of mortality and morbidity in patients admitted after suicidal hanging to an Indian multidisciplinary Intensive Care Unit

PubMed Central

Renuka, MK; Kalaiselvan, MS; Arunkumar, AS

2017-01-01

Background and Aims: Hanging is a frequently used method to attempt suicide in India. There is a lack of data in the Indian population regarding clinical features and outcomes of suicidal hanging. The purpose of this study was to evaluate the factors affecting mortality and morbidity in patients admitted with suicidal hanging to the Intensive Care Unit (ICU). Methods: A 6-year retrospective study of adult patients admitted to the ICU with suicidal hanging was analysed for demographics, mode of hanging, lead time to emergency room (ER) admission, clinical presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, admission Glasgow coma scale (GCS) and neurological outcomes. The primary outcome was in-hospital mortality rate. Secondary outcomes were hospital length of stay (LOS), ICU-LOS, time for neurological recovery, organ support and duration of mechanical ventilation. Statistical analysis was performed using the Student's t-test for continuous variables and Chi-square test for categorical variables. Results: We analysed data of 106 patients. The median age was 27 years [Interquartile Range (IQR) (22–34)]. The median lead time to ER admission was 1 h [IQR (0.5–1.4)] with median ICU stay of 3 days [IQR (2–4)]. Vasopressors were administered to 27.4% patients. GCS was ≤7 in 65% patients, and 84.9% patients received mechanical ventilation. Mortality rate was 10.3%. Survivors recovered with normal organ function. Conclusion: Suicidal hanging is associated with significant mortality. Admission GCS, APACHE II and 48 h SOFA score were predictors of poor outcome. PMID:28794524

Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage.

PubMed

Zumofen, Daniel W; Roethlisberger, Michel; Achermann, Rita; Bawarjan, Schatlo; Stienen, Martin N; Fung, Christian; D'Alonzo, Donato; Maldaner, Nicolai; Ferrari, Andrea; Corniola, Marco V; Schoeni, Daniel; Goldberg, Johannes; Valsecchi, Daniele; Robert, Thomas; Maduri, Rodolfo; Seule, Martin; Burkhardt, Jan-Karl; Marbacher, Serge; Bijlenga, Philippe; Blackham, Kristine A; Bucher, Heiner C; Mariani, Luigi; Guzman, Raphael

2018-02-10

Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and serve as to guide treatment decisions and for prognostication. The purpose of this cohort study was to determine what factors govern a patient's disease-specific admission scores in a representative Central European cohort. The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral centers serving subarachnoid hemorrhage patients in Switzerland. The 2009-2014 dataset was used to evaluate the impact of patient and aneurysm characteristics on the patients' status at admission using descriptive and multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The secondary endpoints were the Fisher grade, the presence of a thick cisternal or ventricular clot, the presence of a new focal neurological deficit or cranial nerve palsy, and the patient's intubation status. In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal functional status (mRS 3-5) were inversely correlated with "high" GCS score (GCS ≥ 13) (OR 0.91, 95% CI 0.84-0.97 and OR 0.67, 95% CI 0.31-1.46), "low" WFNS grade (grade VI-V) (OR 1.21, 95% CI 1.04-1.20 and OR 1.47, 95% CI 0.66-3.27), and high Fisher grade (grade III-IV) (OR 1.08, 95% CI 1.00-1.17 and OR 1.54, 95% CI 0.55-4.32). Other independent predictors for the patients' clinical and radiological condition at admission were the ruptured aneurysms' location and its size. In sum, chronological age and pre-ictal functional status, as well as the ruptured aneurysm's location and size, determine the patients' clinical and radiological condition at admission to the tertiary referral hospital.

[Risk factors for surgical site infections in patients undergoing craniotomy].

PubMed

Cha, Kyeong-Sook; Cho, Ok-Hee; Yoo, So-Yeon

2010-04-01

The objectives of this study were to determine the prevalence, incidence, and risk factors for postoperative surgical site infections (SSIs) after craniotomy. This study was a retrospective case-control study of 103 patients who had craniotomies between March 2007 and December 2008. A retrospective review of prospectively collected databases of consecutive patients who underwent craniotomy was done. SSIs were defined by using the Centers for Disease Control criteria. Twenty-six cases (infection) and 77 controls (no infection) were matched for age, gender and time of surgery. Descriptive analysis, t-test, X(2)-test and logistic regression analyses were used for data analysis. The statistical difference between cases and controls was significant for hospital length of stay (>14 days), intensive care unit stay more than 15 days, Glasgrow Coma Scale (GCS) score (< or = 7 days), extra-ventricular drainage and coexistent infection. Risk factors were identified by logistic regression and included hospital length of stay of more than 14 days (odds ratio [OR]=23.39, 95% confidence interval [CI]=2.53-216.11) and GCS score (< or = 7 scores) (OR=4.71, 95% CI=1.64-13.50). The results of this study show that patients are at high risk for infection when they have a low level of consciousness or their length hospital stay is long term. Nurses have to take an active and continuous approach to infection control to help with patients having these risk factors.

Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan.

PubMed

Mata-Mbemba, Daddy; Mugikura, Shunji; Nakagawa, Atsuhiro; Murata, Takaki; Kato, Yumiko; Tatewaki, Yasuko; Takase, Kei; Kushimoto, Shigeki; Tominaga, Teiji; Takahashi, Shoki

2016-01-01

We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13-15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient's score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings. Only the Canadian was significantly associated with important CT findings in multivariate analyses and showed higher area under the receiver operating characteristic curve (AUC) either in all 142 patients (GCS 13-15: P = 0.0130; AUC = 0.69) or in the 67 with a GCS = 15 (P = 0.0128, AUC = 0.73). Of items, ">60 years" or "≥65 years" included in either guideline was the strongest predictor of important CT finding, followed by "GCS < 15 after 2 h" included only in the CCHR. In a tertiary referral hospital in Japan, CCHR had higher performance than the NOC in predicting important CT findings.

Surgical management and outcomes of non-missile open head injury: Report of 44 cases from a single trauma centre.

PubMed

Chen, Lei; Bao, Yinghui; Liang, Yumin; Wang, Yong; Jiang, Jiyao

2016-01-01

To retrospectively analyse the surgical management and outcomes of non-missile open head injuries (NMOHI). Forty-four patients who suffered from NMOHI were included. The Glasgow outcome score (GOS), computed tomography (CT), aetiology and outcomes and complications at discharge and during a 6-month follow-up were analysed. All patients underwent debridement. Intracranial haematoma evacuation, decompressive craniectomy (DC) or replacement were performed. Motor vehicle accident and struck by/against were the most common causes (43.2% each). At admission, 33 patients had Glasgow coma scores (GCS) > 8 and 27 of them had a GCS score of > 13. Mean follow-up was 8.7 ± 4.3 months. All patients underwent debridement, 20 underwent bone fracture replacement and 27 underwent haematoma evacuation; 11 patients underwent haematoma evacuation and DC and one had bilateral DC. Twenty-seven patients showed good recovery; 11 patients had moderate disability; three patients had severe disability; and three patients died. After 6 months, 32 patients had good recovery and the morbidity of severe disability had decreased to 13.6%. Thirteen patients developed intracranial infection. Post-traumatic epilepsy and hydrocephalus was detected in three patients. Cerebrospinal fluid fistula was found in five patients. Only one patient developed a brain abscess after 6 months. NMOHI yielded satisfactory recovery and achieved good outcomes.

Model mice for mild-form glycine encephalopathy: behavioral and biochemical characterizations and efficacy of antagonists for the glycine binding site of N-methyl D-aspartate receptor.

PubMed

Kojima-ishii, Kanako; Kure, Shigeo; Ichinohe, Akiko; Shinka, Toshikatsu; Narisawa, Ayumi; Komatsuzaki, Shoko; Kanno, Junnko; Kamada, Fumiaki; Aoki, Yoko; Yokoyama, Hiroyuki; Oda, Masaya; Sugawara, Taku; Mizoi, Kazuo; Nakahara, Daiichiro; Matsubara, Yoichi

2008-09-01

Glycine encephalopathy (GE) is caused by an inherited deficiency of the glycine cleavage system (GCS) and characterized by accumulation of glycine in body fluids and various neurologic symptoms. Coma and convulsions develop in neonates in typical GE while psychomotor retardation and behavioral abnormalities in infancy and childhood are observed in mild GE. Recently, we have established a transgenic mouse line (low-GCS) with reduced GCS activity (29% of wild-type (WT) C57BL/6) and accumulation of glycine in the brain (Stroke, 2007; 38:2157). The purpose of the present study is to characterize behavioral features of the low-GCS mouse as a model of mild GE. Two other transgenic mouse lines were also analyzed: high-GCS mice with elevated GCS activity and low-GCS-2 mice with reduced GCS activity. As compared with controls, low-GCS mice manifested increased seizure susceptibility, aggressiveness and anxiety-like activity, which resembled abnormal behaviors reported in mild GE, whereas high-GCS mice were less sensitive to seizures, hypoactive and less anxious. Antagonists for the glycine-binding site of the N-methyl-D-aspartate receptor significantly ameliorated elevated locomotor activity and seizure susceptibility in the low-GCS mice. Our results suggest the usefulness of low-GCS mice as a mouse model for mild GE and a novel therapeutic strategy.

The impact of early hyperglycaemia on children with traumatic brain injury.

PubMed

Fu, Yue-Qiang; Chong, Shu-Ling; Lee, Jan Hau; Liu, Cheng-Jun; Fu, Sheng; Loh, Tsee Foong; Ng, Kee Chong; Xu, Feng

2017-01-01

Hyperglycaemia is common amongst children with traumatic brain injury (TBI). We aim to investigate the association between early hyperglycaemia and poor clinical outcomes in children with moderate to severe TBI. We performed a retrospective study in a tertiary paediatric hospital between May 2012 and October 2014 of all patients with TBI who were aged <16 years with a Glasgow Coma Scale (GCS) of ≤13. The primary outcome was death. Secondary outcomes were 14 ventilation-free, 14 paediatric intensive care unit (PICU)-free and 28 hospital-free days. We defined hyperglycaemia as glucose >11.1 mmol/L (200 mg/dL). There were 109 patients with a median age of 54 months [inter-quartile range (IQR): 17-82]. Median glucose on arrival was 6.1 mmol/L (IQR: 5.2-9.8). Median GCS in our cohort was 8 (IQR: 6-12). Multivariate logistic regression demonstrated that initial hyperglycaemia [odds ratio (OR): 15.23; 95% confidence interval (CI): 3.74-62.00; P < 0.001], and GCS <8 (OR: 13.02; 95% CI: 2.31-73.33; P = 0.004) were risk factors for mortality. Multivariate linear regression showed that initial hyperglycaemia was a risk factor for reduced ventilation-free, PICU-free and hospital-free days. Early hyperglycaemia predicts for in-hospital mortality, reduced ventilation-free, PICU-free and hospital-free days in children with moderate to severe TBI.

Distress and Burnout among Genetic Service Providers

PubMed Central

Bernhardt, Barbara A.; Rushton, Cynda H.; Carrese, Joseph; Pyeritz, Reed E.; Kolodner, Ken; Geller, Gail

2009-01-01

Purpose To determine the nature, sources, prevalence and consequences of distress and burnout among genetics professionals. Methods Mailed survey of randomly selected clinical geneticists (MDs), genetic counselors (GCs) and genetic nurses. Results 214 providers completed the survey (55% response rate). Eight discrete sources of distress were identified forming a valid 28-item scale (alpha=.89). The greatest sources of distress were compassion stress, the burden of professional responsibility, negative patient regard and concerns about informational bias. GCs were significantly more likely to experience personal values conflicts, burden of professional responsibility, and concerns about informational bias than MDs or nurses. Burnout scores were lower among those practicing more than 20 years and nurses. Distress scores were positively correlated with burnout and professional dissatisfaction (p<.0001). 18% of respondents think about leaving patient care, and burnout was the most significant predictor. Predictors of burnout included greater distress, fewer years in practice, working in university-based settings, being a GC or an MD, and deriving less meaning from patient care. Conclusions Genetic service providers experience various types of distress that may be risk factors for burnout and professional dissatisfaction. Interventions to reduce distress and burnout are needed for both trainees and practitioners. PMID:19444128

Hypothermia is a frequent sign of severe hypoglycaemia in patients with diabetes.

PubMed

Tran, C; Gariani, K; Herrmann, F R; Juan, L; Philippe, J; Rutschmann, O T; Vischer, U M

2012-10-01

Hypothermia is a recognized complication of severe hypoglycaemia, but its prevalence and characteristics are poorly studied. For this reason, this study aimed to evaluate hypothermia in severely hypoglycaemic patients. A retrospective chart review was performed including all patients discharged between 2007 and 2010 from the Emergency Department of the Geneva University Hospital with a diagnosis of severe hypoglycaemia. Hypothermia was identified in 30 (23.4%) out of 128 patients with severe hypoglycaemia. Its incidence was not affected by age, type of diabetes, season or time of day (day/night). Using linear regression, the lowest recorded temperature was associated with the Glasgow coma scale (GCS) score (r2 = 13.8%, P < 0.0001) and inversely associated with the leukocyte count (r2 = 13.1%, P = 0.001). Hypothermia is a frequent sign of severe hypoglycaemia in patients with diabetes. The associations between hypothermia and the GCS score and the leukocyte count suggest that it is a marker of hypoglycaemia severity and/or duration. Hypothermia may represent an important compensatory mechanism in severe hypoglycaemia, reflecting a decrease in energy demand during glucose deprivation. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Traumatic brain injury due to gunshot wounds: a single institution's experience with 442 consecutive patients.

PubMed

Solmaz, Ilker; Kural, Cahit; Temiz, Cağlar; Seçer, Halil Ibrahim; Düz, Bülent; Gönül, Engin; Izci, Yusuf

2009-07-01

Traumatic brain injury (TBI) caused by a gunshot wound is a complex injury with a broad spectrum of symptoms and high rates of mortality and morbidity. This study presents an evaluation of TBI caused by gunshot wounds presenting at a single institution and discusses possible predictive factors for the outcome of surgical intervention. The study sample consisted of 442 patients who underwent surgery for TBI over a 16-year period. All injuries were caused by gunshot wounds, such as bullets and shrapnel. All patients underwent surgical intervention. Almost all patients (99.3%) were male, and the mean patient age was 22.3 years. Wounds were caused by shrapnel in 68 percent of patients. The Glasgow Coma Scale (GCS) score at admission was below 8 in 116 patients (26.2%) and above 8 in 326 patients (73.8%). In total, 47 patients (10.6%) died despite surgical management, with diffuse brain injury the most common cause of death. Low GCS scores, ventricular injuries and bihemispheric injuries are correlated with poor prognosis. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.

Hydrocephalus after decompressive craniectomy for malignant hemispheric cerebral infarction.

PubMed

Wang, Qiang-Ping; Ma, Jun-Peng; Zhou, Zhang-Ming; Yang, Min; You, Chao

2016-08-01

Several studies have investigated the incidence and risk factors of hydrocephalus after decompressive craniectomy (DC) for malignant hemispheric cerebral infarction. However, the results are controversial. Therefore, the following is a retrospective cohort study to determine the incidence and risk factors of hydrocephalus after DC for malignant hemispheric cerebral infarction. From January 2004 to June 2014, patients at two medical centres in south-west China, who underwent DC for malignant hemispheric cerebral infarction, were included. The patients' clinical and radiologic findings were retrospectively reviewed. A chi-square test, Mann-Whitney U-test and logistic regression model were used to identify the risk factors. A total of 128 patients were included in the study. The incidence of ventriculomegaly and shunt-dependent hydrocephalus were 42.2% (54/128) and 14.8% (19/128), respectively. Lower preoperative Glasgow Coma Scale (GCS) score and presence of subarachnoid haemorrhage (SAH) were factors significantly associated with the development of post-operative hydrocephalus after DC. Cerebral infarction patients receiving DC have a moderate tendency to suffer from post-operative hydrocephalus. A poor GCS score and the presence of SAH were significantly associated with the development of hydrocephalus after DC.

Stellar Population Properties of Ultracompact Dwarfs in M87: A Mass–Metallicity Correlation Connecting Low-metallicity Globular Clusters and Compact Ellipticals

NASA Astrophysics Data System (ADS)

Zhang, Hong-Xin; Puzia, Thomas H.; Peng, Eric W.; Liu, Chengze; Côté, Patrick; Ferrarese, Laura; Duc, Pierre-Alain; Eigenthaler, Paul; Lim, Sungsoon; Lançon, Ariane; Muñoz, Roberto P.; Roediger, Joel; Sánchez-Janssen, Ruben; Taylor, Matthew A.; Yu, Jincheng

2018-05-01

We derive stellar population parameters for a representative sample of ultracompact dwarfs (UCDs) and a large sample of massive globular clusters (GCs) with stellar masses ≳ 106 M ⊙ in the central galaxy M87 of the Virgo galaxy cluster, based on model fitting to the Lick-index measurements from both the literature and new observations. After necessary spectral stacking of the relatively faint objects in our initial sample of 40 UCDs and 118 GCs, we obtain 30 sets of Lick-index measurements for UCDs and 80 for GCs. The M87 UCDs have ages ≳ 8 Gyr and [α/Fe] ≃ 0.4 dex, in agreement with previous studies based on smaller samples. The literature UCDs, located in lower-density environments than M87, extend to younger ages and smaller [α/Fe] (at given metallicities) than M87 UCDs, resembling the environmental dependence of the stellar nuclei of dwarf elliptical galaxies (dEs) in the Virgo cluster. The UCDs exhibit a positive mass–metallicity relation (MZR), which flattens and connects compact ellipticals at stellar masses ≳ 108 M ⊙. The Virgo dE nuclei largely follow the average MZR of UCDs, whereas most of the M87 GCs are offset toward higher metallicities for given stellar masses. The difference between the mass–metallicity distributions of UCDs and GCs may be qualitatively understood as a result of their different physical sizes at birth in a self-enrichment scenario or of galactic nuclear cluster star formation efficiency being relatively low in a tidal stripping scenario for UCD formation. The existing observations provide the necessary but not sufficient evidence for tidally stripped dE nuclei being the dominant contributors to the M87 UCDs.

Risk factors of postictal generalized EEG suppression in generalized convulsive seizures.

PubMed

Alexandre, Veriano; Mercedes, Blanca; Valton, Luc; Maillard, Louis; Bartolomei, Fabrice; Szurhaj, William; Hirsch, Edouard; Marchal, Cécile; Chassoux, Francine; Petit, Jérôme; Crespel, Arielle; Nica, Anca; Navarro, Vincent; Kahane, Philippe; De Toffol, Bertrand; Thomas, Pierre; Rosenberg, Sarah; Denuelle, Marie; Jonas, Jacques; Ryvlin, Philippe; Rheims, Sylvain

2015-11-03

To identify the clinical determinants of occurrence of postictal generalized EEG suppression (PGES) after generalized convulsive seizures (GCS). We reviewed the video-EEG recordings of 417 patients included in the REPO2MSE study, a multicenter prospective cohort study of patients with drug-resistant focal epilepsy. According to ictal semiology, we classified GCS into 3 types: tonic-clonic GCS with bilateral and symmetric tonic arm extension (type 1), clonic GCS without tonic arm extension or flexion (type 2), and GCS with unilateral or asymmetric tonic arm extension or flexion (type 3). Association between PGES and person-specific or seizure-specific variables was analyzed after correction for individual effects and the varying number of seizures. A total of 99 GCS in 69 patients were included. Occurrence of PGES was independently associated with GCS type (p < 0.001) and lack of early administration of oxygen (p < 0.001). Odds ratio (OR) for GCS type 1 in comparison with GCS type 2 was 66.0 (95% confidence interval [CI 5.4-801.6]). In GCS type 1, risk of PGES was significantly increased when the seizure occurred during sleep (OR 5.0, 95% CI 1.2-20.9) and when oxygen was not administered early (OR 13.4, 95% CI 3.2-55.9). The risk of PGES dramatically varied as a function of GCS semiologic characteristics. Whatever the type of GCS, occurrence of PGES was prevented by early administration of oxygen. © 2015 American Academy of Neurology.

Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

PubMed Central

2012-01-01

Background The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months. Methods Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. Results There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. Conclusions Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months. PMID:23249478

Ventilator-associated pneumonia in surgical emergency intensive care unit.

PubMed

Ertugrul, Bulent M; Yildirim, Ayse; Ay, Pinar; Oncu, Serkan; Cagatay, Atahan; Cakar, Nahit; Ertekin, Cemalettin; Ozsut, Halit; Eraksoy, Haluk; Calangu, Semra

2006-01-01

To investigate the incidence, risk factors and the etiology of ventilator-associated pneumonia (VAP) in surgical emergency intensive care unit (ICU) patients. We conducted this prospective cohort study in the surgical emergency ICU of Istanbul Medical Faculty between December 1999 and May 2001. We included 100 mechanically ventilated patients in this study. We diagnosed VAP according to the current diagnostic criteria. We identified the etiology of VAP cases by both quantitative cultures of endotracheal aspiration and blood cultures. To analyze the predisposing factors for the development of VAP, we recorded the following variables: age, gender, acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma scale (GCS), sequential organ failure assessment (SOFA) score, serum albumin level, duration of mechanical ventilation (MV) prior to the development of VAP, and underlying diseases. We determined the VAP incidence rate as 28%. We found the APACHE II score and the duration of MV to be statistically significant variables for the development of VAP. There were no significant differences regarding age, gender, GCS, SOFA score, albumin level, or underlying diseases for the development of VAP. The isolated bacteria among VAP cases were as follows: Staphylococcus aureus (n=12, 43%), Acinetobacter spp. (n=6, 21%), coagulase-negative Staphylococci (n=4, 15%), Pseudomonas aeruginosa (n=3, 10.7%) and Klebsiella pneumoniae (n=3, 10.7%). Ventilator-associated pneumonia is a common infection, and certain interventions might affect the incidence of VAP. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to minimize the risk of VAP.

The predictive value of resting heart rate following osmotherapy in brain injury: back to basics

PubMed Central

2012-01-01

Background The importance of resting heart rate as a prognostic factor was described in several studies. An elevated heart rate is an independent risk factor for adverse cardiovascular events and total mortality in patients with coronary artery disease, chronic heart failure, and the general population. Also heart rate is elevated in the Multi Organ Dysfunction Syndrome (MODS) and the mortality due to MODS is highly correlated with inadequate sinus tachycardia. To evaluate the value of resting heart rate in predicting mortality in patients with traumatic brain injury along scoring systems like Acute Physiology and Chronic Health Evaluation(APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Score (GCS). Method By analyzing data which was collected from an open labeled randomized clinical trial that compared the different means of osmotherapy (mannitol vs bolus or infusion hypertonic saline), heart rate, GCS, APACHE II and SOFA score were measured at baseline and daily for 7 days up to 60 days and the relationship between elevated heart rate and mortality during the first 7 days and 60th day were assessed. Results After adjustments for confounding factors, although there was no difference in mean heart rate between either groups of alive and expired patients, however, we have found a relative correlation between 60th day mortality rate and resting heart rate (P=0.07). Conclusion Heart rate can be a prognostic factor for estimating mortality rate in brain injury patients along with APACHE II and SOFA scores in patients with brain injury. PMID:23351393

Risk Factors for Multiple Organ Dysfunction Syndrome in Severe Stroke Patients

PubMed Central

Yang, Shuna; Li, Yue; Yuan, Junliang; Yang, Lei; Li, Shujuan; Hu, Wenli

2016-01-01

Background Severe stroke patients have poor clinical outcome which may be associated with development of multiple organ dysfunction syndrome (MODS). Therefore, the aim of our study was to investigate independent risk factors for development of MODS in severe stroke patients. Methods Ninety seven severe stroke patients were prospective recruited from Jan 2011 to Jun 2015. The development of MODS was identified by Sequential Organ Failure Assessment (SOFA) score (score ≥ 3, at least two organs), which was assessed on day 1, 4, 7, 10 and 14 after admission. Baseline characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow coma score (GCS) and cerebral imaging parameters were collected at admission. Cox regression was performed to determine predictors for the development of MODS. Medical complications after admission and in-hospital mortality were also investigated. Results 33 (34%) patients were in MODS group and 64 (66%) were in non-MODS group within 14 days after admission. Patients in MODS group had more smoker (51.5% vs 28.1%, p = 0.023), higher NIHSS score (23.48 ± 6.12 vs 19.81 ± 4.83, p = 0.004), higher APACHE II score (18.70 ± 5.18 vs 15.64 ± 4.36, p = 0.003) and lower GCS score (6.33 ± 2.48 vs 8.14 ± 2.73, p = 0.002). They also had higher rate of infarction in multi vascular territories (36.4% vs 10.9%, p = 0.003). The most common complication in all patients was pulmonary infection, while complication scores were comparable between two groups. Patients with MODS had higher in-hospital mortality (69.7% vs 9.4%, p = 0.000). In Cox regression, NIHSS score (RR = 1.084, 95% CI 1.019–1.153) and infarction in multi vascular territories (RR = 2.345 95% CI 1.105–4.978) were independent risk factors for development of MODS. Conclusions In acute phase of stroke, NIHSS score and infarction in multi vascular territories predicted MODS in severe stroke patients. Moreover, patients with MODS had higher in-hospital mortality, suggesting that early identification of MODS is critical important. PMID:27893797

Development of new ionic gelation strategy: Towards the preparation of new monodisperse and stable hyaluronic acid/β-cyclodextrin-grafted chitosan nanoparticles as drug delivery carriers for doxorubicin

NASA Astrophysics Data System (ADS)

Mihoub, Amina Ben; Saidat, Boubakeur; Bal, Youssef; Frochot, Céline; Vanderesse, Régis; Acherar, Samir

2018-03-01

In the present study, β-cyclodextrin-grafted chitosan nanoparticles (β-CD- g-CS NPs) were prepared using a new ionic gelation strategy involving a synergistic effect of NaCl (150 mmol/L), 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES, 10 mmol/L), and water bath sonication. This new strategy afforded smaller and more monodisperse β-CD- g-CS NPs vs. the classical ionic gelation method. New HA/β-CD- g-CS NPs were also prepared using the above-mentioned strategy by adding hyaluronic acid (HA) to the β-CD- g-CS copolymer at different weight ratios until the ZP values conversion. The best result was obtained with the weight ratio of w(HA): w(β-CD- g-CS) = 2:1 and furnished new spherical and smooth HA/β-CD- g-CS NPs. Furthermore, the stability of β- CD- g-CS NPs and HA/β-CD- g-CS NPs at 4°C in physiological medium (pH 7.4) was compared for 3 weeks period and showed that HA/β-CD- g-CS NPs were more stable all maintaining their monodispersity and high negative ZP values compared to β-CD- g-CS NPs. Finally, preliminary study of HA/β-CD- g-CS NPs as carrier for the controlled release of the anticancer drug doxorubicin was investigated. These new HA/β-CD- g-CS NPs can potentially be used as drug delivery and targeting systems for cancer treatment.

Effects of grade control structures on the macroinvertebrate assemblage of an agriculturally impacted stream

USGS Publications Warehouse

Litvan, M.E.; Stewart, T.W.; Pierce, C.L.; Larson, C.J.

2008-01-01

Nearly 400 rock rip-rap grade control structures (hereafter GCS) were recently placed in streams of western Iowa, USA to reduce streambank erosion and protect bridge infrastructure and farmland. In this region, streams are characterized by channelized reaches, highly incised banks and silt and sand substrates that normally support low macroinvertebrate abundance and diversity. Therefore, GCS composed of rip-rap provide the majority of coarse substrate habitat for benthic macroinvertebrates in these streams. We sampled 20 sites on Walnut Creek, Montgomery County, Iowa to quantify macroinvertebrate assemblage characteristics (1) on GCS rip-rap and at sites located (2) 5-50 m upstream of GCS, (3) 5-50 m downstream of GCS and (4) at least 1 km from any GCS (five sites each). Macroinvertebrate biomass, numerical densities and diversity were greatest at sites with coarse substrates, including GCS sites and one natural riffle site and relatively low at remaining sites with soft substrates. Densities of macroinvertebrates in the orders Ephemeroptera, Trichoptera, Diptera, Coleoptera and Acariformes were abundant on GCS rip-rap. Increases in macroinvertebrate biomass, density and diversity at GCS may improve local efficiency of breakdown of organic matter and nutrient and energy flow, and provide enhanced food resources for aquatic vertebrates. However, lack of positive macroinvertebrate responses immediately upstream and downstream of GCS suggest that positive effects might be restricted to the small areas of streambed covered by GCS. Improved understanding of GCS effects at both local and ecosystem scales is essential for stream management when these structures are present. Copyright ?? 2007 John Wiley & Sons, Ltd.

Risk factors for mortality in Asian Taiwanese patients with methanol poisoning.

PubMed

Lee, Chen-Yen; Chang, Eileen Kevyn; Lin, Ja-Liang; Weng, Cheng-Hao; Lee, Shen-Yang; Juan, Kuo-Chang; Yang, Huang-Yu; Lin, Chemin; Lee, Shwu-Hua; Wang, I-Kwan; Yen, Tzung-Hai

2014-01-01

Methanol poisoning continues to be a serious public health issue in Taiwan, but very little work has been done to study the outcomes of methanol toxicity in the Asian population. In this study, we examined the value of multiple clinical variables in predicting mortality after methanol exposure. We performed a retrospective observational study on patients with acute poisoning who were admitted to the Chang Gung Memorial Hospital over a period of 9 years (2000-2008). Out of the 6,347 patients, only 32 suffered methanol intoxication. The demographic, clinical, laboratory, and mortality data were obtained for analysis. Most patients were middle aged (46.1±13.8 years), male (87.5%), and habitual alcohol consumers (75.0%). All the poisonings were from an oral exposure (96.9%), except for one case of intentionally injected methanol (3.1%). After a latent period of 9.3±10.1 hours, many patients began to experience hypothermia (50.0%), hypotension (15.6%), renal failure (59.4%), respiratory failure (50.0%), and consciousness disturbance (Glasgow coma scale [GCS] score 10.5±5.4). Notably, the majority of patients were treated with ethanol antidote (59.4%) and hemodialysis (58.1%). The remaining 41.6% of patients did not meet the indications for ethanol therapy. At the end of analysis, there were six (18.8%), 15 (46.9%), and eleven (34.4%) patients alive, alive with chronic complications, and dead, respectively. In a multivariate Cox regression model, it was revealed that the GCS score (odds ratio [OR] 0.816, 95% confidence interval [CI] 0.682-0.976) (P=0.026), hypothermia (OR 168.686, 95% CI 2.685-10,595.977) (P=0.015), and serum creatinine level (OR 4.799, 95% CI 1.321-17.440) (P=0.017) were significant risk factors associated with mortality. The outcomes (mortality rate 34.4%) of the Taiwanese patients subjected to intensive detoxification protocols were comparable with published data from other international poison centers. Furthermore, the analytical results indicate that GCS score, hypothermia, and serum creatinine level help predict mortality after methanol poisoning.

Comparison of Two Predictive Models for Short-Term Mortality in Patients after Severe Traumatic Brain Injury.

PubMed

Kesmarky, Klara; Delhumeau, Cecile; Zenobi, Marie; Walder, Bernhard

2017-07-15

The Glasgow Coma Scale (GCS) and the Abbreviated Injury Score of the head region (HAIS) are validated prognostic factors in traumatic brain injury (TBI). The aim of this study was to compare the prognostic performance of an alternative predictive model including motor GCS, pupillary reactivity, age, HAIS, and presence of multi-trauma for short-term mortality with a reference predictive model including motor GCS, pupil reaction, and age (IMPACT core model). A secondary analysis of a prospective epidemiological cohort study in Switzerland including patients after severe TBI (HAIS >3) with the outcome death at 14 days was performed. Performance of prediction, accuracy of discrimination (area under the receiver operating characteristic curve [AUROC]), calibration, and validity of the two predictive models were investigated. The cohort included 808 patients (median age, 56; interquartile range, 33-71), median GCS at hospital admission 3 (3-14), abnormal pupil reaction 29%, with a death rate of 29.7% at 14 days. The alternative predictive model had a higher accuracy of discrimination to predict death at 14 days than the reference predictive model (AUROC 0.852, 95% confidence interval [CI] 0.824-0.880 vs. AUROC 0.826, 95% CI 0.795-0.857; p < 0.0001). The alternative predictive model had an equivalent calibration, compared with the reference predictive model Hosmer-Lemeshow p values (Chi2 8.52, Hosmer-Lemeshow p = 0.345 vs. Chi2 8.66, Hosmer-Lemeshow p = 0.372). The optimism-corrected value of AUROC for the alternative predictive model was 0.845. After severe TBI, a higher performance of prediction for short-term mortality was observed with the alternative predictive model, compared with the reference predictive model.

A model to predict progression in brain-injured patients.

PubMed

Tommasino, N; Forteza, D; Godino, M; Mizraji, R; Alvarez, I

2014-11-01

The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD. This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447). The independent predictor factors of death and BD were studied using logistic regression analysis. A hierarchical model consisting of 2 nested logit regression models was then created. With these models, the probabilities of death, BD, and death by cardiorespiratory arrest were analyzed. In the first regression, we observed that as the GCS decreased and age increased, the probability of death rose. Each additional year of age increased the probability of death by 0.014. In the second model, however, BD risk decreased with each year of age. The presence of swelling, mass effect, and/or space-occupying lesion increased BD risk for the same given GCS. In the presence of injuries compatible with intracranial hypertension, age behaved as a protective factor that reduced the probability of BD. Based on the analysis of the local epidemiology, a model to predict the probability of death and BD can be developed. The organ potential donation of a country, region, or hospital can be predicted on the basis of this model, customizing it to each specific situation.

Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population.

PubMed

Budnick, Hailey C; Tyroch, Alan H; Milan, Stacey A

2017-07-01

Functional outcomes after traumatic brain injury (TBI) can be significantly improved by discharge to posthospitalization care facilities. Many variables influence the discharge disposition of the TBI patient, including insurance status, patient condition, and patient prognosis. The literature has demonstrated an ethnic disparity in posthospitalization care referral, with Hispanics being discharged to rehabilitation and nursing facilities less often than non-Hispanics. However, this relationship has not been studied in a Hispanic-majority population, and thus, this study seeks to determine if differences in neurorehabilitation referrals exist among ethnic groups in a predominately Hispanic region. This study is a retrospective cohort that includes 1128 TBI patients who presented to University Medical Center El Paso, Texas, between the years 2005 and 2015. The patients' age, sex, race, residence, admission Glasgow Coma Scale (GCS), GCS motor, Injury Severity Score (ISS), hospital and intensive care unit length of stay (LOS), mechanism of injury, and discharge disposition were analyzed in univariate and multivariate models. Our study population had an insurance rate of 55.5%. Insurance status and markers of injury severity (hospital LOS, intensive care unit LOS, ISS, GCS, and GCS motor) were predictive of discharge disposition to rehabilitation facilities. The study population was 70% Hispanic, yet Hispanics were discharged to rehabilitation facilities (relative risk: 0.56, P: 0.001) and to long-term acute care/nursing facilities (relative risk: 0.35, P < 0.0001) less than non-Hispanics even after LOS, ISS, ethnicity, insurance status, and residence were adjusted for in multivariate analysis. This study suggests that patients of different ethnicities but comparable traumatic severity and insurance status receive different discharge dispositions post-TBI even in regions in which Hispanics are the demographic majority. Copyright © 2017 Elsevier Inc. All rights reserved.

Music therapy for coma patients: preliminary results.

PubMed

Sun, J; Chen, W

2015-04-01

The application of quantitative EEG (δ+θ/α+β value) and GCS value to evaluate the role of music therapy for traumatic brain injury coma patients. Forty patients of traumatic brain injury coma were selected to meet the inclusion criteria. Twenty cases were selected for the rehabilitation, neurology and neurosurgery ward, whose families could actively cooperate with, and the patients could receive a long-term fixed nursing staff with formal music therapy (music group). Twenty cases were in the intensive care unit of the rehabilitation, neurology and neurosurgery ward. Their families members cooperated poorly, had often changing nursing staff, and without a formal music therapy (control group). After a one monthe follow up, the GCS value and quantitative EEG (δ+θ/α+β value) were compared between the two groups. Between the two groups, except for the presence or absence of formal music therapy, the rest of treatment had no significant difference and was matched by age, gender, and injury types. In 40 cases of traumatic brain injury patients, the GCS value increased in the music group after treatment when compared to the control group. The difference between the two groups was significant (p < 0.05). The quantitative EEG value (δ+θ/α+β value) of music group values were decreased after treatment, and the difference was significant compared with the control group (p < 0.05). Through the quantitative EEG (δ+θ/α+β value) and the GCS observation score, music therapy in patients with craniocerebral trauma coma has obviously an effect on promoting to regain consciousness. The quantitative EEG (δ+θ/α+β value) can be used as an objective index to evaluate the state of brain function.

Ruprecht 106: The first single population globular cluster?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Villanova, S.; Geisler, D.; Muñoz, C.

2013-12-01

All old Galactic globular clusters (GCs) studied in detail to date host at least two generations of stars, where the second is formed from gas polluted by processed material produced by massive stars of the first. This process can happen if the initial mass of the cluster exceeds a threshold above which ejecta are retained and a second generation is formed. A determination of this mass threshold is mandatory in order to understand how GCs form. We analyzed nine red giant branch stars belonging to the cluster Ruprecht 106. Targets were observed with the UVES@VLT2 spectrograph. Spectra cover a widemore » range and allowed us to measure abundances for light (O, Na, Mg, Al), α (Si, Ca, Ti), iron-peak (Sc, V, Cr, Mn, Fe, Co, Ni, Cu, Zn), and neutron-capture (Y, Zr, Ba, La, Ce, Pr, Nd, Sm, Eu, Dy, Pb) elements. Based on these abundances, we show that Ruprecht 106 is the first convincing example of a single-population GC (i.e., a true simple stellar population), although the sample is relatively small. This result is supported also by an independent photometric test and by the horizontal branch morphology and the dynamical state. It is old (∼12 Gyr) and, at odds with other GCs, has no α-enhancement. The material it formed from was contaminated by both s- and r-process elements. The abundance pattern points toward an extragalactic origin. Its present-day mass (M = 10{sup 4.83} M {sub ☉}) can be assumed as a strong lower limit for the initial mass threshold below which no second generation is formed. Clearly, its initial mass must have been significantly greater, but we have no current constraints on the amount of mass loss during its evolution.« less

The Origins of the Ultra Compact Dwarfs in the halos of the central cluster galaxies in Fornax and Virgo

NASA Astrophysics Data System (ADS)

Voggel, Karina Theresia

2015-08-01

Ultra-Compact Dwarf Galaxies (UCDs) have filled the size gap (10-100pc) in the scaling relations of early-type stellar systems. Before their discovery, no objects were known in the parameter space between globular clusters (GCs) and dwarf galaxies. The nature of UCDs is widely debated. Two formation channels have been suggested: either UCDs are surviving nuclei of tidally stripped dwarf galaxies, or they constitute the high mass end of the GC population. In this work we establish new strategies to constrain the formation channel of UCDs, looking for the observational signatures of stripped nuclei.Before falling into a galaxy cluster dwarf galaxies initially host their own GC system. Through tidal interaction the GCs outside of the shrinking tidal radius are lost and disperse in the general GC population of the cluster, whereas GCs inside the tidal radius remain bound to the dwarf galaxy. Therefore, we expect to find some GCs close to the stripped nuclei that have not been removed yet, but dragged towards the nucleus via dynamical friction.We tested this prediction in the halo of NGC 1399, the central Fornax cluster galaxy, where we find a local overabundance of GCs on scales of 0.5 to 1 kpc around UCDs. A similar analysis of GC overdensities around UCDs in the halo of M87, the central Virgo cluster galaxy, is ongoing. Such a clustering signal of GCs around UCDs could be a hint that these UCDs formed as nuclei, and what we see is the remnant GC population of the ancestor galaxy.We also have studied the detailed structural composition of ~100 UCDs in the halo of NGC 1399 by analyzing their surface brightness profiles. We present new evidence for faint asymmetric structures and tidal tails around several UCDs, possible tracers for the assembly history of the central cluster galaxy. With new numbers on the abundance of tidal features and close GC companions within large UCD samples, the contribution of each formation channel to the GC/UCD populations in galaxy halos can be constrained.

Delayed coupling to feedback inhibition during a critical period for the integration of adult-born granule cells

PubMed Central

Temprana, Silvio G.; Mongiat, Lucas A.; Yang, Sung M.; Trinchero, Mariela F.; Alvarez, Diego D.; Kropff, Emilio; Giacomini, Damiana; Beltramone, Natalia; Lanuza, Guillermo M.; Schinder, Alejandro F.

2014-01-01

SUMMARY Developing granule cells (GCs) of the adult dentate gyrus undergo a critical period of enhanced activity and synaptic plasticity before becoming mature. The impact of developing GCs on the activity of preexisting dentate circuits remains unknown. Here we combine optogenetics, acute slice electrophysiology, and in vivo chemogenetics to activate GCs at different stages of maturation to study the recruitment of local target networks. We show that immature (four-week-old) GCs can efficiently drive distal CA3 targets, but poorly activate proximal interneurons responsible for feedback inhibition (FBI). As new GCs transition towards maturity, they reliably recruit GABAergic feedback loops that restrict spiking of neighbor GCs, a mechanism that would promote sparse coding. Such inhibitory loop impinges only weakly in new cohorts of young GCs. A computational model reveals that the delayed coupling of new GCs to FBI could be crucial to achieve a fine-grain representation of novel inputs in the dentate gyrus. PMID:25533485

Delayed coupling to feedback inhibition during a critical period for the integration of adult-born granule cells.

PubMed

Temprana, Silvio G; Mongiat, Lucas A; Yang, Sung M; Trinchero, Mariela F; Alvarez, Diego D; Kropff, Emilio; Giacomini, Damiana; Beltramone, Natalia; Lanuza, Guillermo M; Schinder, Alejandro F

2015-01-07

Developing granule cells (GCs) of the adult dentate gyrus undergo a critical period of enhanced activity and synaptic plasticity before becoming mature. The impact of developing GCs on the activity of preexisting dentate circuits remains unknown. Here we combine optogenetics, acute slice electrophysiology, and in vivo chemogenetics to activate GCs at different stages of maturation to study the recruitment of local target networks. We show that immature (4-week-old) GCs can efficiently drive distal CA3 targets but poorly activate proximal interneurons responsible for feedback inhibition (FBI). As new GCs transition toward maturity, they reliably recruit GABAergic feedback loops that restrict spiking of neighbor GCs, a mechanism that would promote sparse coding. Such inhibitory loop impinges only weakly in new cohorts of young GCs. A computational model reveals that the delayed coupling of new GCs to FBI could be crucial to achieve a fine-grain representation of novel inputs in the dentate gyrus. Copyright © 2015 Elsevier Inc. All rights reserved.

The formation of ultra compact dwarf galaxies and massive globular clusters. Quasar-like objects to test for a variable stellar initial mass function

NASA Astrophysics Data System (ADS)

Jeřábková, T.; Kroupa, P.; Dabringhausen, J.; Hilker, M.; Bekki, K.

2017-12-01

The stellar initial mass function (IMF) has been described as being invariant, bottom-heavy, or top-heavy in extremely dense star-burst conditions. To provide usable observable diagnostics, we calculate redshift dependent spectral energy distributions of stellar populations in extreme star-burst clusters, which are likely to have been the precursors of present day massive globular clusters (GCs) and of ultra compact dwarf galaxies (UCDs). The retention fraction of stellar remnants is taken into account to assess the mass to light ratios of the ageing star-burst. Their redshift dependent photometric properties are calculated as predictions for James Webb Space Telescope (JWST) observations. While the present day GCs and UCDs are largely degenerate concerning bottom-heavy or top-heavy IMFs, a metallicity- and density-dependent top-heavy IMF implies the most massive UCDs, at ages < 100 Myr, to appear as objects with quasar-like luminosities with a 0.1-10% variability on a monthly timescale due to core collapse supernovae.

FEEDBACK FROM MASSIVE STARS AND GAS EXPULSION FROM PROTO-GLOBULAR CLUSTERS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Calura, F.; Romano, D.; D’Ercole, A.

2015-11-20

Globular clusters (GCs) are considerably more complex structures than previously thought, harboring at least two stellar generations that present clearly distinct chemical abundances. Scenarios explaining the abundance patterns in GCs mostly assume that originally the clusters had to be much more massive than today, and that the second generation of stars originates from the gas shed by stars of the first generation (FG). The lack of metallicity spread in most GCs further requires that the supernova-enriched gas ejected by the FG is completely lost within ∼30 Myr, a hypothesis never tested by means of three-dimensional hydrodynamic simulations. In this paper,more » we use 3D hydrodynamic simulations including stellar feedback from winds and supernovae, radiative cooling and self-gravity to study whether a realistic distribution of OB associations in a massive proto-GC of initial mass M{sub tot} ∼ 10{sup 7} M{sub ⊙} is sufficient to expel its entire gas content. Our numerical experiment shows that the coherence of different associations plays a fundamental role: as the bubbles interact, distort, and merge, they carve narrow tunnels that reach deeper and deeper toward the innermost cluster regions, and through which the gas is able to escape. Our results indicate that after 3 Myr, the feedback from stellar winds is responsible for the removal of ∼40% of the pristine gas, and that after 14 Myr, 99% of the initial gas mass has been removed.« less

Roles of glucocorticoids in human parturition: a controversial fact?

PubMed

Li, X Q; Zhu, P; Myatt, L; Sun, K

2014-05-01

The pivotal role of glucocorticoids in the initiation of parturition has been very well documented in several domestic mammalian animal species. However the role of glucocorticoids in human parturition remains controversial mainly because of the absence of effect of synthetic glucocorticoids, given to promote fetal organ maturation in pregnant women with threatened preterm delivery, on the length of gestation. This article will review studies of glucocorticoids in human parturition and provide evidence for an important role of glucocorticoids in human parturition as well but a simultaneous high concentration of estrogen within the intrauterine tissues may be necessary for GCs to initiate parturition. The synthetic GCs dexamethasone and betamethasone pass through the placenta intact resulting in potent negative feedback on the fetal HPA axis and diminished production of DHEA from fetal adrenal glands for estrogen synthesis by the placenta. This may negate the effect of systemic administration of GCs on the induction of labor, especially in cases where the myometrium is not yet fully primed by estrogen. Endogenous glucocorticoids are inactivated by the placental 11β-HSD2 thus limiting the negative feedback of maternal cortisol on the fetal HPA axis and allowing the simultaneous rise of cortisol and estrogen levels towards the end of gestation. Therefore, endogenous glucocorticoids, particularly glucocorticoids produced locally in the intrauterine tissues may play an important role in parturition in humans by enhancing prostaglandin production in the fetal membranes and stimulating estrogen and CRH production in the placenta. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recovery of consciousness and an injured ascending reticular activating system in a patient who survived cardiac arrest: A case report.

PubMed

Jang, Sung Ho; Hyun, Yi Ji; Lee, Han Do

2016-06-01

We report on a patient who survived cardiac arrest and showed recovery of consciousness and an injured ARAS at the early stage of hypoxic-ischemic brain injury (HI- BI) for 3 weeks, which was demonstrated by diffusion tensor tractography (DTT).A 52-year-old male patient who had suffered cardiac arrest caused by acute coronary syndrome was resuscitated immediately by a layman and paramedics for ∼25 minutes. He was then transferred immediately to the emergency room of a local medical center. When starting rehabilitation at 2 weeks after onset, his consciousness was impaired, with a Glasgow Coma Scale (GCS) score of 8 and Coma Recovery Scale-Revised (GRS-R) score of 8. He underwent comprehensive rehabilitative therapy, including drugs for recovery of consciousness. He recovered well and rapidly so that his consciousness had recovered to full scores in terms of GCS:15 and GRS-R:23 at 5 weeks after onset.The left lower dorsal and right lower ventral ARAS had become thicker on 5-week DTT compared with 2-week DTT (Fig. 1B). Regarding the change of neural connectivity of the thalamic ILN, increased neural connectivity to the basal forebrain and prefrontal cortex was observed in both hemispheres on 5-week DTT compared with 2-week DTT.Recovery of an injured ARAS was demonstrated in a patient who survived cardiac arrest and his consciousness showed rapid and good recovery for 3 weeks at the early stage of HI-BI.

The impact of menopause on work ability in women with severe menopausal symptoms.

PubMed

Geukes, Marije; van Aalst, Mariëlle P; Robroek, Suzan J W; Laven, Joop S E; Oosterhof, Henk

2016-08-01

To measure the impact of menopause on work ability in women with severe menopausal symptoms. This cross-sectional study compared the work ability of a sample of otherwise healthy employed Dutch women (n=205) with that of a sample of first-time attendees of a menopause clinic (n=60); both groups were aged 44-60 years. Self-reported questionnaire data assessing work ability (Work Ability Index; WAI) and menopausal symptoms (Greene Climacteric Scale; GCS) were used. Logistic regression analyses were used to examine whether women with severe menopausal symptoms were more likely to have low work ability (defined as a score <37.0 points on the WAI) than were women in the reference group, after adjustment for individual and lifestyle factors. Symptomatic women had significantly higher total GCS scores (mean 26.7 vs 14.2, t=10.8, P<0.001) and significantly lower WAI scores (median 32.0 vs 40.0, U=2380, P<0.001) than the reference group. They were 8.4 times more likely to report low work ability than their healthy counterparts: 76.7% versus 30.2% (OR 8.4, 95% CI 4.1-17.2). Over three-quarters of symptomatic menopausal women report serious problems in dealing with the physical and mental demands of their work (recorded here as low work ability); hence these women might be at risk of prolonged sickness absence from work. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

New Constraints on a Complex Relation between Globular Cluster Colors and Environment

NASA Astrophysics Data System (ADS)

Powalka, Mathieu; Puzia, Thomas H.; Lançon, Ariane; Peng, Eric W.; Schönebeck, Frederik; Alamo-Martínez, Karla; Ángel, Simón; Blakeslee, John P.; Côté, Patrick; Cuillandre, Jean-Charles; Duc, Pierre-Alain; Durrell, Patrick; Ferrarese, Laura; Grebel, Eva K.; Guhathakurta, Puragra; Gwyn, S. D. J.; Kuntschner, Harald; Lim, Sungsoon; Liu, Chengze; Lyubenova, Mariya; Mihos, J. Christopher; Muñoz, Roberto P.; Ordenes-Briceño, Yasna; Roediger, Joel; Sánchez-Janssen, Rubén; Spengler, Chelsea; Toloba, Elisa; Zhang, Hongxin

2016-09-01

We present an analysis of high-quality photometry for globular clusters (GCs) in the Virgo cluster core region, based on data from the Next Generation Virgo Cluster Survey (NGVS) pilot field, and in the Milky Way (MW), based on Very Large Telescope/X-Shooter spectrophotometry. We find significant discrepancies in color-color diagrams between sub-samples from different environments, confirming that the environment has a strong influence on the integrated colors of GCs. GC color distributions along a single color are not sufficient to capture the differences we observe in color-color space. While the average photometric colors become bluer with increasing radial distance to the cD galaxy M87, we also find a relation between the environment and the slope and intercept of the color-color relations. A denser environment seems to produce a larger dynamic range in certain color indices. We argue that these results are not due solely to differential extinction, Initial Mass Function variations, calibration uncertainties, or overall age/metallicity variations. We therefore suggest that the relation between the environment and GC colors is, at least in part, due to chemical abundance variations, which affect stellar spectra and stellar evolution tracks. Our results demonstrate that stellar population diagnostics derived from model predictions which are calibrated on one particular sample of GCs may not be appropriate for all extragalactic GCs. These results advocate a more complex model of the assembly history of GC systems in massive galaxies that goes beyond the simple bimodality found in previous decades.

Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in Prediction of Mortality Rate Among Patients With Traumatic Brain Injury Admitted to Intensive Care Unit

PubMed Central

Hosseini, Seyed Hossein; Ayyasi, Mitra; Akbari, Hooshang; Heidari Gorji, Mohammad Ali

2016-01-01

Background Traumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis. Objectives This study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit. Patients and Methods This diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics. Results The results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively. Conclusions Considering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality. PMID:29696116

First CT findings and improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury.

PubMed

Corral, Luisa; Herrero, José Ignacio; Monfort, José Luis; Ventura, José Luis; Javierre, Casimiro F; Juncadella, Montserrat; García-Huete, Lucía; Bartolomé, Carlos; Gabarrós, Andreu

2009-05-01

To analyse the association between individual initial computerized tomography (CT) scan characteristics and Glasgow Outcome Scale (GOS) and Extended Glasgow Outcome Scale (GOSE) improvement between 6 months and 1 year. Two hundred and twenty-four adult patients with severe traumatic brain injury and Glasgow Coma Scale (GCS) score of 8 or less who were admitted to an intensive care unit were studied. GOS and GOSE scores were obtained 6 and 12 months after injury in 203 subjects. Patients were predominantly male (84%) and median age was 35 years. Traumatic Coma Data Bank (TCDB) CT classification was associated with GOS/GOSE improvement between 6 months and 1 year, with diffuse injury type I, type II and evacuated mass improving more than diffuse injury type III, type IV and non-evacuated mass; for GOS 43/155 (28%) vs 3/48 (6%) (chi(2) = 9.66, p < 0.01) and for GOSE 71/155 (46%) vs 7/48 (15%) (chi(2) = 15.1, p < 0.01). CT individual abnormalities were not associated with GOS/GOSE improvement, with the exception of subarachnoid haemorrhage, which showed a negative association with GOSE improvement (chi(2) = 4.08, p < 0.05). TCDB CT scan classification and subarachnoid haemorrhage were associated with GOS/GOSE improvement from 6-12 months, but individual CT abnormalities were not associated.

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.

PubMed

Qureshi, Adnan I; Palesch, Yuko Y; Barsan, William G; Hanley, Daniel F; Hsu, Chung Y; Martin, Renee L; Moy, Claudia S; Silbergleit, Robert; Steiner, Thorsten; Suarez, Jose I; Toyoda, Kazunori; Wang, Yongjun; Yamamoto, Haruko; Yoon, Byung-Woo

2016-09-15

Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments. Among 1000 participants with a mean (±SD) systolic blood pressure of 200.6±27.0 mm Hg at baseline, 500 were assigned to intensive treatment and 500 to standard treatment. The mean age of the patients was 61.9 years, and 56.2% were Asian. Enrollment was stopped because of futility after a prespecified interim analysis. The primary outcome of death or disability was observed in 38.7% of the participants (186 of 481) in the intensive-treatment group and in 37.7% (181 of 480) in the standard-treatment group (relative risk, 1.04; 95% confidence interval, 0.85 to 1.27; analysis was adjusted for age, initial GCS score, and presence or absence of intraventricular hemorrhage). Serious adverse events occurring within 72 hours after randomization that were considered by the site investigator to be related to treatment were reported in 1.6% of the patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group. The rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group than in the standard-treatment group (9.0% vs. 4.0%, P=0.002). The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. (Funded by the National Institute of Neurological Disorders and Stroke and the National Cerebral and Cardiovascular Center; ATACH-2 ClinicalTrials.gov number, NCT01176565 .).

The United States Army Medical Department Journal. July-September 2010

DTIC Science & Technology

2010-09-01

or Flail chest Respiratory rate < 10 or > 29 with distress, or Bilateral femur fractures GCS motor score  5 Unstable pelvis or suspected...significant pelvic fracture Paralysis or evidence of spinal cord injury Amputation above the wrist or ankle Significant burns Unreactive or...emphasis is on the individual who is failing to show signs of improvement in the immediate postinjury phase. Suspected skull fracture , especially with

Delayed Traumatic Intracranial Haemorrhage and Progressive Traumatic Brain Injury in a Major Referral Centre Based in a Developing Country

PubMed Central

Jeng, Toh Charng; Haspani, Mohd Saffari Mohd; Adnan, Johari Siregar; Naing, Nyi Nyi

2008-01-01

A repeat Computer Tomographic (CT) brain after 24–48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS). Most of the time the prognosis of any intervention may be too late especially in hospitals with high patient-to-doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred, as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain was studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorised into patient factors, CT brain findings and laboratory investigations. The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, 81.5% were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, 9.9% of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p<0.001), platelet count (p=0.011) and time interval between trauma and first CT brain (p=0.022). In the PTBI group, 42.0% of the patients were found to have new changes (new clot occurrence, old clot expansion and oedema) in the repeat CT brain. Univariate statistical analysis revealed that age (p=0.03), race (p=0.035), types of admission (p=0.024), GCS status (p=0.02), pupillary changes (p=0.014), number of intracranial lesion (p=0.004), haemoglobin level (p=0.038), prothrombin time (p=0.016) as the best predictors of early detection of changes. Multiple logistics regression analysis indicated that age, severity, GCS status (motor component) and GCS during admission were significantly associated with second CT scan with changes. This study showed that 9.9% of the total patients seen in the period of study had DTICH and 42% had PTBI. In the early period after traumatic head injury, the initial CT brain did not reveal the full extent of haemorrhagic injury and associated cerebral oedema. Different referral hospitals of different trauma level, GCS status, motor component of the GCS, haemoglobin level, platelet count and time interval between trauma and the first CT brain were the significant predictors for DTICH. Whereas the key determinants of PTBI were age, race, types of admission, GCS status, pupillary changes, number of intracranial bleed, haemoglobin level, prothrombin time and of course time interval between trauma and first CT brain. Any patients who had traumatic head injury in hospitals with no protocol of repeat CT scan or intracranial pressure monitoring especially in developing countries are advised to have to repeat CT brain at the appropriate quickest time . PMID:22589639

High-velocity gunshot wounds to the head: analysis of 135 patients.

PubMed

Bakir, Abdurrahman; Temiz, Cüneyt; Umur, Sukru; Aydin, Varol; Torun, Fuat

2005-06-01

Head injuries due to high-velocity missiles and shrapnel as a result of military conflicts have become a very important cause of death or severe neurological deficits. Military-type missiles have high velocities and transfer higher amounts of energy to neural tissue, compared to civil-type missiles. This physical phenomenon also causes greater neural tissue destruction. Shrapnel particles derive from blasts and cause less severe injury because of the irregular particle shape and low energy transmission. This study analyzed 135 patients with head trauma, 80 patients (59%) injured by missiles and 55 patients (41%) by shrapnel. Glasgow Coma Scale (GCS) scores at admission were 3 to 7 in 69 patients, 8 to 10 in 29 patients, and 11 to 15 in 37 patients. The most common anatomical localizations were the right frontoparietal region in 42 patients and the left frontoparietal region in 40 patients. One hundred patients (74%) were operated on immediately and 35 patients (26%) were treated conservatively in the intensive care unit. Ten of the 135 patients died (7.4%), seven from missile injury and three from shrapnel injury. In this study, we found that high mortality was associated with low GCS score at admission, presence of multilobar or skull base injuries, and involvement of ventricles. Early and aggressive surgical intervention decreased the mortality.

Predictors of carbon monoxide poisoning-induced delayed neuropsychological sequelae.

PubMed

Ku, Hsiao-Lun; Yang, Kai-Chun; Lee, Ying-Chiao; Lee, Ming-Been; Chou, Yuan-Hwa

2010-01-01

Carbon monoxide poisoning (COP) commonly results in delayed neuropsychological sequelae (DNS). The aim of the article is to demonstrate the clinical characteristics and potential predictors of COP-induced DNS later. Retrospective medical record review was performed for patients who had COP in the past year at a National Medical Center in Taiwan. Sixty patients with COP were registered during a one-year period. Fifty-six of them (93.3%) were COP because of suicide attempt. Patients with COP who have a complete medical record of carboxyhemoglobin (COHb) and Glasgow Coma Scale (GCS) and Mini-Mental Status Examination (MMSE) scores were recruited. Multiple regression analysis was performed to search for the predictive factors of DNS. Forty-three patients were recruited. Most had attempted suicide (93.0%) using CO, and thirteen developed DNS later. A longer duration of admission, more sessions of hyperbaric oxygen therapy, and positive findings in brain computed tomography (CT) scans were more often found in patients with DNS than those without DNS. The GCS and MMSE scores and positive findings in brain CT scans were associated with the development of DNS but COHb was not. Our results identified several potential predictors of DNS. This finding may help clinicians understand and treat COP patients efficiently. Copyright 2010 Elsevier Inc. All rights reserved.

A French validation study of the Coma Recovery Scale-Revised (CRS-R).

PubMed

Schnakers, Caroline; Majerus, Steve; Giacino, Joseph; Vanhaudenhuyse, Audrey; Bruno, Marie-Aurelie; Boly, Melanie; Moonen, Gustave; Damas, Pierre; Lambermont, Bernard; Lamy, Maurice; Damas, Francois; Ventura, Manfredi; Laureys, Steven

2008-09-01

The aim of the present study was to explore the concurrent validity, inter-rater agreement and diagnostic sensitivity of a French adaptation of the Coma Recovery Scale-Revised (CRS-R) as compared to other coma scales such as the Glasgow Coma Scale (GCS), the Full Outline of UnResponsiveness scale (FOUR) and the Wessex Head Injury Matrix (WHIM). Multi-centric prospective study. To test concurrent validity and diagnostic sensitivity, the four behavioural scales were administered in a randomized order in 77 vegetative and minimally conscious patients. Twenty-four clinicians with different professional backgrounds, levels of expertise and CRS-R experience were recruited to assess inter-rater agreement. Good concurrent validity was obtained between the CRS-R and the three other standardized behavioural scales. Inter-rater reliability for the CRS-R total score and sub-scores was good, indicating that the scale yields reproducible findings across examiners and does not appear to be systematically biased by profession, level of expertise or CRS-R experience. Finally, the CRS-R demonstrated a significantly higher sensitivity to detect MCS patients, as compared to the GCS, the FOUR and the WHIM. The results show that the French version of the CRS-R is a valid and sensitive scale which can be used in severely brain damaged patients by all members of the medical staff.

A disynaptic feedback network activated by experience promotes the integration of new granule cells.

PubMed

Alvarez, Diego D; Giacomini, Damiana; Yang, Sung Min; Trinchero, Mariela F; Temprana, Silvio G; Büttner, Karina A; Beltramone, Natalia; Schinder, Alejandro F

2016-10-28

Experience shapes the development and connectivity of adult-born granule cells (GCs) through mechanisms that are poorly understood. We examined the remodeling of dentate gyrus microcircuits in mice in an enriched environment (EE). Short exposure to EE during early development of new GCs accelerated their functional integration. This effect was mimicked by in vivo chemogenetic activation of a limited population of mature GCs. Slice recordings showed that mature GCs recruit parvalbumin γ-aminobutyric acid-releasing interneurons (PV-INs) that feed back onto developing GCs. Accordingly, chemogenetic stimulation of PV-INs or direct depolarization of developing GCs accelerated GC integration, whereas inactivation of PV-INs prevented the effects of EE. Our results reveal a mechanism for dynamic remodeling in which experience activates dentate networks that "prime" young GCs through a disynaptic feedback loop mediated by PV-INs. Copyright © 2016, American Association for the Advancement of Science.

Evolutionary history of the HAP2/GCS1 gene and sexual reproduction in metazoans.

PubMed

Steele, Robert E; Dana, Catherine E

2009-11-03

The HAP2/GCS1 gene first appeared in the common ancestor of plants, animals, and protists, and is required in the male gamete for fusion to the female gamete in the unicellular organisms Chlamydomonas and Plasmodium. We have identified a HAP2/GCS1 gene in the genome sequence of the sponge Amphimedon queenslandica. This finding provides a continuous evolutionary history of HAP2/GCS1 from unicellular organisms into the metazoan lineage. Divergent versions of the HAP2/GCS1 gene are also present in the genomes of some but not all arthropods. By examining the expression of the HAP2/GCS1 gene in the cnidarian Hydra, we have found the first evidence supporting the hypothesis that HAP2/GCS1 was used for male gamete fusion in the ancestor of extant metazoans and that it retains that function in modern cnidarians.

MOCCA-SURVEY Database I: Galactic Globular Clusters Harbouring a Black Hole Subsystem

NASA Astrophysics Data System (ADS)

Askar, Abbas; Sedda, Manuel Arca; Giersz, Mirek

2018-05-01

There have been increasing theoretical speculations and observational indications that certain globular clusters (GCs) could contain a sizeable population of stellar mass black holes (BHs). In this paper, we shortlist at least 29 Galactic GCs that could be hosting a subsystem of BHs (BHS). In a companion paper, we analysed results from a wide array of GC models (simulated with the MOCCA code for cluster simulations) that retained few tens to several hundreds of BHs at 12 Gyr and showed that the properties of the BHS in those GCs correlate with the GC's observable properties. Building on those results, we use available observational properties of 140 Galactic GCs to identify 29 GCs that could potentially be harbouring up to a few hundreds of BHs. Utilizing observational properties and theoretical scaling relations, we estimate the density, size and mass of the BHS in these GCs. We also calculate the total number of BHs and the fraction of BHs contained in a binary system for our shortlisted Galactic GCs. Additionally, we mention other Galactic GCs that could also contain significant number of single BHs or BHs in binary systems.

THE EFFECT OF SECOND-GENERATION POPULATIONS ON THE INTEGRATED COLORS OF METAL-RICH GLOBULAR CLUSTERS IN EARLY-TYPE GALAXIES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, Chul; Lee, Sang-Yoon; Yoon, Suk-Jin

2013-05-20

The mean color of globular clusters (GCs) in early-type galaxies is in general bluer than the integrated color of halo field stars in host galaxies. Metal-rich GCs often appear more associated with field stars than metal-poor GCs, yet show bluer colors than their host galaxy light. Motivated by the discovery of multiple stellar populations in Milky Way GCs, we present a new scenario in which the presence of second-generation (SG) stars in GCs is responsible for the color discrepancy between metal-rich GCs and field stars. The model assumes that the SG populations have an enhanced helium abundance as evidenced bymore » observations, and it gives a good explanation of the bluer optical colors of metal-rich GCs than field stars as well as strong Balmer lines and blue UV colors of metal-rich GCs. Ours may be complementary to the recent scenario suggesting the difference in stellar mass functions (MFs) as an origin for the GC-to-star color offset. A quantitative comparison is given between the SG and MF models.« less

Prehospital injury severity of children evacuated by helicopters from combat zones: a retrospective report.

PubMed

Samuel, Nir; Hirschhorn, Gil; Chen, Jacob; Steiner, Ivan P; Shavit, Itai

2013-03-01

In Israel, the Airborne Rescue and Evacuation Unit (AREU) provides prehospital trauma care in times of peace and during times of armed conflict. In peacetime, the AREU transports children who were involved in motor vehicle collisions (MVC) and those who fall off cliffs (FOC). During armed conflict, the AREU evacuates children who sustain firearm injuries (FI) from the fighting zones. To report on prehospital injury severity of children who were evacuated by the AREU from combat zones. A retrospective comparative analysis was conducted on indicators of prehospital injury severity for patients who had MVC, FOC, and FI. It included the National Advisory Committee for Aeronautics (NACA) score, the Glasgow Coma Scale (GCS) score on scene, and the number of procedures performed by emergency medical personnel and by the AREU air-crew. From January 2003 to December 2009, 36 MVC, 25 FOC, and 17 FI children were transported from the scene by the AREU. Five patients were dead at the scene: 1 (2.8%) MVC, 1 (4%) FOC, and 3 (17.6%) FI. Two (11.7%) FI patients were dead on arrival at the hospital. MVC, FOC, and FI patients had mean (±SD) NACA scores of 4.4 ± 1.2, 3.6 ± 1.2, and 5 ± 0.7, respectively. Mean (±SD) GCS scores were 8.9 ± 5.6, 13.6 ± 4, and 6.9 ± 5.3, respectively. Life support interventions were required by 29 (80.6%) MVC, 3 (12%) FOC, and 15 (88.2%) FI patients. In the prehospital setting, children evacuated from combat zones were more severely injured than children who were transported from the scene during peacetime. Copyright © 2013 Elsevier Inc. All rights reserved.

Steroid profiling reveals widespread local regulation of glucocorticoid levels during mouse development.

PubMed

Taves, Matthew D; Plumb, Adam W; Sandkam, Benjamin A; Ma, Chunqi; Van Der Gugten, Jessica Grace; Holmes, Daniel T; Close, David A; Abraham, Ninan; Soma, Kiran K

2015-02-01

Glucocorticoids (GCs) are produced by the adrenal glands and circulate in the blood to coordinate organismal physiology. In addition, different tissues may independently regulate their local GC levels via local GC synthesis. Here, we find that in the mouse, endogenous GCs show tissue-specific developmental patterns, rather than mirroring GCs in the blood. Using solid-phase extraction, HPLC, and specific immunoassays, we quantified endogenous steroids and found that in tissues of female and male mice, (1) local GC levels can be much higher than systemic GC levels, (2) local GCs follow age-related patterns different from those of systemic GCs, and (3) local GCs have identities different from those of systemic GCs. For example, whereas corticosterone is the predominant circulating adrenal GC in mice, high concentrations of cortisol were measured in neonatal thymus, bone marrow, and heart. The presence of cortisol was confirmed with liquid chromatography-tandem mass spectrometry. In addition, gene expression of steroidogenic enzymes was detected across multiple tissues, consistent with local GC production. Our results demonstrate that local GCs can differ from GCs in circulating blood. This finding suggests that steroids are widely used as local (paracrine or autocrine) signals, in addition to their classic role as systemic (endocrine) signals. Local GC regulation may even be the norm, rather than the exception, especially during development.

THE AGES, METALLICITIES, AND ALPHA ELEMENT ENHANCEMENTS OF GLOBULAR CLUSTERS IN THE ELLIPTICAL NGC 5128: A HOMOGENEOUS SPECTROSCOPIC STUDY WITH GEMINI/GEMINI MULTI-OBJECT SPECTROGRAPH

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woodley, Kristin A.; Harris, William E.; Puzia, Thomas H.

2010-01-10

We present new integrated light spectroscopy of globular clusters (GCs) in NGC 5128, a nearby giant elliptical galaxy less than 4 Mpc away, in order to measure radial velocities and derive ages, metallicities, and alpha-element abundance ratios. Using the Gemini South 8 meter telescope with the instrument Gemini Multi-Object Spectrograph, we obtained spectroscopy in the range of approx3400-5700 A for 72 GCs with a signal-to-noise ratio greater than 30 A{sup -1}; and we have also discovered 35 new GCs within NGC 5128 from our radial velocity measurements. We measured and compared the Lick indices from Hdelta{sub A} through Fe5406 withmore » the single stellar population models of Thomas et al. in order to derive age, metallicity, and [alpha/Fe] values. We also measure Lick indices for 41 Milky Way GCs from Puzia et al. and Schiavon et al. with the same methodology for direct comparison. Our results show that 68% of the NGC 5128 GCs have old ages (>8 Gyr), 14% have intermediate ages (5-8 Gyr), and 18% have young ages (<5 Gyr). However, when we look at the metallicity of the GCs as a function of age, we find 92% of metal-poor GCs and 56% of metal-rich GCs in NGC 5128 have ages >8 Gyr, indicating that the majority of both metallicity subpopulations of GCs formed earlier, with a significant population of young and metal-rich GCs forming later. Our metallicity distribution function generated directly from spectroscopic Lick indices is clearly bimodal, as is the color distribution of the same set of GCs. Thus, the metallicity bimodality is real and not an artifact of the color to metallicity conversion. However, the metallicity distribution function obtained from comparison with the single stellar population models is consistent with a unimodal, bimodal, or multimodal shape. The [alpha/Fe] values are supersolar with a mean value of 0.14 +- 0.04, indicating a fast formation timescale. However, the GCs in NGC 5128 are not as [alpha/Fe] enhanced as the Milky Way GCs also examined in this study. Our measured indices also indicate that the GCs in NGC 5128 may have a slight overabundance in nitrogen and a wider range of calcium strength compared to the Milky Way GCs. Our results support a rapid, early formation of the GC system in NGC 5128, with subsequent major accretion and/or GC and star-forming events in more recent times.« less

VEGAS-SSS. II. Comparing the globular cluster systems in NGC 3115 and NGC 1399 using VEGAS and FDS survey data. The quest for a common genetic heritage of globular cluster systems

NASA Astrophysics Data System (ADS)

Cantiello, Michele; D'Abrusco, Raffaele; Spavone, Marilena; Paolillo, Maurizio; Capaccioli, Massimo; Limatola, Luca; Grado, Aniello; Iodice, Enrica; Raimondo, Gabriella; Napolitano, Nicola; Blakeslee, John P.; Brocato, Enzo; Forbes, Duncan A.; Hilker, Michael; Mieske, Steffen; Peletier, Reynier; van de Ven, Glenn; Schipani, Pietro

2018-04-01

We analyze the globular cluster (GC) systems in two very different galaxies, NGC 3115 and NGC 1399. With the papers of this series, we aim at highlighting common and different properties in the GC systems in galaxies covering a wide range of parameter space. We compare the GCs in NGC 3115 and NGC 1399 as derived from the analysis of one square degree u-, g-, and i-band images taken with the VST telescope as part of the VST early-type galaxy survey (VEGAS) and Fornax deep survey (FDS). We selected GC candidates using as reference the morpho-photometric and color properties of confirmed GCs. The surface density maps of GCs in NGC 3115 reveal a morphology similar to the light profile of field stars; the same is true when blue and red GCs are taken separately. The GC maps for NGC 1399 are richer in structure and confirm the existence of an intra-cluster GC component. We confirm the presence of a spatial offset in the NGC 1399 GC centroid and find that the centroid of the GCs for NGC 3115 coincides well with the galaxy center. Both GC systems show unambiguous color bimodality in (g - i) and (u - i); the color-color relations of the two GC systems are slightly different with NGC 3115 appearing more linear than NGC 1399. The azimuthal average of the radial density profiles in both galaxies reveals a larger spatial extent for the total GCs population with respect to the galaxy surface brightness profile. For both galaxies, the red GCs have radial density profiles compatible with the galaxy light profile, while the radial profiles for blue GCs are shallower. As for the specific frequency of GCs, SN, we find it is a factor of two higher in NGC 1399 than for NGC 3115; this is mainly the result of extra blue GCs. By inspecting the radial behavior of the specific frequency, SN(

Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience

PubMed Central

Christopher, Nim A.; De Luca, Francesco; Spilotros, Marco; Ralph, David J.

2014-01-01

Background and purpose What factors influence transgender men’s decisions to undergo (and to not undergo) specific genital gender confirming surgeries (GCS) has not been described in the literature. Sexual function outcomes related to clitoral transposition and penile prosthesis placement is also not well described. Durability of neophallus dimensions after phalloplasty has not been described. A better understanding of these factors is necessary for pre-op counseling. We sought to assess patient genital-GCS related satisfaction, regret, pre/post-op sexual function, genital preferences, and genital measurements post-op. Materials and methods We evaluated ten female to male transgender patients who had previously undergone suprapubic pedicle-flap phalloplasty [suprapubic phalloplasty (SP); N=10] and 15 who had undergone radial artery forearm-flap phalloplasty [(RAP); N=15; 5/15 without and 10/15 with cutaneous nerve to clitoral nerve anastomosis] at our center (UK). We queried patients’ surgery related preferences and concerns, satisfaction, and sexual function pre/post-surgery, and accounted for whether patients had undergone clitoral transposition and/or cutaneous-to-clitoral nerve anastomosis. We measured flaccid and (where applicable) erect length and girth using a smart-phone app we designed. Results Mean age at surgery and follow-up for those that underwent SP was 35.1 and 2.23 years, and 34 and 6.8 for those that underwent RAP. Mean satisfaction scores were 9.1/10 and 9/10 for those that underwent SP and RAP, respectively. No patient (0%) regretted starting genital-GCS surgery. All (100%) patients that could achieve orgasm before GCS with clitoral transposition could achieve orgasm after surgery, and the vast majority reported preserved quality of erogenous sensation by our transposition technique. All (100%) RAP and 9/10 SP patients reported masturbation with their phallus. Inflatable penile prosthesis placement was not associated with decreased erogenous sensation/orgasm. Penile dimensions were relatively stable through follow-up for both groups. Our App length measurements correlated with a ruler within ±<4.5%. Conclusions Female-to-male genital-GCS offered in 3-stages was associated with high overall satisfaction and no regret among our sample. Sexual function appears to be preserved after both clitoral transposition and inflatable prosthesis placement, and consolidation of erogenous sensation to the phallus was described as important to all subjects. Discussion of patient’s pre-op sexual function, as well as specific concerns and preferences related to specific genital-GCS surgeries is important. PMID:26816764

Employing individual measures of baseline glucocorticoids as population-level conservation biomarkers: considering within-individual variation in a breeding passerine

PubMed Central

Madliger, Christine L; Love, Oliver P

2016-01-01

Abstract Labile physiological variables, such as stress hormones [i.e. glucocorticoids (GCs)], allow individuals to react to perturbations in their environment and may therefore reflect the effect of disturbances or positive conservation initiatives in advance of population-level demographic measures. Although the application of GCs as conservation biomarkers has been of extensive interest, few studies have explicitly investigated whether baseline GC concentrations respond to disturbances consistently across individuals. However, confirmation of consistent responses is of paramount importance to assessing the ease of use of GCs in natural systems and to making valid interpretations regarding population-level change (or lack of change) in GC concentrations. We investigated whether free-ranging female tree swallows (Tachycineta bicolor) display individually specific changes in baseline glucocorticoid concentrations naturally over the breeding season (from incubation to offspring provisioning) and in response to a manipulation of foraging profitability (representing a decrease in access to food resources). We show that baseline GC concentrations are repeatable within individuals over reproduction in natural conditions. However, in response to a reduction in foraging ability, baseline GC concentrations increase at the population level but are not repeatable within individuals, indicating a high level of within-individual variation. Overall, we suggest that baseline GCs measured on a subset of individuals may not provide a representative indication of responses to environmental change at the population level, and multiple within-individual measures may be necessary to determine the fitness correlates of GC concentrations. Further validation should be completed across a variety of taxa and life-history stages. Moving beyond a traditional cross-sectional approach by incorporating repeated-measures methods will be necessary to assess the suitability of baseline GCs as biomarkers of environmental change and population persistence, particularly from a logistical and ease-of-use perspective for conservation managers. PMID:27757239

The Effect of Whole Body Massage on the Process and Physiological Outcome of Trauma ICU Patients: A Double-Blind Randomized Clinical Trial

PubMed Central

Hatefi, Masoud; Jaafarpour, Molouk; Khajavikhan, Javaher; Kokhazade, Taleb

2015-01-01

Background and Aim Hospitalization of traumatic patients in the Intensive Care Unit (ICU) and their critical condition can cause haemodynamic instabilities and deterioration in the level of consciousness. The study aimed to investigate the effect of whole body massage on the vital signs, Glasgow Coma Scale (GCS) scores and arterial blood gases (ABG) in trauma ICU patients. Materials and Methods In a randomized, double-blind trial, 108 trauma ICU patients received whole body massage {experimental group (n=54)}, or routine care {control group (n=54)}. The patients vital signs; systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR), Temperature (T), GCS score and ABG parameters were measured by a nurse at the same time in both groups before the intervention and 1 hour and 3 hours after the intervention with a checklist. The patient in experimental group received full body massage in 45 minute by a family member. Results According to the findings, significant differences were observed between experimental and control groups in SBP 1 hour and 3 hours after intervention (p< 0.001), DBP, RR and PR 1 hour after intervention (p<0.001) and GCS 1 hour and 3 hours after intervention (p<0.05). Of ABG parameters, significant differences were observed between experimental and control groups in O2 saturation (p<0.001), PH (p<0.001) and pO2 (p<0.05). No significant differences between experimental and control groups in Temperature, pCO2 and HCO3 (p>0.05). Conclusion With respect to this study, massage therapy is a safe and effective treatment in intensive care units to reduce patient’s physical and psychological problems. Therefore the use of massage therapy is recommended to clinical practice as a routine method. PMID:26266191

Penetrating injuries to the duodenum: An analysis of 879 patients from the National Trauma Data Bank, 2010 to 2014.

PubMed

Phillips, Bradley; Turco, Lauren; McDonald, Dan; Mause, Alison; Walters, Ryan W

2017-11-01

Despite wide belief that the duodenal Organ Injury Scale has been validated, this has not been reported in the published literature. Based on clinical experience, we hypothesize that the American Association for Surgery of Trauma Organ Injury Scale (AAST-OIS) for duodenal injuries can independently predict mortality. Our objectives were threefold: (1) describe the national profile of penetrating duodenal injuries, (2) identify predictors of morbidity and mortality, and (3) validate the duodenum AAST-OIS as a statistically significant predictor of mortality. Using the Abbreviated Injury Scale 2005 and International Classification of Diseases-9th Rev.-Clinical Modification (ICD-9-CM) E-codes, we identified 879 penetrating duodenal trauma patients from the National Trauma Data Bank between 2010 and 2014. We controlled patient-level covariates of age, biological sex, systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, pulse, Injury Severity Score (ISS), and Organ Injury Scale (OIS) grade. We estimated multivariable generalized linear mixed models to account for the nesting of patients within trauma centers. Our results indicated an overall mortality rate of 14.4%. Approximately 10% of patients died within 24 hours of admission, of whom 76% died in the first 6 hours. Patients averaged approximately five associated injuries, 45% of which involved the liver and colon. Statistically significant independent predictors of mortality were firearm mechanism, SBP, GCS, pulse, ISS, and AAST-OIS grade. Specifically, odds of death were decreased with 10 mm Hg higher admission SBP (13% decreased odds), one point higher GCS (14.4%), 10-beat lower pulse (8.2%), and 10-point lower ISS (51.0%). This study is the first to report the national profile of penetrating duodenal injuries. Using the National Trauma Data Bank, we identified patterns of injury, predictors of outcome, and validated the AAST-OIS for duodenal injuries as a statistically significant predictor of morbidity and mortality. Epidemiologic/Prognostic, level IV.

Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan?

PubMed

Griffen, Margaret M; Frykberg, Eric R; Kerwin, Andrew J; Schinco, Miren A; Tepas, Joseph J; Rowe, Kathleen; Abboud, Jennifer

2003-08-01

The purpose of this study was to evaluate the roles of cervical spine radiographs (CSR) and computed tomography of the cervical spine (CTC) in the exclusion of cervical spine injury for adult blunt trauma patients. At the authors' institution, all adult blunt trauma patients with physical findings of posterior midline neck tenderness, altered mental status, or neurologic deficit are considered at risk of cervical spine injury and undergo both CSR and CTC for evaluation of the cervical spine. The TRACS database at level 1 of the trauma center at this institution was queried for all blunt trauma patients from November 2000 to October 2001. Patient injury severity score (ISS), Glascow Coma Score (GCS), age, gender, CSR results, CTC results, and treatment data were analyzed. The review included 3,018 blunt trauma patients with appropriate data. For 1,199 of these patients (779 men and 420 women) (40%) at risk for cervical spine injury, both CSR and CTC were performed for cervical spine evaluation. The average age of these patients was 39.4 years (range, 18-89 years). The average GCS was 13 and the average ISS was 8.4 in this study population. In 116 (9.5%) of these patients, a cervical spine injury (fracture or subluxation) was detected. The injury was identified on both CSR and CTC in 75 of these patients. In the remaining 41 patients (3.2%), the CSR results were negative, but injury was detected by CTC. All these injuries missed by CSR required treatment. For this group with false-negative CSR, the average GCS was 12 and the average ISS was 14.6. There were no missed cervical spine injuries among the patients with negative CTC results. No identifiable factors predicted false-negative CSR. There does not appear to be any role for CSR screening in this setting. The data from this study add to the growing body of evidence that CTC should replace CSR for the evaluation of the cervical spine in blunt trauma.

A Comparison of Functional Outcome in Patients Sustaining Major Trauma: A Multicentre, Prospective, International Study

PubMed Central

Rainer, Timothy H.; Yeung, Hiu Hung; Gabbe, Belinda J.; Yuen, Kai Y.; Ho, Hiu F.; Kam, Chak W.; Chang, Annice; Poon, Wai S.; Cameron, Peter A.; Graham, Colin A.

2014-01-01

Objectives To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. Summary Background Data Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR). Methods Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury. Results 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: −1.2, 3.6) and 12-months (adjusted mean difference: −0.4, 95% CI: −3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: −2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: −0.8, 4.5). Conclusion The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions. PMID:25157522

H-FABP: A new biomarker to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury

PubMed Central

Lagerstedt, Linnéa; Egea-Guerrero, Juan José; Bustamante, Alejandro; Montaner, Joan; Rodríguez-Rodríguez, Ana; El Rahal, Amir; Turck, Natacha; Quintana, Manuel; García-Armengol, Roser; Prica, Carmen Melinda; Andereggen, Elisabeth; Rinaldi, Lara; Sarrafzadeh, Asita; Schaller, Karl; Sanchez, Jean-Charles

2017-01-01

The majority of patients with mild traumatic brain injury (mTBI) will have normal Glasgow coma scale (GCS) of 15. Furthermore, only 5%–8% of them will be CT-positive for an mTBI. Having a useful biomarker would help clinicians evaluate a patient’s risk of developing intracranial lesions. The S100B protein is currently the most studied and promising biomarker for this purpose. Heart fatty-acid binding protein (H-FABP) has been highlighted in brain injury models and investigated as a biomarker for stroke and severe TBI, for example. Here, we evaluate the performances of S100B and H-FABP for differentiating between CT-positive and CT-negative patients. A total of 261 patients with a GCS score of 15 and at least one clinical symptom of mTBI were recruited at three different European sites. Blood samples from 172 of them were collected ≤ 6 h after trauma. Patients underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. H-FABP and S100B levels were measured using commercial kits, and their capacities to detect all CT-positive scans were evaluated, with sensitivity set to 100%. For patients recruited ≤ 6 h after trauma, the CT-positive group demonstrated significantly higher levels of both H-FABP (p = 0.004) and S100B (p = 0.003) than the CT-negative group. At 100% sensitivity, specificity reached 6% (95% CI 2.8–10.7) for S100B and 29% (95% CI 21.4–37.1) for H-FABP. Similar results were obtained when including all the patients recruited, i.e. hospital arrival within 24 h of trauma onset. H-FABP out-performed S100B and thus seems to be an interesting protein for detecting all CT-positive mTBI patients with a GCS score of 15 and at least one clinical symptom. PMID:28419114

H-FABP: A new biomarker to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury.

PubMed

Lagerstedt, Linnéa; Egea-Guerrero, Juan José; Bustamante, Alejandro; Montaner, Joan; Rodríguez-Rodríguez, Ana; El Rahal, Amir; Turck, Natacha; Quintana, Manuel; García-Armengol, Roser; Prica, Carmen Melinda; Andereggen, Elisabeth; Rinaldi, Lara; Sarrafzadeh, Asita; Schaller, Karl; Sanchez, Jean-Charles

2017-01-01

The majority of patients with mild traumatic brain injury (mTBI) will have normal Glasgow coma scale (GCS) of 15. Furthermore, only 5%-8% of them will be CT-positive for an mTBI. Having a useful biomarker would help clinicians evaluate a patient's risk of developing intracranial lesions. The S100B protein is currently the most studied and promising biomarker for this purpose. Heart fatty-acid binding protein (H-FABP) has been highlighted in brain injury models and investigated as a biomarker for stroke and severe TBI, for example. Here, we evaluate the performances of S100B and H-FABP for differentiating between CT-positive and CT-negative patients. A total of 261 patients with a GCS score of 15 and at least one clinical symptom of mTBI were recruited at three different European sites. Blood samples from 172 of them were collected ≤ 6 h after trauma. Patients underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. H-FABP and S100B levels were measured using commercial kits, and their capacities to detect all CT-positive scans were evaluated, with sensitivity set to 100%. For patients recruited ≤ 6 h after trauma, the CT-positive group demonstrated significantly higher levels of both H-FABP (p = 0.004) and S100B (p = 0.003) than the CT-negative group. At 100% sensitivity, specificity reached 6% (95% CI 2.8-10.7) for S100B and 29% (95% CI 21.4-37.1) for H-FABP. Similar results were obtained when including all the patients recruited, i.e. hospital arrival within 24 h of trauma onset. H-FABP out-performed S100B and thus seems to be an interesting protein for detecting all CT-positive mTBI patients with a GCS score of 15 and at least one clinical symptom.

Evidence of differential tidal effects in the old globular cluster population of the Large Magellanic Cloud

NASA Astrophysics Data System (ADS)

Piatti, A. E.; Mackey, A. D.

2018-04-01

We present for the first time extended stellar density and/or surface brightness radial profiles for almost all the known Large Magellanic Cloud (LMC) old globular clusters (GCs). These were built from DECam images and reach out to ˜ 4 times the GCs' tidal radii. The background subtracted radial profiles reveal that the GCs located closer than ˜ 5 kpc from the LMC centre contain an excess of stars in their outermost regions with respect to the stellar density expected from a King profile. Such a residual amount of stars - not seen in GCs located farther than ˜ 5 kpc from the LMC centre-, as well as the GCs' dimensions, show a clear dependence with the GCs' positions in the galaxy, in the sense that, the farther the GC from the centre of the LMC, the larger both the excess of stars in its outskirts and size. Although the masses of GCs located inside and outside ˜ 5 kpc are commensurate, the outermost regions of GCs located closer than ˜ 5 kpc from the LMC centre appear to have dynamically evolved more quickly. These outcomes can be fully interpreted in the light of the known GC radial velocity disc-like kinematics, from which GCs have been somehow mostly experiencing the influence of the LMC gravitational field at their respective mean distances from the LMC centre.

Apatite glass-ceramics: a review

NASA Astrophysics Data System (ADS)

Duminis, Tomas; Shahid, Saroash; Hill, Robert Graham

2016-12-01

This article is a review of the published literature on apatite glass-ceramics (GCs). Topics covered include crystallization mechanisms of the various families of the apatite GCs and an update on research and development on apatite GCs for applications in orthopedics, dentistry, optoelectronics and nuclear waste management. Most apatite GCs crystallize through a homogenous nucleation and crystallization mechanism, which is aided by a prior liquid-liquid phase separation. Careful control of the base glass composition and heat-treatment conditions, which determine the nature and morphology of the crystal phases in the GC can produce GC materials with exceptional thermal, mechanical, optical and biological properties. The GCs reviewed for orthopedic applications exhibit suitable mechanical properties and can chemically bond to bone and stimulate its regeneration. The most commercially successful apatite GCs are those developed for dental veneering. These materials exhibit excellent translucency and clinical esthetics, and mimic the natural tooth mineral. Due to the ease of solid solution of the apatite lattice, rare earth doped apatite GCs are discussed for potential applications in optoelectronics and nuclear waste management. One of the drawbacks of the commercial apatite GCs used in orthopedics is the lack of resorbability, therefore the review provides a direction for future research in the field.

Development of an Intelligent Monitoring System for Geological Carbon Sequestration (GCS) Systems

NASA Astrophysics Data System (ADS)

Sun, A. Y.; Jeong, H.; Xu, W.; Hovorka, S. D.; Zhu, T.; Templeton, T.; Arctur, D. K.

2016-12-01

To provide stakeholders timely evidence that GCS repositories are operating safely and efficiently requires integrated monitoring to assess the performance of the storage reservoir as the CO2 plume moves within it. As a result, GCS projects can be data intensive, as a result of proliferation of digital instrumentation and smart-sensing technologies. GCS projects are also resource intensive, often requiring multidisciplinary teams performing different monitoring, verification, and accounting (MVA) tasks throughout the lifecycle of a project to ensure secure containment of injected CO2. How to correlate anomaly detected by a certain sensor to events observed by other devices to verify leakage incidents? How to optimally allocate resources for task-oriented monitoring if reservoir integrity is in question? These are issues that warrant further investigation before real integration can take place. In this work, we are building a web-based, data integration, assimilation, and learning framework for geologic carbon sequestration projects (DIAL-GCS). DIAL-GCS will be an intelligent monitoring system (IMS) for automating GCS closed-loop management by leveraging recent developments in high-throughput database, complex event processing, data assimilation, and machine learning technologies. Results will be demonstrated using realistic data and model derived from a GCS site.

NEW CONSTRAINTS ON A COMPLEX RELATION BETWEEN GLOBULAR CLUSTER COLORS AND ENVIRONMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Powalka, Mathieu; Lançon, Ariane; Puzia, Thomas H.

We present an analysis of high-quality photometry for globular clusters (GCs) in the Virgo cluster core region, based on data from the Next Generation Virgo Cluster Survey (NGVS) pilot field, and in the Milky Way (MW), based on Very Large Telescope/X-Shooter spectrophotometry. We find significant discrepancies in color–color diagrams between sub-samples from different environments, confirming that the environment has a strong influence on the integrated colors of GCs. GC color distributions along a single color are not sufficient to capture the differences we observe in color–color space. While the average photometric colors become bluer with increasing radial distance to themore » cD galaxy M87, we also find a relation between the environment and the slope and intercept of the color–color relations. A denser environment seems to produce a larger dynamic range in certain color indices. We argue that these results are not due solely to differential extinction, Initial Mass Function variations, calibration uncertainties, or overall age/metallicity variations. We therefore suggest that the relation between the environment and GC colors is, at least in part, due to chemical abundance variations, which affect stellar spectra and stellar evolution tracks. Our results demonstrate that stellar population diagnostics derived from model predictions which are calibrated on one particular sample of GCs may not be appropriate for all extragalactic GCs. These results advocate a more complex model of the assembly history of GC systems in massive galaxies that goes beyond the simple bimodality found in previous decades.« less

The origin of discrete multiple stellar populations in globular clusters

NASA Astrophysics Data System (ADS)

Bekki, K.; Jeřábková, T.; Kroupa, P.

2017-10-01

Recent observations have revealed that at least several old globular clusters (GCs) in the Galaxy have discrete distributions of stars along the Mg-Al anticorrelation. In order to discuss this recent observation, we construct a new one-zone GC formation model in which the maximum stellar mass (mmax) in the initial mass function of stars in a forming GC depends on the star formation rate, as deduced from independent observations. We investigate the star formation histories of forming GCs. The principal results are as follows. About 30 Myr after the formation of the first generation (1G) of stars within a particular GC, new stars can be formed from ejecta from asymptotic giant branch (AGB) stars of 1G. However, the formation of this second generation (2G) of stars can last only for [10-20] Myr because the most massive SNe of 2G expel all of the remaining gas. The third generation (3G) of stars are then formed from AGB ejecta ≈30 Myr after the truncation of 2G star formation. This cycle of star formation followed by its truncation by SNe can continue until all AGB ejecta is removed from the GC by some physical process. Thus, it is inevitable that GCs have discrete multiple stellar populations in the [Mg/Fe]-[Al/Fe] diagram. Our model predicts that low-mass GCs are unlikely to have discrete multiple stellar populations, and young massive clusters may not have massive OB stars owing to low mmax (<[20-30] M⊙) during the secondary star formation.

Predictive Utility of the Total Glasgow Coma Scale Versus the Motor Component of the Glasgow Coma Scale for Identification of Patients With Serious Traumatic Injuries.

PubMed

Chou, Roger; Totten, Annette M; Carney, Nancy; Dandy, Spencer; Fu, Rongwei; Grusing, Sara; Pappas, Miranda; Wasson, Ngoc; Newgard, Craig D

2017-08-01

The motor component of the Glasgow Coma Scale (mGCS) has been proposed as an easier-to-use alternative to the total GCS (tGCS) for field assessment of trauma patients by emergency medical services. We perform a systematic review and meta-analysis to compare the predictive utility of the tGCS versus the mGCS or Simplified Motor Scale in field triage of trauma for identifying patients with adverse outcomes (inhospital mortality or severe brain injury) or who underwent procedures (neurosurgical intervention or emergency intubation) indicating need for high-level trauma care. Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Health and Psychosocial Instruments, and the Cochrane databases were searched through June 2016 for English-language cohort studies. We included studies that compared the area under the receiver operating characteristic curve (AUROC) of the tGCS versus the mGCS or Simplified Motor Scale assessed in the field or shortly after arrival in the emergency department for predicting the outcomes described above. Meta-analyses were performed with a random-effects model, and subgroup and sensitivity analyses were conducted. We included 18 head-to-head studies of predictive utility (n=1,703,388). For inhospital mortality, the tGCS was associated with slightly greater discrimination than the mGCS (pooled mean difference in [AUROC] 0.015; 95% confidence interval [CI] 0.009 to 0.022; I 2 =85%; 12 studies) or the Simplified Motor Scale (pooled mean difference in AUROC 0.030; 95% CI 0.024 to 0.036; I 2 =0%; 5 studies). The tGCS was also associated with greater discrimination than the mGCS or Simplified Motor Scale for nonmortality outcomes (differences in AUROC from 0.03 to 0.05). Findings were robust in subgroup and sensitivity analyses. The tGCS is associated with slightly greater discrimination than the mGCS or Simplified Motor Scale for identifying severe trauma. The small differences in discrimination are likely to be clinically unimportant and could be offset by factors such as convenience and ease of use. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Repeat neuroimaging of mild traumatic brain-injured patients with acute traumatic intracranial hemorrhage: clinical outcomes and radiographic features.

PubMed

Kreitzer, Natalie; Lyons, Michael S; Hart, Kim; Lindsell, Cristopher J; Chung, Sora; Yick, Andrew; Bonomo, Jordan

2014-10-01

Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown. This study characterized clinical outcomes in mild TBI patients with acute traumatic ICH seen on initial ED neuroimaging. This retrospective cohort study included patients presenting to the ED with blunt mild TBI with Glasgow Coma Scale (GCS) scores of 14 or 15 and stable vital signs, during the period from January 2001 to January 2010. Patients with any ICH on initial head CT and repeat head CT within 24 hours were eligible. Cases were excluded for initial GCS < 14, injury > 24 hours old, pregnancy, concomitant nonminor injuries, and coagulopathy. A single investigator abstracted data from records using a standardized case report form and data dictionary. Primary endpoints included death, neurosurgical procedures, and for discharged patients, return to the ED within 7 days. Differences in proportions were computed with 95% confidence intervals (CIs). Of 1,011 patients who presented to the ED and had two head CTs within 24 hours, 323 (32%) met inclusion criteria. The median time between CT scans was 6 hours (interquartile range = 5 to 7 hours). A total of 153 (47%) patients had subarachnoid hemorrhage, 132 (41%) patients had subdural hemorrhage, 11 (3%) patients had epidural hemorrhage, 78 (24%) patients had cerebral contusions, and 59 (18%) patients had intraparenchymal hemorrhage. Four of 323 (1.2%, 95% CI = 0.3% to 3.2%) patients died within 2 weeks of injury. Three of the patients who died had been admitted from the ED on their initial visits, and one had been discharged home. There were 206 patients (64%) discharged from the ED, 28 (13.6%) of whom returned to the ED within 1 week. Of the 92 who were hospitalized, three (0.9%, 95% CI = 0.2% to 2.7%) required neurosurgical intervention. Discharge after a repeat head CT and brief period of observation in the ED allowed early discharge of a cohort of mild TBI patients with traumatic ICH without delayed adverse outcomes. Whether this justifies the cost and radiation exposure involved with this pattern of practice requires further study. © 2014 by the Society for Academic Emergency Medicine.

Glucocorticoids Inhibit Basal and Hormone-Induced Serotonin Synthesis in Pancreatic Beta Cells

PubMed Central

Hasni Ebou, Moina; Singh-Estivalet, Amrit; Launay, Jean-Marie; Callebert, Jacques; Tronche, François; Ferré, Pascal; Gautier, Jean-François; Guillemain, Ghislaine; Bréant, Bernadette

2016-01-01

Diabetes is a major complication of chronic Glucocorticoids (GCs) treatment. GCs induce insulin resistance and also inhibit insulin secretion from pancreatic beta cells. Yet, a full understanding of this negative regulation remains to be deciphered. In the present study, we investigated whether GCs could inhibit serotonin synthesis in beta cell since this neurotransmitter has been shown to be involved in the regulation of insulin secretion. To this aim, serotonin synthesis was evaluated in vitro after treatment with GCs of either islets from CD1 mice or MIN6 cells, a beta-cell line. We also explored the effect of GCs on the stimulation of serotonin synthesis by several hormones such as prolactin and GLP 1. We finally studied this regulation in islet in two in vivo models: mice treated with GCs and with liraglutide, a GLP1 analog, and mice deleted for the glucocorticoid receptor in the pancreas. We showed in isolated islets and MIN6 cells that GCs decreased expression and activity of the two key enzymes of serotonin synthesis, Tryptophan Hydroxylase 1 (Tph1) and 2 (Tph2), leading to reduced serotonin contents. GCs also blocked the induction of serotonin synthesis by prolactin or by a previously unknown serotonin activator, the GLP-1 analog exendin-4. In vivo, activation of the Glucagon-like-Peptide-1 receptor with liraglutide during 4 weeks increased islet serotonin contents and GCs treatment prevented this increase. Finally, islets from mice deleted for the GR in the pancreas displayed an increased expression of Tph1 and Tph2 and a strong increased serotonin content per islet. In conclusion, our results demonstrate an original inhibition of serotonin synthesis by GCs, both in basal condition and after stimulation by prolactin or activators of the GLP-1 receptor. This regulation may contribute to the deleterious effects of GCs on beta cells. PMID:26901633

The Next Generation Virgo Cluster Survey. VI. The Kinematics of Ultra-compact Dwarfs and Globular Clusters in M87

NASA Astrophysics Data System (ADS)

Zhang, Hong-Xin; Peng, Eric W.; Côté, Patrick; Liu, Chengze; Ferrarese, Laura; Cuillandre, Jean-Charles; Caldwell, Nelson; Gwyn, Stephen D. J.; Jordán, Andrés; Lançon, Ariane; Li, Biao; Muñoz, Roberto P.; Puzia, Thomas H.; Bekki, Kenji; Blakeslee, John P.; Boselli, Alessandro; Drinkwater, Michael J.; Duc, Pierre-Alain; Durrell, Patrick; Emsellem, Eric; Firth, Peter; Sánchez-Janssen, Rubén

2015-03-01

The origin of ultra-compact dwarfs (UCDs; rh >~ 10 pc)—objects larger and more massive than typical globular clusters (GCs), but more compact than typical dwarf galaxies—has been hotly debated in the 15 years since their discovery. Even whether UCDs should be considered galactic in origin, or simply the most extreme star clusters, is not yet settled. We present the dynamical properties of 97 spectroscopically confirmed UCDs and 911 GCs associated with the central cD galaxy of the Virgo cluster, M87. Our UCDs, of which 89% have M sstarf gsim 2× 106 M ⊙ and 92% are as blue as the classic blue GCs, nearly triple the confirmed sample of Virgo UCDs, providing by far the best opportunity for studying global dynamics of a UCD system. We found that (1) UCDs have a surface number density profile that is shallower than that of blue GCs in the inner ~70 kpc and as steep as that of red GCs at larger radii; (2) UCDs exhibit a significantly stronger rotation than GCs, and blue GCs seem to have a velocity field that is more consistent with that of the surrounding dwarf ellipticals than with that of UCDs; (3) UCDs have an orbital anisotropy profile that is tangentially biased at radii lsim40 kpc and radially biased farther out, whereas blue GCs become more tangentially biased at larger radii beyond ~40 kpc (4) GCs with M sstarf gsim 2 × 106 M ⊙ have rotational properties indistinguishable from the less massive ones, suggesting that it is the size, instead of mass, that differentiates UCDs from GCs as kinematically distinct populations. We conclude that most UCDs in M87 are not consistent with being merely the most luminous and extended examples of otherwise normal GCs. The radially biased orbital structure of UCDs at large radii is in general agreement with the "tidally threshed dwarf galaxy" scenario.

Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations.

PubMed

McNamara, Caitlin; Mironova, Irina; Lehman, Erik; Olympia, Robert P

2017-06-01

Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. We performed a retrospective chart review of pediatric patients (<18 years of age) who presented to the Emergency Department of a Level I trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) < 15 (27% with abnormality vs. 13% without abnormality), hypoxia (22% vs. 5%), syncope/loss of consciousness (55% vs. 35%), cervical spine tenderness (12% vs. 3%), thoraco-lumbar-sacral spine tenderness (41% vs. 17%), and abdominal/pelvic tenderness (12% vs. 3%). Based on our data, predictors of thoracic injury in children after blunt torso trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effectiveness of Subdural Drains Using Urokinase after Burr Hole Evacuation of Subacute Subdural Hematoma in Elderly Patients: A Prelimilary Report

PubMed Central

Yeo, Chang-Gi; Jeon, Woo-Yeol; Kim, Seong-Ho; Kim, Oh-Lyong

2016-01-01

Objective A subdural drain using urokinase after a burr hole hematoma evacuation was performed for subacute subdural hematoma (SASDH), and its effectiveness and safety in elderly patients were evaluated. Methods Between January 2013 and May 2015, subdural drains using urokinase after burr hole hematoma evacuation were performed in 19 elderly patients. The inclusion criteria were as follows: 1) a subdural hematoma occurring between 4 and 20 days after injury; 2) worsening neurological symptoms, from mild to moderate or severe, due to injury during the subacute stage; 3) a mix of solid clots (high-density lighter shadow) and fluid hematoma (low-density darker shadow) on the computed tomography (CT) scan; 4) a score of ≥9 on the Glasgow Coma Scale (GCS) assessed immediately before surgery; and 5) an age of ≥65 years. When the majority of the hematoma was evacuated on the CT, we removed the catheter. Results Under local anesthesia, a catheter was inserted into the hematoma through a burr hole. The mean age of the patients was 73.7 years (range, 65-87 years). The mean preoperative GCS score was 11.2 (range, 10-13), and the mean Glasgow Outcome Scale score for all patients was 5 at discharge. No recurrences of hematomas or surgical complications were observed. Conclusion A subdural drain using urokinase after burr hole hematoma evacuation under local anesthesia is thought to be an effective and safe method of blood clot removal with low morbidity. This surgical method is less invasive for treating elderly patients with SASDH. PMID:27857916

A dual role for glucocorticoid-induced leucine zipper in glucocorticoid function: tumor growth promotion or suppression?

PubMed

Ayroldi, Emira; Cannarile, Lorenza; Delfino, Domenico V; Riccardi, Carlo

2018-04-26

Glucocorticoids (GCs), important therapeutic tools to treat inflammatory and immunosuppressive diseases, can also be used as part of cancer therapy. In oncology, GCs are used as anticancer drugs for lymphohematopoietic malignancies, while in solid neoplasms primarily to control the side effects of chemo/radiotherapy treatments. The molecular mechanisms underlying the effects of GCs are numerous and often overlapping, but not all have been elucidated. In normal, cancerous, and inflammatory tissues, the response to GCs differs based on the tissue type. The effects of GCs are dependent on several factors: the tumor type, the GC therapy being used, the expression level of the glucocorticoid receptor (GR), and the presence of any other stimuli such as signals from immune cells and the tumor microenvironment. Therefore, GCs may either promote or suppress tumor growth via different molecular mechanisms. Stress exposure results in dysregulation of the hypothalamic-pituitary-adrenal axis with increased levels of endogenous GCs that promote tumorigenesis, confirming the importance of GCs in tumor growth. Most of the effects of GCs are genomic and mediated by the modulation of GR gene transcription. Moreover, among the GR-induced genes, glucocorticoid-induced leucine zipper (GILZ), which was cloned and characterized primarily in our laboratory, mediates many GC anti-inflammatory effects. In this review, we analyzed the possible role for GILZ in the effects GCs have on tumors cells. We also suggest that GILZ, by affecting the immune system, tumor microenvironment, and directly cancer cell biology, has a tumor-promoting function. However, it may also induce apoptosis or decrease the proliferation of cancer cells, thus inhibiting tumor growth. The potential therapeutic implications of GILZ activity on tumor cells are discussed here.

Physiological effects of wearing graduated compression stockings during running.

PubMed

Ali, Ajmol; Creasy, Robert H; Edge, Johann A

2010-08-01

This study examined the effect of wearing different grades of graduated compression stockings (GCS) on physiological and perceptual measures during and following treadmill running in competitive runners. Nine males and one female performed three 40-min treadmill runs (80 +/- 5% maximal oxygen uptake) wearing either control (0 mmHg; CON), low (12-15 mmHg; LO-GCS), or high (23-32 mmHg; HI-GCS) grade GCS in a double-blind counterbalanced order. Oxygen uptake, heart rate and blood lactate were measured. Perceptual scales were used pre- and post-run to assess comfort, tightness and any pain associated with wearing GCS. Changes in muscle function, soreness and damage were determined pre-run, immediately after running and 24 and 48 h post-run by measuring creatine kinase and myoglobin, counter-movement jump height, perceived soreness diagrams, and pressure sensitivity. There were no significant differences between trials for oxygen uptake, heart rate or blood lactate during exercise. HI-GCS was perceived as tighter (P < 0.05) and more pain-inducing (P < 0.05) than the other interventions; CON and LO-GCS were rated more comfortable than HI-GCS (P < 0.05). Creatine kinase (P < 0.05), myoglobin (P < 0.05) and jump height (P < 0.05) were higher and pressure sensitivity was more pronounced (P < 0.05) immediately after running but not after 24 and 48 h. Only four participants reported muscle soreness during recovery from running and there were no differences in muscle function between trials. In conclusion, healthy runners wearing GCS did not experience any physiological benefits during or following treadmill running. However, athletes felt more comfortable wearing low-grade GCS whilst running.

Endothelial Response to Glucocorticoids in Inflammatory Diseases

PubMed Central

Zielińska, Karolina A.; Van Moortel, Laura; Opdenakker, Ghislain; De Bosscher, Karolien; Van den Steen, Philippe E.

2016-01-01

The endothelium plays a crucial role in inflammation. A balanced control of inflammation requires the action of glucocorticoids (GCs), steroidal hormones with potent cell-specific anti-inflammatory properties. Besides the classic anti-inflammatory effects of GCs on leukocytes, recent studies confirm that endothelial cells also represent an important target for GCs. GCs regulate different aspects of endothelial physiology including expression of adhesion molecules, production of pro-inflammatory cytokines and chemokines, and maintenance of endothelial barrier integrity. However, the regulation of endothelial GC sensitivity remains incompletely understood. In this review, we specifically examine the endothelial response to GCs in various inflammatory diseases ranging from multiple sclerosis, stroke, sepsis, and vasculitis to atherosclerosis. Shedding more light on the cross talk between GCs and endothelium will help to improve existing therapeutic strategies and develop new therapies better tailored to the needs of patients. PMID:28018358

Unique processing during a period of high excitation/inhibition balance in adult-born neurons.

PubMed

Marín-Burgin, Antonia; Mongiat, Lucas A; Pardi, M Belén; Schinder, Alejandro F

2012-03-09

The adult dentate gyrus generates new granule cells (GCs) that develop over several weeks and integrate into the preexisting network. Although adult hippocampal neurogenesis has been implicated in learning and memory, the specific role of new GCs remains unclear. We examined whether immature adult-born neurons contribute to information encoding. By combining calcium imaging and electrophysiology in acute slices, we found that weak afferent activity recruits few mature GCs while activating a substantial proportion of the immature neurons. These different activation thresholds are dictated by an enhanced excitation/inhibition balance transiently expressed in immature GCs. Immature GCs exhibit low input specificity that switches with time toward a highly specific responsiveness. Therefore, activity patterns entering the dentate gyrus can undergo differential decoding by a heterogeneous population of GCs originated at different times.

Coherent and Semiclassical States of a Charged Particle in Electromagnetic Fields

NASA Astrophysics Data System (ADS)

Pereira, A. S.

2018-06-01

In the present article, we extend our study (Bagrov et al., Braz. J. Phys. 45, 369, 2015) of generalized coherent states (GCS) of a one-dimensional particle considering such important physical system as a three-dimensional charged particle in electric and magnetic fields. Constructing GCS in a many-dimensional case, we meet technical complications that make the consideration nontrivial and instructive. The GCS of the system under consideration are constructed. We study the properties of this GCS such as completeness relations, minimization of uncertainty relations, and so on. We point out which family of the obtained GCS of a charged particle in a magnetic field is related to the CS constructed first by Malkin and Man'ko. We obtain conditions under which some of the GCS can be considered as semiclassical states (SS).

Coherent and Semiclassical States of a Charged Particle in Electromagnetic Fields

NASA Astrophysics Data System (ADS)

Pereira, A. S.

2018-03-01

In the present article, we extend our study (Bagrov et al., Braz. J. Phys. 45, 369, 2015) of generalized coherent states (GCS) of a one-dimensional particle considering such important physical system as a three-dimensional charged particle in electric and magnetic fields. Constructing GCS in a many-dimensional case, we meet technical complications that make the consideration nontrivial and instructive. The GCS of the system under consideration are constructed. We study the properties of this GCS such as completeness relations, minimization of uncertainty relations, and so on. We point out which family of the obtained GCS of a charged particle in a magnetic field is related to the CS constructed first by Malkin and Man'ko. We obtain conditions under which some of the GCS can be considered as semiclassical states (SS).

Glucocorticoids promote Von Hippel Lindau degradation and Hif-1α stabilization

PubMed Central

Greenald, David; Wilson, Garrick K.; Peron, Margherita; Markham, Eleanor; Sinnakaruppan, Mathavan; Matthews, Laura C.; McKeating, Jane A.; Argenton, Francesco; van Eeden, Fredericus J. M.

2017-01-01

Glucocorticoid (GC) and hypoxic transcriptional responses play a central role in tissue homeostasis and regulate the cellular response to stress and inflammation, highlighting the potential for cross-talk between these two signaling pathways. We present results from an unbiased in vivo chemical screen in zebrafish that identifies GCs as activators of hypoxia-inducible factors (HIFs) in the liver. GCs activated consensus hypoxia response element (HRE) reporters in a glucocorticoid receptor (GR)-dependent manner. Importantly, GCs activated HIF transcriptional responses in a zebrafish mutant line harboring a point mutation in the GR DNA-binding domain, suggesting a nontranscriptional route for GR to activate HIF signaling. We noted that GCs increase the transcription of several key regulators of glucose metabolism that contain HREs, suggesting a role for GC/HIF cross-talk in regulating glucose homeostasis. Importantly, we show that GCs stabilize HIF protein in intact human liver tissue and isolated hepatocytes. We find that GCs limit the expression of Von Hippel Lindau protein (pVHL), a negative regulator of HIF, and that treatment with the c-src inhibitor PP2 rescued this effect, suggesting a role for GCs in promoting c-src–mediated proteosomal degradation of pVHL. Our data support a model for GCs to stabilize HIF through activation of c-src and subsequent destabilization of pVHL. PMID:28851829

Time-lapse imaging reveals highly dynamic structural maturation of postnatally born dentate granule cells in organotypic entorhino-hippocampal slice cultures

PubMed Central

Radic, Tijana; Jungenitz, Tassilo; Singer, Mathias; Beining, Marcel; Cuntz, Hermann; Vlachos, Andreas; Deller, Thomas; Schwarzacher, Stephan W.

2017-01-01

Neurogenesis of hippocampal granule cells (GCs) persists throughout mammalian life and is important for learning and memory. How newborn GCs differentiate and mature into an existing circuit during this time period is not yet fully understood. We established a method to visualize postnatally generated GCs in organotypic entorhino-hippocampal slice cultures (OTCs) using retroviral (RV) GFP-labeling and performed time-lapse imaging to study their morphological development in vitro. Using anterograde tracing we could, furthermore, demonstrate that the postnatally generated GCs in OTCs, similar to adult born GCs, grow into an existing entorhino-dentate circuitry. RV-labeled GCs were identified and individual cells were followed for up to four weeks post injection. Postnatally born GCs exhibited highly dynamic structural changes, including dendritic growth spurts but also retraction of dendrites and phases of dendritic stabilization. In contrast, older, presumably prenatally born GCs labeled with an adeno-associated virus (AAV), were far less dynamic. We propose that the high degree of structural flexibility seen in our preparations is necessary for the integration of newborn granule cells into an already existing neuronal circuit of the dentate gyrus in which they have to compete for entorhinal input with cells generated and integrated earlier. PMID:28256620

[Effects of glutamine-enriched enteral nutrition on nutritional status and prognosis of patients with severe head injury].

PubMed

Zeng, Jing; Zhao, Xiao-yu; Huang, Qiong; Wang, En-ren

2009-10-01

To investigate the effects of glutamine-enriched enteral nutrition on the nutritional status and prognosis of patients with severe head injury. Thirty-three patients with severe head injury were randomly divided into control group (C, 15 cases) and glutamine-enriched group (Gln, 18 cases). Patients in both groups were given routine treatment and enteral nutrition with the same amount of nitrogen and calorie. Patients in Gln group were given glutamine 0.5 g x kg(-1) x d(-1) additionally added into the nutrient fluid. Vital signs and the occurrence of side effects of all patients were observed before and after nutrition support. Venous blood and urine sample of all patients were collected before and 7, 14 days after treatment to determine the parameters of blood, urine routine and hepatorenal function. At the same time points, body mass, skin fold thickness at the region of triceps brachii (TSF), upper arm circumference (AC), upper arm muscle circumference (AMC) and fasting blood glucose of all patients were detected and determined, Glasgow coma scale (GCS) scoring was performed. The length of hospital stay of all patients was recorded. Vital signs and parameters of blood, urine routine and hepatorenal function of patients in 2 groups after nutrition treatment were close to those before treatment. Side effects, such as nausea and diarrhea occurred with spontaneous remission in a few patients. There was no statistical significant difference between 2 groups, and within each group before and after treatment, in respect of body mass and TSF (P > 0.05). Values of AC and AMC of patients in Gln group were obviously higher than those of C group (P < 0.01) on post-treatment day 14. Fasting blood glucose and GCS score of all patients before treatment were close to those on post-treatment day 14 (P > 0.05). Fasting blood glucose and GCS score of patients was respectively lower and higher in Gln group than that in C group on post-treatment day 7 (P < 0.05). Length of hospital stay of patients in Gln group (25 +/- 9) d was obviously shorter than that of C group (33 +/- 12) d (P < 0.05). Glutamine-enriched enteral nutrition can control the blood glucose level, prevent the loss of lean tissue, improve nutrition status of patients,shorten hospital stay, and accelerate the recovery of patients to some extent.

The Influence of Traumatic Axonal Injury in Thalamus and Brainstem on Level of Consciousness at Scene or Admission: A Clinical Magnetic Resonance Imaging Study

PubMed Central

Moen, Kent Gøran; Skandsen, Toril; Kvistad, Kjell Arne; Laureys, Steven; Håberg, Asta; Vik, Anne

2018-01-01

Abstract The aim of this study was to investigate how traumatic axonal injury (TAI) lesions in the thalamus, basal ganglia, and brainstem on clinical brain magnetic resonance imaging (MRI) are associated with level of consciousness in the acute phase in patients with moderate to severe traumatic brain injury (TBI). There were 158 patients with moderate to severe TBI (7–70 years) with early 1.5T MRI (median 7 days, range 0–35) without mass lesion included prospectively. Glasgow Coma Scale (GCS) scores were registered before intubation or at admission. The TAI lesions were identified in T2*gradient echo, fluid attenuated inversion recovery, and diffusion weighted imaging scans. In addition to registering TAI lesions in hemispheric white matter and the corpus callosum, TAI lesions in the thalamus, basal ganglia, and brainstem were classified as uni- or bilateral. Twenty percent of patients had TAI lesions in the thalamus (7% bilateral), 18% in basal ganglia (2% bilateral), and 29% in the brainstem (9% bilateral). One of 26 bilateral lesions in the thalamus or brainstem was found on computed tomography. The GCS scores were lower in patients with bilateral lesions in the thalamus (median four) and brainstem (median five) than in those with corresponding unilateral lesions (median six and eight, p = 0.002 and 0.022). The TAI locations most associated with low GCS scores in univariable ordinal regression analyses were bilateral TAI lesions in the thalamus (odds ratio [OR] 35.8; confidence interval [CI: 10.5−121.8], p < 0.001), followed by bilateral lesions in basal ganglia (OR 13.1 [CI: 2.0–88.2], p = 0.008) and bilateral lesions in the brainstem (OR 11.4 [CI: 4.0–32.2], p < 0.001). This Trondheim TBI study showed that patients with bilateral TAI lesions in the thalamus, basal ganglia, or brainstem had particularly low consciousness at admission. We suggest these bilateral lesions should be evaluated further as possible biomarkers in a new TAI-MRI classification as a worst grade, because they could explain low consciousness in patients without mass lesions. PMID:29334825

Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.

PubMed

Hasler, Rebecca M; Exadaktylos, Aristomenis K; Bouamra, Omar; Benneker, Lorin M; Clancy, Mike; Sieber, Robert; Zimmermann, Heinz; Lecky, Fiona

2012-04-01

Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. This cohort study investigated predictors for cervical spine injury in adult (≥ 16 years) major trauma patients using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Univariate and multivariate logistic regression analyses were used to determine predictors for cervical fractures/dislocations or cord injury. A total of 250,584 patients were analyzed. Median age was 47.2 years (interquartile range, 29.8-66.0) and Injury Severity Score 9 (interquartile range, 4-11); 60.2% were male. Six thousand eight hundred two patients (2.3%) sustained cervical fractures/dislocations alone. Two thousand sixty-nine (0.8%) sustained cervical cord injury with/without fractures/dislocations; 39.9% of fracture/dislocation and 25.8% of cord injury patients suffered injuries to other body regions. Age ≥ 65 years (odds ratio [OR], 1.45-1.92), males (females OR, 0.91; 95% CI, 0.86-0.96), Glasgow Coma Scale (GCS) score <15 (OR, 1.26-1.30), LeFort facial fractures (OR, 1.29; 95% confidence interval [CI], 1.05-1.59), sports injuries (OR, 3.51; 95% CI, 2.87-4.31), road traffic collisions (OR, 3.24; 95% CI, 3.01-3.49), and falls >2 m (OR, 2.74; 95% CI, 2.53-2.97) were predictive for fractures/dislocations. Age <35 years (OR, 1.25-1.72), males (females OR, 0.59; 95% CI, 0.53-0.65), GCS score <15 (OR, 1.35-1.85), systolic blood pressure <110 mm Hg (OR, 1.16; 95% CI, 1.02-1.31), sports injuries (OR, 4.42; 95% CI, 3.28-5.95), road traffic collisions (OR, 2.58; 95% CI, 2.26-2.94), and falls >2 m (OR, 2.24; 95% CI, 1.94-2.58) were predictors for cord injury. 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.

Low-mass X-ray binaries from black hole retaining globular clusters

NASA Astrophysics Data System (ADS)

Giesler, Matthew; Clausen, Drew; Ott, Christian D.

2018-06-01

Recent studies suggest that globular clusters (GCs) may retain a substantial population of stellar-mass black holes (BHs), in contrast to the long-held belief of a few to zero BHs. We model the population of BH low-mass X-ray binaries (BH-LMXBs), an ideal observable proxy for elusive single BHs, produced from a representative group of Milky Way GCs with variable BH populations. We simulate the formation of BH binaries in GCs through exchange interactions between binary and single stars in the company of tens to hundreds of BHs. Additionally, we consider the impact of the BH population on the rate of compact binaries undergoing gravitational wave driven mergers. The characteristics of the BH-LMXB population and binary properties are sensitive to the GCs structural parameters as well as its unobservable BH population. We find that GCs retaining ˜1000 BHs produce a galactic population of ˜150 ejected BH-LMXBs, whereas GCs retaining only ˜20 BHs produce zero ejected BH-LMXBs. Moreover, we explore the possibility that some of the presently known BH-LMXBs might have originated in GCs and identify five candidate systems.

5-HT1A Receptors on Mature Dentate Gyrus Granule Cells are Critical for the Antidepressant Response

PubMed Central

Samuels, Benjamin Adam; Anacker, Christoph; Hu, Alice; Levinstein, Marjorie R.; Pickenhagen, Anouchka; Tsetsenis, Theodore; Madroñal, Noelia; Donaldson, Zoe R.; Drew, Liam John; Dranovsky, Alex; Gross, Cornelius T.; Tanaka, Kenji F.; Hen, René

2015-01-01

Selective serotonin reuptake inhibitors (SSRIs) are widely used antidepressants, but the mechanisms by which they influence behavior are only partially resolved. Adult hippocampal neurogenesis is necessary for some of the responses to SSRIs, but it is unknown whether the mature dentate gyrus granule cells (mature DG GCs) also contribute. We deleted Serotonin 1A receptor (5HT1AR; a receptor required for the SSRI response) specifically from DG GCs and found that the effects of the SSRI fluoxetine on behavior and the Hypothalamic-Pituitary-Adrenal (HPA) axis were abolished. By contrast, mice lacking 5HT1ARs only in young adult born granule cells (abGCs) showed normal fluoxetine responses. Importantly, 5HT1AR deficient mice engineered to express functional 5HT1ARs only in DG GCs responded to fluoxetine, indicating that 5HT1ARs in DG GCs are sufficient to mediate an antidepressant response. Taken together, these data indicate that both mature DG GCs and young abGCs must be engaged for an antidepressant response. PMID:26389840

[Clinical decision to perform cranial computed tomography in children with non-severe head injury].

PubMed

Franco-Koehrlen, Celine Alicia; Iglesias-Leboreiro, José; Bernárdez-Zapata, Isabel; Rendón-Macías, Mario Enrique

The main goal of this article was to evaluate if the decision to perform cranial computed tomography (CT) in children with minor head injury is determined by the presence or absence of the physician during assessment in the emergency room. Clinical files of 92 patients from 8 months to 4 years of age were selected. Those children were evaluated at the emergency department of the Spanish Hospital of Mexico due to non-severe traumatic brain injury. Glasgow Coma Scale (GCS) score was determined in all patients. Groups of patients were compared: 1) patients having CT, 2) patients with a physician who attended the initial assessment, 3) patients whose attending physician did not arrive to assess the patient and 4) patients assessed by the emergency room staff. 38% of patients with non-severe brain injury underwent CT, 8.6% had a brain injury visible on the CT. Moderate intensity impacts were greater in patients with CT. Regarding the ECG, it was found that most children scored 15 points (p=0.03). In patients without a physician, a greater trend was demonstrated for performing CT. Patients with minor head injury but without neurological signs should undergo a detailed clinical evaluation in order to avoid unwarranted CT. Copyright © 2015. Publicado por Masson Doyma México S.A.

Associations of HSP90AA2 gene polymorphisms with disease susceptibility, glucocorticoids efficacy and health-related quality of life in Chinese systemic lupus erythematosus patients.

PubMed

Zhang, Man; Li, Su-Su; Xie, Qiao-Mei; Xu, Jian-Hua; Sun, Xiu-Xiu; Pan, Fa-Ming; Xu, Sheng-Qian; Liu, Sheng-Xiu; Tao, Jin-Hui; Liu, Shuang; Cai, Jing; Chen, Pei-Ling; Qian, Long; Wang, Chun-Huai; Liang, Chun-Mei; Huang, Hai-Liang; Pan, Hai-Feng; Su, Hong; Zou, Yan-Feng

2018-06-15

Although the current glucocorticoids (GCs) treatment for systemic lupus erythematosus (SLE) is effective to a certain extent, the difference in therapeutic effect between patients is still a widespread problem. Some patients can have repeated attacks that greatly diminish their quality of life. This study was conducted to investigate the relationship between HSP90AA2 polymorphisms and disease susceptibility, GCs efficacy and health-related quality of life (HRQoL) in Chinese SLE patients. A case-control study was performed in 470 SLE patients and 470 normal controls. Then, 444 patients in the case group were followed up for 12 weeks to observe efficacy of GCs and improvement of HRQoL. Two single nucleotide polymorphisms (SNPs) of HSP90AA2 were selected for genotyping: rs1826330 and rs6484340. HRQoL was assessed using the SF-36 questionnaire. The minor T allele of rs1826330 and the TT haplotype formed by rs1826330 and rs6484340 showed associations with decreased SLE risk (T allele: P BH  = 0.022; TT haplotype: P BH  = 0.033). A significant association between rs6484340 and improvement of HRQoL was revealed in the follow-up study. Five subscales of SF-36 were appeared to be influenced by rs6484340: total score of SF-36 (additive model: P BH  = 0.026), physical function (additive model: P BH  = 0.026), role-physical (recessive model: P BH  = 0.041), mental health (dominant model: P BH  = 0.047), and physical component summary (additive model: P BH  = 0.026). No statistical significance was found between HSP90AA2 gene polymorphisms and GCs efficacy. These results revealed a genetic association between HSP90AA2 and SLE. Remarkably, HSP90AA2 has an impact on the improvement of HRQoL in Chinese population with SLE.

A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting.

PubMed

Dunham, Mark Peter; Sartorius, Benn; Laing, Grant Llewellyn; Bruce, John Lambert; Clarke, Damian Luiz

2017-09-01

An assessment of physiological status is a key step in the early assessment of trauma patients with implications for triage, investigation and management. This has traditionally been done using vital signs. Previous work from large European trauma datasets has suggested that base deficit (BD) predicts clinically important outcomes better than vital signs (VS). A BD derived classification of haemorrhagic shock appeared superior to one based on VS derived from ATLS criteria in a population of predominantly blunt trauma patients. The initial aim of this study was to see if this observation would be reproduced in penetrating trauma patients. The power of each individual variable (BD, heart rate (HR), systolic blood pressure (SBP), shock index(SI) (HR/SBP) and Glasgow Coma Score (GCS)) to predict mortality was then also compared. A retrospective analysis of adult trauma patients presenting to the Pietermaritzburg Metropolitan Trauma Service was performed. Patients were classified into four "shock" groups using VS or BD and the outcomes compared. Receiver Operator Characteristic (ROC) curves were then generated to compare the predictive power for mortality of each individual variable. 1863 patients were identified. The overall mortality rate was 2.1%. When classified by BD, HR rose and SBP fell as the "shock class" increased but not to the degree suggested by the ATLS classification. The BD classification of haemorrhagic shock appeared to predict mortality better than that based on the ATLS criteria. Mortality increased from 0.2% (Class 1) to 19.7% (Class 4) based on the 4 level BD classification. Mortality increased from 0.3% (Class 1) to 12.6% (Class 4) when classified based by VS. Area under the receiver operator characteristic (AUROC) curve analysis of the individual variables demonstrated that BD predicted mortality significantly better than HR, GCS, SBP and SI. AUROC curve (95% Confidence Interval (CI)) for BD was 0.90 (0.85-0.95) compared to HR 0.67(0.56-0.77), GCS 0.70(0.62-0.79), SBP 0.75(0.65-0.85) and SI 0.77(0.68-0.86). BD appears superior to vital signs in the immediate physiological assessment of penetrating trauma patients. The use of BD to assess physiological status may help refine their early triage, investigation and management. Copyright © 2017 Elsevier Ltd. All rights reserved.

An Index of Trauma Severity Based on Multiattribute Utility: An Illustration of Complex Utility Modeling.

DTIC Science & Technology

1981-10-01

measure for Central Nervus System is the Glasgow Cons Score (GCS), a scale of brain and spinal cord injury (Langfitt [1978]), and is itself an additive...concerns directly relating to the injury itself were identified. These were: 1. Ventilation Severity 2 Circulation Severity 3. Central Nervous System ...interacting system within which these concerns represent interacting parts. Most trauma involves only one of these systems , but more than one may be

North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury: A Consortium of Military, Veterans Administration, and Civilian Hospitals

DTIC Science & Technology

2011-01-31

of the patient on arrival and includes a clinical evaluation, 5 measurement of state of consciousness with the Glasgow Coma Scale (GCS) and of...associated injuries with the Abbreviated Injury Scale . The American Spinal Injury Association impairment scale (AIS) is scored on admission and at key...the AIS Impairment Scale , and where appropriate, the Functional Independence Measure FIM™, the Spinal Cord Independence Measure (SCIM), and the

Glucocorticoid-induced leucine zipper expression is associated with response to treatment and immunoregulation in systemic lupus erythematosus.

PubMed

Mohammadi, Saeed; Ebadpour, Mohammad Reza; Sedighi, Sima; Saeedi, Mohsen; Memarian, Ali

2017-08-01

Systemic lupus erythematosus (SLE) is an autoimmune disorder in which cytokine balance is disturbed. Glucocorticoids (GCs) are shown to balance immune response by transcriptional regulation of glucocorticoid receptor target genes such as Glucocorticoid-induced leucine zipper (GILZ) which has been introduced as an endogenous anti-inflammatory mediator. In the present study, we assessed the expression of GILZ in association with interferon-γ (IFN-γ), interleukine-10 (IL-10), and B lymphocyte stimulator (BLyS) plasma levels in SLE patients. A total of 40 female patients (18 under treatment and 22 newly diagnosed) were recruited in this study. Real-time RT PCR was conducted to quantify the mRNA expression of GILZ. The plasma levels of IFN-γ, IL-10, and BLyS were evaluated using ELISA method. GILZ was overexpressed among under treatment SLE patients. The mRNA expression of GILZ was significantly correlated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. IFN-γ and BLyS were downregulated in response to therapies with negative correlations to GILZ. Moreover, IL-10 was upregulated among treated patients. The levels of IFN-γ and BLyS were correlated with the severity of disease, while IL-10 was negatively correlated with SLEDAI score. GILZ could be introduced as one of the acting molecules in mediating the regulatory effects of GCs on producing pro- and anti-inflammatory cytokines in SLE.

Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.

PubMed

Lee, Lois K; Dayan, Peter S; Gerardi, Michael J; Borgialli, Dominic A; Badawy, Mohamed K; Callahan, James M; Lillis, Kathleen A; Stanley, Rachel M; Gorelick, Marc H; Dong, Li; Zuspan, Sally Jo; Holmes, James F; Kuppermann, Nathan

2011-06-01

To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children <18 years old with blunt head trauma evaluated in 25 emergency departments. A total of 230 children had bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders. Copyright © 2011 Mosby, Inc. All rights reserved.

Variation in PPP3CC Genotype Is Associated with Long-Term Recovery after Severe Brain Injury.

PubMed

Osier, Nicole D; Bales, James W; Pugh, Bunny; Shin, Samuel; Wyrobek, Julie; Puccio, Ava M; Okonkwo, David O; Ren, Dianxu; Alexander, Sheila; Conley, Yvette P; Dixon, C Edward

2017-01-01

After experimental traumatic brain injury (TBI), calcineurin is upregulated; blocking calcineurin is associated with improved outcomes. In humans, variation in the calcineurin A-gamma gene (PPP3CC) has been associated with neuropsychiatric disorders, though any role in TBI recovery remains unknown. This study examines associations between PPP3CC genotype and mortality, as well as gross functional status assessed at admission using the Glasgow Coma Scale (GCS) and at 3, 6, and 12 months after severe TBI using the Glasgow Outcome Score (GOS). The following tagging single nucleotide polymorphisms (tSNPs) in PPP3CC were genotyped: rs2443504, rs2461491, rs2469749, and rs10108011. The rs2443504 AA genotype was univariately associated with GCS (p = 0.022), GOS at 3, 6, and 12 months (p = 0.002, p = 0.034, and p = 0.004, respectively), and mortality (p = 0.007). In multivariate analysis controlling for age, sex, and GCS, the AA genotype of rs2443504 was associated with GOS at 3 (p = 0.02), and 12 months (p = 0.01), with a trend toward significance at 6 months (p = 0.05); the AA genotype also was associated with mortality in the multivariate model (p = 0.04). Further work is warranted to better understand the role of calcineurin, as well as the genes encoding it and their relevance to outcomes after brain injury.

Yonsei Evolutionary Population Synthesis (YEPS). II. Spectro-photometric Evolution of Helium-enhanced Stellar Populations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, Chul; Yoon, Suk-Jin; Lee, Young-Wook, E-mail: chulchung@yonsei.ac.kr, E-mail: sjyoon0691@yonsei.ac.kr

The discovery of multiple stellar populations in Milky Way globular clusters (GCs) has stimulated various follow-up studies on helium-enhanced stellar populations. Here we present the evolutionary population synthesis models for the spectro-photometric evolution of simple stellar populations (SSPs) with varying initial helium abundance ( Y {sub ini}). We show that Y {sub ini} brings about dramatic changes in spectro-photometric properties of SSPs. Like the normal-helium SSPs, the integrated spectro-photometric evolution of helium-enhanced SSPs is also dependent on metallicity and age for a given Y {sub ini}. We discuss the implications and prospects for the helium-enhanced populations in relation to themore » second-generation populations found in the Milky Way GCs. All of the models are available at http://web.yonsei.ac.kr/cosmic/data/YEPS.htm.« less

THE NEXT GENERATION VIRGO CLUSTER SURVEY. VI. THE KINEMATICS OF ULTRA-COMPACT DWARFS AND GLOBULAR CLUSTERS IN M87

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Hong-Xin; Peng, Eric W.; Li, Biao

2015-03-20

The origin of ultra-compact dwarfs (UCDs; r{sub h} ≳ 10 pc)—objects larger and more massive than typical globular clusters (GCs), but more compact than typical dwarf galaxies—has been hotly debated in the 15 years since their discovery. Even whether UCDs should be considered galactic in origin, or simply the most extreme star clusters, is not yet settled. We present the dynamical properties of 97 spectroscopically confirmed UCDs and 911 GCs associated with the central cD galaxy of the Virgo cluster, M87. Our UCDs, of which 89% have M {sub *} ≳ 2× 10{sup 6} M {sub ☉} and 92% are as blue asmore » the classic blue GCs, nearly triple the confirmed sample of Virgo UCDs, providing by far the best opportunity for studying global dynamics of a UCD system. We found that (1) UCDs have a surface number density profile that is shallower than that of blue GCs in the inner ∼70 kpc and as steep as that of red GCs at larger radii; (2) UCDs exhibit a significantly stronger rotation than GCs, and blue GCs seem to have a velocity field that is more consistent with that of the surrounding dwarf ellipticals than with that of UCDs; (3) UCDs have an orbital anisotropy profile that is tangentially biased at radii ≲40 kpc and radially biased farther out, whereas blue GCs become more tangentially biased at larger radii beyond ∼40 kpc; (4) GCs with M {sub *} ≳ 2 × 10{sup 6} M {sub ☉} have rotational properties indistinguishable from the less massive ones, suggesting that it is the size, instead of mass, that differentiates UCDs from GCs as kinematically distinct populations. We conclude that most UCDs in M87 are not consistent with being merely the most luminous and extended examples of otherwise normal GCs. The radially biased orbital structure of UCDs at large radii is in general agreement with the 'tidally threshed dwarf galaxy' scenario.« less

Cell type-specific regulatory effects of glucocorticoids on cutaneous TLR2 expression and signalling.

PubMed

Su, Qi; Pfalzgraff, Anja; Weindl, Günther

2017-07-01

Glucocorticoids (GCs) induce Toll-like receptor (TLR) 2 expression and synergistically upregulate TLR2 with pro-inflammatory cytokines or bacteria. These paradoxical effects have drawn attention to the inflammatory initiating or promoting effects of GCs, as GC treatment can provoke inflammatory skin diseases. Here, we aimed to investigate the regulatory effects of GCs in human skin cells of different epidermal and dermal layers. We found that Dex induced TLR2 expression mainly in undifferentiated and less in calcium-induced differentiated keratinocytes but not in HaCaT cells or fibroblasts, however, Dex reduced TLR1/6 expression. Stimulation with Dex under inflammatory conditions further increased TLR2 but not TLR1 or TLR6 levels in keratinocytes. Increased ligand-induced interaction of TLR2 with MyD88 and expression of the adaptor protein TRAF6 indicated enhanced TLR2 signalling, whereas TLR2/1 or TLR2/6 signalling was not increased in Dex-pretreated keratinocytes. GC-increased TLR2 expression was negatively regulated by JNK MAPK signalling when stimulated with Propionibacterium acnes. Our results provide novel insights into the molecular mechanisms of glucocorticoid-mediated expression and function of TLR2 in human skin cells and the understanding of the mechanisms of corticosteroid side effects. Copyright © 2017 Elsevier Ltd. All rights reserved.

Feminizing Genital Gender-Confirmation Surgery.

PubMed

Hadj-Moussa, Miriam; Ohl, Dana A; Kuzon, William M

2018-02-14

For many patients with gender dysphoria, gender-confirmation surgery (GCS) helps align their physical characteristics with their gender identity and is a fundamental element of comprehensive treatment. This article is the 2nd in a 3-part series about the treatment of gender dysphoria. Non-operative management was covered in part 1. This section begins broadly by reviewing surgical eligibility criteria, benefits of GCS, and factors associated with regret for transgender men and women. Then, the scope narrows to focus on aspects of feminizing genital GCS, including a discussion of vaginoplasty techniques, complications, and sexual function outcomes. Part 3 features operative considerations for masculinizing genital GCS. To summarize the World Professional Association for Transgender Health's (WPATH) surgical eligibility criteria and describe how patients with gender dysphoria benefit from GCS, provide an overview of genital and non-genital feminizing gender-confirmation procedures, and review vaginoplasty techniques, preoperative considerations, complications, and outcomes. A review of relevant literature through April 2017 was performed using PubMed. Review of literature related to surgical eligibility criteria for GCS, benefits of GCS, and surgical considerations for feminizing genitoplasty. Most transgender men and women who satisfy WPATH eligibility criteria experience improved quality of life, overall happiness, and sexual function after GCS; regret is rare. Penile inversion vaginoplasty is the preferred technique for feminizing genital GCS according to most surgeons, including the authors whose surgical technique is described. Intestinal vaginoplasty is reserved for certain scenarios. After vaginoplasty most patients report overall high satisfaction with their sexual function even when complications occur, because most are minor and easily treatable. GCS alleviates gender dysphoria for appropriately selected transgender men and women. Preoperative, intraoperative, and postoperative considerations of feminizing genital gender-confirmation procedures were reviewed. Hadj-Moussa M, Ohl DA, Kuzon WM. Feminizing Genital Gender-Confirmation Surgery. Sex Med Rev 2018;XX:XXX-XXX. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Binding Affinity of Glycoconjugates to BACILLUS Spores and Toxins

NASA Astrophysics Data System (ADS)

Rasol, Aveen; Eassa, Souzan; Tarasenko, Olga

2010-04-01

Early recognition of Bacillus cereus group species is important since they can cause food-borne illnesses and deadly diseases in humans. Glycoconjugates (GCs) are carbohydrates covalently linked to non-sugar moieties including lipids, proteins or other entities. GCs are involved in recognition and signaling processes intrinsic to biochemical functions in cells. They also stimulate cell-cell adhesion and subsequent recognition and activation of receptors. We have demonstrated that GCs are involved in Bacillus cereus spore recognition. In the present study, we have investigated whether GCs possess the ability to bind and recognize B. cereus spores and Bacillus anthracis recombinant single toxins (sTX) and complex toxins (cTX). The affinity of GCs to spores + sTX and spores + cTX toxins was studied in the binding essay. Our results demonstrated that GC9 and GC10 were able to selectively bind to B. cereus spores and B. anthracis toxins. Different binding affinities for GCs were found toward Bacillus cereus spores + sTX and spores + cTX. Dilution of GCs does not impede the recognition and binding. Developed method provides a tool for simultaneous recognition and targeting of spores, bacteria toxins, and/or other entities.

Arabidopsis HAP2/GCS1 is a gamete fusion protein homologous to somatic and viral fusogens

PubMed Central

Valansi, Clari; Moi, David; Leikina, Evgenia; Matveev, Elena; Chernomordik, Leonid V.

2017-01-01

Cell–cell fusion is inherent to sexual reproduction. Loss of HAPLESS 2/GENERATIVE CELL SPECIFIC 1 (HAP2/GCS1) proteins results in gamete fusion failure in diverse organisms, but their exact role is unclear. In this study, we show that Arabidopsis thaliana HAP2/GCS1 is sufficient to promote mammalian cell–cell fusion. Hemifusion and complete fusion depend on HAP2/GCS1 presence in both fusing cells. Furthermore, expression of HAP2 on the surface of pseudotyped vesicular stomatitis virus results in homotypic virus–cell fusion. We demonstrate that the Caenorhabditis elegans Epithelial Fusion Failure 1 (EFF-1) somatic cell fusogen can replace HAP2/GCS1 in one of the fusing membranes, indicating that HAP2/GCS1 and EFF-1 share a similar fusion mechanism. Structural modeling of the HAP2/GCS1 protein family predicts that they are homologous to EFF-1 and viral class II fusion proteins (e.g., Zika virus). We name this superfamily Fusexins: fusion proteins essential for sexual reproduction and exoplasmic merger of plasma membranes. We suggest a common origin and evolution of sexual reproduction, enveloped virus entry into cells, and somatic cell fusion. PMID:28137780

Mucoadhesive properties and interaction with P-glycoprotein (P-gp) of thiolated-chitosans and -glycol chitosans and corresponding parent polymers: a comparative study.

PubMed

Trapani, Adriana; Palazzo, Claudio; Contino, Marialessandra; Perrone, Maria Grazia; Cioffi, Nicola; Ditaranto, Nicoletta; Colabufo, Nicola Antonio; Conese, Massimo; Trapani, Giuseppe; Puglisi, Giovanni

2014-03-10

The aim of the present work was to compare the mucoadhesive and efflux pump P-glycoprotein (P-gp) interacting properties of chitosan (CS)- and glycolchitosan (GCS)-based thiomers and corresponding unmodified parent polymers. For this purpose, the glycol chitosan-N-acetyl-cysteine (GCS-NAC) and glycol chitosan-glutathione (GCS-GSH) thiomers were prepared under simple and mild conditions. Their mucoadhesive characteristics were studied by turbidimetric and zeta potential measurements. The P-gp interacting properties were evaluated measuring the effects of thiolated- and unmodified-polymers on the bidirectional transport (BA/AB) of rhodamine-123 across Caco-2 cells as well as in the calcein-AM and ATPase activity assays. Although all the thiomers and unmodified polymers showed optimal-excellent mucoadhesive properties, the best mucoadhesive performances have been obtained by CS and CS-based thiomers. Moreover, it was found that the pretreatment of Caco-2 cell monolayer with GCS-NAC or GCS restores Rho-123 cell entrance by inhibiting P-gp activity. Hence, GCS-NAC and GCS may constitute new biomaterials useful for improving the bioavailability of P-gp substrates.

Globular clusters in high-redshift dwarf galaxies: a case study from the Local Group

NASA Astrophysics Data System (ADS)

Zick, Tom O.; Weisz, Daniel R.; Boylan-Kolchin, Michael

2018-06-01

We present the reconstructed evolution of rest-frame ultraviolet (UV) luminosities of the most massive Milky Way dwarf spheroidal satellite galaxy, Fornax, and its five globular clusters (GCs) across redshift, based on analysis of the stellar fossil record and stellar population synthesis modelling. We find that (1) Fornax's (proto-)GCs can generate 10-100 times more UV flux than the field population, despite comprising <˜{5} per cent of the stellar mass at the relevant redshifts; (2) due to their respective surface brightnesses, it is more likely that faint, compact sources in the Hubble Frontier Fields (HFFs) are GCs hosted by faint galaxies, than faint galaxies themselves. This may significantly complicate the construction of a galaxy UV luminosity function at z > 3. (3) GC formation can introduce order-of-magnitude errors in abundance matching. We also find that some compact HFF objects are consistent with the reconstructed properties of Fornax's GCs at the same redshifts (e.g. surface brightness, star formation rate), suggesting we may have already detected proto-GCs in the early Universe. Finally, we discuss the prospects for improving the connections between local GCs and proto-GCs detected in the early Universe.

Gravitational wave sources from inspiralling globular clusters in the Galactic Centre and similar environments

NASA Astrophysics Data System (ADS)

Arca-Sedda, Manuel; Gualandris, Alessia

2018-07-01

We model the inspiral of globular clusters (GCs) towards a galactic nucleus harbouring a supermassive black hole (SMBH), a leading scenario for the formation of nuclear star clusters. We consider the case of GCs containing either an intermediate-mass black hole (IMBH) or a population of stellar-mass black holes (BHs), and study the formation of gravitational wave (GW) sources. We perform direct summation N-body simulations of the infall of GCs with different orbital eccentricities in the live background of a galaxy with either a shallow or steep density profile. We find that the GC acts as an efficient carrier for the IMBH, facilitating the formation of a bound pair. The hardening and evolution of the binary depends sensitively on the galaxy's density profile. If the host galaxy has a shallow profile, the hardening is too slow to allow for coalescence within a Hubble time, unless the initial cluster orbit is highly eccentric. If the galaxy hosts a nuclear star cluster, the hardening leads to coalescence by emission of GWs within 3-4 Gyr. In this case, we find an IMBH-SMBH merger rate of ΓIMBH-SMBH = 2.8 × 10-3 yr-1 Gpc3. If the GC hosts a population of stellar BHs, these are deposited close enough to the SMBH to form extreme mass ratio inspirals with a merger rate of ΓEMRI = 0.25 yr-1 Gpc3. Finally, the SMBH tidal field can boost the coalescence of stellar black hole binaries delivered from the infalling GCs. The merger rate for this merging channel is ΓBHB = 0.4-4 yr-1 Gpc3.

Glossary of AWS Acrinabs. Acronyms, Initialisms, and Abbreviations Commonly Used in Air Weather Service

DTIC Science & Technology

1991-01-01

Foundation FYDP ......... Five Year Defense Plan FSI ............ Fog Stability Index 17 G G ................ gravity, giga- GISM ......... Gridded ...Global Circulation Model GOES-TAP GOES imagery processing & dissemination system GCS .......... grid course GOFS ........ Global Ocean Flux Study GD...Analysis Support System Complex Systems GRID .......... Global Resource Information Data -Base GEMAG ..... geomagnetic GRIST..... grazing-incidence solar

Glucosylceramide is Critical for Cell-Type Differentiation and Organogenesis, but not for Cell Viability in Arabidopsis

PubMed Central

Msanne, Joseph; Chen, Ming; Luttgeharm, Kyle D.; Bradley, Amanda M.; Mays, Elizabeth S.; Paper, Janet M.; Boyle, Daniel L.; Cahoon, Rebecca E.; Schrick, Kathrin; Cahoon, Edgar B.

2015-01-01

Summary Glucosylceramides (GlcCer), glucose-conjugated sphingolipids, are major components of the endomembrane system and plasma membrane in most eukaryote cells. Yet, the quantitative significance and cellular functions of GlcCer are not well characterized in plants and other multi-organ eukaryotes. To address this, we examined Arabidopsis lines lacking or deficient in GlcCer by insertional disruption or by RNAi suppression of the single gene for GlcCer synthase (GCS, At2g19880), the enzyme that catalyzes GlcCer synthesis. Null mutants for GCS (designated “gcs-1”) were viable as seedlings, albeit strongly reduced in size, and failed to develop beyond the seedling stage. Heterozygous plants harboring the insertion allele exhibited reduced transmission through the male gametophyte. Undifferentiated calli generated from gcs-1 seedlings and lacking GlcCer proliferated in a manner similar to calli from wild-type plants. However, gcs-1 calli, in contrast to wild-type calli, were unable to develop organs on differentiation media. Consistent with a role for GlcCer in organ-specific cell differentiation, calli from gcs-1 mutants formed roots and leaves on media supplemented with the glucosylated sphingosine glucopsychosine, which was readily converted to GlcCer independent of GCS. Underlying these phenotypes, gcs-1 cells had altered Golgi morphology and fewer cisternae per Golgi apparatus relative to wild-type cells, indicative of protein trafficking defects. Despite seedling lethality in the null mutant, GCS RNAi suppression lines with ≤2% of wild-type GlcCer levels were viable and fertile. Collectively, these results indicate that GlcCer are essential for cell-type differentiation and organogenesis, and plant cells produce GlcCer amounts in excess of that required for normal development. PMID:26313010

Emerging Genetic Counselor Roles within the Biotechnology and Pharmaceutical Industries: as Industry Interest Grows in Rare Genetic Disorders, How are Genetic Counselors Joining the Discussion?

PubMed

Field, Tessa; Brewster, Stephanie Jo; Towne, Meghan; Campion, MaryAnn W

2016-08-01

Traditionally, the biotechnology and pharmaceutical industry (BPI) has focused drug development at the mass-market level targeting common medical issues. However, a recent trend is the development of therapies for orphan or rare disorders, including many genetic disorders. Developing treatments for genetic disorders requires an understanding of the needs of the community and translating genomic information to clinical and non-clinical audiences. The core skills of genetic counselors (GCs) include a deep knowledge of genetics and ability to communicate complex information to a broad audience, making GCs a choice fit for this shift in drug development. To date there is limited data defining the roles GCs hold within this industry. This exploratory study aimed to define the roles and motivation of GCs working in BPI, assess job satisfaction, and identify translatable skills and current gaps in GC training programs. The authors surveyed 26 GCs working in BPI in the United States; 79 % work for companies focused on rare disorders. GC positions in BPI are growing, with 57 % of respondents being the first GC in their role. GCs in BPI continue to utilize core genetic counseling competencies, though 72 % felt their training did not fully prepare them for BPI. These data suggest opportunities for exposure to BPI in GC training to better prepare future generations of GCs for these career opportunities. GC satisfaction was high in BPI, notably in areas traditionally reported as less satisfying on the National Society for Genetic Counselors Professional Status Survey: salary and advancement opportunities. BPI's growing interest in rare disorders represents a career opportunity for GCs, addressing both historic areas of dissatisfaction for GCs and BPI's genomic communication needs.

Prohibitin regulates the FSH signaling pathway in rat granulosa cell differentiation.

PubMed

Chowdhury, Indrajit; Thomas, Kelwyn; Zeleznik, Anthony; Thompson, Winston E

2016-05-01

Published results from our laboratory identified prohibitin (PHB), a gene product expressed in granulosa cells (GCs) that progressively increases during follicle maturation. Our current in vitro studies demonstrate that follicle-stimulating hormone (FSH) stimulates Phb expression in rat primary GCs. The FSH-dependent expression of PHB was primarily localized within mitochondria, and positively correlates with the morphological changes in GCs organelles, and synthesis and secretions of estradiol (E2) and progesterone (P4). In order to confirm that PHB plays a regulatory role in rat GC differentiation, endogenous PHB-knockdown studies were carried out in undifferentiated GCs using adenoviral (Ad)-mediated RNA interference methodology. Knockdown of PHB in GCs resulted in the suppression of the key steroidogenic enzymes including steroidogenic acute regulatory protein (StAR), p450 cholesterol side-chain cleavage enzyme (p450scc), 3β-hydroxysteroid dehydrogenase (3β-HSD), and aromatase (Cyp19a1); and decreased E2 and P4 synthesis and secretions in the presence of FSH stimulation. Furthermore, these experimental studies also provided direct evidence that PHB within the mitochondrial fraction in GCs is phosphorylated at residues Y249, T258, and Y259 in response to FSH stimulation. The observed levels of phosphorylation of PHB at Y249, T258, and Y259 were significantly low in GCs in the absence of FSH stimulation. In addition, during GC differentiation FSH-induced expression of phospho-PHB (pPHB) requires the activation of MEK1-ERK1/2 signaling pathway. Taken together, these studies provide new evidence supporting FSH-dependent PHB/pPHB upregulation in GCs is required to sustain the differentiated state of GCs. © 2016 The authors.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang Qiushi; Peng, Eric W.; Blakeslee, John P.

We study the azimuthal distribution of globular clusters (GCs) in early-type galaxies and compare them to their host galaxies using data from the ACS Virgo Cluster Survey. We find that in host galaxies with visible elongation ({epsilon} > 0.2) and intermediate to high luminosities (M{sub z} < -19), the GCs are preferentially aligned along the major axis of the stellar light. The red (metal-rich) GC subpopulations show strong alignment with the major axis of the host galaxy, which supports the notion that these GCs are associated with metal-rich field stars. The metal-rich GCs in lenticular galaxies show signs of beingmore » more strongly associated with disks rather than bulges. Surprisingly, we also find that the blue (metal-poor) GCs can also show the same correlation. If the metal-poor GCs are part of the early formation of the halo and built up through mergers, then our results support a picture where halo formation and merging occur anisotropically, and that the present-day major axis is an indicator of the preferred merging axis.« less

Glasgow Coma Scale and Its Components on Admission: Are They Valuable Prognostic Tools in Acute Mixed Drug Poisoning?

PubMed Central

Eizadi Mood, N.; Sabzghabaee, A. M.; Yadegarfar, Gh.; Yaraghi, A.; Ramazani Chaleshtori, M.

2011-01-01

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning. PMID:21559299

Glycoconjugates as Mediators of Nitric Oxide Production upon Exposure to Bacterial Spores by Macrophages

NASA Astrophysics Data System (ADS)

Lahiani, Mohamed; Soderberg, Lee; Tarasenko, Olga

2011-06-01

Phagocytes generate nitric oxide (NO) in large quantities to combat bacteria. The spore-producing Gram-positive organisms of Bacillus cereus family are causative agents from mild to a life threatening infection in humans and domestic animals. Our group have shown that glycoconjugates (GCs) activate macrophages and enhance killing of Bacillus spores. In this investigation, we will explore the effect of different GCs structures on NO production. The objective of this study is to study effects of GCs 2, 4, 6, 8, 10 on NO release upon exposure to B. cereus and Bacillus anthracis spores by macrophages. Our results demonstrated that GCs activated macrophages and increased NO production using studied GCs ligands compared to macrophage only (p<0.001). GC2 and GC8 were able to further increase NO production in macrophages compared to the B. anthracis spores treated macrophages (p<0.001). Our finding suggests that GCs could be used as potential mediators of NO production in macrophages to fight B. anthracis and other pathogens.

Unique Fe2P Nanoparticles Enveloped in Sandwichlike Graphited Carbon Sheets as Excellent Hydrogen Evolution Reaction Catalyst and Lithium-Ion Battery Anode.

PubMed

Zhang, Yan; Zhang, Huijuan; Feng, Yangyang; Liu, Li; Wang, Yu

2015-12-09

The novel Fe2P nanoparticles encapsulated in sandwichlike graphited carbon envelope nanocomposite (Fe2P/GCS) that can be first applied in hydrogen evolution reaction (HER) as well as lithium-ion batteries (LIBs) has been designed and fabricated. The unique sandwiched Fe2P/GCS is characterized with several prominent merits, including large specific surface area, nanoporous structure, excellent electronic conductivity, enhanced structural integrity and so on. All of these endow the Fe2P/GCS with brilliant electrochemical performance. When used as a HER electrocatalyst in acidic media, the harvested Fe2P/GCS demonstrates low onset overpotential and Tafel slope as well as particularly outstanding durability. Moreover, as an anode material for LIBs, the sandwiched Fe2P/GCS presents high specific capacity and excellent cyclability and rate capability. As a consequence, the acquired Fe2P/GCS is a promising material for energy applications, especially HER and LIBs.

Development of Magnetic Resonance Imaging Biomarkers for Traumatic Brain Injury

DTIC Science & Technology

2014-09-01

beta4 improves functional neurological outcome in a rat model of embolic stroke. Neuroscience 169:674–682. Morris DC, Zhang ZG, Zhang J, Xiong Y, Zhang...score of 15 with abrasion and a small laceration on his left eyebrow without closure and left clavicle fracture . His major clinical symptoms were left...Issue 11 | e80296 patient was a victim of an assault and suffered brief loss of consciousness and femur fracture . He presented in the ED with a GCS

The Little Engines That Could? Globular Clusters Contribute Significantly to Reionization-era Star Formation

NASA Astrophysics Data System (ADS)

Boylan-Kolchin, Michael

2018-06-01

Metal-poor globular clusters (GCs) are both numerous and ancient, which indicates that they may be important contributors to ionizing radiation in the reionization era. Starting from the observed number density and stellar mass function of old GCs at z = 0, I compute the contribution of GCs to ultraviolet luminosity functions (UVLFs) in the high-redshift Universe (10 ≳ z ≳ 4). Even under absolutely minimal assumptions - no disruption of GCs and no reduction in GC stellar mass from early times to the present - GC star formation contributes non-negligibly to the UVLF at luminosities that are accessible to the Hubble Space Telescope (HST; M1500 ≈ -17). If the stellar masses of GCs were significantly higher in the past, as is predicted by most models explaining GC chemical anomalies, then GCs dominate the UV emission from many galaxies in existing deep-field observations. On the other hand, it is difficult to reconcile observed UVLFs with models requiring stellar masses at birth that exceed present-day stellar masses by more than a factor of 5. The James Webb Space Telescope (JWST) will be able to directly detect individual GCs at z ˜ 6 in essentially all bright galaxies, and many galaxies below the knee of the UVLF, for most of the scenarios considered here. The properties of a subset of high-redshift sources with -19 ≲ M_{1500} ≲ -14 in HST lensing fields indicate that they may actually be GCs in formation.

A Bayesian framework for early risk prediction in traumatic brain injury

NASA Astrophysics Data System (ADS)

Chaganti, Shikha; Plassard, Andrew J.; Wilson, Laura; Smith, Miya A.; Patel, Mayur B.; Landman, Bennett A.

2016-03-01

Early detection of risk is critical in determining the course of treatment in traumatic brain injury (TBI). Computed tomography (CT) acquired at admission has shown latent prognostic value in prior studies; however, no robust clinical risk predictions have been achieved based on the imaging data in large-scale TBI analysis. The major challenge lies in the lack of consistent and complete medical records for patients, and an inherent bias associated with the limited number of patients samples with high-risk outcomes in available TBI datasets. Herein, we propose a Bayesian framework with mutual information-based forward feature selection to handle this type of data. Using multi-atlas segmentation, 154 image-based features (capturing intensity, volume and texture) were computed over 22 ROIs in 1791 CT scans. These features were combined with 14 clinical parameters and converted into risk likelihood scores using Bayes modeling. We explore the prediction power of the image features versus the clinical measures for various risk outcomes. The imaging data alone were more predictive of outcomes than the clinical data (including Marshall CT classification) for discharge disposition with an area under the curve of 0.81 vs. 0.67, but less predictive than clinical data for discharge Glasgow Coma Scale (GCS) score with an area under the curve of 0.65 vs. 0.85. However, in both cases, combining imaging and clinical data increased the combined area under the curve with 0.86 for discharge disposition and 0.88 for discharge GCS score. In conclusion, CT data have meaningful prognostic value for TBI patients beyond what is captured in clinical measures and the Marshall CT classification.

Detailed abundance analysis of globular clusters in the Local Group. NGC 147, NGC 6822, and Messier 33

NASA Astrophysics Data System (ADS)

Larsen, S. S.; Brodie, J. P.; Wasserman, A.; Strader, J.

2018-06-01

Context. Globular clusters (GCs) are emerging as powerful tracers of the chemical composition of extragalactic stellar populations. Aims: We present new abundance measurements for 11 GCs in the Local Group galaxies NGC 147, NGC 6822, and Messier 33. These are combined with previously published observations of four GCs in the Fornax and Wolf-Lundmark-Melotte (WLM) galaxies. Methods: The abundances were determined from analyses of integrated-light spectra obtained with the HIRES spectrograph on the Keck I telescope and with UVES on the Very Large Telescope (VLT). We used our analysis technique that was developed for this purpose and tested on Milky Way GCs. Results: We find that the clusters with [Fe/H] < -1.5 are all α-enhanced at about the same level as Milky Way GCs. Their Na abundances are also generally enhanced relative to Milky Way halo stars, suggesting that these extragalactic GCs resemble their Milky Way counterparts in containing large numbers of Na-rich stars. For [Fe/H] > -1.5, the GCs in M33 are also α-enhanced, while the GCs that belong to dwarfs (NGC 6822 SC7 and Fornax 4) have closer to solar-scaled α-element abundances. The abundance patterns in SC7 are remarkably similar to those in the Galactic GC Ruprecht 106, including significantly subsolar [Na/Fe] and [Ni/Fe] ratios. In NGC 147, the GCs with [Fe/H] < -2.0 account for about 6% of the total luminosity of stars in the same metallicity range, a lower fraction than those previously found in the Fornax and WLM galaxies, but substantially higher than in the Milky Way halo. Conclusions: At low metallicities, the abundance patterns suggest that GCs in the Milky Way, dwarf galaxies, and M33 experienced similar enrichment histories and/or processes. At higher metallicities, the lower levels of α-enhancement in the GCs found in dwarf galaxies resemble the abundance patterns observed in field stars in nearby dwarfs. Constraining the presence of multiple populations in these GCs is complicated by lack of information about detailed abundances in field stars of the corresponding metallicities. We suggest that correlations such as [Na/Fe] versus [Ni/Fe] may prove useful for this purpose if an accuracy of 0.1 dex or better can be reached for integrated-light measurements. Tables A.1-A.15 (individual abundance measurements) are only available at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/613/A56

Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims.

PubMed

Staff, T; Eken, T; Wik, L; Røislien, J; Søvik, S

2014-01-01

Current literature on motor vehicle accidents (MVAs) has few reports regarding field factors that predict the degree of injury. Also, studies of mechanistic factors rarely consider concurrent predictive effects of on-scene patient physiology. The New Injury Severity Score (NISS) has previously been found to correlate with mortality, need for ICU admission, length of hospital stay, and functional recovery after trauma. To potentially increase future precision of trauma triage, we assessed how the NISS is associated with physiologic, demographic and mechanistic variables from the accident site. Using mixed-model linear regression analyses, we explored the association between NISS and pre-hospital Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS) categories of respiratory rate (RR) and systolic blood pressure (SBP), gender, age, subject position in the vehicle, seatbelt use, airbag deployment, and the estimated squared change in vehicle velocity on impact ((Δv)(2)). Missing values were handled with multiple imputation. We included 190 accidents with 353 dead or injured subjects (mean NISS 17, median NISS 8, IQR 1-27). For the 307 subjects in front-impact MVAs, the mean increase in NISS was -2.58 per GCS point, -2.52 per RR category level, -2.77 per SBP category level, -1.08 for male gender, 0.18 per year of age, 4.98 for driver vs. rear passengers, 4.83 for no seatbelt use, 13.52 for indeterminable seatbelt use, 5.07 for no airbag deployment, and 0.0003 per (km/h)(2) velocity change (all p<0.002). This study in victims of MVAs demonstrated that injury severity (NISS) was concurrently and independently predicted by poor pre-hospital physiologic status, increasing age and female gender, and several mechanistic measures of localised and generalised trauma energy. Our findings underscore the need for precise information from the site of trauma, to reduce undertriage, target diagnostic efforts, and anticipate need for high-level care and rehabilitative resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

Tacrolimus in the treatment of myasthenia gravis in patients with an inadequate response to glucocorticoid therapy: randomized, double-blind, placebo-controlled study conducted in China.

PubMed

Zhou, Lei; Liu, Weibin; Li, Wei; Li, Haifeng; Zhang, Xu; Shang, Huifang; Zhang, Xu; Bu, Bitao; Deng, Hui; Fang, Qi; Li, Jimei; Zhang, Hua; Song, Zhi; Ou, Changyi; Yan, Chuanzhu; Liu, Tao; Zhou, Hongyu; Bao, Jianhong; Lu, Jiahong; Shi, Huawei; Zhao, Chongbo

2017-09-01

To determine the efficacy of low-dose, immediate-release tacrolimus in patients with myasthenia gravis (MG) with inadequate response to glucocorticoid therapy in a randomized, double-blind, placebo-controlled study. Eligible patients had inadequate response to glucocorticoids (GCs) after ⩾6 weeks of treatment with prednisone ⩾0.75 mg/kg/day or 60-100 mg/day. Patients were randomized to receive 3 mg tacrolimus or placebo daily (orally) for 24 weeks. Concomitant glucocorticoids and pyridostigmine were allowed. Patients continued GC therapy from weeks 1-4; from week 5, the dose was decreased at the discretion of the investigator. The primary efficacy outcome measure was a reduction, relative to baseline, in quantitative myasthenia gravis (QMG) score assessed using a generalized linear model; supportive analyses used alternative models. Of 138 patients screened, 83 [tacrolimus ( n = 45); placebo ( n = 38)] were enrolled and treated. The change in adjusted mean QMG score from baseline to week 24 was -4.9 for tacrolimus and -3.3 for placebo (least squares mean difference: -1.7, 95% confidence interval: -3.5, -0.1; p = 0.067). A post-hoc analysis demonstrated a statistically significant difference for QMG score reduction of ⩾4 points in the tacrolimus group (68.2%) versus the placebo group (44.7%; p = 0.044). Adverse event profiles were similar between treatment groups. Tacrolimus 3 mg treatment for patients with MG and inadequate response to GCs did not demonstrate a statistically significant improvement in the primary endpoint versus placebo over 24 weeks; however, a post-hoc analysis demonstrated a statistically significant difference for QMG score reduction of ⩾4 points in the tacrolimus group versus the placebo group. This study was limited by the low number of patients, the absence of testing for acetylcholine receptor antibody and the absence of stratification by disease duration (which led to a disparity between the two groups). ClinicalTrials.gov identifier: NCT01325571.

Early increase of neutrophil-to-lymphocyte ratio predicts 30-day mortality in patients with spontaneous intracerebral hemorrhage.

PubMed

Wang, Fei; Xu, Feng; Quan, Ye; Wang, Li; Xia, Jian-Jun; Jiang, Ting-Ting; Shen, Li-Juan; Kang, Wen-Hui; Ding, Yong; Mei, Li-Xia; Ju, Xue-Feng; Hu, Shan-You; Wu, Xiao

2018-05-16

To examine whether early rise of neutrophil-to-lymphocyte ratio (NLR) after patient hospitalization correlates with 30-day mortality in patients with spontaneous intracerebral hemorrhage (ICH). This retrospective study included all patients receiving treatment for spontaneous ICH between January 2015 and September 2016 at the Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences in Shanghai, China. NLR was determined at admission (T1), at 24-48 hours (T2) and 5-7 days (T3). NLR and clinicopathologic features were compared between those who survived for >30 days vs not. Multivariate regression was used to identify risk factors for 30-day mortality. A total of 275 subjects were included in the analysis: 235 survived for at least 30 days; the remaining 40 subjects died within 30 days. The patients who died within 30 days had higher ICH score, larger ICH volume, and lower GCS score (all P < 0.05). In comparison with the baseline (NLR T 1 ), NLR at 24-48 hours (NLR T 2 ) and 5-7 days (NLR T 3 ) was significantly higher in patients who died within 30 days (P < 0.05), but not in patients surviving for >30 days. In the multivariate analysis, the 30-day mortality was associated with both NLR T 2 (OR 1.112, 95%CI 1.032-1.199, P = 0.006) and NLR T 3 (OR 1.163, 95%CI 1.067-1.268, P = 0.001). Spearman correlation analysis showed that both NLR T 2 and NLR T 3 correlated inversely with GCS score and positively with ICH score and ICH volume at the baseline. Early rise of NLR predicts 30-day mortality in patients with spontaneous ICH. © 2018 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Decompressive craniectomy or medical management for refractory intracranial hypertension: an AAST-MIT propensity score analysis.

PubMed

Nirula, Ram; Millar, D; Greene, Tom; McFadden, Molly; Shah, Lubdha; Scalea, Thomas M; Stein, Deborah M; Magnotti, Louis J; Jurkovich, Gregory J; Vercruysse, Gary; Demetriades, Demetrios; Scherer, Lynette A; Peitzman, Andrew; Sperry, Jason; Beauchamp, Kathryn; Bell, Scott; Feiz-Erfan, Iman; O'Neill, Patrick; Coimbra, Raul

2014-04-01

Moderate/severe traumatic brain injury (TBI) management involves minimizing cerebral edema to maintain brain oxygen delivery. While medical therapy (MT) consisting of diuresis, hyperosmolar therapy, ventriculostomy, and barbiturate coma is the standard of care, decompressive craniectomy (DC) for refractory intracranial hypertension (ICH) has gained renewed interest. Since TBI treatment guidelines consider DC a second-tier intervention after MT failure, we sought to determine if early DC (<48 hours) was associated with improved survival in patients with refractory ICH. Eleven Level 1 trauma centers provided clinical data and head computed tomographic scans for patients with a Glasgow Coma Scale (GCS) score of 13 or less and radiographic evidence of TBI excluding deaths within 48 hours. Computed tomographic scans were graded according to the Marshall classification. A propensity score to receive DC (regardless of whether DC was performed) was calculated for each patient based on patient characteristics, physiology, injury severity, GCS, severity of intracranial injury, and treatment center. Patients who actually received a DC were matched to patients with similar propensity scores who received MT for analysis. Outcomes were compared between early (<48 hours of injury) primary or secondary DC and matched controls and then between early primary DC only and matched controls. There were 2,602 patients who met the inclusion criteria ,of whom 264 (10.1%) received DC (either primary or secondary to another cranial procedure) and 109 (5%) had a DC that was primary. Variables associated with performing a DC included sex, race, intracranial pressure monitor placement, in-house trauma attending, traumatic subarachnoid hemorrhage, midline shift, and basal cistern compression. There was no survival benefit with early primary DC compared with the controls (relative risk, 1.07; 95% confidence interval, 0.67-1.73; p = 0.77), and resource use was higher. Early DC does not seem to significantly improve mortality in patients with refractory ICH compared with MT. Neurosurgeons should pause before entertaining this resource-demanding form of therapy. Therapeutic care/management, level III.

Quantitative analysis of development and aging of genital corpuscles in glans penis of the rat.

PubMed

Shiino, Mizuho; Hoshi, Hideo; Kawashima, Tomokazu; Ishikawa, Youichi; Takayanagi, Masaaki; Murakami, Kunio; Kishi, Kiyoshi; Sato, Fumi

2015-02-01

The aim of the present postnatal developmental study was to determine densities of unique genital corpuscles (GCs) in glans penis of developing and aged rats. GCs were identified as corpuscular endings consisting of highly branched and coiled axons with many varicosities, which were immunoreactive for protein gene product 9.5. In addition, GCs were immunoreactive for calcitonin gene-related peptide and substance P, but not for vasoactive intestinal polypeptide and neuropeptide Y. GCs were not found in the glans penis of 1 week old rats. Densities of GCs were low at 3 weeks, significantly increased at 5 and 10 weeks, reached the peak of density at 40 weeks, and tended to decrease at 70 and 100 weeks. Sizes of GCs were small in 3 weeks old rats, increased at 5 and 10 weeks, reached the peak-size at 40 weeks and reduced in size at 70 and 100 weeks. Considering sexual maturation of the rat, the results reveal that GCs of the rat begins to develop postnatal and reaches to the peak of their development after puberty and continues to exist until old age, in contrast to prenatal and early postnatal development of other sensory receptors of glabrous skin. Copyright © 2014 Elsevier Ltd. All rights reserved.

Deep photometry of two accreted families of globular clusters in the remote M31 halo

NASA Astrophysics Data System (ADS)

Mackey, Dougal

2013-10-01

Globular clusters {GCs} are fossil relics from which we can obtain critical insights into the merger and accretion events that underlie hierarchical galaxy assembly. As part of the major Pan-Andromeda Archaeological Survey {PAndAS} we have discovered two groups of GCs that closely trace narrow stellar debris streams in the M31 halo. These clearly represent two distinct accreted families of GCs - the only known examples apart from the few Galactic GCs arriving with the Sagittarius dwarf. We propose to obtain deep ACS imaging of 14 GCs spanning these two accreted families, allowing us to measure the constituent stellar populations, line-of-sight distance, and structural parameters of each object. We will, for the first time, quantify the typical properties of accreted GCs in the M31 halo as well as the degree of variation amongst them, and how closely they correspond to the suspected accreted GC population in the Milky Way. Combined with new radial velocity measurements for the GCs, our proposed observations will allow us to trace the 3D orbits of the two streams within the M31 halo, and thus break the main degeneracies that plague numerical models designed to probe the gravitational potential and distribution of dark mass.

Glycoconjugates Effects: do Gender and Ethnicity Influence Exposure of Pathogen by Peripheral Mononuclear Cells ?

NASA Astrophysics Data System (ADS)

Lahiani, Mohamed; Tarasenko, Olga

2010-04-01

Members of the Bacillus cereus group demonstrate different pathological effects. B. cereus is a spore-forming, gram positive bacterium responsible for most foodborne illnesses. It was shown that susceptibility to infection and response to vaccines or treatments can be attributed to specific immunogenetic factors including gender and ethnicity. Glycoconjugate polymers (GCs) are potentially important in pharmaceutical and biomedical research. Our group has shown that GCs activate murine macrophages and promote killing of Bacillus cereus spores during phagocytosis. We hypothesized that the GCs effects are independent from gender and race. The goal of the present study was two-folds: A) determine whether GCs influence on human PMNC exposure of B. cereus spores and B) analyze whether gender and ethnicity influence of the effect of GCs. GCs were studied during exposure and post-exposure conditions. Phagocytosis was performed during exposure of PMNC to Bacillus spores. Post-exposure analysis involved cytotoxicity, cell viability and activation, and colonies forming unit. GC1 and GC3 enhance Bacillus spore killing. GC1 proved more effective than GC3 in spore killing while activating PMNC. Results demonstrate GCs effect were independent from ethnicity or gender. Findings of this research demonstrated that GC can be used as ligands to stimulate PMNC and kill B. cereus spores.

Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

PubMed

Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

2016-10-01

Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61.6%), the neurosurgery group had the highest proportion of intensive care unit admission (29.8%), and the neurology group had the longest emergency department stay (7.5 hours), there were no significant differences in duration of hospital stay, in-hospital complications, and readmission within 30 days. Although there were differences in use of health care resources, and the proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma, most clinical outcomes were similar in INOMHI patients admitted to trauma surgery, neurosurgery, or neurology in our institution. A rotational policy of admitting INOMHI patients is feasible among services with expertise in and commitment to the care of these patients. Therapeutic/care management study, level IV.

Clinical review: Do glucocorticosteroids alter vitamin D status? A systematic review with meta-analyses of observational studies.

PubMed

Davidson, Zoe E; Walker, Karen Z; Truby, Helen

2012-03-01

Vitamin D supplementation is an important adjunct therapy for the prevention and management of glucocorticoid-induced osteoporosis. There has been little exploration of the relationship between glucocorticosteroid (GCS) use and serum 25-hydroxyvitamin D [25(OH)D]. The aim of this study was to systematically explore how serum 25(OH)D is altered in adult patients receiving GCS. We reviewed Medline and Cinahl databases between January 1970 and August 2011. Experimental studies were included where 25(OH)D was measured in patients more than 18 yr of age receiving GCS therapy. Studies were excluded if patients received at least 400 IU/d (10 μg/d) vitamin D, if GCS treatment was less than 2-wk duration, if more than 50% of the study population received GCS for renal or hepatic disease or after transplant, or if the study population included patients with Cushing's syndrome. A consensus method was used to classify studies. Of identified studies, 3% met the selection criteria. Data were extracted by a single author. Study quality was assessed using criteria developed by the American Dietetic Association. The weighted mean 25(OH)D (by sample size or sd) was 22.4 [95% confidence interval (CI), 19.4, 25.3] ng/ml and 21.0 (95% CI, 13.5, 28.5) ng/ml, respectively. Random effects meta-analysis was used to compare serum 25(OH)D in patients treated with GCS compared to steroid-naive controls (either healthy or with active disease) and in patients before and after GCS administration. Serum 25(OH)D in GCS users was on average -0.5 (95% CI, -1.0, -0.1) ng/ml lower than in healthy controls (P=0.03; I2=56.4%). Serum 25(OH)D did not differ between GCS users and disease controls [standardized mean difference=0.0 (95% CI, -0.2, 0.3) ng/ml; P=0.793; I2=16.2%]. The suboptimal concentrations of serum 25(OH)D found in adults receiving GCS are inadequate for prevention and management of glucocorticoid-induced osteoporosis. Recommendations for vitamin D supplementation should be adjusted accordingly.

Optical-near-IR analysis of globular clusters in the IKN dwarf spheroidal: a complex star formation history

NASA Astrophysics Data System (ADS)

Tudorica, A.; Georgiev, I. Y.; Chies-Santos, A. L.

2015-09-01

Context. Age, metallicity, and spatial distribution of globular clusters (GCs) provide a powerful tool for reconstructing major star-formation episodes in galaxies. IKN is a faint dwarf spheroidal (dSph) in the M 81 group of galaxies. It contains five old GCs, which makes it the galaxy with the highest known specific frequency (SN = 126). Aims: We estimate the photometric age, metallicity, and spatial distribution of the poorly studied IKN GCs. We search SDSS for GC candidates beyond the HST/ACS field of view, which covers half of IKN. Methods: To break the age-metallicity degeneracy in the colour, we used WHT/LIRIS KS-band photometry and derived photometric ages and metallicities by comparison with SSP models in the V,I,Ks colour space. Results: IKN GCs' VIKs colours are consistent with old ages (≥8 Gyr) and a metallicity distribution with a higher mean than is typical for such a dSph ([Fe/H] ≃ -1.4-0.2+0.6 dex). Their photometric mass range (0.5 < ℳGC< 4 × 105 M⊙) implies an unusually high mass ratio between GCs and field stars, of 10.6%. Mixture model analysis of the RGB field stars' metallicity suggests that 72% of the stars may have formed together with the GCs. Using the most massive GC-SFR relation, we calculated a star formation rate (SFR) of ~10 M⊙/yr during its formation epoch. We note that the more massive GCs are closer to the galaxy photometric centre. IKN GCs also appear spatially aligned along a line close to the major axis of the IKN and nearly orthogonal to the plane of spatial distribution of galaxies in the M 81 group. We identify one new IKN GC candidate based on colour and the PSF analysis of the SDSS data. Conclusions: The evidence of i) broad and high metallicity distribution of the field IKN RGB stars and its GCs, ii) high fraction, and iii) spatial alignment of IKN GCs supports a scenario for tidally triggered, complex IKN's star formation history in the context of interactions with galaxies in the M 81 group.

Evaluation of Trastuzumab-induced early cardiac dysfunction using two-dimensional Strain Echocardiography.

PubMed

Emren, Sadik Volkan; Tuluce, Selcen Yakar; Levent, Fatih; Tuluce, Kamil; Kalkan, Toygar; Yildiz, Yasar; Alacacioğlu, Ahmet; Kucukzeybek, Yüksel; Akyol, Murat; Salman, Tarık

2015-12-01

Trastuzumab, a chemotherapeutic agent used in the treatment of breast cancer. has been shown to induce subclinical left ventricular (LV) dysfunction during a three to six month period as evidenced by strain echocardiographic examination without any change occurring in the ejection fraction of LV. The present study evaluated the presence of subclinical LV dysfunction using strain echocardiography 1 day and 7 days after the initiation of trastuzumab therapy. The patients with breast cancer receiving adjuvant trastuzumab therapy underwent 2-dimensional, tissue Doppler, and strain echocardiographic examination at baseline and 1 day and 7 days after therapy. LV global longitudinal strain (GLS), global circumferential strain (GCS) values, and other echocardiographic parameters were calculated. A total of 40 females, mean age 50+/-10 years, were evaluated. Of these patients, 97% received anthracycline and 73% received radiotherapy before the initiation of trastuzumab therapy. No change was observed in any of the echocardiographic parameters 1 day after the initiation of trastuzumab therapy (p>0.05). The LV ejection fraction, tissue Doppler parameters, and GCS values did not show any changes 7 days after the initiation of therapy, whereas significant decreases were observed in GLS value (19.2+/-4.0% vs. 17.2+/-3.4, p=0.001) and systolic annular velocity of the lateral LV wall (S' velocity) (10.5+/-3.2 vs. 8.6+/-2.2, p=0.002). Trastuzumab therapy is associated with subclinical LV dysfunction as early as 7 days after initiation of the therapy as evidenced by the decreases in GLS value of LV and systolic annular velocity of the lateral LV wall.

Review article: the investigation and management of gastric neuroendocrine tumours.

PubMed

Basuroy, R; Srirajaskanthan, R; Prachalias, A; Quaglia, A; Ramage, J K

2014-05-01

Gastric carcinoids (GCs) or neuroendocrine tumours (NETs) are increasingly identified at endoscopy, and account for 0.6-2% of all gastric polyps identified. The SEER database in the US has demonstrated a rising incidence of gastric NETs amongst all NETs; from 2.2% between 1950 and 1969 to 6.0% between 2000 and 2007. To review the literature and assist clinicians in managing patients with GCs. A literature search was conducted through MEDLINE using search terms: gastric, carcinoid, neuroendocrine tumour, therapy, endoscopy, mucosal resection, submucosal dissection. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles. There are three types of GCs with important epidemiological, pathophysiological, histological and endoscopic differences that affect prognosis and management. Type 1 and 2 GCs develop in the context of hypergastrinaemia that originates from achlorhydria in atrophic gastritis and a gastrinoma, respectively. Type 3 GCs occur sporadically and independent of gastrin. The histological type, grade and Ki67 index are used to determine prognosis and direct clinical management. Type 1 GCs >1 cm in size and type 2 GCs should be assessed for invasion beyond the submucosa with EUS prior to endoscopic resection with EMR or ESD. Type 3 GCs should be managed as per recommendations for gastric adenocarcinoma. The treatment of advanced disease is multimodal. Patients with gastric carcinoids should be discussed in a specialist neuroendocrine tumour multidisciplinary meeting to ensure all treatment options are explored in localised and advanced disease. Areas of controversy exist that need further research. © 2014 John Wiley & Sons Ltd.

A Chandra Study of the Stellar X-Ray Emissivity of Globular Clusters in the M31 Bulge

NASA Astrophysics Data System (ADS)

Xu, Xiao-jie; Li, Zhiyuan

2018-03-01

The X-ray emissivity (i.e., luminosity per unit stellar mass) of globular clusters (GCs) is an important indicator of their dynamical evolution history. Based on deep archival Chandra observations, we report a stacking analysis of 44 GCs with 0.5–8 keV luminosities L X ≲ 1035 erg s‑1 in the M31 bulge, which are supposed to be dominated by cataclysmic variables (CVs) and coronally active binaries (ABs). We obtain a significant detection at the 5σ level in 0.5–8 keV band. The average X-ray luminosity per GC and the average X-ray emissivity are determined to be 5.3 ± 1.6 × 1033 erg s‑1 and 13.2 ± 4.3 × 1027 erg s‑1 {M}ȯ -1, respectively. Both of these values are consistent with those of Milky Way GCs. Moreover, the measured emissivity of M31 GCs is also consistent with that of the Milky Way field stars. Massive GCs have X-ray luminosities that are marginally higher than those of less massive ones. Massive GCs also show a lower emissivity (5.0+/- 2.5× {10}27 {erg} {{{s}}}-1 {M}ȯ -1) than less massive ones (26.5+/- 14.3× {10}27 {erg} {{{s}}}-1 {M}ȯ -1), which is consistent with the scenario that the (progenitors of) CVs and ABs were more efficiently destroyed via stellar encounters in the more massive GCs. No dependence of the X-ray emissivity on GC color or on the projected galactocentric distance of GCs is found.

Opposite Effects of Cortisol on Consolidation of Temporal Sequence Memory during Waking and Sleep

ERIC Educational Resources Information Center

Wilhelm, Ines; Wagner, Ullrich; Born, Jan

2011-01-01

Memory functions involve three stages: encoding, consolidation, and retrieval. Modulating effects of glucocorticoids (GCs) have been consistently observed for declarative memory with GCs enhancing encoding and impairing retrieval, but surprisingly, little is known on how GCs affect memory consolidation. Studies in rats suggest a beneficial effect…

Can Graduated Compressive Stockings Reduce Muscle Activity during Running?

ERIC Educational Resources Information Center

Lucas-Cuevas, Ángel Gabriel; Priego Quesada, José Ignacio; Giménez, José Vicente; Aparicio, Inmaculada; Cortell-Tormo, Juan Manuel; Pérez-Soriano, Pedro

2017-01-01

Purpose: Graduated compressive stockings (GCS) have been suggested to influence performance by reducing muscle oscillations and improving muscle function and efficiency. However, no study to date has analyzed the influence of GCS on muscle activity during running. The objective of the study was to analyze the influence of GCS on the perception of…

Hyperammonemia in Urinary Tract Infections.

PubMed

Kenzaka, Tsuneaki; Kato, Ken; Kitao, Akihito; Kosami, Koki; Minami, Kensuke; Yahata, Shinsuke; Fukui, Miho; Okayama, Masanobu

2015-01-01

The present study investigated the incidence of hyperammonemia in urinary tract infections and explored the utility of urinary obstruction relief and antimicrobial administration to improve hyperammonemia. This was an observational study. Subjects were patients who were diagnosed with urinary tract infection and hospitalized between June 2008 and June 2009. We measured plasma ammonia levels on admission in patients who were clinically diagnosed with urinary tract infection and hospitalized. We assessed each patient's level of consciousness on admission using the Glasgow Coma Scale (GCS) and performed urine and blood cultures. We also assessed hearing prior to hospitalization using the Eastern Cooperative Oncology Group performance status (ECOG-PS). In cases with high ammonia levels on admission, plasma ammonia and GCS were measured 24 hours and 5-7 days later. Sixty-seven candidates were enrolled; of these, 60 cases (89.6%) with bacterial cell counts ≥10(4) CFU/mL were studied. Five cases (8.3%) presented with high plasma ammonia levels. Cases with hyperammonemia were significantly more likely to present with low GCS scores and urinary retention rate. All five cases received antimicrobial therapy with an indwelling bladder catheter to relieve urinary retention. The case 5 patient died shortly after admission due to complicated aspiration pneumonia; in the remaining cases, plasma ammonia levels were rapidly normalized and the level of consciousness improved. The occurrence of hyperammonemia in urinary tract infections is not rare. The cause of hyperammonemia is urinary retention obstruction. Therefore, along with antimicrobial administration, relief of obstruction is important for the treatment of hyperammonemia caused by this mechanism.

Long-term air pollution and traffic noise exposures and cognitive function:A cross-sectional analysis of the Heinz Nixdorf Recall study.

PubMed

Tzivian, Lilian; Dlugaj, Martha; Winkler, Angela; Hennig, Frauke; Fuks, Kateryna; Sugiri, Dorothee; Schikowski, Tamara; Jakobs, Hermann; Erbel, Raimund; Jöckel, Karl-Heinz; Moebus, Susanne; Hoffmann, Barbara; Weimar, Christian

2016-01-01

Investigations of adverse effects of air pollution (AP) and ambient noise on cognitive functions are apparently scarce, and findings seem to be inconsistent. The aim of this study was to examine the associations of long-term exposure to AP and traffic noise with cognitive performance. At the second examination of the population-based Heinz Nixdorf Recall study (2006-2008), cognitive performance was evaluated in 4086 participants. Long-term residential exposure to size-specific particulate matter (PM) and nitrogen oxides (NOx) with land use regression, to and traffic noise (weighted 24-h (L DEN ) and nighttime (L NIGHT ) means), was assessed according to the European Union (EU) Directive 2002/49/EC. Multiple regression models were calculated for the relationship of environmental exposures with a global cognitive score (GCS) and in five cognitive subtests, using single- and two-exposure models. In fully adjusted models, several AP metrics were negatively associated with four of five subtests and with GCS. For example, an interquartile range increase in PM 2.5 was correlated with verbal fluency, labyrinth test, and immediate and delayed verbal recall. A 10 dB(A) elevation in L DEN and L NIGHT was associated with GCS. Similar but not significant associations were found for the cognitive subtests. In two-exposure models including noise and air pollution simultaneously, the associations did not change markedly for air pollution, but attenuated numerically for noise. Long-term exposures to AP and traffic noise are negatively correlated with subtests related to memory and executive functions. There appears to be little evidence for mutual confounding.

Does semiology of status epilepticus have an impact on treatment response and outcome?

PubMed

Baysal-Kirac, Leyla; Feddersen, Berend; Einhellig, Marion; Rémi, Jan; Noachtar, Soheyl

2018-06-01

This study investigated whether there is an association between semiology of status epilepticus (SE) and response to treatment and outcome. Two hundred ninety-eight consecutive adult patients (160 females, 138 males) with SE at the University of Munich Hospital were prospectively enrolled. Mean age was 63.2±17.5 (18-97) years. Patient demographics, SE semiology and electroencephalography (EEG) findings, etiology, duration of SE, treatment, and outcome measures were investigated. Status epilepticus semiology was classified according to a semiological status classification. Patient's short-term outcome was determined by Glasgow Outcome Scale (GOS). The most frequent SE type was nonconvulsive SE (NCSE) (39.2%), mostly associated with cerebrovascular etiology (46.6%). A potentially fatal etiology was found in 34.8% of the patients. More than half (60.7%) of the patients had poor short-term outcome (GOS≤3) with an overall mortality of 12.4%. SE was refractory to treatment in 21.5% of the patients. Older age, potentially fatal etiology, systemic infections, NCSE in coma, refractory SE, treatment with anesthetics, long SE duration (>24h), low Glasgow Coma Scale (GCS) (≤8) at onset, and high Status Epilepticus Severity Score (STESS-3) (≥3) were associated with poor short-term outcome and death (p<0.05). Potentially fatal etiology and low GCS were the strongest predictors of poor outcome (Exp [b]: 4.74 and 4.10 respectively, p<0.05). Status epilepticus semiology has no independent association with outcome, but potentially fatal etiology and low GCS were strong predictive factors for poor short-term outcome of SE. Copyright © 2018 Elsevier Inc. All rights reserved.

The Hypothalamic-Pituitary-Adrenal Axis and the Fetus.

PubMed

Morsi, Amr; DeFranco, Donald; Witchel, Selma

2018-06-06

Glucocorticoids (GCs), cortisol in humans, influence multiple essential maturational events during gestation. In the human fetus, fetal hypothalamic-pituitary-adrenal (HPA) axis function, fetal adrenal steroidogenesis, placental 11β- hydroxysteroid dehydrogenase type 2 activity, maternal cortisol concentrations, and environmental factors impact fetal cortisol exposure. The beneficial effects of synthetic glucocorticoids (sGCs), such as dexamethasone and betamethasone, on fetal lung maturation have significantly shifted the management of preterm labor and threatened preterm birth. Accumulating evidence suggests that exposure to sGCs in utero at critical developmental stages can alter the function of organ systems and that these effects may have sequelae that extend into adult life. Maternal stress and environmental influences may also impact fetal GC exposure. This article explores the vulnerability of the fetal HPA axis to endogenous GCs and exogenous sGCs. © 2018 S. Karger AG, Basel.

The outer halo globular cluster system of M31 - I. The final PAndAS catalogue

NASA Astrophysics Data System (ADS)

Huxor, A. P.; Mackey, A. D.; Ferguson, A. M. N.; Irwin, M. J.; Martin, N. F.; Tanvir, N. R.; Veljanoski, J.; McConnachie, A.; Fishlock, C. K.; Ibata, R.; Lewis, G. F.

2014-08-01

We report the discovery of 59 globular clusters (GCs) and two candidate GCs in a search of the halo of M31, primarily via visual inspection of Canada-France-Hawaii Telescope/MegaCam imagery from the Pan-Andromeda Archaeological Survey (PAndAS). The superior quality of these data also allows us to check the classification of remote objects in the Revised Bologna Catalogue (RBC), plus a subset of GC candidates drawn from Sloan Digital Sky Survey (SDSS) imaging. We identify three additional new GCs from the RBC, and confirm the GC nature of 11 SDSS objects (8 of which appear independently in our remote halo catalogue); the remaining 188 candidates across both lists are either foreground stars or background galaxies. Our new catalogue represents the first uniform census of GCs across the M31 halo - we find clusters to the limit of the PAndAS survey area at projected radii of up to Rproj ˜ 150 kpc. Tests using artificial clusters reveal that detection incompleteness cuts in at luminosities below MV = -6.0; our 50 per cent completeness limit is MV ≈ -4.1. We construct a uniform set of PAndAS photometric measurements for all known GCs outside Rproj = 25 kpc, and any new GCs within this radius. With these data, we update results from Huxor et al., investigating the luminosity function (LF), colours and effective radii of M31 GCs with a particular focus on the remote halo. We find that the GCLF is clearly bimodal in the outer halo (Rproj > 30 kpc), with the secondary peak at MV ˜ -5.5. We argue that the GCs in this peak have most likely been accreted along with their host dwarf galaxies. Notwithstanding, we also find, as in previous surveys, a substantial number of GCs with above-average luminosity in the outer M31 halo - a population with no clear counterpart in the Milky Way.

Foamed Cement Interactions with CO 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

Verba, Circe; Montross, Scott; Spaulding, Richard

2017-02-02

Geologic carbon storage (GCS) is a potentially viable strategy to reduce greenhouse emissions. Understanding the risks to engineered and geologic structures associated with GCS is an important first step towards developing practices for safe and effective storage. The widespread utilization of foamed cement in wells may mean that carbon dioxide (CO 2)/brine/foamed cement reactions may occur within these GCS sites. Characterizing the difference in alteration rates as well as the physical and mechanical impact of CO 2/brine/foamed cement is an important preliminary step to ensuring offshore and onshore GCS is a prudent anthropogenic CO 2 mitigation choice.

Using formal specification in the Guidance and Control Software (GCS) experiment. Formal design and verification technology for life critical systems

NASA Technical Reports Server (NTRS)

Weber, Doug; Jamsek, Damir

1994-01-01

The goal of this task was to investigate how formal methods could be incorporated into a software engineering process for flight-control systems under DO-178B and to demonstrate that process by developing a formal specification for NASA's Guidance and Controls Software (GCS) Experiment. GCS is software to control the descent of a spacecraft onto a planet's surface. The GCS example is simplified from a real example spacecraft, but exhibits the characteristics of realistic spacecraft control software. The formal specification is written in Larch.

Pilot Aircraft Interface Objectives/Rationale

NASA Technical Reports Server (NTRS)

Shively, Jay

2010-01-01

Objective: Database and proof of concept for guidelines for GCS compliance a) Rationale: 1) Provide research test-bed to develop guidelines. 2) Modify GCS for NAS Compliance to provide proof of concept. b) Approach: 1) Assess current state of GCS technology. 2) Information Requirements Definition. 3) SME Workshop. 4) Modify an Existing GCS for NAS Compliance. 5) Define exemplar UAS (choose system to develop prototype). 6) Define Candidate Displays & Controls. 7) Evaluate/ refine in Simulations. 8) Demonstrate in flight. c) Deliverables: 1) Information Requirements Report. 2) Workshop Proceedings. 3) Technical Reports/ papers on Simulations & Flight Demo. 4) Database for guidelines.

A possible formation channel for blue hook stars in globular cluster - II. Effects of metallicity, mass ratio, tidal enhancement efficiency and helium abundance

NASA Astrophysics Data System (ADS)

Lei, Zhenxin; Zhao, Gang; Zeng, Aihua; Shen, Lihua; Lan, Zhongjian; Jiang, Dengkai; Han, Zhanwen

2016-12-01

Employing tidally enhanced stellar wind, we studied in binaries the effects of metallicity, mass ratio of primary to secondary, tidal enhancement efficiency and helium abundance on the formation of blue hook (BHk) stars in globular clusters (GCs). A total of 28 sets of binary models combined with different input parameters are studied. For each set of binary model, we presented a range of initial orbital periods that is needed to produce BHk stars in binaries. All the binary models could produce BHk stars within different range of initial orbital periods. We also compared our results with the observation in the Teff-logg diagram of GC NGC 2808 and ω Cen. Most of the BHk stars in these two GCs locate well in the region predicted by our theoretical models, especially when C/N-enhanced model atmospheres are considered. We found that mass ratio of primary to secondary and tidal enhancement efficiency have little effects on the formation of BHk stars in binaries, while metallicity and helium abundance would play important roles, especially for helium abundance. Specifically, with helium abundance increasing in binary models, the space range of initial orbital periods needed to produce BHk stars becomes obviously wider, regardless of other input parameters adopted. Our results were discussed with recent observations and other theoretical models.

Oxygen-Dependent Globin Coupled Sensor Signaling Modulates Motility and Virulence of the Plant Pathogen Pectobacterium carotovorum.

PubMed

Burns, Justin L; Jariwala, Parth B; Rivera, Shannon; Fontaine, Benjamin M; Briggs, Laura; Weinert, Emily E

2017-08-18

Bacterial pathogens utilize numerous signals to identify the presence of their host and coordinate changes in gene expression that allow for infection. Within plant pathogens, these signals typically include small molecules and/or proteins from their plant hosts and bacterial quorum sensing molecules to ensure sufficient bacterial cell density for successful infection. In addition, bacteria use environmental signals to identify conditions when the host defenses are weakened and potentially to signal entry into an appropriate host/niche for infection. A globin coupled sensor protein (GCS), termed PccGCS, within the soft rot bacterium Pectobacterium carotovorum ssp. carotovorum WPP14 has been identified as an O 2 sensor and demonstrated to alter virulence factor excretion and control motility, with deletion of PccGCS resulting in decreased rotting of a potato host. Using small molecules that modulate bacterial growth and quorum sensing, PccGCS signaling also has been shown to modulate quorum sensing pathways, resulting in the PccGCS deletion strain being more sensitive to plant-derived phenolic acids, which can function as quorum sensing inhibitors, and exhibiting increased N-acylhomoserine lactone (AHL) production. These findings highlight a role for GCS proteins in controlling key O 2 -dependent phenotypes of pathogenic bacteria and suggest that modulating GCS signaling to limit P. carotovorum motility may provide a means to decrease rotting of plant hosts.

Validity and cultural equivalence of the standard Greene Climacteric Scale in Hong Kong.

PubMed

Chen, Run Qiu; Davis, Susan R; Wong, Chit Ming; Lam, Tai Hing

2010-01-01

The aim of this study was to translate the standard Greene Climacteric Scale (GCS) and a urogenital symptom scale into colloquial Chinese (Hong Kong) and test their validity and reliability in Hong Kong Chinese women. The scales were translated with standard techniques, and cross-cultural construct validity, internal consistency, test-retest reliability, and responsiveness were tested on samples of women aged 40 to 60 years recruited from the community. A total of 611 women, with mean (SD) age of 48.9 (5.3) years, provided completed scales for the study. Confirmatory factor analysis demonstrated construct validity of the translated standard GCS. The items were found to have good homogeneity in measuring the scale concepts (Cronbach alpha > 0.7). But the three-item urogenital scale had poor internal consistency (Cronbach alpha = 0.43), and a combination of this scale with the standard GCS resulted in a reduced model fit to the data. Test-retest reliability for the GCS was good on women recruited for a retest (n = 52). The translated GCS was found to be responsive to change over time (effect size, 0.59; n = 19). The Chinese (Hong Kong) version of the standard GCS is a valid and cultural-equivalent instrument. Our data do not support inclusion of the urogenital scale to the standard GCS. Measurement of urogenital symptoms is subject to further study.

PRIMORDIAL r-PROCESS DISPERSION IN METAL-POOR GLOBULAR CLUSTERS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roederer, Ian U., E-mail: iur@obs.carnegiescience.edu

Heavy elements, those produced by neutron-capture reactions, have traditionally shown no star-to-star dispersion in all but a handful of metal-poor globular clusters (GCs). Recent detections of low [Pb/Eu] ratios or upper limits in several metal-poor GCs indicate that the heavy elements in these GCs were produced exclusively by an r-process. Re-examining GC heavy element abundances from the literature, we find unmistakable correlations between the [La/Fe] and [Eu/Fe] ratios in four metal-poor GCs (M5, M15, M92, and NGC 3201), only two of which were known previously. This indicates that the total r-process abundances vary from star to star (by factors ofmore » 2-6) relative to Fe within each GC. We also identify potential dispersion in two other GCs (M3 and M13). Several GCs (M12, M80, and NGC 6752) show no evidence of r-process dispersion. The r-process dispersion is not correlated with the well-known light element dispersion, indicating that it was present in the gas throughout the duration of star formation. The observations available at present suggest that star-to-star r-process dispersion within metal-poor GCs may be a common but not ubiquitous phenomenon that is neither predicted by nor accounted for in current models of GC formation and evolution.« less

VLT photometry in the Antlia cluster: the giant ellipticals NGC3258 and NGC3268 and their globular cluster systems

NASA Astrophysics Data System (ADS)

Bassino, Lilia P.; Richtler, Tom; Dirsch, Boris

2008-05-01

We present a deep Very Large Telescope (VLT) photometry in the regions surrounding the two dominant galaxies of the Antlia cluster, the giant ellipticals NGC3258 and NGC3268. We construct the luminosity functions of their globular cluster systems (GCSs) and determine their distances through the turn-over magnitudes. These distances are in good agreement with those obtained by the SBF method. There is some, but not conclusive, evidence that the distance to NGC3268 is larger by several Mpc. The GCSs colour distributions are bimodal but the brightest globular clusters (GCs) show a unimodal distribution with an intermediate colour peak. The radial distributions of both GCSs are well fitted by de Vaucouleurs laws up to 5arcmin. Red GCs present a steeper radial density profile than the blue GCs, and follow closely the galaxies' brightness profiles. Total GC populations are estimated to be about 6000 +/- 150GCs in NGC3258 and NGC4750 +/- 150GCs in NGC3268. We discuss the possible existence of GCs in a field located between the two giant galaxies (intracluster GCs). Their luminosity functions and number densities are consistent with the two GCSs overlapping in projection. Based on observations carried out at the European Southern Observatory, Paranal (Chile). Programme 71.B-0122(A). E-mail: lbassino@fcaglp.unlp.edu.ar (LPB); tom@mobydick.cfm.udec.cl (TR); borischacabuco@yahoo.co.uk (BD)

Metal-rich, Metal-poor: Updated Stellar Population Models for Old Stellar Systems

NASA Astrophysics Data System (ADS)

Conroy, Charlie; Villaume, Alexa; van Dokkum, Pieter G.; Lind, Karin

2018-02-01

We present updated stellar population models appropriate for old ages (>1 Gyr) and covering a wide range in metallicities (‑1.5 ≲ [Fe/H] ≲ 0.3). These models predict the full spectral variation associated with individual element abundance variation as a function of metallicity and age. The models span the optical–NIR wavelength range (0.37–2.4 μm), include a range of initial mass functions, and contain the flexibility to vary 18 individual elements including C, N, O, Mg, Si, Ca, Ti, and Fe. To test the fidelity of the models, we fit them to integrated light optical spectra of 41 Galactic globular clusters (GCs). The value of testing models against GCs is that their ages, metallicities, and detailed abundance patterns have been derived from the Hertzsprung–Russell diagram in combination with high-resolution spectroscopy of individual stars. We determine stellar population parameters from fits to all wavelengths simultaneously (“full spectrum fitting”), and demonstrate explicitly with mock tests that this approach produces smaller uncertainties at fixed signal-to-noise ratio than fitting a standard set of 14 line indices. Comparison of our integrated-light results to literature values reveals good agreement in metallicity, [Fe/H]. When restricting to GCs without prominent blue horizontal branch populations, we also find good agreement with literature values for ages, [Mg/Fe], [Si/Fe], and [Ti/Fe].

Software quality assurance plan for GCS

NASA Technical Reports Server (NTRS)

Duncan, Stephen E.; Bailey, Elizabeth K.

1990-01-01

The software quality assurance (SQA) function for the Guidance and Control Software (GCS) project which is part of a software error studies research program is described. The SQA plan outlines all of the procedures, controls, and audits to be carried out by the SQA organization to ensure adherence to the policies, procedures, and standards for the GCS project.

Myxedema coma: a new look into an old crisis.

PubMed

Mathew, Vivek; Misgar, Raiz Ahmad; Ghosh, Sujoy; Mukhopadhyay, Pradip; Roychowdhury, Pradip; Pandit, Kaushik; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2011-01-01

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis.

Myxedema Coma: A New Look into an Old Crisis

PubMed Central

Mathew, Vivek; Misgar, Raiz Ahmad; Ghosh, Sujoy; Mukhopadhyay, Pradip; Roychowdhury, Pradip; Pandit, Kaushik; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2011-01-01

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis. PMID:21941682

Use of parenteral glucocorticoids and the risk of new onset type 2 diabetes mellitus: A case-control study.

PubMed

Keyany, Ala; Nielen, Johannes T H; Souverein, Patrick C; de Vries, Frank; van den Bemt, Bart

2018-05-01

Use of oral glucocorticoids (GCs) has been associated with hyperglycaemia and type 2 diabetes mellitus (T2DM). However, unlike oral GCs, there is minimal or no data on the effect of parenteral GC use on T2DM. To assess the association between use of parenteral GCs and the risk of receiving a first prescription of a non-insulin antidiabetic drug (NIAD) as a proxy for new onset of T2DM. A population based case-control study was performed using the Clinical Practice Research Datalink (CPRD). Cases (n = 177,154) were defined as patients >18 years of age who had their first ever NIAD prescription between January 1987 and October 2013. Controls were matched by age, gender and general practitioner practice. Conditional logistic regression analyses were used to estimate the risk of NIAD prescription and use of parenteral GCs. Our analyses were statistically adjusted for lifestyle factors, comorbidities and concomitant drug use. Although this study confirmed that oral GCs increases the risk of receiving a first prescription of a NIAD (OR 2.63 [95% CI 2.53-2.73]), there was no association between the use of parenterally administered GCs and the risk of receiving a first prescription of a NIAD (OR 0.88 [95% CI 0.76-1.02]). The number of GC prescriptions was not associated with risk of new onset T2DM compared to no parenteral GCs use; neither the type of GC. Our study does not demonstrate an association between the use of parenteral GCs and the risk of new onset of T2DM. Copyright © 2018 Elsevier B.V. All rights reserved.

HUBBLE SPACE TELESCOPE SNAPSHOT SEARCH FOR PLANETARY NEBULAE IN GLOBULAR CLUSTERS OF THE LOCAL GROUP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bond, Howard E., E-mail: heb11@psu.edu

2015-04-15

Single stars in ancient globular clusters (GCs) are believed incapable of producing planetary nebulae (PNs), because their post-asymptotic-giant-branch evolutionary timescales are slower than the dissipation timescales for PNs. Nevertheless, four PNs are known in Galactic GCs. Their existence likely requires more exotic evolutionary channels, including stellar mergers and common-envelope binary interactions. I carried out a snapshot imaging search with the Hubble Space Telescope (HST) for PNs in bright Local Group GCs outside the Milky Way. I used a filter covering the 5007 Å nebular emission line of [O iii], and another one in the nearby continuum, to image 66 GCs.more » Inclusion of archival HST frames brought the total number of extragalactic GCs imaged at 5007 Å to 75, whose total luminosity slightly exceeds that of the entire Galactic GC system. I found no convincing PNs in these clusters, aside from one PN in a young M31 cluster misclassified as a GC, and two PNs at such large angular separations from an M31 GC that membership is doubtful. In a ground-based spectroscopic survey of 274 old GCs in M31, Jacoby et al. found three candidate PNs. My HST images of one of them suggest that the [O iii] emission actually arises from ambient interstellar medium rather than a PN; for the other two candidates, there are broadband archival UV HST images that show bright, blue point sources that are probably the PNs. In a literature search, I also identified five further PN candidates lying near old GCs in M31, for which follow-up observations are necessary to confirm their membership. The rates of incidence of PNs are similar, and small but nonzero, throughout the GCs of the Local Group.« less

Globular Cluster Orbits from HST Proper Motions: Constraining the Formation and Mass of the Milky Way Halo

NASA Astrophysics Data System (ADS)

Sohn, S. Tony; Van Der Marel, Roeland P.; Deason, Alis J.; Bellini, Andrea; Besla, Gurtina; Watkins, Laura

2016-06-01

The globular cluster (GC) system of the Milky Way (MW) provides important information on the MW's present structure and past evolution. GCs in the halo are particularly useful tracers; because of their long dynamical timescales, their orbits retain imprints of their origin or accretion history. Full 3D motions are required to calculate past orbits. While most GCs have known line of sight velocities, accurate proper motion (PM) measurements are currently available for only a few halo GCs. Our goal is to create the first high-quality PM database for halo GCs. We have identified suitable 1st-epoch data in the HST Archive for 20 halo GCs at 10-100 kpc from the Galactic Center. We are in the process of obtaining the necessary 2nd-epoch data to determine absolute PMs of the target GCs through our HST program GO-14235. We will use the same advanced astrometric techniques that allowed us to measure the PMs of M31 and Leo I. Previous studies of the halo GC system based on e.g., stellar populations, metallicities, RR Lyrae properties, and structural properties have revealed a dichotomy between old and young halo GCs. This may reflect distinct formation scenarios (in situ vs. accreted). Orbit calculations based on our PMs will directly test this. The PMs will also yield the best handle yet on the velocity anisotropy profile of any tracer population in the halo. This will resolve the mass-anisotropy degeneracy to provide an improved estimate of the MW mass, which is at present poorly known. In summary, our project will deliver the first accurate PMs for halo GCs, and will significantly increase our understanding of the formation, evolution, and mass of the MW.

Signatures of tumour immunity distinguish Asian and non-Asian gastric adenocarcinomas

PubMed Central

Lin, Suling J; Gagnon-Bartsch, Johann A; Tan, Iain Beehuat; Earle, Sophie; Ruff, Louise; Pettinger, Katherine; Ylstra, Bauke; van Grieken, Nicole; Rha, Sun Young; Chung, Hyun Cheol; Lee, Ju-Seog; Cheong, Jae Ho; Noh, Sung Hoon; Aoyama, Toru; Miyagi, Yohei; Tsuburaya, Akira; Yoshikawa, Takaki; Ajani, Jaffer A; Boussioutas, Alex; Yeoh, Khay Guan; Yong, Wei Peng; So, Jimmy; Lee, Jeeyun; Kang, Won Ki; Kim, Sung; Kameda, Yoichi; Arai, Tomio; zur Hausen, Axel; Speed, Terence P; Grabsch, Heike I; Tan, Patrick

2015-01-01

Objective Differences in gastric cancer (GC) clinical outcomes between patients in Asian and non-Asian countries has been historically attributed to variability in clinical management. However, recent international Phase III trials suggest that even with standardised treatments, GC outcomes differ by geography. Here, we investigated gene expression differences between Asian and non-Asian GCs, and if these molecular differences might influence clinical outcome. Design We compared gene expression profiles of 1016 GCs from six Asian and three non-Asian GC cohorts, using a two-stage meta-analysis design and a novel biostatistical method (RUV-4) to adjust for technical variation between cohorts. We further validated our findings by computerised immunohistochemical analysis on two independent tissue microarray (TMA) cohorts from Asian and non-Asian localities (n=665). Results Gene signatures differentially expressed between Asians and non-Asian GCs were related to immune function and inflammation. Non-Asian GCs were significantly enriched in signatures related to T-cell biology, including CTLA-4 signalling. Similarly, in the TMA cohorts, non-Asian GCs showed significantly higher expression of T-cell markers (CD3, CD45R0, CD8) and lower expression of the immunosuppressive T-regulatory cell marker FOXP3 compared to Asian GCs (p<0.05). Inflammatory cell markers CD66b and CD68 also exhibited significant cohort differences (p<0.05). Exploratory analyses revealed a significant relationship between tumour immunity factors, geographic locality-specific prognosis, and postchemotherapy outcomes. Conclusions Analyses of >1600 GCs suggest that Asian and non-Asian GCs exhibit distinct tumour immunity signatures related to T-cell function. These differences may influence geographical differences in clinical outcome, and the design of future trials particularly in immuno-oncology. PMID:25385008

Research Resource: Preovulatory LH Surge Effects on Follicular Theca and Granulosa Transcriptomes

PubMed Central

Gunewardena, Sumedha; Hong, Xiaoman; Spitschak, Marion; Baufeld, Anja

2013-01-01

The molecular mechanisms that regulate the pivotal transformation processes observed in the follicular wall following the preovulatory LH surge, are still not established, particularly for cells of the thecal layer. To elucidate thecal cell (TC) and granulosa cell (GC) type-specific biologic functions and signaling pathways, large dominant bovine follicles were collected before and 21 hours after an exogenous GnRH-induced LH surge. Antral GCs (aGCs; aspirated by follicular puncture) and membrane-associated GCs (mGCs; scraped from the follicular wall) were compared with TC expression profiles determined by mRNA microarrays. Of the approximately 11 000 total genes expressed in the periovulatory follicle, only 2% of thecal vs 25% of the granulosa genes changed in response to the LH surge. The majority of the 203 LH-regulated thecal genes were also LH regulated in GCs, leaving a total of 57 genes as LH-regulated TC-specific genes. Of the 57 thecal-specific LH-regulated genes, 74% were down-regulated including CYP17A1 and NR5A1, whereas most other genes are being identified for the first time within theca. Many of the newly identified up-regulated thecal genes (eg, PTX3, RND3, PPP4R4) were also up-regulated in granulosa. Minimal expression differences were observed between aGCs and mGCs; however, transcripts encoding extracellular proteins (NID2) and matrix modulators (ADAMTS1, SASH1) dominated these differences. We also identified large numbers of unknown LH-regulated GC genes and discuss their putative roles in ovarian function. This Research Resource provides an easy-to-access global evaluation of LH regulation in TCs and GCs that implicates numerous molecular pathways heretofore unknown within the follicle. PMID:23716604

Research resource: preovulatory LH surge effects on follicular theca and granulosa transcriptomes.

PubMed

Christenson, Lane K; Gunewardena, Sumedha; Hong, Xiaoman; Spitschak, Marion; Baufeld, Anja; Vanselow, Jens

2013-07-01

The molecular mechanisms that regulate the pivotal transformation processes observed in the follicular wall following the preovulatory LH surge, are still not established, particularly for cells of the thecal layer. To elucidate thecal cell (TC) and granulosa cell (GC) type-specific biologic functions and signaling pathways, large dominant bovine follicles were collected before and 21 hours after an exogenous GnRH-induced LH surge. Antral GCs (aGCs; aspirated by follicular puncture) and membrane-associated GCs (mGCs; scraped from the follicular wall) were compared with TC expression profiles determined by mRNA microarrays. Of the approximately 11 000 total genes expressed in the periovulatory follicle, only 2% of thecal vs 25% of the granulosa genes changed in response to the LH surge. The majority of the 203 LH-regulated thecal genes were also LH regulated in GCs, leaving a total of 57 genes as LH-regulated TC-specific genes. Of the 57 thecal-specific LH-regulated genes, 74% were down-regulated including CYP17A1 and NR5A1, whereas most other genes are being identified for the first time within theca. Many of the newly identified up-regulated thecal genes (eg, PTX3, RND3, PPP4R4) were also up-regulated in granulosa. Minimal expression differences were observed between aGCs and mGCs; however, transcripts encoding extracellular proteins (NID2) and matrix modulators (ADAMTS1, SASH1) dominated these differences. We also identified large numbers of unknown LH-regulated GC genes and discuss their putative roles in ovarian function. This Research Resource provides an easy-to-access global evaluation of LH regulation in TCs and GCs that implicates numerous molecular pathways heretofore unknown within the follicle.

Weaker control of the electrical properties of cerebellar granule cells by tonically active GABAA receptors in the Ts65Dn mouse model of Down’s syndrome

PubMed Central

2013-01-01

Background Down’s syndrome (DS) is caused by triplication of all or part of human chromosome 21 and is characterized by a decrease in the overall size of the brain. One of the brain regions most affected is the cerebellum, in which the number of granule cells (GCs) is markedly decreased. GCs process sensory information entering the cerebellum via mossy fibres and pass it on to Purkinje cells and inhibitory interneurons. How GCs transform incoming signals depends on their input–output relationship, which is adjusted by tonically active GABAA receptor channels. Results We report that in the Ts65Dn mouse model of DS, in which cerebellar volume and GC number are decreased as in DS, the tonic GABAA receptor current in GCs is smaller than in wild-type mice and is less effective in moderating input resistance and raising the minimum current required for action potential firing. We also find that tonically active GABAA receptors curb the height and broaden the width of action potentials in wild-type GCs but not in Ts65Dn GCs. Single-cell real-time quantitative PCR reveals that these electrical differences are accompanied by decreased expression of the gene encoding the GABAA receptor β3 subunit but not genes coding for some of the other GABAA receptor subunits expressed in GCs (α1, α6, β2 and δ). Conclusions Weaker moderation of excitability and action potential waveform in GCs of the Ts65Dn mouse by tonically active GABAA receptors is likely to contribute to atypical transfer of information through the cerebellum. Similar changes may occur in DS. PMID:23870245

NR2B-dependent plasticity of adult-born granule cells is necessary for context discrimination.

PubMed

Kheirbek, Mazen A; Tannenholz, Lindsay; Hen, René

2012-06-20

Adult-generated granule cells (GCs) in the dentate gyrus (DG) exhibit a period of heightened plasticity 4-6 weeks postmitosis. However, the functional contribution of this critical window of plasticity to hippocampal neurogenesis and behavior remains unknown. Here, we show that deletion of NR2B-containing NMDA receptors from adult-born GCs impairs a neurogenesis-dependent form of LTP in the DG and reduces dendritic complexity of adult-born GCs, but does not impact their survival. Mice in which the NR2B-containing NMDA receptor was deleted from adult-born GCs did not differ from controls in baseline anxiety-like behavior or discrimination of very different contexts, but were impaired in discrimination of highly similar contexts. These results indicate that NR2B-dependent plasticity of adult-born GCs is necessary for fine contextual discrimination and is consistent with their proposed role in pattern separation.

GCS plan for software aspects of certification

NASA Technical Reports Server (NTRS)

Shagnea, Anita M.; Lowman, Douglas S.; Withers, B. Edward

1990-01-01

As part of the Guidance and Control Software (GCS) research project being sponsored by NASA to evaluate the failure processes of software, standard industry software development procedures are being employed. To ensure that these procedures are authentic, the guidelines outlined in the Radio Technical Commission for Aeronautics (RTCA/DO-178A document entitled, software considerations in airborne systems and equipment certification, were adopted. A major aspect of these guidelines is proper documentation. As such, this report, the plan for software aspects of certification, was produced in accordance with DO-178A. An overview is given of the GCS research project, including the goals of the project, project organization, and project schedules. It also specifies the plans for all aspects of the project which relate to the certification of the GCS implementations developed under a NASA contract. These plans include decisions made regarding the software specification, accuracy requirements, configuration management, implementation development and verification, and the development of the GCS simulator.

[Predicting the outcome in severe injuries: an analysis of 2069 patients from the trauma register of the German Society of Traumatology (DGU)].

PubMed

Rixen, D; Raum, M; Bouillon, B; Schlosser, L E; Neugebauer, E

2001-03-01

On hospital admission numerous variables are documented from multiple trauma patients. The value of these variables to predict outcome are discussed controversially. The aim was the ability to initially determine the probability of death of multiple trauma patients. Thus, a multivariate probability model was developed based on data obtained from the trauma registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU). On hospital admission the DGU trauma registry collects more than 30 variables prospectively. In the first step of analysis those variables were selected, that were assumed to be clinical predictors for outcome from literature. In a second step a univariate analysis of these variables was performed. For all primary variables with univariate significance in outcome prediction a multivariate logistic regression was performed in the third step and a multivariate prognostic model was developed. 2069 patients from 20 hospitals were prospectively included in the trauma registry from 01.01.1993-31.12.1997 (age 39 +/- 19 years; 70.0% males; ISS 22 +/- 13; 18.6% lethality). From more than 30 initially documented variables, the age, the GCS, the ISS, the base excess (BE) and the prothrombin time were the most important prognostic factors to predict the probability of death (P(death)). The following prognostic model was developed: P(death) = 1/1 + e(-[k + beta 1(age) + beta 2(GCS) + beta 3(ISS) + beta 4(BE) + beta 5(prothrombin time)]) where: k = -0.1551, beta 1 = 0.0438 with p < 0.0001, beta 2 = -0.2067 with p < 0.0001, beta 3 = 0.0252 with p = 0.0071, beta 4 = -0.0840 with p < 0.0001 and beta 5 = -0.0359 with p < 0.0001. Each of the five variables contributed significantly to the multifactorial model. These data show that the age, GCS, ISS, base excess and prothrombin time are potentially important predictors to initially identify multiple trauma patients with a high risk of lethality. With the base excess and prothrombin time value, as only variables of this multifactorial model that can be therapeutically influenced, it might be possible to better guide early and aggressive therapy.

Gradient cuts and extremal edges in relative depth and figure-ground perception.

PubMed

Ghose, Tandra; Palmer, Stephen E

2016-02-01

Extremal edges (EEs) are borders consisting of luminance gradients along the projected edge of a partly self-occluding curved surface (e.g., a cylinder), with equiluminant contours (ELCs) that run approximately parallel to that edge. Gradient cuts (GCs) are similar luminance gradients with ELCs that intersect (are "cut" by) an edge that could be due to occlusion. EEs are strongly biased toward being seen as closer/figural surfaces (Palmer & Ghose, Psychological Science, 19(1), 77-83, 2008). Do GCs produce a complementary bias toward being seen as ground? Experiment 1 shows that, with EEs on the opposite side, GCs produce a ground bias that increases with increasing ELC angles between ELCs and the shared edge. Experiment 2 shows that, with flat surfaces on the opposite side, GCs do not produce a ground bias, suggesting that more than one factor may be operating. We suggest that two partially dissociable factors may operate for curved surfaces-ELC angle and 3-D surface convexity-that reinforce each other in the figural cues of EEs but compete with each other in GCs. Moreover, this figural bias is modulated by the presence of EEs and GCs, as specified by the ELC angle between ELCs and the shared contour.

Acidity-triggered charge-convertible nanoparticles that can cause bacterium-specific aggregation in situ to enhance photothermal ablation of focal infection.

PubMed

Korupalli, Chiranjeevi; Huang, Chieh-Cheng; Lin, Wei-Chih; Pan, Wen-Yu; Lin, Po-Yen; Wan, Wei-Lin; Li, Meng-Ju; Chang, Yen; Sung, Hsing-Wen

2017-02-01

Focal infections that are caused by antibiotic-resistant bacteria are becoming an ever-growing challenge to human health. To address this challenge, a pH-responsive amphiphilic polymer of polyaniline-conjugated glycol chitosan (PANI-GCS) that can self-assemble into nanoparticles (NPs) in situ is developed. The PANI-GCS NPs undergo a unique surface charge conversion that is induced by their local pH, favoring bacterium-specific aggregation without direct contact with host cells. Following conjugation onto GCS, the optical-absorbance peak of PANI is red-shifted toward the near-infrared (NIR) region, enabling PANI-GCS NPs to generate a substantial amount of heat, which is emitted to their neighborhood. The local temperature of the NIR-irradiated PANI-GCS NPs is estimated to be approximately 5 °C higher than their ambient tissue temperature, ensuring specific and direct heating of their aggregated bacteria; hence, damage to tissue is reduced and wound healing is accelerated. The above results demonstrate that PANI-GCS NPs are practical for use in the photothermal ablation of focal infections. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adverse eff ects of polymeric nanoparticle poly(ethylene glycol)- block-polylactide methyl ether (PEG-b-PLA) on steroid hormone secretion by porcine granulosa cells.

PubMed

Scsukova, Sona; Bujnakova, Mlynarcikova A; Kiss, A; Rollerova, E

2017-04-25

Development of nanoparticles (NPs) for biomedical applications, including medical imaging and drug delivery, is currently undergoing a dramatic expansion. Diverse effects of different type NPs relating to mammalian reproductive tissues have been demonstrated. Th e objective of this study was to explore the in vitro effects of polymeric nanoparticle poly(ethylene glycol)-blockpolylactide methyl ether (PEG-b-PLA NPs) on functional state and viability of ovarian granulosa cells (GCs), which play an important role in maintaining ovarian function and female fertility. The GCs isolated from porcine ovarian follicles were incubated with the different concentrations of PEG-b-PLA NPs (PEG average Mn=350 g/mol and PLA average Mn=1000 g/mol; 0.2-100 μg/ml) or poly(ethylene glycol) with an average molecular weight of 300 (PEG-300; 0.2- 40 mg/ml) in the presence or absence of stimulators, follicle-stimulating hormone (FSH; 1 μg/ml), androstenedione (100 nM), forskolin (10 μM) or 8Br-cAMP (100 μM), for different time periods (24, 48, 72 h). At the end of the incubation, progesterone and estradiol levels produced by GCs were measured in the culture media by radioimmunoassay. Th e viability of GCs was determined by the method using a colorimetric assay with MTT. Treatment of GCs with PEG-b-PLA NPs induced a significant decrease in basal as well as FSH-stimulated progesterone secretion above the concentration of 20 and 4 μg/ml, respectively. Moreover, PEG-b-PLA NPs reduced forskolin-stimulated, but not cAMP-stimulated progesterone production by GCs. A dose-dependent inhibition of androstenedione-stimulated estradiol release by GCs was found by the action of PEG-b-PLA NPs. Incubation of GCs with PEG-300 significantly inhibited basal as well as FSH-stimulated progesterone secretion above the concentration of 40 mg/ml. PEG-b-PLA NPs and PEG-300 significantly reduced the viability of GCs at the highest tested concentrations (100 μg/ml and 40 mg/ml, respectively). The obtained results indicate that polymeric NPs PEG-b-PLA might induce alterations in steroid hormone production by ovarian GCs and thereby could modify reproductive functions.

Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients.

PubMed

Giannakopoulos, G F; Saltzherr, T P; Beenen, L F M; Reitsma, J B; Bloemers, F W; Goslings, J C; Bakker, F C

2012-09-01

Despite the presence of diagnostic guidelines for the initial evaluation in trauma, the reported incidence of missed injuries is considerable. The aim of this study was to assess the missed injuries in a large cohort of trauma patients originating from two European Level-1 trauma centres. We analysed the 1124 patients included in the randomised REACT trial. Missed injuries were defined as injuries not diagnosed or suspected during initial clinical and radiological evaluation in the trauma room. We assessed the frequency, type, consequences and the phase in which the missed injuries were diagnosed and used univariate analysis to identify potential contributing factors. Eight hundred and three patients were male, median age was 38 years and 1079 patients sustained blunt trauma. Overall, 122 injuries were missed in 92 patients (8.2%). Most injuries concerned the extremities. Sixteen injuries had an AIS grade of ≥ 3. Patients with missed injuries had significantly higher injury severity scores (ISSs) (median of 15 versus 5, p<0.001). Factors associated with missed injuries were severe traumatic brain injury (GCS ≤ 8) and multitrauma (ISS ≥ 16). Seventy-two missed injuries remained undetected during tertiary survey (59%). In total, 31 operations were required for 26 initially missed injuries. Despite guidelines to avoid missed injuries, this problem is hard to prevent, especially in the severely injured. The present study showed that the rate of missed injuries was comparable with the literature and their consequences not severe. A high index of suspicion remains warranted, especially in multitrauma patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

Mucoadhesive properties of low molecular weight chitosan- or glycol chitosan- and corresponding thiomer-coated poly(isobutylcyanoacrylate) core-shell nanoparticles.

PubMed

Palazzo, Claudio; Trapani, Giuseppe; Ponchel, Gilles; Trapani, Adriana; Vauthier, Christine

2017-08-01

The aim of the present work was to evaluate the mucoadhesive properties of poly(isobutyl cyanoacrylate) (PIBCA) nanoparticles (NPs) coated with Low Molecular Weight (LMW) chitosan (CS)- and glycol chitosan (GCS)-based thiomers as well as with the corresponding LMW unmodified polysaccharides. For this purpose, all the CS- and GCS-based thiomers were prepared under simple and mild conditions starting from the LMW unmodified polymers CS and GCS. The resulting NPs were of spherical shape with diameters ranging from 400 to 600nm and 187 to 309nm, for CS- and GCS-based NPs, respectively. The mucoadhesive characteristics of these core shell NPs were studied in Ussing chambers measuring the percentage of NPs stuck on the mucosal of fresh intestinal tissue after 2h of incubation. Moreover, incubation of nanoparticle formulations with the intestinal tissue induced changes in transmucosal electrical resistance which were measured to gain information into the opening of tight junctions and to control the integrity of the mucosa. Thus, it was found that PIBCA NPs coated with the GCS-Glutathione conjugate (GCGPIBCA NPs) possessed the most favorable mucoadhesive performances. Moreover, both GCGPIBCA- and GCS-N-acetyl-cysteine (GCNPIBCA)-core-shell NPs might induced an enlargement of the epithelial cell tight junctions. In conclusion, coating of PIBCA NPs with GCS-based thiomers may be useful for improving the mucoadhesive and permeation properties of these nanocarriers. Copyright © 2017 Elsevier B.V. All rights reserved.

Formation of Globular Clusters with Internal Abundance Spreads in r-Process Elements: Strong Evidence for Prolonged Star Formation

NASA Astrophysics Data System (ADS)

Bekki, Kenji; Tsujimoto, Takuji

2017-07-01

Several globular clusters (GCs) in the Galaxy are observed to show internal abundance spreads in r-process elements (e.g., Eu). We propose a new scenario that explains the origin of these GCs (e.g., M5 and M15). In this scenario, stars with no/little abundance variations first form from a massive molecular cloud (MC). After all of the remaining gas of the MC is expelled by numerous supernovae, gas ejected from asymptotic giant branch stars can be accumulated in the central region of the GC to form a high-density intracluster medium (ICM). Merging of neutron stars then occurs to eject r-process elements, which can be efficiently trapped in and subsequently mixed with the ICM. New stars formed from the ICM can have r-process abundances that are quite different from those of earlier generations of stars within the GC. This scenario can explain both (I) why r-process elements can be trapped within GCs and (II) why GCs with internal abundance spreads in r-process elements do not show [Fe/H] spreads. Our model shows (I) that a large fraction of Eu-rich stars can be seen in Na-enhanced stellar populations of GCs, as observed in M15, and (II) why most of the Galactic GCs do not exhibit such internal abundance spreads. Our model demonstrates that the observed internal spreads of r-process elements in GCs provide strong evidence for prolonged star formation (˜108 yr).

An Automated Strategy for Unbiased Morphometric Analyses and Classifications of Growth Cones In Vitro

PubMed Central

Chitsaz, Daryan; Morales, Daniel; Law, Chris; Kania, Artur

2015-01-01

During neural circuit development, attractive or repulsive guidance cue molecules direct growth cones (GCs) to their targets by eliciting cytoskeletal remodeling, which is reflected in their morphology. The experimental power of in vitro neuronal cultures to assay this process and its molecular mechanisms is well established, however, a method to rapidly find and quantify multiple morphological aspects of GCs is lacking. To this end, we have developed a free, easy to use, and fully automated Fiji macro, Conographer, which accurately identifies and measures many morphological parameters of GCs in 2D explant culture images. These measurements are then subjected to principle component analysis and k-means clustering to mathematically classify the GCs as “collapsed” or “extended”. The morphological parameters measured for each GC are found to be significantly different between collapsed and extended GCs, and are sufficient to classify GCs as such with the same level of accuracy as human observers. Application of a known collapse-inducing ligand results in significant changes in all parameters, resulting in an increase in ‘collapsed’ GCs determined by k-means clustering, as expected. Our strategy provides a powerful tool for exploring the relationship between GC morphology and guidance cue signaling, which in particular will greatly facilitate high-throughput studies of the effects of drugs, gene silencing or overexpression, or any other experimental manipulation in the context of an in vitro axon guidance assay. PMID:26496644

DOE Office of Scientific and Technical Information (OSTI.GOV)

Powalka, Mathieu; Lançon, Ariane; Duc, Pierre-Alain

Large samples of globular clusters (GC) with precise multi-wavelength photometry are becoming increasingly available and can be used to constrain the formation history of galaxies. We present the results of an analysis of Milky Way (MW) and Virgo core GCs based on 5 optical-near-infrared colors and 10 synthetic stellar population models. For the MW GCs, the models tend to agree on photometric ages and metallicities, with values similar to those obtained with previous studies. When used with Virgo core GCs, for which photometry is provided by the Next Generation Virgo cluster Survey (NGVS), the same models generically return younger ages.more » This is a consequence of the systematic differences observed between the locus occupied by Virgo core GCs and models in panchromatic color space. Only extreme fine-tuning of the adjustable parameters available to us can make the majority of the best-fit ages old. Although we cannot exclude that the formation history of the Virgo core may lead to more conspicuous populations of relatively young GCs than in other environments, we emphasize that the intrinsic properties of the Virgo GCs are likely to differ systematically from those assumed in the models. Thus, the large wavelength coverage and photometric quality of modern GC samples, such as those used here, is not by itself sufficient to better constrain the GC formation histories. Models matching the environment-dependent characteristics of GCs in multi-dimensional color space are needed to improve the situation.« less

Benzylic rearrangement stable isotope labeling for quantitation of guanidino and ureido compounds in thyroid tissues by liquid chromatography-electrospray ionization mass spectrometry.

PubMed

Fan, Ruo-Jing; Guan, Qing; Zhang, Fang; Leng, Jia-Peng; Sun, Tuan-Qi; Guo, Yin-Long

2016-02-18

Benzylic rearrangement stable isotope labeling (BRSIL) was explored to quantify the guanidino and ureido compounds (GCs and UCs). This method employed a common reagent, benzil, to label the guanidino and ureido groups through nucleophilic attacking then benzylic migrating. The use of BRSIL was investigated in the analysis of five GCs (creatine, l-arginine, homoarginine, 4-guanidinobutyric acid, and methylguanidine) and two UCs (urea and citrulline). The labeling was found simple and specific. The introduction of bi-phenyl group and the generation of nitrogen heterocyclic ring in the benzil-d0/d5 labeled GCs and UCs improved the retention behaviors in liquid chromatography (LC) and increased the sensitivity of electrospray ionization mass spectrometry (ESI MS) detection. The fragment ion pairs of m/z 182/187 and m/z 210/215 from the benzil-d0/d5 tags facilitated the discovery of potential GCs and UCs candidates residing in biological matrices. The use of BRSIL combined with LC-ESI MS was applied for simultaneously quantitation of GCs and UCs in thyroid tissues. It was demonstrated that nine GCs and UCs were detected, six of which were further quantified based on corresponding standards. It was concluded that five GCs and UCs (l-arginine, homoarginine, 4-guanidinobutyric acid, methylguanidine, and citrulline) were statistically significantly different (p < 0.05) between the para-carcinoma and carcinoma thyroid tissue samples. Copyright © 2016 Elsevier B.V. All rights reserved.

The value of eutherian-marsupial comparisons for understanding the function of glucocorticoids in female mammal reproduction.

PubMed

Fanson, Kerry V; Parrott, Marissa L

2015-11-01

This article is part of a Special Issue "SBN 2014". Chronic stress is known to inhibit female reproductive function. Consequently, it is often assumed that glucocorticoid (GC) concentrations should be negatively correlated with reproductive success because of the role they play in stress physiology. In contrast, a growing body of evidence indicates that GCs play an active role in promoting reproductive function. It is precisely because GCs are so integral to the entire process that disruptions to adrenal activity have negative consequences for reproduction. The goal of this paper is to draw attention to the increasing evidence showing that increases in adrenal activity are important for healthy female reproduction. Furthermore, we outline several hypotheses about the functional role(s) that GCs may play in mediating reproduction and argue that comparative studies between eutherian and marsupial mammals, which exhibit some pronounced differences in reproductive physiology, may be particularly useful for testing different hypotheses about the functional role of GCs in reproduction. Much of our current thinking about GCs and reproduction comes from research involving stress-induced levels of GCs and has led to broad assumptions about the effects of GCs on reproduction. Unfortunately, this has left a gaping hole in our knowledge about basal GC levels and how they may influence reproductive function, thereby preventing a broader understanding of adrenal physiology and obscuring potential solutions for reproductive dysfunction. Copyright © 2015 Elsevier Inc. All rights reserved.

Cryoprecipitate use in the PROMMTT study.

PubMed

Holcomb, John B; Fox, Erin E; Zhang, Xuan; White, Nathan; Wade, Charles E; Cotton, Bryan A; del Junco, Deborah J; Bulger, Eileen M; Cohen, Mitchell J; Schreiber, Martin A; Myers, John G; Brasel, Karen J; Phelan, Herb A; Alarcon, Louis H; Muskat, Peter; Rahbar, Mohammad H

2013-07-01

There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. Cryoprecipitate use varied significantly by center, ranging from 7% to 82%. Among patients who received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10-20). The median time from admission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients. We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

Molecular Transducers from Roots Are Triggered in Arabidopsis Leaves by Root-Knot Nematodes for Successful Feeding Site Formation: A Conserved Post-Embryogenic De novo Organogenesis Program?

PubMed Central

Olmo, Rocío; Cabrera, Javier; Moreno-Risueno, Miguel A.; Fukaki, Hidehiro; Fenoll, Carmen; Escobar, Carolina

2017-01-01

Root-knot nematodes (RKNs; Meloidogyne spp.) induce feeding cells (giant cells; GCs) inside a pseudo-organ (gall) from still unknown root cells. Understanding GCs ontogeny is essential to the basic knowledge of RKN–plant interaction and to discover novel and effective control strategies. Hence, we report for the first time in a model plant, Arabidopsis, molecular, and cellular features concerning ectopic de novo organogenesis of RKNs GCs in leaves. RKNs induce GCs in leaves with irregular shape, a reticulated cytosol, and fragmented vacuoles as GCs from roots. Leaf cells around the nematode enter G2-M shown by ProCycB1;1:CycB1;1(NT)-GUS expression, consistent to multinucleated GCs. In addition, GCs nuclei present irregular and varied sizes. All these characteristics mentioned, being equivalent to GCs in root-galls. RKNs complete their life cycle forming a gall/callus-like structure in the leaf vascular tissues resembling auxin-induced callus with an auxin-response maxima, indicated by high expression of DR5::GUS that is dependent on leaf auxin-transport. Notably, induction of leaves calli/GCs requires molecular components from roots crucial for lateral roots (LRs), auxin-induced callus and root-gall formation, i.e., LBD16. Hence, LBD16 is a xylem pole pericycle specific and local marker in LR primordia unexpectedly induced locally in the vascular tissue of leaves after RKN infection. LBD16 is also fundamental for feeding site formation as RKNs could not stablish in 35S::LBD16-SRDX leaves, and likely it is also a conserved molecular hub between biotic and developmental signals in Arabidopsis either in roots or leaves. Moreover, RKNs induce the ectopic development of roots from leaf and root-galls, also formed in mutants compromised in LR formation, arf7/arf19, slr, and alf4. Therefore, nematodes must target molecular signatures to induce post-embryogenic de novo organogenesis through the LBD16 callus formation pathway partially different from those prevalent during normal LR development. PMID:28603536

Molecular Transducers from Roots Are Triggered in Arabidopsis Leaves by Root-Knot Nematodes for Successful Feeding Site Formation: A Conserved Post-Embryogenic De novo Organogenesis Program?

PubMed

Olmo, Rocío; Cabrera, Javier; Moreno-Risueno, Miguel A; Fukaki, Hidehiro; Fenoll, Carmen; Escobar, Carolina

2017-01-01

Root-knot nematodes (RKNs; Meloidogyne spp.) induce feeding cells (giant cells; GCs) inside a pseudo-organ (gall) from still unknown root cells. Understanding GCs ontogeny is essential to the basic knowledge of RKN-plant interaction and to discover novel and effective control strategies. Hence, we report for the first time in a model plant, Arabidopsis, molecular, and cellular features concerning ectopic de novo organogenesis of RKNs GCs in leaves. RKNs induce GCs in leaves with irregular shape, a reticulated cytosol, and fragmented vacuoles as GCs from roots. Leaf cells around the nematode enter G2-M shown by ProCycB1;1:CycB1;1(NT)-GUS expression, consistent to multinucleated GCs. In addition, GCs nuclei present irregular and varied sizes. All these characteristics mentioned, being equivalent to GCs in root-galls. RKNs complete their life cycle forming a gall/callus-like structure in the leaf vascular tissues resembling auxin-induced callus with an auxin-response maxima, indicated by high expression of DR5::GUS that is dependent on leaf auxin-transport. Notably, induction of leaves calli/GCs requires molecular components from roots crucial for lateral roots (LRs), auxin-induced callus and root-gall formation, i.e., LBD16. Hence, LBD16 is a xylem pole pericycle specific and local marker in LR primordia unexpectedly induced locally in the vascular tissue of leaves after RKN infection. LBD16 is also fundamental for feeding site formation as RKNs could not stablish in 35S::LBD16-SRDX leaves, and likely it is also a conserved molecular hub between biotic and developmental signals in Arabidopsis either in roots or leaves. Moreover, RKNs induce the ectopic development of roots from leaf and root-galls, also formed in mutants compromised in LR formation, arf7/arf19 , slr , and alf4 . Therefore, nematodes must target molecular signatures to induce post-embryogenic de novo organogenesis through the LBD16 callus formation pathway partially different from those prevalent during normal LR development.

Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern.

PubMed

Baerg, Joanne; Thirumoorthi, Arul; Vannix, Rosemary; Taha, Asma; Young, Amy; Zouros, Alexander

2017-05-01

The purpose of this study was to document the incidence and pattern of cervical spine (c-spine) injuries in children below 36months with inflicted trauma. An IRB approved, prospective cohort study was performed between July 2011 and January 2016. Inclusion criteria were: age below 36months, loss of consciousness after inflicted trauma, and one initial head computed tomography finding: a subdural, intraventricular, intraparenchymal, subarachnoid hemorrhage, diffuse axonal injury, hypoxic injury, or cerebral edema. A protocol of brain and neck magnetic resonance imaging and angiography was obtained within 48h. Variables were compared by t-test and Fisher-exact test. There were 53 children (median age: five months; range: 1-35months), 38 males (71.7%), of which seven died (13.2%). C-spine injury was identified in 8 (15.1%): ligamentous injury (2), vertebral artery shear injury (1), atlantooccipital dissociation (AOD) (1), cord injury with cord epidural hematoma (2), and isolated cord epidural hematoma (2). Retinal hemorrhages (p=0.02), shaking (p=0.04), lower Glasgow coma score (GCS) (p=0.01), brain infarcts (p=0.01), and hypoxic/ischemic injury (p=0.01) were associated with c-spine injury. One with AOD died. Six had significant disability. For small children with inflicted trauma, the c-spine injury incidence is 15.1%. The injury pattern includes retinal hemorrhages, shaking, lower GCS, and brain injury. Evaluation of shaken infants should include c-spine imaging. Level 2 A- This is a prospective cohort study with complete follow-up to hospital discharge or death. In all cases, inflicted trauma was confirmed. Owing to the nature of child abuse, the precise time of injury is not known. All children underwent a strict imaging protocol on arrival to hospital that was supervised on a prospective basis. Copyright © 2017 Elsevier Inc. All rights reserved.

Coma Associated with Microscopy-Diagnosed Plasmodium vivax: A Prospective Study in Papua, Indonesia

PubMed Central

Hardianto, Setiawan O.; Tjitra, Emiliana; Kenangalem, Enny; Sugiarto, Paulus; Price, Ric N.; Anstey, Nicholas M.

2011-01-01

Background Coma complicates Plasmodium falciparum infection but is uncommonly associated with P. vivax. Most series of vivax coma have been retrospective and have not utilized molecular methods to exclude mixed infections with P. falciparum. Methods We prospectively enrolled patients hospitalized in Timika, Indonesia, with a Glasgow Coma Score (GCS) ≤10 and P. vivax monoinfection on initial microscopy over a four year period. Hematological, biochemical, serological, radiological and cerebrospinal fluid (CSF) examinations were performed to identify other causes of coma. Repeat microscopy, antigen detection and polymerase chain reaction (PCR) were performed to exclude infections with other Plasmodium species. Results Of 24 patients fulfilling enrolment criteria, 5 had clear evidence for other non-malarial etiologies. PCR demonstrated 10 mixed infections and 3 P. falciparum monoinfections. 6 (25%) patients had vivax monoinfection and no apparent alternative cause, with a median GCS of 9 (range 8–10) and a median coma duration of 42 (range 36–48) hours. CSF leukocyte counts were <10/ul (n = 3); 2 of the 3 patients without CSF examination recovered with antimalarial therapy alone. One patient had a tremor on discharge consistent with a post-malarial neurological syndrome. No patient had other organ dysfunction. The only death was associated with pure P. falciparum infection by PCR. Vivax monoinfection-associated risk of coma was estimated at 1 in 29,486 clinical vivax infections with no deaths. In comparison, the risk of falciparum-associated coma was estimated at 1 in 1,276 clinical infections with an 18.5% mortality rate. Conclusions P. vivax-associated coma is rare, occurring 23 times less frequently than that seen with falciparum malaria, and is associated with a high proportion of non-malarial causes and mixed infections using PCR. The pathogenesis of coma associated with vivax malaria, particularly the role of comorbidities, is uncertain and requires further investigation. PMID:21666785

Intubation is not a marker for coma after in-hospital cardiac arrest: A retrospective study.

PubMed

Berg, Katherine M; Grossestreuer, Anne V; Uber, Amy; Patel, Parth V; Donnino, Michael W

2017-10-01

In-hospital cardiac arrest (IHCA) strikes over 200,000 people in the United States annually. Targeted temperature management (TTM) is considered beneficial in other settings, but there is no prospective data for IHCA. Recent work on TTM and IHCA found an association between TTM and worse outcome. However, the authors used intubation as a marker for coma to determine eligibility for TTM. The validity of this approach is unexplored. Retrospective, single center study of adult patients with IHCA occurring in an intensive care unit, intubated prior to or during the event, or immediately after ROSC. We evaluated the percentage of patients documented as comatose after arrest, defined as Glasgow Comas Score (GCS) <8 for the primary analysis. We also evaluated the difference in hospital survival in patients with GCS <8 versus ≥8. Two sensitivity analyses using different methods for defining coma using post-ROSC GCS were conducted. 29/102 (28%) intubated patients had a post-ROSC GCS≥8, and 22 (22%) were documented as following commands. Survival in patients with GCS≥8 vs.<8 was 62% (18/29) vs. 37% (27/73) in unadjusted analysis (p=0.02). The adjusted odds ratio for survival to hospital discharge was 3.81 (95%CI: 1.37-10.61, p=0.01). Results were similar in both sensitivity analyses. Intubation prior to or during IHCA was not a valid marker of coma after ROSC. Post-ROSC mental status was associated with hospital survival, and thus could be an important confounder when conducting observational studies on the association of TTM with outcomes in this patient population. Copyright © 2017 Elsevier B.V. All rights reserved.

Prevalence and predictive factors of post-traumatic hypopituitarism.

PubMed

Klose, M; Juul, A; Poulsgaard, L; Kosteljanetz, M; Brennum, J; Feldt-Rasmussen, U

2007-08-01

To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI). A cross-sectional cohort study. One hundred and four hospitalized TBI patients (26F/78M), median age 41 (range 18-64) years, body mass index (BMI) 25 (17-39) kg/m(2); severity: mild [Glasgow Coma Scale (GCS) score 13-15) n = 44, moderate (GCS 9-12) n = 20, severe (GCS < 9) n = 40]. Patients were evaluated 13 (10-27) months post-injury, with measurement of baseline (0800-1000 h) and post-stimulatory hormonal levels during an insulin tolerance test (ITT) (86%) or, if contraindicated, an arginine(arg)-GHRH test + Synacthen test (14%). Insufficiencies were confirmed by retesting. Hypopituitarism was found in 16 (15%) patients, affecting one axis in 10, two axes in four and more than two axes in two patients. The GH axis was most frequently affected (15%), followed by secondary hypoadrenalism (5%), hypogonadism (2%), hypothyroidism (2%) and diabetes insipidus (2%). The risk of pituitary insufficiency was increased in patients with severe TBI as opposed to mild TBI [odds ratio (OR) 10.1, 95% confidence interval (CI) 2.1-48.4, P = 0.004], and in those patients with increased intracerebral pressure [OR 6.5, 95% CI 1.0-42.2, P = 0.03]. Patients with only one affected axis were all GH deficient; 60% (n = 6) of these were overweight or obese. The prevalence of hypopituitarism was estimated at 16%. Although high, this value was lower than previously reported, and may still be overestimated because of well-known confounding factors, such as obesity. Indicators of increased TBI severity were predictive of hypopituitarism, with a high negative predictive value. Neuroendocrine evaluation should therefore be considered in patients with severe TBI, and in particular in those with increased intracerebral pressure (ICP).

Associations of long-term exposure to air pollution and road traffic noise with cognitive function-An analysis of effect measure modification.

PubMed

Tzivian, Lilian; Jokisch, Martha; Winkler, Angela; Weimar, Christian; Hennig, Frauke; Sugiri, Dorothea; Soppa, Vanessa J; Dragano, Nico; Erbel, Raimund; Jöckel, Karl-Heinz; Moebus, Susanne; Hoffmann, Barbara

2017-06-01

Adverse effects of traffic-related air pollution (AP) and noise on cognitive functions have been proposed, but little is known about their interactions and the combined effect of co-exposure. Cognitive assessment was completed by 4086 participants of the population-based Heinz Nixdorf Recall cohort study using five neuropsychological subtests and an additively calculated global cognitive score (GCS). We assessed long-term residential concentrations for size-fractioned particulate matter (PM) and nitrogen oxides with land use regression. Road traffic noise (weighted 24-h (L DEN ) and night-time (L NIGHT ) means) was assessed according to the EU directive 2002/49/EC. Linear regression models adjusted for individual-level characteristics were calculated to estimate effect modification of associations between AP and noise with cognitive function. We used multiplicative interaction terms and categories of single or double high exposure, dichotomizing the potential effect modifier at the median (AP) or at an a priori defined threshold (road traffic noise). In fully adjusted models, high noise exposure increased the association of AP with cognitive function. For example, for an interquartile range increase of PM 2.5 (IQR 1.43), association s with GCS were: estimate (β)=-0.16 [95% confidence interval: -0.33; 0.01] and β=-0.48 [-0.72; -0.23] for low and high L DEN , respectively. The association of noise with GCS was restricted to highly AP-exposed participants. We observed stronger negative associations in those participants with double exposure compared to the addition of effect estimates of each single exposure. Our study suggests that AP and road traffic noise might act synergistically on cognitive function in adults. Copyright © 2017 Elsevier Ltd. All rights reserved.

A novel strategy for development of glucocorticoids through non-genomic mechanism.

PubMed

Zhou, Jian; Li, Min; Sheng, Chun-Quan; Liu, Lei; Li, Zhen; Wang, Yan; Zhou, Jiang-Rui; Jing, Zai-Ping; Chen, Yi-Zhang; Jiang, Chun-Lei

2011-04-01

Glucocorticoids (GCs) are routinely believed to take effect through genomic mechanisms, which are also largely responsible for GCs' side effects. Beneficial non-genomic effects of GCs have been reported as being independent of the genomic pathway. Here, we synthesized a new type of GCs, which took effect mainly via non-genomic mechanisms. Hydrocortisone was conjugated with glycine, lysine and phenylalanine to get a bigger molecular structure, which could hardly go through the cell membrane. Evaluation of the anti-inflammatory efficacy showed that hydrocortisone-conjugated glycine (HG) and lysine could inhibit neutrophil degranulation within 15 min. HG could inhibit IgE-mediated histamine release from mast cells via a non-genomic pathway, and rapidly alleviate allergic reaction. Luciferase reporter assay showed that HG would not activate the glucocorticoid response element within 30 min, which verified the rapid effects independent of the genomic pathway. The work proposes a novel insight into the development of novel GCs, and provides new tools for experimental study on non-genomic mechanisms.

Effects of thinned young apple polyphenols on the quality of grass carp (Ctenopharyngodon idellus) surimi during cold storage.

PubMed

Sun, Lijun; Sun, Jiaojiao; Thavaraj, Pridhuvi; Yang, Xingbin; Guo, Yurong

2017-06-01

The aim of this study was to investigate the effects of young apple polyphenols (YAP) on the quality of grass cap surimi (GCS) during storage at 4°C. The addition of YAP into GCS was found to be effective in delaying lipid oxidation, soluble myofibrillar protein (SMP) degradation and changes of L ∗ , a ∗ and b ∗ values of GCS. Chlorogenic acid was screened to be the primary component showing preservative effects. YAP was shown to protect the functional properties of SMP during cold storage, retarding both the decrease in emulsifying activity and stability, and the increase in surface hydrophobicity of SMP. Additionally, the loss of gel strength and texture of GCS with YAP were significantly (P<0.05) lower than that of GCS without YAP during cold storage. Therefore, YAP may be developed as a natural antioxidant to maintain the quality and to extend the shelf life of freshwater fish surimi. Copyright © 2016 Elsevier Ltd. All rights reserved.

Security Verification of Secure MANET Routing Protocols

DTIC Science & Technology

2012-03-22

SECURITY VERIFICATION OF SECURE MANET ROUTING PROTOCOLS THESIS Matthew F. Steele, Captain, USAF AFIT/GCS/ ENG /12-03 DEPARTMENT OF THE AIR FORCE AIR...States AFIT/GCS/ ENG /12-03 SECURITY VERIFICATION OF SECURE MANET ROUTING PROTOCOLS THESIS Presented to the Faculty Department of Electrical and Computer...DISTRIBUTION UNLIMITED AFIT/GCS/ ENG /12-03 SECURITY VERIFICATION OF SECURE MANET ROUTING PROTOCOLS Matthew F. Steele, B.S.E.E. Captain, USAF

Central Rotations of Milky Way Globular Clusters

NASA Astrophysics Data System (ADS)

Fabricius, Maximilian H.; Noyola, Eva; Rukdee, Surangkhana; Saglia, Roberto P.; Bender, Ralf; Hopp, Ulrich; Thomas, Jens; Opitsch, Michael; Williams, Michael J.

2014-06-01

Most Milky Way globular clusters (GCs) exhibit measurable flattening, even if on a very low level. Both cluster rotation and tidal fields are thought to cause this flattening. Nevertheless, rotation has only been confirmed in a handful of GCs, based mostly on individual radial velocities at large radii. We are conducting a survey of the central kinematics of Galactic GCs using the new Integral Field Unit instrument VIRUS-W. We detect rotation in all 11 GCs that we have observed so far, rendering it likely that a large majority of the Milky Way GCs rotate. We use published catalogs of GCs to derive central ellipticities and position angles. We show that in all cases where the central ellipticity permits an accurate measurement of the position angle, those angles are in excellent agreement with the kinematic position angles that we derive from the VIRUS-W velocity fields. We find an unexpected tight correlation between central rotation and outer ellipticity, indicating that rotation drives flattening for the objects in our sample. We also find a tight correlation between central rotation and published values for the central velocity dispersion, most likely due to rotation impacting the old dispersion measurements. This Letter includes data taken at The McDonald Observatory of The University of Texas at Austin.

Comparative assessment of a DNA and protein Leishmania donovani gamma glutamyl cysteine synthetase vaccine to cross-protect against murine cutaneous leishmaniasis caused by L. major or L. mexicana infection.

PubMed

Campbell, S A; Alawa, J; Doro, B; Henriquez, F L; Roberts, C W; Nok, A; Alawa, C B I; Alsaadi, M; Mullen, A B; Carter, K C

2012-02-08

Leishmaniasis is a major health problem and it is estimated that 12 million people are currently infected. A vaccine which could cross-protect people against different Leishmania spp. would facilitate control of this disease as more than one species of Leishmania may be present. In this study the ability of a DNA vaccine, using the full gene sequence for L. donovani gamma glutamyl cysteine synthetase (γGCS) incorporated in the pVAX vector (pVAXγGCS), and a protein vaccine, using the corresponding recombinant L. donovani γGCS protein (LdγGCS), to protect against L. major or L. mexicana infection was evaluated. DNA vaccination gave transient protection against L. major and no protection against L. mexicana despite significantly enhancing specific antibody titres in vaccinated infected mice compared to infected controls. Vaccination with the LdγGCS protected against both species but only if the protein was incorporated into non-ionic surfactant vesicles for L. mexicana. The results of this study indicate that a L. donovani γGCS vaccine could be used to vaccinate against more than one Leishmania species but only if the recombinant protein is used. Copyright © 2012 Elsevier Ltd. All rights reserved.

Atrial granular cells of the snail Achatina fulica release proteins into hemolymph after stimulation of the heart nerve.

PubMed

Shabelnikov, Sergej V; Bystrova, Olga A; Ivanov, Vadim A; Margulis, Boris A; Martynova, Marina

2009-10-01

The atrium of the gastropod mollusc Achatina fulica receives rich innervation and contains numerous granular cells (GCs). We studied the atrial innervation and discovered that axon profiles typical in appearance of peptidergic neurons form close unspecialized membrane contacts with GCs. Then, we investigated, at both morphological and biochemical levels, the effect of electrical stimulation of the heart nerve on GCs of Achatina heart perfused in situ. The ultrastructural study demonstrated changes in granule morphology consistent with secretion. These events included alteration of granule content, intracellular granule fusion and formation of complex degranulation channels, within which the granule matrix solubilized. It was shown that electrical stimulation resulted in a significant increase of the total protein concentration in the perfusate. Furthermore, SDS-PAGE analysis of the perfusate revealed three new proteins with molecular masses of 16, 22, and 57 kDa. Affinity-purified polyclonal antibodies against the 16 kDa protein were obtained; the whole-mount immunofluorescence technique revealed the presence of this protein in the granules of atrial GCs. In GCs of the stimulated atrium, a progressive loss of their granular content was observed. The results suggest that the central nervous system can modulate the secretory activity of the atrial GCs through non-synaptic pathways.

Movement of Genetic Counselors from Clinical to Non-clinical Positions: Identifying Driving Forces.

PubMed

Cohen, Stephanie A; Tucker, Megan E

2018-03-05

A previous study of genetic counselors (GCs) in the state of Indiana identified movement out of clinical positions within the past 2 years. The aims of this study were to determine if this trend is nationwide and identify reasons why GCs are leaving their positions and factors that might help employers attract and retain GCs. An email was sent to members of the American Board of Genetic Counseling with a link to an online confidential survey. There were 939 responses (23.5% response rate). Overall, 52% of GCs report being highly satisfied in their current position, although almost two thirds think about leaving and one third had changed jobs within the past 2 years. Of those who had changed jobs (n = 295), 74.9% had been working in a hospital/clinic setting but only 46.3% currently do, demonstrating a major shift out of the clinic (p < 0.001). The top three reasons cited for leaving a position were work environment/institutional climate, salary/benefits, and a lack of feeling valued/recognized as a professional. These results confirm that GCs are moving out of clinical positions and document elements of job satisfaction. We suggest points for employers to consider when trying to recruit or retain GCs.

Retrograde transport from the yeast Golgi is mediated by two ARF GAP proteins with overlapping function.

PubMed Central

Poon, P P; Cassel, D; Spang, A; Rotman, M; Pick, E; Singer, R A; Johnston, G C

1999-01-01

ARF proteins, which mediate vesicular transport, have little or no intrinsic GTPase activity. They rely on the actions of GTPase-activating proteins (GAPs) for their function. The in vitro GTPase activity of the Saccharomyces cerevisiae ARF proteins Arf1 and Arf2 is stimulated by the yeast Gcs1 protein, and in vivo genetic interactions between arf and gcs1 mutations implicate Gcs1 in vesicular transport. However, the Gcs1 protein is dispensable, indicating that additional ARF GAP proteins exist. We show that the structurally related protein Glo3, which is also dispensable, also exhibits ARF GAP activity. Genetic and in vitro approaches reveal that Glo3 and Gcs1 have an overlapping essential function at the endoplasmic reticulum (ER)-Golgi stage of vesicular transport. Mutant cells deficient for both ARF GAPs cannot proliferate, undergo a dramatic accumulation of ER and are defective for protein transport between ER and Golgi. The glo3Delta and gcs1Delta single mutations each interact with a sec21 mutation that affects a component of COPI, which mediates vesicular transport within the ER-Golgi shuttle, while increased dosage of the BET1, BOS1 and SEC22 genes encoding members of a v-SNARE family that functions within the ER-Golgi alleviates the effects of a glo3Delta mutation. An in vitro assay indicates that efficient retrieval from the Golgi to the ER requires these two proteins. These findings suggest that Glo3 and Gcs1 ARF GAPs mediate retrograde vesicular transport from the Golgi to the ER. PMID:9927415

Formation of Globular Clusters with Internal Abundance Spreads in r -Process Elements: Strong Evidence for Prolonged Star Formation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bekki, Kenji; Tsujimoto, Takuji

Several globular clusters (GCs) in the Galaxy are observed to show internal abundance spreads in r -process elements (e.g., Eu). We propose a new scenario that explains the origin of these GCs (e.g., M5 and M15). In this scenario, stars with no/little abundance variations first form from a massive molecular cloud (MC). After all of the remaining gas of the MC is expelled by numerous supernovae, gas ejected from asymptotic giant branch stars can be accumulated in the central region of the GC to form a high-density intracluster medium (ICM). Merging of neutron stars then occurs to eject r -processmore » elements, which can be efficiently trapped in and subsequently mixed with the ICM. New stars formed from the ICM can have r -process abundances that are quite different from those of earlier generations of stars within the GC. This scenario can explain both (i) why r -process elements can be trapped within GCs and (ii) why GCs with internal abundance spreads in r -process elements do not show [Fe/H] spreads. Our model shows (i) that a large fraction of Eu-rich stars can be seen in Na-enhanced stellar populations of GCs, as observed in M15, and (ii) why most of the Galactic GCs do not exhibit such internal abundance spreads. Our model demonstrates that the observed internal spreads of r -process elements in GCs provide strong evidence for prolonged star formation (∼10{sup 8} yr).« less

Signatures of tumour immunity distinguish Asian and non-Asian gastric adenocarcinomas.

PubMed

Lin, Suling J; Gagnon-Bartsch, Johann A; Tan, Iain Beehuat; Earle, Sophie; Ruff, Louise; Pettinger, Katherine; Ylstra, Bauke; van Grieken, Nicole; Rha, Sun Young; Chung, Hyun Cheol; Lee, Ju-Seog; Cheong, Jae Ho; Noh, Sung Hoon; Aoyama, Toru; Miyagi, Yohei; Tsuburaya, Akira; Yoshikawa, Takaki; Ajani, Jaffer A; Boussioutas, Alex; Yeoh, Khay Guan; Yong, Wei Peng; So, Jimmy; Lee, Jeeyun; Kang, Won Ki; Kim, Sung; Kameda, Yoichi; Arai, Tomio; Zur Hausen, Axel; Speed, Terence P; Grabsch, Heike I; Tan, Patrick

2015-11-01

Differences in gastric cancer (GC) clinical outcomes between patients in Asian and non-Asian countries has been historically attributed to variability in clinical management. However, recent international Phase III trials suggest that even with standardised treatments, GC outcomes differ by geography. Here, we investigated gene expression differences between Asian and non-Asian GCs, and if these molecular differences might influence clinical outcome. We compared gene expression profiles of 1016 GCs from six Asian and three non-Asian GC cohorts, using a two-stage meta-analysis design and a novel biostatistical method (RUV-4) to adjust for technical variation between cohorts. We further validated our findings by computerised immunohistochemical analysis on two independent tissue microarray (TMA) cohorts from Asian and non-Asian localities (n=665). Gene signatures differentially expressed between Asians and non-Asian GCs were related to immune function and inflammation. Non-Asian GCs were significantly enriched in signatures related to T-cell biology, including CTLA-4 signalling. Similarly, in the TMA cohorts, non-Asian GCs showed significantly higher expression of T-cell markers (CD3, CD45R0, CD8) and lower expression of the immunosuppressive T-regulatory cell marker FOXP3 compared to Asian GCs (p<0.05). Inflammatory cell markers CD66b and CD68 also exhibited significant cohort differences (p<0.05). Exploratory analyses revealed a significant relationship between tumour immunity factors, geographic locality-specific prognosis, and postchemotherapy outcomes. Analyses of >1600 GCs suggest that Asian and non-Asian GCs exhibit distinct tumour immunity signatures related to T-cell function. These differences may influence geographical differences in clinical outcome, and the design of future trials particularly in immuno-oncology. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

In situ free-floating craniectomy: an unusual cause of chronic post-traumatic cephalalgia

PubMed Central

Kaliaperumal, Chandrasekaran; Raveendran, Savitha

2012-01-01

We describe a case of post-traumatic cephalalgia in a 54-year-old man with chronic right parieto-occipital headache 3 years posthead injury. At the initial presentation, his Glasgow Coma Scale (GCS) was 13/15 and CT brain revealed an acute subdural haematoma with fronto-temporal contusions. After 24 h his GCS dropped to 8/15 and subsequently he underwent a right-sided craniotomy and evacuation of the subdural haematoma and contusionectomy and intracranial pressure monitoring. To manage the cerebral oedema, the cranial bone flap was left in situ free-floating and was managed in an intensive care setting. He made good clinical recovery and 3 months postoperatively he complained of right-sided headache not relieved with medication and occipital nerve block. Three years later he underwent an exploration of the previous craniotomy scalp wound and the free-floating bone flap under the scalp was immobilised. The headache completely resolved following the procedure and is currently asymptomatic. PMID:22891026

T cell-replacing factor for glucocorticosteroid-induced immunoglobulin production. A unique steroid-dependent cytokine

PubMed Central

1983-01-01

Glucocorticosteroids (GCS) added to otherwise unstimulated cultures of human peripheral blood mononuclear cells (PBMC) induce the synthesis and secretion of all classes of immunoglobulin. The magnitude of this response is similar to that seen with other polyclonal B cell activators such as pokeweed mitogen (PWM), and like that of PWM, the steroid effect is dependent on both T cells and monocytes. To determine the cellular target for GCS in these cultures, separated populations of T cells and non-T cells were preincubated with steroids and then recombined. No immunoglobulin was produced in any of these preincubation experiments. As a different approach to this question, supernatants were collected from various cell populations following stimulation with PWM, concanavalin A (Con A), phytohemagglutinin (PHA), alloantigens, or GCS. These supernatants were tested for their effects on GCS-induced Ig production by B cells. Supernatants from 3-d cultures of unstimulated, as well as GCS-treated, PBMC contained a T cell- replacing factor that permitted T-depleted PBMC to produce Ig upon steroid stimulation. This supernatant factor (TRF-S) could be produced in the absence of steroid stimulation, but both the factor and GCS were necessary for the induction of Ig synthesis. Production of the TRF-S required the presence of both T cells and adherent cells in culture and was found in the highest concentrations at 3-4 d of culture. Supernatants from cultures stimulated with PWM, PHA, Con A, and alloantigens did not contain detectable TRF-S activity, and TRF-S was unable to replace helper T cells for PWM-induced Ig production. TRF-S required the presence of adherent cells in the T cell-depleted responder population for its action. Further, it was effective in inducing Ig production along with GCS in the presence of a sufficient concentration of cyclosporin A to block all T cell helper activity for primary responses of PBMC to PWM or GCS. TRF-S was inactivated by trypsin treatment, heating to 56 degrees C, freezing, lyophilization, and storage at 4 degrees C for greater than 3 wk. Its molecular weight is probably 10,000 daltons or more, since TRF-S activity is not rapidly dialyzable. These experiments indicate that GCS-induced Ig production by human B cells does not require the presence of intact T cells in the cultures and therefore the steroids are not exerting their influence directly on T suppressor or T helper cells. Furthermore, they demonstrate a previously unrecognized cytokine that induces the differentiation of human B cells to Ig production in the presence of GCS. PMID:6605406

The effect of replacing lactose by starch on protein and fat digestion in milk-fed veal calves.

PubMed

Pluschke, A M; Gilbert, M S; Williams, B A; van den Borne, J J G C; Schols, H A; Gerrits, W J J

2016-08-01

Replacing dairy components from milk replacer (MR) with vegetable products has been previously associated with decreased protein and fat digestibility in milk-fed calves resulting in lower live weight gain. In this experiment, the major carbohydrate source in MR, lactose, was partly replaced with gelatinized corn starch (GCS) to determine the effect on protein and fat digestibility in milk-fed calves. In total, 16 male Holstein-Friesian calves received either MR with lactose as the carbohydrate source (control) or 18% GCS at the expense of lactose. In the adaptation period, calves were exposed to an increasing dose of GCS for 14 weeks. The indigestible marker cobalt ethylenediaminetetraacetic acid was incorporated into the MR for calculating apparent nutrient digestibility, whereas a pulse dose of chromium (Cr) chloride was fed with the last MR meal 4 h before slaughter as an indicator of passage rates. The calves were anesthetized and exsanguinated at 30 weeks of age. The small intestine was divided in three; small intestine 1 and 2 (SI1 and SI2, respectively) and the terminal ileum (last ~100 cm of small intestine) and samples of digesta were collected. Small intestinal digesta was analysed for α-amylase, lipase and trypsin activity. Digestibility of protein was determined for SI1, SI2, ileum and total tract, whereas digestibility of fat was determined for SI1, SI2 and total tract. Apparent protein digestibility in the small intestine did not differ between treatments but was higher in control calves at total tract level. Apparent crude fat digestibility tended to be increased in SI1 and SI2 for GCS calves, but no difference was found at total tract level. Activity of α-amylase in SI2 and lipase in both SI1 and SI2 was higher in GCS calves. Activity of trypsin tended to be higher in control calves and was higher in SI1 compared with SI2. A lower recovery of Cr in SI2 and a higher recovery of Cr in the large intestine suggest an increased rate of passage for GCS calves. Including 18% of GCS in a milk replacer at the expense of lactose increased passage rate and decreased apparent total tract protein digestibility. In the small intestine, protein digestion did not decrease when feeding GCS and fat digestion even tended to increase. Overall, effects on digestion might be levelled when partially replacing lactose with GCS, because starch digestion is lower than that of lactose but fat digestion may be slightly increased when feeding GCS.

A Subtype of Olfactory Bulb Interneurons Is Required for Odor Detection and Discrimination Behaviors.

PubMed

Takahashi, Hiroo; Ogawa, Yoichi; Yoshihara, Sei-Ichi; Asahina, Ryo; Kinoshita, Masahito; Kitano, Tatsuro; Kitsuki, Michiko; Tatsumi, Kana; Okuda, Mamiko; Tatsumi, Kouko; Wanaka, Akio; Hirai, Hirokazu; Stern, Peter L; Tsuboi, Akio

2016-08-03

Neural circuits that undergo reorganization by newborn interneurons in the olfactory bulb (OB) are necessary for odor detection and discrimination, olfactory memory, and innate olfactory responses, including predator avoidance and sexual behaviors. The OB possesses many interneurons, including various types of granule cells (GCs); however, the contribution that each type of interneuron makes to olfactory behavioral control remains unknown. Here, we investigated the in vivo functional role of oncofetal trophoblast glycoprotein 5T4, a regulator for dendritic arborization of 5T4-expressing GCs (5T4 GCs), the level of which is reduced in the OB of 5T4 knock-out (KO) mice. Electrophysiological recordings with acute OB slices indicated that external tufted cells (ETCs) can be divided into two types, bursting and nonbursting. Optogenetic stimulation of 5T4 GCs revealed their connection to both bursting and nonbursting ETCs, as well as to mitral cells (MCs). Interestingly, nonbursting ETCs received fewer inhibitory inputs from GCs in 5T4 KO mice than from those in wild-type (WT) mice, whereas bursting ETCs and MCs received similar inputs in both mice. Furthermore, 5T4 GCs received significantly fewer excitatory inputs in 5T4 KO mice. Remarkably, in olfactory behavior tests, 5T4 KO mice had higher odor detection thresholds than the WT, as well as defects in odor discrimination learning. Therefore, the loss of 5T4 attenuates inhibitory inputs from 5T4 GCs to nonbursting ETCs and excitatory inputs to 5T4 GCs, contributing to disturbances in olfactory behavior. Our novel findings suggest that, among the various types of OB interneurons, the 5T4 GC subtype is required for odor detection and discrimination behaviors. Neuronal circuits in the brain include glutamatergic principal neurons and GABAergic interneurons. Although the latter is a minority cell type, they are vital for normal brain function because they regulate the activity of principal neurons. If interneuron function is impaired, brain function may be damaged, leading to behavior disorder. The olfactory bulb (OB) possesses various types of interneurons, including granule cells (GCs); however, the contribution that each type of interneuron makes to the control of olfactory behavior remains unknown. Here, we analyzed electrophysiologically and behaviorally the function of oncofetal trophoblast glycoprotein 5T4, a regulator for dendritic branching in OB GCs. We found that, among the various types of OB interneuron, the 5T4 GC subtype is required for odor detection and odor discrimination behaviors. Copyright © 2016 the authors 0270-6474/16/368211-18$15.00/0.

Commentary on the management of type II odontoid process fractures in octogenarians: Article by Graffeo et al. and Editorial by Falavigna (J Neurosurgery Spine August 19, 2016).

PubMed

Epstein, Nancy E

2016-01-01

Establishing a clear treatment paradigm for octogenarians with type II odontoid fractures in hampered by a literature replete with level III articles. In the study by Graffeo et al ., the authors evaluated 111 patients over the age of 79 (average age: 87) with type II odontoid fractures undergoing nonoperative (94 patients) vs. operative intervention (17 total; 15 posterior and 2 anterior). They studied multiple variables and utilized several scales [abbreviated injury scale (AIS), injury severity score (ISS), and the Glasgow coma scale (GCS)] to determine the outcomes of nonoperative vs. operative management. Graffeo et al . concluded that there were no significant differences between nonoperative and operative management for type II odontoid fractures in octogenarians. They found similar frequencies of additional cervical fractures, mechanisms of injury, GCS of 8 or under, AIS/ISS scores, and disposition to "nonhome" facilities. Furthermore, both appeared to have increased mortality rates at 1-year post injury; 13% during hospitalization, 26% within the first post-injury month, and 41% at 1 year. In the editorial by Falavigna, his major criticism of Graffeo's article was the marked disparity in the number of patients in the operative (17 patients) vs. the nonoperative group (94 patients), making it difficult to accept any conclusions as "significant". He further noted that few prior studies provided level I evidence, and that most, like this one, were level III analyses that did not "significantly" advance our knowledge as to whether to treat octogenarians with type II odontoid fractures operatively vs. nonoperatively.

Computed tomography characteristics in pediatric versus adult traumatic brain injury.

PubMed

Sarkar, Korak; Keachie, Krista; Nguyen, UyenThao; Muizelaar, J Paul; Zwienenberg-Lee, Marike; Shahlaie, Kiarash

2014-03-01

Traumatic brain injury (TBI) is a leading cause of injury, hospitalization, and death among pediatric patients. Admission CT scans play an important role in classifying TBI and directing clinical care, but little is known about the differences in CT findings between pediatric and adult patients. The aim of this study was to determine if radiographic differences exist between adult and pediatric TBI. The authors retrospectively analyzed TBI registry data from 1206 consecutive patients with nonpenetrating TBI treated at a Level 1 adult and pediatric trauma center over a 30-month period. The distribution of sex, race, and Glasgow Coma Scale (GCS) score was not significantly different between the adult and pediatric populations; however, the distribution of CT findings was significantly different. Pediatric patients with TBI were more likely to have skull fractures (OR 3.21, p < 0.01) and epidural hematomas (OR 1.96, p < 0.01). Pediatric TBI was less likely to be associated with contusion, subdural hematoma, subarachnoid hemorrhage, or compression of the basal cisterns (p < 0.05). Rotterdam CT scores were significantly lower in the pediatric population (2.3 vs 2.6, p < 0.001). There are significant differences in the CT findings in pediatric versus adult TBI, despite statistical similarities with regard to clinical severity of injury as measured by the GCS. These differences may be due to anatomical characteristics, the biomechanics of injury, and/or differences in injury mechanisms between pediatric and adult patients. The unique characteristics of pediatric TBI warrant consideration when formulating a clinical trial design or predicting functional outcome using prognostic models developed from adult TBI data.

GCRBS score: a new scoring system for predicting outcome in severe falciparum malaria.

PubMed

Mohapatra, Biranchi Narayan; Jangid, Sanjay Kumar; Mohanty, Rina

2014-01-01

Severe falciparum malaria is a critical illness resulting in multi-organ dysfunction and death. Severe malaria is defined by the World Health Organisation as a qualitative variable. The purpose of this study is to devise a scoring system for predicting outcome in severe falciparum malaria. 112 cases of severe falciparum malaria diagnosed as per the WHO criteria, were evaluated to determine the parameters which were significantly associated with mortality. Of all the parameters studied, five variables namely cerebral malaria (GCS < 11), Renal failure (Creatinine > 3 mg/dl), Respiratory distress (Respiratory rate > 24/min), Jaundice (Bilirubin >10 mg/dl) and Shock (Systolic BP < 90 mm of Hg) were all found to be associated with a poor prognosis. The five selected parameters were analysed using the Odds ratio and a new scoring system named as GCRBS score was designed with a possible score from 0-10. With a cut-off score of 5, the GCRBS score predicted mortality with a sensitivity of 85.3% and a specificity of 95.6%. The GCRBS score is easy to calculate and apply. Of the 5 parameters, 3 are clinical which can be determined at bedside and only 2 are biochemical which can be done in any laboratory.The most important advantage of this scoring system is that all the 5 parameters are to be assessed quantitatively for allotting a score, which would eliminate the possibility of observer bias.

VizieR Online Data Catalog: Carbon in red giants in GCs and dSph galaxies (Kirby+, 2015)

NASA Astrophysics Data System (ADS)

Kirby, E. N.; Guo, M.; Zhang, A. J.; Deng, M.; Cohen, J. G.; Guhathakurta, P.; Shetrone, M. D.; Lee, Y. S.; Rizzi, L.

2015-07-01

We obtained Keck/DEIMOS spectra of the carbon G band in red giants in Milky Way (MW) globular clusters (GCs) and dwarf spheroidal galaxies (dSphs) between 2011 Jul 29 and 2012 Mar 19. The GCs are NGC 2419, NGC 4590 (M68), and NGC 7078 (M15). The dSphs are Sculptor, Fornax, Ursa Minor, and Draco. See table 1. (3 data files).

Air Versus Ground Transportation in Isolated Severe Head Trauma: A National Trauma Data Bank Study.

PubMed

Aiolfi, Alberto; Benjamin, Elizabeth; Recinos, Gustavo; De Leon Castro, Alejandro; Inaba, Kenji; Demetriades, Demetrios

2018-03-01

The effect of prehospital helicopter emergency medical services (HEMS) on mortality has been analyzed previously in polytrauma patients with discordant results. Our aim was to compare outcomes in patients with isolated severe blunt traumatic brain injuries (TBIs) transported by HEMS or ground emergency medical services (GEMS). We conducted a National Trauma Data Bank study (2007-2014). All adult patients (≥16 years old) who sustained an isolated severe blunt TBI and were transported by HEMS or GEMS were included in the study. There were 145,559 patients who met the inclusion criteria. Overall, 116,391 (80%) patients were transported via GEMS and 29,168 (20%) via HEMS. Median transportation time was longer for HEMS patients (41 vs. 25 min; p < 0.001). HEMS patients were more likely to have hypotension (2.7% vs. 1.5%; p < 0.001), Glasgow Coma Scale (GCS) score < 9 (38.2% vs. 10.9%; p < 0.001), and head Abbreviation Injury Scale (AIS) score of 5 (20.1% vs. 9.7%; p < 0.001). Stepwise logistic regression analysis identified age ≥ 65 years old, male sex, hypotension, GCS score < 9, prehospital intubation, and head AIS scores 4 and 5 as independent predictors of mortality. Helicopter transportation was independently associated with improved survival (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.47-0.67; p < 0.001). Admission to a Level I trauma center was an independent predictor of survival (OR 0.64; 95% CI 0.53-0.82; p = 0.001). Regardless of head AIS, helicopter transport was an independent predictor of survival (AIS 3: OR 0.35; p < 0.001; AIS 4: OR 0.44; p < 0.001; AIS 5: OR 0.76; p < 0.001). A prolonged transport time was not an independent predictor of mortality. Helicopter transport, in adult patients with isolated severe TBI, is associated with improved survival. Copyright © 2017 Elsevier Inc. All rights reserved.

Potentially modifiable factors contributing to sepsis-associated encephalopathy.

PubMed

Sonneville, Romain; de Montmollin, Etienne; Poujade, Julien; Garrouste-Orgeas, Maïté; Souweine, Bertrand; Darmon, Michael; Mariotte, Eric; Argaud, Laurent; Barbier, François; Goldgran-Toledano, Dany; Marcotte, Guillaume; Dumenil, Anne-Sylvie; Jamali, Samir; Lacave, Guillaume; Ruckly, Stéphane; Mourvillier, Bruno; Timsit, Jean-François

2017-08-01

Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes. We conducted a retrospective analysis of a prospective multicenter database. Sepsis-associated encephalopathy (SAE) was defined by a score on the Glasgow coma scale (GCS) <15 or when features of delirium were noted. Potentially modifiable risk factors for SAE at ICU admission and its impact on mortality were investigated using multivariate logistic regression analysis and Cox proportional hazard modeling, respectively. We included 2513 patients with sepsis at ICU admission, of whom 1341 (53%) had sepsis-associated encephalopathy. After adjusting for baseline characteristics, site of infection, and type of admission, the following factors remained independently associated with sepsis-associated encephalopathy: acute renal failure [adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) 1.19-1.67], hypoglycemia <3 mmol/l (aOR = 2.66, 95% CI 1.27-5.59), hyperglycemia >10 mmol/l (aOR = 1.37, 95% CI 1.09-1.72), hypercapnia >45 mmHg (aOR = 1.91, 95% CI 1.53-2.38), hypernatremia >145 mmol/l (aOR = 2.30, 95% CI 1.48-3.57), and S. aureus (aOR = 1.54, 95% CI 1.05-2.25). Sepsis-associated encephalopathy was associated with higher mortality, higher use of ICU resources, and longer hospital stay. After adjusting for age, comorbidities, year of admission, and non-neurological SOFA score, even mild alteration of mental status (i.e., a score on the GCS of 13-14) remained independently associated with mortality (adjusted hazard ratio = 1.38, 95% CI 1.09-1.76). Acute renal failure and common metabolic disturbances represent potentially modifiable factors contributing to sepsis-associated encephalopathy. However, a true causal relationship has yet to be demonstrated. Our study confirms the prognostic significance of mild alteration of mental status in patients with sepsis.

Management of diaphragmatic rupture from blunt trauma.

PubMed

Tan, K K; Yan, Z Y; Vijayan, A; Chiu, M T

2009-12-01

Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. We reviewed our institution's management of patients with diaphragmatic rupture after blunt trauma. All patients in this study were treated at Tan Tock Seng Hospital, Singapore, from March 2002 to October 2008. Patients with penetrating injuries were excluded. The parameters included age, mechanism of injury, haemodynamic status at admission, Glasgow coma scale (GCS) score, injury severity score (ISS), imaging studies, location of diaphragmatic injuries, associated injuries and outcome. 14 patients with a median age of 38 years formed the study group. Vehicular-related incidents accounted for 71.4 percent of the injuries. The median GCS score on admission was 14 (range 3-15), while the median systolic blood pressure and heart rate were 94 (range 50-164) mmHg and 110 (range 76-140) beats per minute, respectively. The median ISS was 41 (range 14-66). All had chest radiographs performed in the emergency department, six (42.9 percent) had computed tomography performed before surgery, while the remaining eight (57.1 percent) were sent straight to the operating theatre from the emergency department. There were five (35.7 percent) right-sided and nine (64.3 percent) left-sided diaphragmatic ruptures. The mortality rate was 35.7 percent. Some of the associated injuries included eight (57.1 percent) splenic lacerations, five (35.7 percent) haemothorax and lung injuries, four (28.6 percent) bone fractures and three (21.4 percent) liver lacerations. 12 (85.7 percent) patients underwent repair of the diaphragmatic rupture using interrupted polypropylene suture, while the remaining two (14.3 percent) were too haemodynamically unstable to undergo definitive treatment. Advanced age, haemodynamic instability and raised ISS were associated with mortality. An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult, and a thorough examination of both the hemidiaphragms is mandatory during emergency laparotomy for these patients. Those with more severe injuries and decreased physiological reserves usually fare worse.

Factors of Pelvic Infection and Death in Patients with Open Pelvic Fractures and Rectal Injuries.

PubMed

Song, Wenhao; Zhou, Dongsheng; Xu, Weicheng; Zhang, Guoming; Wang, Chunhui; Qiu, Daodi; Dong, Jinlei

Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries. We retrospectively reviewed the records of patients with open pelvic fractures and rectal injuries who were treated at our institution from January 2010-April 2014. From the medical records, age, gender, Injury Severity Score (ISS), cause of fracture, associated injuries, classification of the fracture, degree of soft-tissue injury, Glasgow Coma Score (GCS), Revised Trauma Score (RTS), packed red blood cells (PRBCs) needed, presence/absence of shock, early colostomy (yes or no), drainage (yes or no), and rectal washout (yes or no) were extracted. Univariable and multivariable analysis were performed to determine the association between risk factors and pelvic infection or death. Twenty patients were identified. Pelvic infection occurred in 50% (n = 10) of the patients. Four patients suffered septicemia, and three patients died of multiple organ dysfunction. The mortality rate thus was 15%. According to the univariable analysis, the patients in whom pelvic infection developed had shock, RTS ≤8, GCS ≤8, blood transfusion ≥10 units in the first 24 h, no colostomy, or Gustilo grade III soft-tissue injury. According to the multivariable analysis, shock and absence of colostomy were independently associated with pelvic infection. By univariable analysis, the only factor associated with death was RTS ≤8. The incidence of pelvic infection was lower in patients having early colostomy (p < 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and concurrent rectal injury. Open reduction and internal fixation after extensive debridement is recommended in patients with unstable pelvic fractures.

Using Blue Stragglers to Predict Retained Black Hole Population in Globular Clusters

NASA Astrophysics Data System (ADS)

Hermanek, Keith; Chatterjee, Sourav; Rasio, Frederic

2018-01-01

Large numbers of black holes (BHs) are expected to form in massive star clusters typical of the globular clusters (GCs). Sophisticated theoretical models suggest that many of these BHs can be retained in present-day GCs. Observations have also identified several BH candidates in Galactic and extragalactic GCs (e.g., Macarone et al. 2007; Irwin et al. 2010; Strader et al. 2012; Chomiuk et al. 2013; Miller-Jones et al. 2014). It has also been shown that high-mass and high-density clusters such as GCs are efficient factories of merging binary BHs similar to those observed by the LIGO observatories (Abbott et al. 2016a,b,c,d,e; Rodriguez et al. 2016). Understanding the formation rate and properties of binary BHs are dependent on a detailed understanding of how the BHs dynamically evolve within GCs. Nevertheless, directly detecting BHs in GCs is extremely challenging; BHs only in binaries with limited configurations can be directly detected by the detection of gravitational wave, X-ray, or radio emissions. We propose an indirect of inferring the number of undetected retained BHs in a GC by investigating the dynamical effects of a large number of BHs on the production of other tracer populations such as Blue Straggler Stars (BSS). Using a large grid of detailed GC models we show that there is a clear anti-correlation between the number of BSS in a cluster and the number of retained BHs. Being the most massive species, large numbers of retained BHs will dominate the core of the cluster as a result of mass-segregation driving away other low-mass species such as main-sequence stars from central high-density regions. BSS are expected to form from physical collisions between main-sequence (MS) stars mediated by binary encounters (e.g., Chatterjee et al. 2013) in cores of GCs. Production of BSS by collisions or mass transfer channels are suppressed if a large number of retained BHs in a cluster restrict the number of MS stars in the core. Extensive observational data exist on the number and radial distribution of BSS in GCs. Thus, this anti-correlation between the number of retained BHs and the number of BSS, once carefully calibrated by theoretical models, can be used to infer the population of undetected BHs in GCs.

Comparison of Intra-cluster and M87 Halo Orphan Globular Clusters in the Virgo Cluster

NASA Astrophysics Data System (ADS)

Louie, Tiffany Kaye; Tuan, Jin Zong; Martellini, Adhara; Guhathakurta, Puragra; Toloba, Elisa; Peng, Eric; Longobardi, Alessia; Lim, Sungsoon

2018-01-01

We present a study of “orphan” globular clusters (GCs) — GCs with no identifiable nearby host galaxy — discovered in NGVS, a 104 deg2 CFHT/MegaCam imaging survey. At the distance of the Virgo cluster, GCs are bright enough to make good spectroscopic targets and many are barely resolved in good ground-based seeing. Our orphan GC sample is derived from a subset of NGVS-selected GC candidates that were followed up with Keck/DEIMOS spectroscopy. While our primary spectroscopic targets were candidate GC satellites of Virgo dwarf elliptical and ultra-diffuse galaxies, many objects turned out to be non-satellites based on a radial velocity mismatch with the Virgo galaxy they are projected close to. Using a combination of spectral characteristics (e.g., absorption vs. emission), Gaussian mixture modeling of radial velocity and positions, and extreme deconvolution analysis of ugrizk photometry and image morphology, these non-satellites were classified into: (1) intra-cluster GCs (ICGCs) in the Virgo cluster, (2) GCs in the outer halo of M87, (3) foreground Milky Way stars, and (4) background galaxies. The statistical distinction between ICGCs and M87 halo GCs is based on velocity distributions (mean of 1100 vs. 1300 km/s and dispersions of 700 vs. 400 km/s, respectively) and radial distribution (diffuse vs. centrally concentrated, respectively). We used coaddition to increase the spectral SNR for the two classes of orphan GCs and measured the equivalent widths (EWs) of the Mg b and H-beta absorption lines. These EWs were compared to single stellar population models to obtain mean age and metallicity estimates. The ICGCs and M87 halo GCs have <[Fe/H> = –0.6+/–0.3 and –0.4+/–0.3 dex, respectively, and mean ages of >~ 5 and >~ 10 Gyr, respectively. This suggests the M87 halo GCs formed in relatively high-mass galaxies that avoided being tidally disrupted by M87 until they were close to the cluster center, while IGCCs formed in relatively low-mass galaxies that were tidally disrupted in the cluster outskirts. Most of this work was carried out by high school students working under the auspices of the Science Internship Program (SIP) at UC Santa Cruz. We are grateful for financial support from the NSF and NASA/STScI.

Central diabetes insipidus is not a common and prognostically worse type of hypernatremia in neurointensive care.

PubMed

Spatenkova, Vera; Bradac, Ondrej; Kazda, Antonin; Suchomel, Petr

2011-01-01

Hypernatremia is a common sodium dysbalance in neurointensive care which is associated with worse outcome. It can be caused by central diabetes insipidus (cDI) or by other mechanisms, more often from osmotherapy and furosemide. The aim of this study was to determine the incidence of cDI and to analyse outcome as compared with other causes of hypernatremias found in neurointesive care. We analysed 75 hypernatremic (serum sodium, SNa+ >150 mmol/l) patients (pts) with brain diseases admitted over a period of five years to Neurologic-Neurosurgical Intensive Care Unit (NNICU). Firstly we diagnosed cDI according to measured serum and urine osmolality, eletrolyte free water clearance (EWC) and response to desmopressin acetate. The remaining hypernatremias were categorised as "non cDI". We observed Glasgow Coma Scale (GCS) on onset of hypernatremia, incidence of cerebral complications, Glasgow Outcome Scale (GOS) upon discharge from NNICU and mortality in NNICU. We found cDI in 8 pts (mean SNa+ 154.8 ± 5.4 mmol/l). Most pts (67) were classified as "non cDI" hypernatremias (mean SNa+ 154.3 ± 3.6 mmol/l). There were no differences in serum sodium (p=0.682), serum osmolality (p=0.476) between the two groups, however patients with cDI indicated low urine osmolality (p=0.001) and positive EWC (p=0.049). We did not find any differences in GCS score on onset of hypernatremia (p=0.395), incidence of cerebral complications (p=0.705), GOS score upon discharge from NNICU (p=0.61) and mortality in NNICU (p=0.638). More patients in the "non cDI" group received antiedematic therapy (p=0.028) and diuretic furosemide (p=0.026). Multivariate logistic regression analysis showed that independent predictors of NNICU mortality was the highest level of serum sodium (Odds ratio, OR 1.13, per 1 mmol/l increase in maximal hypernatremia during NNICU stay, 95% confidence interval, CI 1.01-1.26, p=0.027), and GCS on admission of less than 9 (OR 2.61, 95% CI 1.41-5.44, p=0.003). Central diabetes insipidus is not a frequent type of hypernatremia in neurointensive care. Prognosis is connected with serum sodium level, not with type of hypernatremia.

Emergency department blood alcohol level associates with injury factors and six-month outcome after uncomplicated mild traumatic brain injury.

PubMed

Yue, John K; Ngwenya, Laura B; Upadhyayula, Pavan S; Deng, Hansen; Winkler, Ethan A; Burke, John F; Lee, Young M; Robinson, Caitlin K; Ferguson, Adam R; Lingsma, Hester F; Cnossen, Maryse C; Pirracchio, Romain; Korley, Frederick K; Vassar, Mary J; Yuh, Esther L; Mukherjee, Pratik; Gordon, Wayne A; Valadka, Alex B; Okonkwo, David O; Manley, Geoffrey T

2017-11-01

The relationship between blood alcohol level (BAL) and mild traumatic brain injury (mTBI) remains in need of improved characterization. Adult patients suffering mTBI without intracranial pathology on computed tomography (CT) from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with emergency department (ED) Glasgow Coma Scale (GCS) 13-15 and recorded blood alcohol level (BAL) were extracted. BAL≥80-mg/dl was set as proxy for excessive use. Multivariable regression was performed for patients with six-month Glasgow Outcome Scale-Extended (GOSE; functional recovery) and Wechsler Adult Intelligence Scale Processing Speed Index Composite Score (WAIS-PSI; nonverbal processing speed), using BAL≥80-mg/dl and <80-mg/dl cohorts, adjusting for demographic/injury factors. Overall, 107 patients were aged 42.7±16.8-years, 67.3%-male, and 80.4%-Caucasian; 65.4% had BAL=0-mg/dl, 4.6% BAL<80-mg/dl, and 30.0% BAL≥80-mg/dl (range 100-440-mg/dl). BAL differed across loss of consciousness (LOC; none: median 0-mg/dl [interquartile range (IQR) 0-0], <30-min: 0-mg/dl [0-43], ≥30-min: 224-mg/dl [50-269], unknown: 108-mg/dl [0-232]; p=0.002). GCS<15 associated with higher BAL (19-mg/dl [0-204] vs. 0-mg/dl [0-20]; p=0.013). On univariate analysis, BAL≥80-mg/dl associated with less-than-full functional recovery (GOSE≤7; 38.1% vs. 11.5%; p=0.025) and lower WAIS-PSI (92.4±12.7, 30th-percentile vs. 105.1±11.7, 63rd-percentile; p<0.001). On multivariable regression BAL≥80-mg/dl demonstrated an odds ratio of 8.05 (95% CI [1.35-47.92]; p=0.022) for GOSE≤7 and an adjusted mean decrease of 8.88-points (95% CI [0.67-17.09]; p=0.035) on WAIS-PSI. Day-of-injury BAL>80-mg/dl after uncomplicated mTBI was associated with decreased GCS score and prolongation of reported LOC. BAL may be a biomarker for impaired return to baseline function and decreased nonverbal processing speed at six-months postinjury. Future confirmatory studies are needed. Published by Elsevier Ltd.

Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity.

PubMed

Lee, Mi-Jeong; Pramyothin, Pornpoj; Karastergiou, Kalypso; Fried, Susan K

2014-03-01

Central obesity is associated with insulin resistance and dyslipidemia. Thus, the mechanisms that control fat distribution and its impact on systemic metabolism have importance for understanding the risk for diabetes and cardiovascular disease. Hypercortisolemia at the systemic (Cushing's syndrome) or local levels (due to adipose-specific overproduction via 11β-hydroxysteroid dehydrogenase 1) results in the preferential expansion of central, especially visceral fat depots. At the same time, peripheral subcutaneous depots can become depleted. The biochemical and molecular mechanisms underlying the depot-specific actions of glucocorticoids (GCs) on adipose tissue function remain poorly understood. GCs exert pleiotropic effects on adipocyte metabolic, endocrine and immune functions, and dampen adipose tissue inflammation. GCs also regulate multiple steps in the process of adipogenesis. Acting synergistically with insulin, GCs increase the expression of numerous genes involved in fat deposition. Variable effects of GC on lipolysis are reported, and GC can improve or impair insulin action depending on the experimental conditions. Thus, the net effect of GC on fat storage appears to depend on the physiologic context. The preferential effects of GC on visceral adipose tissue have been linked to higher cortisol production and glucocorticoid receptor expression, but the molecular details of the depot-dependent actions of GCs are only beginning to be understood. In addition, increasing evidence underlines the importance of circadian variations in GCs in relationship to the timing of meals for determining their anabolic actions on the adipocyte. In summary, although the molecular mechanisms remain to be fully elucidated, there is increasing evidence that GCs have multiple, depot-dependent effects on adipocyte gene expression and metabolism that promote central fat deposition. This article is part of a Special Issue entitled: Modulation of Adipose Tissue in Health and Disease. Copyright © 2013 Elsevier B.V. All rights reserved.

The fate of radiation induced giant-nucleated cells of human skin fibroblasts

NASA Astrophysics Data System (ADS)

Almahwasi, A. A.; Jeynes, J. C.; Bradley, D. A.; Regan, P. H.

2017-11-01

Radiation-induced giant-nucleated cells (GCs) have been observed to occur within survivors of irradiated cancerous and within healthy cells, both in vivo and in vitro. The expression of such morphological alterations is associated with genomic instability. This study was designed to investigate the fate of GCs induced in a normal human fibroblast cell line (AG1522) after exposure to 0.2, 1 or 2 Gy of X-ray or proton irradiation. The total of 79 individual AG1522 GCs present at 7, 14 or 21 days after each dose point were analysed from fluorescence microscopy images captured over approximately 120 h. The GCs were identified at the beginning of the observation period for each time point post-irradiation and the area of the cell nucleus was measured (μm2) using a cell-recognition MATLAB code. The results demonstrate that the majority of GCs had undergone a prolonged mitotic arrest, which might be an indication of the survival strategy. The live cell microscopy confirms that a giant-nucleated cell formed 14 days after exposure to 0.2 Gy of proton irradiation was divided into two asymmetrical normal-sized cells. These results suggest that a small fraction of GCs can proliferate and form progeny. Some of GCs had disappeared from the microscopy fields. The rate of their loss was decreased as the dose increased but there remains the potential for them to have progeny that could continue to proliferate, ultimately contributing to development of cancer risk. This important method to access delayed effects in normal tissues could act as a potential radioprotective assay for a dose-limiting parameter when applying radiotherapy. These results might have important implications in evaluating risk estimates for patients during radiation therapy treatment.

The Hubble Space Telescope UV Legacy Survey of Galactic Globular Clusters - XII. The RGB bumps of multiple stellar populations

NASA Astrophysics Data System (ADS)

Lagioia, E. P.; Milone, A. P.; Marino, A. F.; Cassisi, S.; Aparicio, A. J.; Piotto, G.; Anderson, J.; Barbuy, B.; Bedin, L. R.; Bellini, A.; Brown, T.; D'Antona, F.; Nardiello, D.; Ortolani, S.; Pietrinferni, A.; Renzini, A.; Salaris, M.; Sarajedini, A.; van der Marel, R.; Vesperini, E.

2018-04-01

The Hubble Space Telescope UV Legacy Survey of Galactic Globular Clusters is providing a major breakthrough in our knowledge of globular clusters (GCs) and their stellar populations. Among the main results, we discovered that all the studied GCs host two main discrete groups consisting of first generation (1G) and second generation (2G) stars. We exploit the multiwavelength photometry from this project to investigate, for the first time, the Red Giant Branch Bump (RGBB) of the two generations in a large sample of GCs. We identified, with high statistical significance, the RGBB of 1G and 2G stars in 26 GCs and found that their magnitude separation as a function of the filter wavelength follows comparable trends. The comparison of observations to synthetic spectra reveals that the RGBB luminosity depends on the stellar chemical composition and that the 2G RGBB is consistent with stars enhanced in He and N and depleted in C and O with respect to 1G stars. For metal-poor GCs the 1G and 2G RGBB relative luminosity in optical bands mostly depends on helium content, Y. We used the RGBB observations in F606W and F814W bands to infer the relative helium abundance of 1G and 2G stars in 18 GCs, finding an average helium enhancement ΔY = 0.011 ± 0.002 of 2G stars with respect to 1G stars. This is the first determination of the average difference in helium abundance of multiple populations in a large number of clusters and provides a lower limit to the maximum internal variation of helium in GCs.

Autocrine action of BDNF on dendrite development of adult-born hippocampal neurons.

PubMed

Wang, Liang; Chang, Xingya; She, Liang; Xu, Duo; Huang, Wei; Poo, Mu-ming

2015-06-03

Dendrite development of newborn granule cells (GCs) in the dentate gyrus of adult hippocampus is critical for their incorporation into existing hippocampal circuits, but the cellular mechanisms regulating their dendrite development remains largely unclear. In this study, we examined the function of brain-derived neurotrophic factor (BDNF), which is expressed in adult-born GCs, in regulating their dendrite morphogenesis. Using retrovirus-mediated gene transfection, we found that deletion and overexpression of BDNF in adult-born GCs resulted in the reduction and elevation of dendrite growth, respectively. This effect was mainly due to the autocrine rather than paracrine action of BDNF, because deletion of BDNF only in the newborn GCs resulted in dendrite abnormality of these neurons to a similar extent as that observed in conditional knockout (cKO) mice with BDNF deleted in the entire forebrain. Furthermore, selective expression of BDNF in adult-born GCs in BDNF cKO mice fully restored normal dendrite development. The BDNF autocrine action was also required for the development of normal density of spines and normal percentage of spines containing the postsynaptic marker PSD-95, suggesting autocrine BDNF regulation of synaptogenesis. Furthermore, increased dendrite growth of adult-born GCs caused by voluntary exercise was abolished by BDNF deletion specifically in these neurons and elevated dendrite growth due to BDNF overexpression in these neurons was prevented by reducing neuronal activity with coexpression of inward rectifier potassium channels, consistent with activity-dependent autocrine BDNF secretion. Therefore, BDNF expressed in adult-born GCs plays a critical role in dendrite development by acting as an autocrine factor. Copyright © 2015 the authors 0270-6474/15/358384-10$15.00/0.

Student Modeling in an Intelligent Tutoring System

DTIC Science & Technology

1996-12-17

Multi-Agent Architecture." Advances in Artificial Intelligence : Proceedings of the 12 th Brazilian Symposium on Aritificial Intelligence , edited by...STUDENT MODELING IN AN INTELLIGENT TUTORING SYSTEM THESIS Jeremy E. Thompson Captain, USAF AFIT/GCS/ENG/96D-27 DIMTVMON* fCKAJWINT A Appr"v*d t=i...Air Force Base, Ohio AFIT/GCS/ENG/96D-27 STUDENT MODELING IN AN INTELLIGENT TUTORING SYSTEM THESIS Jeremy E. Thompson Captain, USAF AFIT/GCS/ENG/96D

Dysregulated Arl1, a regulator of post-Golgi vesicle tethering, can inhibit endosomal transport and cell proliferation in yeast

PubMed Central

Benjamin, Jeremy J. R.; Poon, Pak P.; Drysdale, John D.; Wang, Xiangmin; Singer, Richard A.; Johnston, Gerald C.

2011-01-01

Small monomeric G proteins regulated in part by GTPase-activating proteins (GAPs) are molecular switches for several aspects of vesicular transport. The yeast Gcs1 protein is a dual-specificity GAP for ADP-ribosylation factor (Arf) and Arf-like (Arl)1 G proteins, and also has GAP-independent activities. The absence of Gcs1 imposes cold sensitivity for growth and endosomal transport; here we present evidence that dysregulated Arl1 may cause these impairments. We show that gene deletions affecting the Arl1 or Ypt6 vesicle-tethering pathways prevent Arl1 activation and membrane localization, and restore growth and trafficking in the absence of Gcs1. A mutant version of Gcs1 deficient for both ArfGAP and Arl1GAP activity in vitro still allows growth and endosomal transport, suggesting that the function of Gcs1 that is required for these processes is independent of GAP activity. We propose that, in the absence of this GAP-independent regulation by Gcs1, the resulting dysregulated Arl1 prevents growth and impairs endosomal transport at low temperatures. In cells with dysregulated Arl1, an increased abundance of the Arl1 effector Imh1 restores growth and trafficking, and does so through Arl1 binding. Protein sequestration at the trans-Golgi membrane by dysregulated, active Arl1 may therefore be the mechanism of inhibition. PMID:21562219

The Next Generation Virgo Cluster Survey (NGVS). XXV. Fiducial Panchromatic Colors of Virgo Core Globular Clusters and Their Comparison to Model Predictions

NASA Astrophysics Data System (ADS)

Powalka, Mathieu; Lançon, Ariane; Puzia, Thomas H.; Peng, Eric W.; Liu, Chengze; Muñoz, Roberto P.; Blakeslee, John P.; Côté, Patrick; Ferrarese, Laura; Roediger, Joel; Sánchez-Janssen, Rúben; Zhang, Hongxin; Durrell, Patrick R.; Cuillandre, Jean-Charles; Duc, Pierre-Alain; Guhathakurta, Puragra; Gwyn, S. D. J.; Hudelot, Patrick; Mei, Simona; Toloba, Elisa

2016-11-01

The central region of the Virgo Cluster of galaxies contains thousands of globular clusters (GCs), an order of magnitude more than the number of clusters found in the Local Group. Relics of early star formation epochs in the universe, these GCs also provide ideal targets to test our understanding of the spectral energy distributions (SEDs) of old stellar populations. Based on photometric data from the Next Generation Virgo Cluster Survey (NGVS) and its near-infrared counterpart NGVS-IR, we select a robust sample of ≈ 2000 GCs with excellent photometry and tha span the full range of colors present in the Virgo core. The selection exploits the well-defined locus of GCs in the uiK diagram and the fact that the GCs are marginally resolved in the images. We show that the GCs define a narrow sequence in five-dimensional color space, with limited but real dispersion around the mean sequence. The comparison of these SEDs with the predictions of 11 widely used population synthesis models highlights differences between the models and also shows that no single model adequately matches the data in all colors. We discuss possible causes for some of these discrepancies. Forthcoming papers of this series will examine how best to estimate photometric metallicities in this context, and compare the Virgo GC colors with those in other environments.

Stochastic injection-strategy optimization for the preliminary assessment of candidate geological storage sites

NASA Astrophysics Data System (ADS)

Cody, Brent M.; Baù, Domenico; González-Nicolás, Ana

2015-09-01

Geological carbon sequestration (GCS) has been identified as having the potential to reduce increasing atmospheric concentrations of carbon dioxide (CO2). However, a global impact will only be achieved if GCS is cost-effectively and safely implemented on a massive scale. This work presents a computationally efficient methodology for identifying optimal injection strategies at candidate GCS sites having uncertainty associated with caprock permeability, effective compressibility, and aquifer permeability. A multi-objective evolutionary optimization algorithm is used to heuristically determine non-dominated solutions between the following two competing objectives: (1) maximize mass of CO2 sequestered and (2) minimize project cost. A semi-analytical algorithm is used to estimate CO2 leakage mass rather than a numerical model, enabling the study of GCS sites having vastly different domain characteristics. The stochastic optimization framework presented herein is applied to a feasibility study of GCS in a brine aquifer in the Michigan Basin (MB), USA. Eight optimization test cases are performed to investigate the impact of decision-maker (DM) preferences on Pareto-optimal objective-function values and carbon-injection strategies. This analysis shows that the feasibility of GCS at the MB test site is highly dependent upon the DM's risk-adversity preference and degree of uncertainty associated with caprock integrity. Finally, large gains in computational efficiency achieved using parallel processing and archiving are discussed.

Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting.

PubMed

Wetke, E; Johannsen, F; Langberg, H

2015-08-01

In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60-90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home-based exercises (concentric, eccentric, and stretching) and optional glucocorticosteroid (GCS) injections in patients with (AT) in a usual clinical setting. Patients unable to commence or progress in exercise were offered GCS, hypothesizing that the GCS would facilitate exercise. Ninety-three consecutive patients with AT referred to two outpatient rheumatology clinics were registered, and seen at five visits over a 6-month period. Exercises seemed to have a slow, but long-lasting effect with GCS having a dramatic short-term effect on symptoms. Twenty-six percent of the patients could proceed with training alone, the remainder received one to three supplementary GCS. There were significant improvements on all outcome variables over time (P ≤ 0.001). At follow-up, 42 had no more symptoms, 29 good result, 16 slightly improved, 4 unchanged, and 2 slightly worse. Overall, 94% of the patients had improved, and we thus recommend the use of GCS injections in AT patients if training alone does not lead to improvement. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Up-regulation of Rho-associated kinase 1/2 by glucocorticoids promotes migration, invasion and metastasis of melanoma.

PubMed

Huang, Gao-Xiang; Wang, Yan; Su, Jie; Zhou, Peng; Li, Bo; Yin, Li-Juan; Lu, Jian

2017-12-01

Although glucocorticoids (GCs) regulate proliferation, differentiation and apoptosis of tumor cells, their influence on metastasis of tumor cells is poorly understood. Melanoma is a type of skin cancers with high metastasis. We investigated the effect of GCs on metastasis of melanoma cells and its mechanism. We found that GCs significantly promoted the adhesion, migration, invasion of melanoma cells in vitro and lung metastasis in experimental melanoma metastasis mice. Dexamethasone (Dex), a synthetic GC, did not change the RhoA, RhoB and RhoC signalings, but significantly increased the expression and activity of Rho-associated kinase 1/2 (ROCK1/2). The effect of Dex was to increase ROCK1/2 stability mediated by glucocorticoid receptor. Inhibiting ROCK1/2 activity with Y-27632, a ROCK1/2 inhibitor abrogated the pro-migration and pro-metastasis effects of GCs in vitro and in vivo, indicating that ROCK1/2 mediated the pro-metastasis effects of GCs. Activation of PI3K/AKT also contributed to the pro-migration and pro-invasion effects of Dex partially through up-regulating ROCK1/2 expression. Additionally, Dex also down-regulated the expression of tissue inhibitors of matrix metalloproteinase-2. Taken together, our findings provide new data to understand the possible promoting roles and mechanisms of GCs in melanoma metastasis. Copyright © 2017. Published by Elsevier B.V.

Chemical abundances of globular clusters in NGC 5128 (Centaurus A)

NASA Astrophysics Data System (ADS)

Hernandez, Svea; Larsen, Søren; Trager, Scott; Kaper, Lex; Groot, Paul

2018-06-01

We perform a detailed abundance analysis on integrated-light spectra of 20 globular clusters (GCs) in the early-type galaxy NGC 5128 (Centaurus A). The GCs were observed with X-Shooter on the Very Large Telescope (VLT). The cluster sample spans a metallicity range of -1.92 < [Fe/H] < -0.13 dex. Using theoretical isochrones, we compute synthetic integrated-light spectra and iterate the individual abundances until the best fit to the observations is obtained. We measured abundances of Mg, Ca, and Ti, and find a slightly higher enhancement in NGC 5128 GCs with metallicities [Fe/H] < -0.75 dex, of the order of ˜0.1 dex, than in the average values observed in the Milky Way (MW) for GCs of the same metallicity. If this α-enhancement in the metal-poor GCs in NGC 5128 is genuine, it could hint at a chemical enrichment history different than that experienced by the MW. We also measure Na abundances in 9 out of 20 GCs. We find evidence for intracluster abundance variations in six of these clusters where we see enhanced [Na/Fe] > +0.25 dex. We obtain the first abundance measurements of Cr, Mn, and Ni for a sample of the GC population in NGC 5128 and find consistency with the overall trends observed in the MW, with a slight enhancement (<0.1 dex) in the Fe-peak abundances measured in the NGC 5128.

Nuclei of dwarf spheroidal galaxies KKs 3 and ESO 269-66 and their counterparts in our Galaxy

NASA Astrophysics Data System (ADS)

Sharina, M. E.; Shimansky, V. V.; Kniazev, A. Y.

2017-10-01

We present the analysis of medium-resolution spectra obtained at the Southern African Large Telescope for nuclear globular clusters (GCs) in two dwarf spheroidal galaxies (dSphs). The galaxies have similar star formation histories, but they are situated in completely different environments. ESO 269-66 is a close neighbour of the giant S0 NGC 5128. KKs 3 is one of the few truly isolated dSphs within 10 Mpc. We estimate the helium abundance Y = 0.3, age = 12.6 ± 1 Gyr, [Fe/H] = -1.5, -1.55 ± 0.2 dex, and abundances of C, N, Mg, Ca, Ti, and Cr for the nuclei of ESO 269-66 and KKs 3. Our surface photometry results using Hubble Space Telescope images yield the half-light radius of the cluster in KKs 3, rh = 4.8 ± 0.2 pc. We demonstrate the similarities of medium-resolution spectra, ages, chemical compositions, and structure for GCs in ESO 269-66 and KKs 3 and for several massive Galactic GCs with [Fe/H] ∼ -1.6 dex. All Galactic GCs posses Extended Blue Horizontal Branches and multiple stellar populations. Five of the selected Galactic objects are iron-complex GCs. Our results indicate that the sample GCs observed now in different environments had similar conditions of their formation ∼1 Gyr after the Big Bang.

Classification of stellar populations in globular clusters

NASA Astrophysics Data System (ADS)

Wang, Yue; Zhao, Gang; Li, Hai-Ning

2017-04-01

Possessing multiple stellar populations has been accepted as a common feature of globular clusters (GCs). Different stellar populations manifest themselves with different chemical features, e.g. the well-known O-Na anti-correlation. Generally, the first (primordial) population has O and Na abundances consistent with those of field stars with similar metallicity; while the second (polluted) population is identified by their Na overabundance and O deficiency. The fraction of the populations is an important constraint on the GC formation scenario. Several methods have been proposed for the classification of GC populations. Here we examine a criterion derived based on the distribution of Galactic field stars, which relies on Na abundance as a function of [Fe/H], to distinguish first and second stellar populations in GCs. By comparing the first population fractions of 17 GCs estimated by the field star criterion with those in the literature derived by methods related to individual GCs, we find that the field star criterion tends to overestimate the first population fractions. The population separation methods, which are related to an individual GC sample, are recommended because the diversity of GCs can be taken into consideration. Currently, more caution should be exercised if one wants to regard field stars as a reference for the identification of a GC population. However, further study on the connection between field stars and GCs populations is still needed.

Genetic Counselors in Startup Companies: Redefining the Genetic Counselor Role.

PubMed

Rabideau, Marina M; Wong, Kenny; Gordon, Erynn S; Ryan, Lauren

2016-08-01

Genetic counselors (GCs) have recently begun moving into non-clinic based roles in increasing numbers. A relatively new role for GCs is working for startup companies. Startups are newly established companies in the phase of developing and researching new scalable businesses. This article explores the experiences of four GCs working at different startup companies and aims to provide resources for GCs interested in learning more about these types of roles. The article describes startup culture, including a relatively flat organizational structure, quick product iterations, and flexibility, among other unique cultural characteristics. Financial considerations are described, including how to understand and evaluate a company's financial status, along with a brief explanation of alternate forms of compensation including stock options and equity. Specifically, the article details the uncertainties and rewards of working in a fast-paced startup environment that affords opportunities to try new roles and use the genetic counseling skill set in new ways. This article aims to aid GCs in determining whether a startup environment would be a good fit, learning how to evaluate a specific startup, and understanding how to market themselves for positions at startups.

Genomic alterations and molecular subtypes of gastric cancers in Asians.

PubMed

Ye, Xiang S; Yu, Chunping; Aggarwal, Amit; Reinhard, Christoph

2016-05-09

Gastric cancer (GC) is a highly heterogenic disease, and it is the second leading cause of cancer death in the world. Common chemotherapies are not very effective for GC, which often presents as an advanced or metastatic disease at diagnosis. Treatment options are limited, and the prognosis for advanced GCs is poor. The landscape of genomic alterations in GCs has recently been characterized by several international cancer genome programs, including studies that focused exclusively on GCs in Asians. These studies identified major recurrent driver mutations and provided new insights into the mutational heterogeneity and genetic profiles of GCs. An analysis of gene expression data by the Asian Cancer Research Group (ACRG) further uncovered four distinct molecular subtypes with well-defined clinical features and their intersections with actionable genetic alterations to which targeted therapeutic agents are either already available or under clinical development. In this article, we review the ACRG GC project. We also discuss the implications of the genetic and molecular findings from various GC genomic studies with respect to developing more precise diagnoses and treatment approaches for GCs.

Ages and chemical compositions of massive globular clusters in NGC147 and M31

NASA Astrophysics Data System (ADS)

Sharina, Margarita; Shimansky, Vladislav

2015-08-01

We present estimates of ages, [Fe/H], helium contents (Y) and abundances of C, N, Mg, Ca, Ti, Cr, Mn, Co and Ni for the following globular clusters (GCs): 7 in NGC147, and Mayall II, Mackey 1 and Mackey 6 in M31. Medium-resolution integrated-light spectra of the GCs were conducted with the 6m telescope. To derive the ages and abundances for the GCs we carried out their population synthesis using model stellar atmospheres, the Padova YZVAR isochrones and the Chabrier mass function. We compare the results with the corresponding data obtained using the same method for several massive Galactic GCs. We show that the differences in the Mg and C abundances between GCs with similar ages and metallicities may reach 0.5-0.6 dex. The corresponding differences for other elements are usually ˜2-3 times smaller. We suggest that at least partially the detected differences may be due to Mg and C abundance variations in the atmospheres of high-luminosity red giant branch stars as a consequence of the transportation of the produced elements to the surface layers.

Ages and chemical compositions of massive clusters in NGC147 and M31

NASA Astrophysics Data System (ADS)

Sharina, Margarita; Shimansky, Vladislav

2017-03-01

We present estimates of ages, [Fe/H], helium content (Y) and abundances of C, N, Mg, Ca, and several other elements for the following globular clusters (GCs): GC7 in NGC147, and Mayall II, Mackey 1 and Mackey 6 in M31. Medium-resolution integrated-light spectra of the GCs were conducted with the 6m telescope. To derive the ages and abundances for the GCs we carried out their population synthesis using model stellar atmospheres, the Padova YZVAR isochrones and the Chabrier mass function. We compare the results with the corresponding data obtained using the same method for several massive Galactic GCs. We show that the differences in the light-element abundances between GCs with similar ages and metallicities may reach 0.5-0.6 dex. The corresponding differences for other elements are usually 2-3 times smaller. We suggest that at least partially the detected differences may be due to light-element abundance variations in the atmospheres of high-luminosity red giant branch stars as a consequence of the transportation of the produced elements to the surface layers.

Therapeutic temperature modulation for fever after intracerebral hemorrhage.

PubMed

Lord, Aaron S; Karinja, Sarah; Lantigua, Hector; Carpenter, Amanda; Schmidt, J Michael; Claassen, Jan; Agarwal, Sachin; Connolly, E Sander; Mayer, Stephan A; Badjatia, Neeraj

2014-10-01

We sought to determine whether therapeutic temperature modulation (TTM) to treat fever after intracerebral hemorrhage (ICH) is associated with improved hospital complications and discharge outcomes. We performed a retrospective case-control study of patients admitted with spontaneous ICH having two consecutive fevers ≥38.3 °C despite acetaminophen administration. Cases were enrolled from a prospective database of patients receiving TTM from 2006 to 2010. All cases received TTM for fever control with goal temperature of 37 °C with a shiver-control protocol. Controls were matched in severity by ICH score and retrospectively obtained from 2001 to 2004, before routine use of TTM for ICH. Primary outcome was discharge-modified Rankin score. Forty patients were enrolled in each group. Median admission ICH Score, ICH volume, and GCS were similar. TTM was initiated with a median of 3 days after ICH onset and for a median duration of 7 days. Mean daily T max was significantly higher in the control group over the first 12 days (38.1 vs. 38.7 °C, p ≤ 0.001). The TTM group had more days of IV sedation (median 8 vs. 1, p < 0.001) and mechanical ventilation (18 vs. 9, p = 0.003), and more frequently underwent tracheostomy (55 vs. 23 %, p = 0.005). Mean NICU length of stay was longer for TTM patients (15 vs. 11 days, p = 0.007). There was no difference in discharge outcomes between the two groups (overall mortality 33 %, moderate or severe disability 67 %). Therapeutic normothermia is associated with increased duration of sedation, mechanical ventilation, and NICU stay, but is not clearly associated with improved discharge outcome.

Warranties in Weapon System Procurement: An Analysis of Practice and Theory.

DTIC Science & Technology

1987-04-01

MICROCOPY RESOLUTION TEST CHART NATIONAL BUREAU OF SIANDARDS 1963 A fD r ILE GW cm AD-A190 933 IDA PAPER P-2024 WARRANTIES IN WEAPON SYSTEM PROCUREMENT...EPWT Essential Performance Warranty Test FAR Federal Acquisition Regulation GCS Guidance Control Section GLD Ground Laser Locator Designator GS General...Service IDA Institute for Defense Analyses I&L Installations and Logistics IPT Initial Production Test LDR Laser Designator Rangefimder MLDT Mean

A Simplified GCS-DCSK Modulation and Its Performance Optimization

NASA Astrophysics Data System (ADS)

Xu, Weikai; Wang, Lin; Chi, Chong-Yung

2016-12-01

In this paper, a simplified Generalized Code-Shifted Differential Chaos Shift Keying (GCS-DCSK) whose transmitter never needs any delay circuits, is proposed. However, its performance is deteriorated because the orthogonality between substreams cannot be guaranteed. In order to optimize its performance, the system model of the proposed GCS-DCSK with power allocations on substreams is presented. An approximate bit error rate (BER) expression of the proposed model, which is a function of substreams’ power, is derived using Gaussian Approximation. Based on the BER expression, an optimal power allocation strategy between information substreams and reference substream is obtained. Simulation results show that the BER performance of the proposed GCS-DCSK with the optimal power allocation can be significantly improved when the number of substreams M is large.

Concentration Dependent Actions of Glucocorticoids on Neuronal Viability and Survival

PubMed Central

Ábrahám, István M; Meerlo, Peter; Luiten, Paul GM

2006-01-01

A growing body of evidence based on experimental data demonstrates that glucocorticoids (GCs) can play a potent role in the survival and death of neurons. However, these observations reflect paradoxical features of GCs, since these adrenal stress hormones are heavily involved in both neurodegenerative and neuroprotective processes. The actual level of GCs appears to have an essential impact in this bimodal action. In the present short review we aim to show the importance of concentration dependent action of GCs on neuronal cell viability and cell survival in the brain. Additionally, we will summarize the possible GC-induced cellular mechanisms at different GC concentrations providing a background for their effect on the fate of nerve cells in conditions that are a challenge to their survival. PMID:18648635

Trauma injury in adult underweight patients

PubMed Central

Hsieh, Ching-Hua; Lai, Wei-Hung; Wu, Shao-Chun; Chen, Yi-Chun; Kuo, Pao-Jen; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun

2017-01-01

Abstract The aim of this study was to investigate and compare the injury characteristics, severity, and outcome between underweight and normal-weight patients hospitalized for the treatment of all kinds of trauma injury. This study was based on a level I trauma center Taiwan. The detailed data of 640 underweight adult trauma patients with a body mass index (BMI) of <18.5 kg/m2 and 6497 normal-weight adult patients (25 > BMI ≥ 18.5 kg/m2) were retrieved from the Trauma Registry System between January 1, 2009, and December 31, 2014. Pearson's chi-square test, Fisher's exact test, and independent Student's t-test were performed to compare the differences. Propensity score matching with logistic regression was used to evaluate the effect of underweight on mortality. Underweight patients presented a different bodily injury pattern and a significantly higher rate of admittance to the intensive care unit (ICU) than did normal-weight patients; however, no significant differences in the Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital mortality, and hospital length of stay were found between the two groups. However, further analysis of the patients stratified by two major injury mechanisms (motorcycle accident and fall injury) revealed that underweight patients had significantly lower GCS scores (13.8 ± 3.0 vs 14.5 ± 2.0, P = 0.020), but higher ISS (10.1 ± 6.9 vs 8.4 ± 5.9, P = 0.005), in-hospital mortality (odds ratio, 4.4; 95% confidence interval, 1.69–11.35; P = 0.006), and ICU admittance rate (24.1% vs 14.3%, P = 0.007) than normal-weight patients in the fall accident group, but not in the motorcycle accident group. However, after propensity score matching, logistic regression analysis of well-matched pairs of patients with either all trauma, motorcycle accident, or fall injury did not show a significant influence of underweight on mortality. Exploratory data analysis revealed that underweight patients presented a different bodily injury pattern from that of normal-weight patients, specifically a higher incidence of pneumothorax in those with penetrating injuries and of femoral fracture in those with struck on/against injuries; however, the injury severity and outcome of underweight patients varied depending on the injury mechanism. PMID:28272241

Analysis of Giant-nucleated Cell Formation Following X-ray and Proton Irradiations

NASA Astrophysics Data System (ADS)

Almahwasi, Ashraf Abdu

Radiation-induced genetic instability has been observed in survivors of irradiated cancerous and normal cells in vitro and in vivo and has been determined in different forms, such as delayed cell death, chromosomal aberration or mutation. A well defined and characterized normal human-diploid AG1522 fibroblast cell line was used to study giant-nucleated cell (GCs) formation as the ultimate endpoint of this research. The average nuclear cross-sectional areas of the AG1522 cells were measured in mum2. The doubling time required by the AG1522 cells to divide was measured. The potential toxicity of the Hoechst dye at a working concentration on the live AG1522 cells was assessed. The yield of giant cells was determined at 7, 14 and 21 days after exposure to equivalent clinical doses of 0.2, 1 or 2 Gy of X-ray or proton irradiation. Significant differences were found to exist between X-ray or proton irradiation when compared with sham-irradiated control populations. The frequency of GCs induced by X-rays was also compared to those formed in proton irradiated cultures. The results confirm that 1 Gy X-rays are shown to induce higher rates of mitotically arrested GCs, increasing continually over time up to 21 days post-irradiation. The yield of GCs was significantly greater (10%) compared to those formed in proton populations (2%) 21 days postirradiation. The GCs can undergo a prolonged mitotic arrest that significantly increases the length of cell cycle. The arrest of GCs at the mitotic phase for longer periods of time might be indicative of a strategy for cell survival, as it increases the time available for DNA repair and enables an alternative route to division for the cells. However, the reduction in their formation 21 days after both types of radiation might favour GCs formation, ultimately contributing to carcinogenesis or cancer therapy resistance. The X-ray experiments revealed a dose-dependent increase in the GCs up to 14 days after irradiation. Although the proton irradiation was less efficient in producing GCs, their frequency was elevated in a dose-dependent manner 7 days after irradiation, with persistent expression of nuclear deformity as an indicator of genetic instability. In addition to the quantification of the GCs, the proliferation of a small fraction of giant cells formed at 14 days after 0.2 Gy of proton irradiation was observed to divide into asymmetrical, normal-sized daughter cells. These results might have important implications in evaluating risk estimates, or could act as a potential radioprotective assay for a dose-limiting parameter for delayed effects in healthy tissues during radiation therapy treatment.

A Spanish validation of the Coma Recovery Scale-Revised (CRS-R).

PubMed

Tamashiro, Mercedes; Rivas, Maria Elisa; Ron, Melania; Salierno, Fernando; Dalera, Marisol; Olmos, Lisandro

2014-01-01

Analysis of inter-rater reliability and concurrent validity. To determine measurement properties of a Spanish version of The Coma Recovery Scale-Revised (CRS-R). A sample of 35 in-patients with severe acquired brain injury. To test concurrent validity of the translated scale, the Glasgow Coma Scale (GSC) and Disability Rating Scale (DRS) were also administered. Two experts in the field were recruited to assess inter-rater agreement. Inter-rater reliability was good for total CRS-R scores (Cronbach α = 0.973, p = 0.001). Sub-scale analysis showed moderate-to-high inter-rater agreement. Total CRS-R scores correlated significantly (p < 0.05) with total GCS (r = 0.74) and DRS (r = 0.54) scores, indicating acceptable concurrent validity. The Spanish version of CRS-R can be administered reliably by trained and experienced examiners. CRS-R appears capable of differentiating patients in Emergence from Minimally Conscious State (EMCS) or in Minimally Conscious State (MCS) from those in a Vegetative State (VS).

Hubble Space Telescope Snapshot Search for Planetary Nebulae in Globular Clusters of the Local Group

NASA Astrophysics Data System (ADS)

Bond, Howard E.

2015-04-01

Single stars in ancient globular clusters (GCs) are believed incapable of producing planetary nebulae (PNs), because their post-asymptotic-giant-branch evolutionary timescales are slower than the dissipation timescales for PNs. Nevertheless, four PNs are known in Galactic GCs. Their existence likely requires more exotic evolutionary channels, including stellar mergers and common-envelope binary interactions. I carried out a snapshot imaging search with the Hubble Space Telescope (HST) for PNs in bright Local Group GCs outside the Milky Way. I used a filter covering the 5007 Å nebular emission line of [O iii], and another one in the nearby continuum, to image 66 GCs. Inclusion of archival HST frames brought the total number of extragalactic GCs imaged at 5007 Å to 75, whose total luminosity slightly exceeds that of the entire Galactic GC system. I found no convincing PNs in these clusters, aside from one PN in a young M31 cluster misclassified as a GC, and two PNs at such large angular separations from an M31 GC that membership is doubtful. In a ground-based spectroscopic survey of 274 old GCs in M31, Jacoby et al. found three candidate PNs. My HST images of one of them suggest that the [O iii] emission actually arises from ambient interstellar medium rather than a PN; for the other two candidates, there are broadband archival UV HST images that show bright, blue point sources that are probably the PNs. In a literature search, I also identified five further PN candidates lying near old GCs in M31, for which follow-up observations are necessary to confirm their membership. The rates of incidence of PNs are similar, and small but nonzero, throughout the GCs of the Local Group. Based on observations with the NASA/ESA Hubble Space Telescope obtained at the Space Telescope Science Institute, and from the data archive at STScI, which are operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555.

Metallicity Variations in the Type II Globular Cluster NGC 6934

NASA Astrophysics Data System (ADS)

Marino, A. F.; Yong, D.; Milone, A. P.; Piotto, G.; Lundquist, M.; Bedin, L. R.; Chené, A.-N.; Da Costa, G.; Asplund, M.; Jerjen, H.

2018-06-01

The Hubble Space Telescope photometric survey of Galactic globular clusters (GCs) has revealed a peculiar “chromosome map” for NGC 6934. In addition to a typical sequence, similar to that observed in Type I GCs, NGC 6934 displays additional stars on the red side, analogous to the anomalous Type II GCs, as defined in our previous work. We present a chemical abundance analysis of four red giants in this GC. Two stars are located on the chromosome map sequence common to all GCs, and another two lie on the additional sequence. We find (i) star-to-star Fe variations, with the two anomalous stars being enriched by ∼0.2 dex. Because of our small-size sample, this difference is at the ∼2.5σ level. (ii) There is no evidence for variations in the slow neutron-capture abundances over Fe, at odds with what is often observed in anomalous Type II GCs, e.g., M 22 and ω Centauri (iii) no large variations in light elements C, O, and Na, compatible with locations of the targets on the lower part of the chromosome map where such variations are not expected. Since the analyzed stars are homogeneous in light elements, the only way to reproduce the photometric splits on the sub-giant (SGB) and the red giant (RGB) branches is to assume that red RGB/faint SGB stars are enhanced in [Fe/H] by ∼0.2. This fact corroborates the spectroscopic evidence of a metallicity variation in NGC 6934. The observed chemical pattern resembles only partially the other Type II GCs, suggesting that NGC 6934 might belong either to a third class of GCs, or be a link between normal Type I and anomalous Type II GCs. Based on observations with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by AURA, Inc., under NASA contract NAS 5-26555. This paper includes data gathered with the 6.5 m Magellan Telescopes located at Las Campanas Observatory, Chile, and Gemini Telescope at Canada–France–Hawaii Telescope.

A novel gene expression-based prognostic scoring system to predict survival in gastric cancer

DOE PAGES

Wang, Pin; Wang, Yunshan; Hang, Bo; ...

2016-07-11

Analysis of gene expression patterns in gastric cancer (GC) can help to identify a comprehensive panel of gene biomarkers for predicting clinical outcomes and to discover potential new therapeutic targets. Here, a multi-step bioinformatics analytic approach was developed to establish a novel prognostic scoring system for GC. We first identified 276 genes that were robustly differentially expressed between normal and GC tissues, of which, 249 were found to be significantly associated with overall survival (OS) by univariate Cox regression analysis. The biological functions of 249 genes are related to cell cycle, RNA/ncRNA process, acetylation and extracellular matrix organization. A networkmore » was generated for view of the gene expression architecture of 249 genes in 265 GCs. Finally, we applied a canonical discriminant analysis approach to identify a 53-gene signature and a prognostic scoring system was established based on a canonical discriminant function of 53 genes. The prognostic scores strongly predicted patients with GC to have either a poor or good OS. Our study raises the prospect that the practicality of GC patient prognosis can be assessed by this prognostic scoring system.« less

A novel gene expression-based prognostic scoring system to predict survival in gastric cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Pin; Wang, Yunshan; Hang, Bo

Analysis of gene expression patterns in gastric cancer (GC) can help to identify a comprehensive panel of gene biomarkers for predicting clinical outcomes and to discover potential new therapeutic targets. Here, a multi-step bioinformatics analytic approach was developed to establish a novel prognostic scoring system for GC. We first identified 276 genes that were robustly differentially expressed between normal and GC tissues, of which, 249 were found to be significantly associated with overall survival (OS) by univariate Cox regression analysis. The biological functions of 249 genes are related to cell cycle, RNA/ncRNA process, acetylation and extracellular matrix organization. A networkmore » was generated for view of the gene expression architecture of 249 genes in 265 GCs. Finally, we applied a canonical discriminant analysis approach to identify a 53-gene signature and a prognostic scoring system was established based on a canonical discriminant function of 53 genes. The prognostic scores strongly predicted patients with GC to have either a poor or good OS. Our study raises the prospect that the practicality of GC patient prognosis can be assessed by this prognostic scoring system.« less

The BRAIN TRIAL: a randomised, placebo controlled trial of a Bradykinin B2 receptor antagonist (Anatibant) in patients with traumatic brain injury.

PubMed

Shakur, Haleema; Andrews, Peter; Asser, Toomas; Balica, Laura; Boeriu, Cristian; Quintero, Juan Diego Ciro; Dewan, Yashbir; Druwé, Patrick; Fletcher, Olivia; Frost, Chris; Hartzenberg, Bennie; Mantilla, Jorge Mejia; Murillo-Cabezas, Francisco; Pachl, Jan; Ravi, Ramalingam R; Rätsep, Indrek; Sampaio, Cristina; Singh, Manmohan; Svoboda, Petr; Roberts, Ian

2009-12-03

Cerebral oedema is associated with significant neurological damage in patients with traumatic brain injury. Bradykinin is an inflammatory mediator that may contribute to cerebral oedema by increasing the permeability of the blood-brain barrier. We evaluated the safety and effectiveness of the non-peptide bradykinin B2 receptor antagonist Anatibant in the treatment of patients with traumatic brain injury. During the course of the trial, funding was withdrawn by the sponsor. Adults with traumatic brain injury and a Glasgow Coma Scale score of 12 or less, who had a CT scan showing an intracranial abnormality consistent with trauma, and were within eight hours of their injury were randomly allocated to low, medium or high dose Anatibant or to placebo. Outcomes were Serious Adverse Events (SAE), mortality 15 days following injury and in-hospital morbidity assessed by the Glasgow Coma Scale (GCS), the Disability Rating Scale (DRS) and a modified version of the Oxford Handicap Scale (HIREOS). 228 patients out of a planned sample size of 400 patients were randomised. The risk of experiencing one or more SAEs was 26.4% (43/163) in the combined Anatibant treated group, compared to 19.3% (11/57) in the placebo group (relative risk = 1.37; 95% CI 0.76 to 2.46). All cause mortality in the Anatibant treated group was 19% and in the placebo group 15.8% (relative risk 1.20, 95% CI 0.61 to 2.36). The mean GCS at discharge was 12.48 in the Anatibant treated group and 13.0 in the placebo group. Mean DRS was 11.18 Anatibant versus 9.73 placebo, and mean HIREOS was 3.94 Anatibant versus 3.54 placebo. The differences between the mean levels for GCS, DRS and HIREOS in the Anatibant and placebo groups, when adjusted for baseline GCS, showed a non-significant trend for worse outcomes in all three measures. This trial did not reach the planned sample size of 400 patients and consequently, the study power to detect an increase in the risk of serious adverse events was reduced. This trial provides no reliable evidence of benefit or harm and a larger trial would be needed to establish safety and effectiveness. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN23625128.

A VST and VISTA study of globular clusters in NGC 253

NASA Astrophysics Data System (ADS)

Cantiello, Michele; Grado, Aniello; Rejkuba, Marina; Arnaboldi, Magda; Capaccioli, Massimo; Greggio, Laura; Iodice, Enrica; Limatola, Luca

2018-03-01

Context. Globular clusters (GCs) are key to our understanding of the Universe, as laboratories of stellar evolution, fossil tracers of the past formation epoch of the host galaxy, and effective distance indicators from local to cosmological scales. Aim. We analyze the properties of the sources in the NGC 253 with the aim of defining an up to date catalog of GC candidates in the galaxy. Given the distance of the galaxy, GCs in NGC 253 are ideal targets for resolved color-magnitude diagram studies of extragalactic GCs with next-generation diffraction limited ground-based telescopes. Methods: Our analysis is based on the science verification data of two ESO survey telescopes, VST and VISTA. Using ugri photometry from VST and JKs from VISTA, GC candidates were selected using as reference the morpho-photometric and color properties of spectroscopically confirmed GCs available in the literature. The strength of the results was verified against available archival HST/ACS data from the GHOSTS survey: all but two of the selected GC candidates appear as star clusters in HST footprints. Results: The adopted GC selection leads to the definition of a sample of ˜350 GC candidates. At visual inspection, we find that 82 objects match all the requirements for selecting GC candidates and 155 are flagged as uncertain GC candidate; however, 110 are unlikely GCs, which are most likely background galaxies. Furthermore, our analysis shows that four of the previously spectroscopically confirmed GCs, i.e., ˜20% of the total spectroscopic sample, are more likely either background galaxies or high-velocity Milky Way stars. The radial density profile of the selected best candidates shows the typically observed r1/4-law radial profile. The analysis of the color distributions reveals only marginal evidence of the presence of color bimodality, which is normally observed in galaxies of similar luminosity. The GC luminosity function does not show the typical symmetry, mainly because of the lack of bright GCs. Part of the bright GCs missing might be at very large galactocentric distances or along the line of sight of the galaxy dusty disk. As an alternative possibility, we speculate that a fraction of low luminosity GC candidates might instead be metal-rich, intermediate age clusters, but fall in a similar color interval of old, metal-poor GCs. Conclusions: Defining a contaminant-free sample of GCs in extragalactic systems is not a straight forward exercise. Using optical and near-IR photometry we purged the list of GCs with spectroscopic membership and photometric GC candidates in NGC 253. Our results show that the use of either spectroscopic or photometric data only does not generally ensure a contaminant-free sample and a combination of both spectroscopy and photometry is preferred. Table 3 is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/611/A21This work is based on observations taken at the ESO La Silla Paranal Observatory within the VST Science Verification Programme ID 60.A-9286(A) and VISTA Science Verification Programme ID 60.A-9285(A).

Facile Synthesis of Three-Dimensional Sandwiched MnO2@GCs@MnO2 Hybrid Nanostructured Electrode for Electrochemical Capacitors.

PubMed

Jian, Xian; Liu, Shiyu; Gao, Yuqi; Zhang, Wanli; He, Weidong; Mahmood, Asif; M Subramaniyam, Chandrasekar; Wang, Xiaolin; Mahmood, Nasir; Dou, Shi Xue

2017-06-07

Designable control over the morphology and structure of active materials is highly desirable for achieving high-performance devices. Here, we develop a facile microwave-assisted synthesis to decorate MnO 2 nanocrystals on three-dimensional (3D) graphite-like capsules (GCs) to obtain sandwich nanostructures (3D MnO 2 @GCs@MnO 2 ) as electrode materials for electrochemical capacitors (ECs). A templated growth of the 3D GCs was carried out via catalytic chemical vapor deposition and MnO 2 was decorated on the exterior and interior surfaces of the GC walls through microwave irradiation to build an engineered architecture with robust structural and morphological stability. The unique sandwiched architecture has a large interfacial surface area, and allows for rapid electrolyte diffusion through its hollow/open framework and fast electronic motion via the carbon backbone. Furthermore, the tough and rigid nature of GCs provides the necessary structural stability, and the strong synergy between MnO 2 and GCs leads to high electrochemical activity in both neutral (265.1 F/g at 0.5 A/g) and alkaline (390 F/g at 0.5 A/g) electrolytes. The developed hybrid exhibits stable capacitance up to 6000 cycles in 1 M Na 2 SO 4 . The hybrid is a potential candidate for future ECs and the present study opens up an effective avenue to design hybrid materials for various applications.

Do cortisol and corticosterone play the same role in coping with stressors? Measuring glucocorticoid serum in free-ranging guanacos (Lama guanicoe).

PubMed

Ovejero, Ramiro; Novillo, Agustina; Soto-Gamboa, Mauricio; Mosca-Torres, Maria E; Cuello, Pablo; Gregório, Pablo; Jahn, Graciela; Carmanchahi, Pablo

2013-12-01

Habitat can constrain and shape successful ecological and physiological strategies, thus providing the context for the evolution of life-history traits. However, unpredictable challenges, such as storms, natural disasters, and human activities can also have great effects on stress. Glucocorticoids (GCs) are adrenal steroid hormones that play an important role in how vertebrates cope with these predictable and unpredictable environmental challenges. Although assessing GCs levels can have many applications in the study of wildlife and/or captive animals, with or without capturing individuals, it requires a species-specific complete validation (analytical and biological) before its use. In this work, our aim was to: (a) validate a radioimmunoassay (RIA) for measuring GCs levels in L. guanicoe serum; (b) assess cortisol and corticosterone levels (if present) in serum of wild L. guanicoe individuals; and (c) compare the response to acute stressors (handling, shearing, and release). Our results successfully: (a) validated RIA for asses GCs levels in wild ungulates; (b) confirmed the presence for cortisol and corticosterone and showed that both GCs are differently affected by environmental stimuli in L. guanicoe; and (c) showed that GCs exhibit different patterns in the field and in response to acute stressors, making these camelids an interesting endocrinological model when seeking the adaptive functions of a given variation and further emphasizing the complexity of GC physiology in wild mammals. © 2013 Wiley Periodicals, Inc.

[Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease].

PubMed

Sánchez-Sánchez, M M; Sánchez-Izquierdo, R; Sánchez-Muñoz, E I; Martínez-Yegles, I; Fraile-Gamo, M P; Arias-Rivera, S

2014-01-01

The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

Guidance and Control Software Project Data - Volume 2: Development Documents

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J. (Editor)

2008-01-01

The Guidance and Control Software (GCS) project was the last in a series of software reliability studies conducted at Langley Research Center between 1977 and 1994. The technical results of the GCS project were recorded after the experiment was completed. Some of the support documentation produced as part of the experiment, however, is serving an unexpected role far beyond its original project context. Some of the software used as part of the GCS project was developed to conform to the RTCA/DO-178B software standard, "Software Considerations in Airborne Systems and Equipment Certification," used in the civil aviation industry. That standard requires extensive documentation throughout the software development life cycle, including plans, software requirements, design and source code, verification cases and results, and configuration management and quality control data. The project documentation that includes this information is open for public scrutiny without the legal or safety implications associated with comparable data from an avionics manufacturer. This public availability has afforded an opportunity to use the GCS project documents for DO-178B training. This report provides a brief overview of the GCS project, describes the 4-volume set of documents and the role they are playing in training, and includes the development documents from the GCS project. Volume 2 contains three appendices: A. Guidance and Control Software Development Specification; B. Design Description for the Pluto Implementation of the Guidance and Control Software; and C. Source Code for the Pluto Implementation of the Guidance and Control Software

DERIVING METALLICITIES FROM THE INTEGRATED SPECTRA OF EXTRAGALACTIC GLOBULAR CLUSTERS USING THE NEAR-INFRARED CALCIUM TRIPLET

DOE Office of Scientific and Technical Information (OSTI.GOV)

Foster, Caroline; Forbes, Duncan A.; Proctor, Robert N.

2010-04-15

The Ca II triplet (CaT) feature in the near-infrared has been employed as a metallicity indicator for individual stars as well as integrated light of Galactic globular clusters (GCs) and galaxies with varying degrees of success, and sometimes puzzling results. Using the DEIMOS multi-object spectrograph on Keck we obtain a sample of 144 integrated light spectra of GCs around the brightest group galaxy NGC 1407 to test whether the CaT index can be used as a metallicity indicator for extragalactic GCs. Different sets of single stellar population models make different predictions for the behavior of the CaT as a functionmore » of metallicity. In this work, the metallicities of the GCs around NGC 1407 are obtained from CaT index values using an empirical conversion. The measured CaT/metallicity distributions show unexpected features, the most remarkable being that the brightest red and blue GCs have similar CaT values despite their large difference in mean color. Suggested explanations for this behavior in the NGC 1407 GC system are (1) the CaT may be affected by a population of hot blue stars, (2) the CaT may saturate earlier than predicted by the models, and/or (3) color may not trace metallicity linearly. Until these possibilities are understood, the use of the CaT as a metallicity indicator for the integrated spectra of extragalactic GCs will remain problematic.« less

Gastric cancer in young vs old Romanian patients: immunoprofile with emphasis on maspin and mena protein reactivity.

PubMed

Gurzu, Simona; Kadar, Zoltan; Sugimura, Haruhiko; Bara, Tivadar; Bara, Tivadar; Halmaciu, Ioana; Jung, Ioan

2015-03-01

Increasing number of early-onset gastric carcinomas (GCs) and controversial results regarding the differences among young and older patients with this type of cancer are the reasons why correlation of clinicopathological factors with molecular markers is necessary. The aim of our study was to compare the demographic, clinical and immunohistochemical (IHC) aspects in Romanian patients with GC diagnosed below and above 45 years old. In 191 samples provided from patients with GC, the clinicopathological parameters were correlated with a panel of 15 antibodies: E-cadherin, HER-2, VEGF, CD31, CD105, COX-2, maspin, bax, bcl-2, p53, Ki67, MLH-1, MSH-2, mena protein and vimentin. Compared to the conventional cases, GCs diagnosed below 45 years old were more frequently located at the gastroesophageal junction and presented a higher percentage of lymph node metastases. The diffuse type E-cadherin/mena/p53/Ki67/bax-negative cases that displayed nuclear maspin positivity were also more frequently in younger patients. The intestinal type early-onset GCs were the most angiogenic ones, the apoptotic rate being lower than in the intestinal type GCs of the aged. Compared to the conventional cases, in the early-onset GCs the nuclear maspin-mediated antiproliferative activity is more intense in diffuse type while the mena-dependent tumor cell proliferation is more characteristic for intestinal type GCs. © 2014 APMIS. Published by John Wiley & Sons Ltd.

ARE SOME MILKY WAY GLOBULAR CLUSTERS HOSTED BY UNDISCOVERED GALAXIES?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zaritsky, Dennis; Crnojević, Denija; Sand, David J., E-mail: dennis.zaritsky@gmail.com

2016-07-20

The confirmation of a globular cluster (GC) in the recently discovered ultrafaint galaxy Eridanus II (Eri II) motivated us to examine the question posed in the title. After estimating the halo mass of Eri II using a published stellar mass—halo mass relation, the one GC in this galaxy supports extending the relationship between the number of GCs hosted by a galaxy and the galaxy’s total mass about two orders of magnitude in stellar mass below the previous limit. For this empirically determined specific frequency of between 0.06 and 0.39 GCs per 10{sup 9} M {sub ⊙} of total mass, themore » surviving Milky Way (MW) subhalos with masses smaller than 10{sup 10} M {sub ⊙} could host as many as 5–31 GCs, broadly consistent with the actual population of outer halo MW GCs, although matching the radial distribution in detail remains a challenge. Using a subhalo mass function from published high-resolution numerical simulations and a Poissonian model for populating those halos with the aforementioned empirically constrained frequency, we find that about 90% of these GCs lie in lower-mass subhalos than that of Eri II. From what we know about the stellar mass–halo mass function, the subhalo mass function, and the mass-normalized GC specific frequency, we conclude that some of the MW’s outer halo GCs are likely to be hosted by undetected subhalos with extremely modest stellar populations.« less

Early detection of cerebral microbleeds following traumatic brain injury using MRI in the hyper-acute phase.

PubMed

Lawrence, Tim P; Pretorius, Pieter M; Ezra, Martyn; Cadoux-Hudson, Tom; Voets, Natalie L

2017-08-10

Traumatic brain injury (TBI) is a leading cause of death and disability in people under 45. Advanced imaging techniques to identify injury and classify severity in the first few hours and days following trauma could improve patient stratification and aid clinical decision making. Traumatic cerebral microbleeds (TCMBs), detectable on magnetic resonance susceptibility weighted imaging (SWI), can be used as markers of long-term clinical outcome. However, the relationship between TCMBs and injury severity in the first few hours after injury, and their natural evolution, is unknown. We obtained SWI scans in 10 healthy controls, and 13 patients scanned 3-24h following TBI and again at 7-15days. TCMBs were identified and total volume quantified for every lesion in each scan. TCMBs were present in 6 patients, all with more severe injury classified by GCS. No lesions were identified in patients with an initial GCS of 15. Improvement in GCS in the first 15days following injury was significantly associated with a reduction in microbleed volume over the same time-period. MRI is feasible in severely injured patients in the first 24h after trauma. Detection of TCMBs using SWI provides an objective early marker of injury severity following trauma. TCMBs revealed in this time frame, offer the potential to help determine the degree of injury, improving stratification, in order to identify patients who require admission to hospital, transfer to a specialist center, or an extended period of intubation on intensive care. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Globular cluster formation with multiple stellar populations from hierarchical star cluster complexes

NASA Astrophysics Data System (ADS)

Bekki, Kenji

2017-05-01

Most old globular clusters (GCs) in the Galaxy are observed to have internal chemical abundance spreads in light elements. We discuss a new GC formation scenario based on hierarchical star formation within fractal molecular clouds. In the new scenario, a cluster of bound and unbound star clusters ('star cluster complex', SCC) that have a power-law cluster mass function with a slope (β) of 2 is first formed from a massive gas clump developed in a dwarf galaxy. Such cluster complexes and β = 2 are observed and expected from hierarchical star formation. The most massive star cluster ('main cluster'), which is the progenitor of a GC, can accrete gas ejected from asymptotic giant branch (AGB) stars initially in the cluster and other low-mass clusters before the clusters are tidally stripped or destroyed to become field stars in the dwarf. The SCC is initially embedded in a giant gas hole created by numerous supernovae of the SCC so that cold gas outside the hole can be accreted on to the main cluster later. New stars formed from the accreted gas have chemical abundances that are different from those of the original SCC. Using hydrodynamical simulations of GC formation based on this scenario, we show that the main cluster with the initial mass as large as [2-5] × 105 M⊙ can accrete more than 105 M⊙ gas from AGB stars of the SCC. We suggest that merging of hierarchical SSCs can play key roles in stellar halo formation around GCs and self-enrichment processes in the early phase of GC formation.

45th Annual Targets, UAVs and Range Operations Symposium and Exhibition - Tools and Technologies for the Warfighter. Volume 1

DTIC Science & Technology

2007-10-30

Flight Test wmv format Joint Ground Robotics Program, Mr. Duane Gotvald, Deputy Project Manager , PEO GCS Robotic Systems Joint Program 1...Mr. Al Brown, TMO Deputy Director, PMITTS, PEO STRI 1. Targets Management Office wmv format Strength through Industry & Technology National...Ferguson, RCN, NDHQ 10:20AM DTRMC, OSD Strategic Plan Jerry Christensen, DOT&E 10:40 Target Management Initiative Ken McCormick, DOT&E 11:10AM

Glucocorticoid-induced changes in glucocorticoid receptor mRNA and protein expression in the human placenta as a potential factor for altering fetal growth and development.

PubMed

Bivol, Svetlana; Owen, Suzzanne J; Rose'Meyer, Roselyn B

2016-02-05

Glucocorticoids (GCs) control essential metabolic processes in virtually every cell in the body and play a vital role in the development of fetal tissues and organ systems. The biological actions of GCs are mediated via glucocorticoid receptors (GRs), the cytoplasmic transcription factors that regulate the transcription of genes involved in placental and fetal growth and development. Several experimental studies have demonstrated that fetal exposure to high maternal GC levels early in gestation is associated with adverse fetal outcomes, including low birthweight, intrauterine growth restriction and anatomical and structural abnormalities that may increase the risk of cardiovascular, metabolic and neuroendocrine disorders in adulthood. The response of the fetus to GCs is dependent on gender, with female fetuses becoming hypersensitive to changes in GC levels whereas male fetuses develop GC resistance in the environment of high maternal GCs. In this paper we review GR function and the physiological and pathological effects of GCs on fetal development. We propose that GC-induced changes in the placental structure and function, including alterations in the expression of GR mRNA and protein levels, may play role in inhibiting in utero fetal growth.

Microparticle-Mediated Delivery of BMP4 for Generation of Meiosis-Competent Germ Cells from Embryonic Stem Cells.

PubMed

Esfandiari, Fereshteh; Ashtiani, Mohammad Kazemi; Sharifi-Tabar, Mehdi; Saber, Maryam; Daemi, Hamed; Ghanian, Mohammad Hossein; Shahverdi, Abdolhossein; Baharvand, Hossein

2017-03-01

Producing meiosis-competent germ cells (GCs) from embryonic stem cells (ESCs) is essential for developing advanced therapies for infertility. Here, a novel approach is presented for generation of GCs from ESCs. In this regard, microparticles (MPs) have been developed from alginate sulfate loaded with bone morphogenetic protein 4 (BMP4). The results here show that BMP4 release from alginate sulfate MPs is significantly retarded by the sulfated groups compared to neat alginate. Then, BMP4-laden MPs are incorporated within the aggregates during differentiation of GCs from ESCs. It is observed that BMP4-laden MPs increase GC differentiation from ESCs at least twofold compared to the conventional soluble delivery method. Interestingly, following meiosis induction, Dazl, an intrinsic factor that enables GCs to enter meiosis, and two essential meiosis genes (Stra8 and Smc1b) are upregulated significantly in MP-induced aggregates compared to aggregates, which are formed by the conventional method. Together, these data show that controlled delivery of BMP4 during ESC differentiation into GC establish meiosis-competent GCs which can serve as an attractive GC source for reproductive medicine. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Semaphorin 5A inhibits synaptogenesis in early postnatal- and adult-born hippocampal dentate granule cells.

PubMed

Duan, Yuntao; Wang, Shih-Hsiu; Song, Juan; Mironova, Yevgeniya; Ming, Guo-li; Kolodkin, Alex L; Giger, Roman J

2014-10-14

Human SEMAPHORIN 5A (SEMA5A) is an autism susceptibility gene; however, its function in brain development is unknown. In this study, we show that mouse Sema5A negatively regulates synaptogenesis in early, developmentally born, hippocampal dentate granule cells (GCs). Sema5A is strongly expressed by GCs and regulates dendritic spine density in a cell-autonomous manner. In the adult mouse brain, newly born Sema5A-/- GCs show an increase in dendritic spine density and increased AMPA-type synaptic responses. Sema5A signals through PlexinA2 co-expressed by GCs, and the PlexinA2-RasGAP activity is necessary to suppress spinogenesis. Like Sema5A-/- mutants, PlexinA2-/- mice show an increase in GC glutamatergic synapses, and we show that Sema5A and PlexinA2 genetically interact with respect to GC spine phenotypes. Sema5A-/- mice display deficits in social interaction, a hallmark of autism-spectrum-disorders. These experiments identify novel intra-dendritic Sema5A/PlexinA2 interactions that inhibit excitatory synapse formation in developmentally born and adult-born GCs, and they provide support for SEMA5A contributions to autism-spectrum-disorders.

An Ecological Approach to the Design of UAV Ground Control Station (GCS) Status Displays

NASA Technical Reports Server (NTRS)

Dowell, Susan; Morphew, Ephimia; Shively, Jay

2003-01-01

Use of UAVs in military and commercial applications will continue to increase. However, there has been limited research devoted to UAV GCS design. The current study employed an ecological approach to interfac e design. Ecological Interface Design (EID) can be characterized as r epresenting the properties of a system, such that an operator is enco uraged to use skill-based behavior when problem solving. When more ef fortful cognitive processes become necessary due to unfamiliar situations, the application of EID philosophy supports the application of kn owledge-based behavior. With advances toward multiple UAV command and control, operators need GCS interfaces designed to support understan ding of complex systems. We hypothesized that use of EID principles f or the display of UAV status information would result in better opera tor performance and situational awareness, while decreasing workload. Pilots flew a series of missions with three UAV GCS displays of statu s information (Alphanumeric, Ecological, and Hybrid display format). Measures of task performance, Situational Awareness, and workload dem onstrated the benefits of using an ecological approach to designing U AV GCS displays. The application of ecological principles to the design of UAV GCSs is a promising area for improving UAV operations.

Stress and Memory: A Selective Review on Recent Developments in the Understanding of Stress Hormone Effects on Memory and Their Clinical Relevance.

PubMed

Wolf, O T; Atsak, P; de Quervain, D J; Roozendaal, B; Wingenfeld, K

2016-08-01

Stress causes a neuroendocrine response cascade, leading to the release of catecholamines and glucocorticoids (GCs). GCs influence learning and memory by acting on mineralocorticoid (MR) and glucocorticoid (GR) receptors. Typically, GCs enhance the consolidation of memory processing at the same time as impairing the retrieval of memory of emotionally arousing experiences. The present selective review addresses four recent developments in this area. First, the role of the endocannabinoid system in mediating the rapid, nongenomic effects of GCs on memory is illustrated in rodents. Subsequently, studies on the impact of the selective stimulation of MRs on different memory processes in humans are summarised. Next, a series of human experiments on the impact of stress or GC treatment on fear extinction and fear reconsolidation is presented. Finally, the clinical relevance of the effects of exogenous GC administration is highlighted by the description of patients with anxiety disorders who demonstrate an enhancement of extinction-based therapies by GC treatment. The review highlights the substantial progress made in our mechanistic understanding of the memory-modulating properties of GCs, as well as their clinical potential. © 2015 British Society for Neuroendocrinology.

A prospective controlled study: Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage

PubMed Central

2011-01-01

Background Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with the high mortality twofold to sixfold higher than that for ischemic stroke. But the treatment of haematomas within the basal ganglia continues to be a matter of debate among neurologists and neurosurgeons. The purpose of this study is to judge the clinical value of minimally invasive stereotactic puncture therapy (MISPT) on acute ICH. Methods A prospective controlled study was undertaken. The clinical trial was in compliance with the WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. According to the enrollment criterion, there were 168 acute ICH cases analyzed, of which 90 cases were performed by MISPT ( MISPT group, MG) and 78 cases by Conventional craniotomy (CC group, CG), by means of compare of Glasgow Coma Scale(GCS) score, postoperative complications(PC) and rebleeding incidence(RI), moreover, long-term outcome of 1 year postoperation judged by Glasgow Outcome Scale (GOS), Barthel Index (BI), modified Rankin Scale (mRS) and case fatality(CF). Results MG patients showed obvious amelioration in GCS score compared with that of CG. The total incidence of PC in MG decreased obviously compared with that of CG. The incidences of rebleeding in MG and CG were 10.0% and 15.4% respectively. There was no obvious difference between CFs of MG and CG. For three parameters representing long-term outcome, the GOS, BI and mRS in MG were ameliorated significantly than that of CG. Conclusion These data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome. Trial Registration The Australian New Zealand Clinical Trials Registry (ANZCTR), the registration number:ACTRN12610000945022. PMID:21699716

GSC configuration management plan

NASA Technical Reports Server (NTRS)

Withers, B. Edward

1990-01-01

The tools and methods used for the configuration management of the artifacts (including software and documentation) associated with the Guidance and Control Software (GCS) project are described. The GCS project is part of a software error studies research program. Three implementations of GCS are being produced in order to study the fundamental characteristics of the software failure process. The Code Management System (CMS) is used to track and retrieve versions of the documentation and software. Application of the CMS for this project is described and the numbering scheme is delineated for the versions of the project artifacts.

Novel aspects of glucocorticoid actions.

PubMed

Uchoa, E T; Aguilera, G; Herman, J P; Fiedler, J L; Deak, T; de Sousa, M B C

2014-09-01

Normal hypothalamic-pituitary-adrenal (HPA) axis activity leading to the rhythmic and episodic release of adrenal glucocorticoids (GCs) is essential for body homeostasis and survival during stress. Acting through specific intracellular receptors in the brain and periphery, GCs regulate behaviour, as well as metabolic, cardiovascular, immune and neuroendocrine activities. By contrast to chronic elevated levels, circadian and acute stress-induced increases in GCs are necessary for hippocampal neuronal survival and memory acquisition and consolidation, as a result of the inhibition of apoptosis, the facilitation of glutamatergic neurotransmission and the formation of excitatory synapses, and the induction of immediate early genes and dendritic spine formation. In addition to metabolic actions leading to increased energy availability, GCs have profound effects on feeding behaviour, mainly via the modulation of orexigenic and anorixegenic neuropeptides. Evidence is also emerging that, in addition to the recognised immune suppressive actions of GCs by counteracting adrenergic pro-inflammatory actions, circadian elevations have priming effects in the immune system, potentiating acute defensive responses. In addition, negative-feedback by GCs involves multiple mechanisms leading to limited HPA axis activation and prevention of the deleterious effects of excessive GC production. Adequate GC secretion to meet body demands is tightly regulated by a complex neural circuitry controlling hypothalamic corticotrophin-releasing hormone (CRH) and vasopressin secretion, which are the main regulators of pituitary adrenocorticotrophic hormone (ACTH). Rapid feedback mechanisms, likely involving nongenomic actions of GCs, mediate the immediate inhibition of hypothalamic CRH and ACTH secretion, whereas intermediate and delayed mechanisms mediated by genomic actions involve the modulation of limbic circuitry and peripheral metabolic messengers. Consistent with their key adaptive roles, HPA axis components are evolutionarily conserved, being present in the earliest vertebrates. An understanding of these basic mechanisms may lead to novel approaches for the development of diagnostic and therapeutic tools for disorders related to stress and alterations of GC secretion. © 2014 British Society for Neuroendocrinology.

The effect of heat stress on gene expression, synthesis of steroids, and apoptosis in bovine granulosa cells.

PubMed

Li, Lian; Wu, Jie; Luo, Man; Sun, Yu; Wang, Genlin

2016-05-01

Summer heat stress (HS) is a major contributing factor in low fertility in lactating dairy cows in hot environments. Heat stress inhibits ovarian follicular development leading to diminished reproductive efficiency of dairy cows during summer. Ovarian follicle development is a complex process. During follicle development, granulosa cells (GCs) replicate, secrete hormones, and support the growth of the oocyte. To obtain an overview of the effects of heat stress on GCs, digital gene expression profiling was employed to screen and identify differentially expressed genes (DEGs; false discovery rate (FDR) ≤ 0.001, fold change ≥2) of cultured GCs during heat stress. A total of 1211 DEGs including 175 upregulated and 1036 downregulated ones were identified, of which DEGs can be classified into Gene Ontology (GO) categories and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The results suggested that heat stress triggers a dramatic and complex program of altered gene expression in GCs. We hypothesized that heat stress could induce the apoptosis and dysfunction of GCs. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate the expression of steroidogenic genes (steroidogenic acute regulatory protein (Star), cytochrome P-450 (CYP11A1), CYP19A1, and steroidogenic factor 1 (SF-1)) and apoptosis-related genes (caspase-3, BCL-2, and BAX). Radio immunoassay (RIA) was used to analyze the level of 17β-estradiol (E2) and progesterone (P4). We also assessed the apoptosis of GCs by flow cytometry. Our data suggested that heat stress induced GC apoptosis through the BAX/BCL-2 pathway and reduced the steroidogenic gene messenger RNA (mRNA) expression and E2 synthesis. These results suggest that the decreased function of GCs may cause ovarian dysfunction and offer an improved understanding of the molecular mechanism responsible for the low fertility in cattle in summer.

Synthesis and characterization of wollastonite glass-ceramics for dental implant applications.

PubMed

Saadaldin, Selma A; Rizkalla, Amin S

2014-03-01

To synthesize a glass-ceramic (GC) that is suitable for non-metallic one-piece dental implant application. Three glasses in a SiO2-Al2O3-CaO-CaF2-K2O-B2O3-P2O5-CeO2-Y2O3 system were produced by wet chemistry. Differential thermal analysis (DTA) was carried out to determine the glass crystallization kinetic parameters and the heating schedules that were used for sintering of GCs. Crystalline phases and crystal morphologies were studied by X-ray diffraction (XRD) and scanning electron microscopy (SEM), respectively. Mechanical properties of the GCs were determined by ultrasonic and indentation tests and its machinability were evaluated. Chemical durability was carried out according to ISO 6872, whereas testing chemical degradation in tris buffered solution was executed according to ISO 10993-14. XRD of the GC specimens showed that wollastonite was the main crystalline with other secondary phases; GC2 had cristobalite as an additional phase. SEM of the GCs revealed dense acicular interlocking crystals. Young's modulus of elasticity (E), true hardness (Ho) and fracture toughness (KIC) of the GCs were 89-100GPa, 4.85-5.17GPa and 4.62-5.58MPam(0.5), respectively. All GCs were demonstrated excellent machinability. The GCs exhibited various chemical durability and degradation rates. KIC values of the GCs following chemical durability testing were not significantly different from those of the original materials (p>0.05). GC2 exhibited significantly higher KIC value compared with GC1 and GC3 (p<0.05) and its chemical durability satisfied ISO 6872 specification for dental ceramics. Wollastonite-cristobalite GC can be considered as a promising material for one-piece dental implant applications due to its strength, machinability and chemical durability. Copyright © 2014. Published by Elsevier Ltd.

REVERSED TREND OF RADIAL DISTRIBUTION OF SUBPOPULATIONS IN THE GLOBULAR CLUSTERS NGC 362 AND NGC 6723

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lim, Dongwook; Lee, Young-Wook; Pasquato, Mario

2016-12-01

Most globular clusters (GCs) are now known to host multiple stellar populations with different abundances of light elements. Here we use narrow-band photometry and low-resolution spectroscopy for NGC 362 and NGC 6723 to investigate their chemical properties and radial distributions of subpopulations. We confirm that NGC 362 and NGC 6723 are among the GCs with multiple populations showing bimodal CN distribution and CN–CH anticorrelation without a significant spread in calcium abundance. These two GCs show more centrally concentrated CN-weak, earlier generation stars compared to the CN-strong, later generation stars. These trends are reversed with respect to those found in previous studies for many othermore » GCs. Our findings, therefore, seem contradictory to the current scenario for the formation of multiple stellar populations, but mass segregation acting on the two subpopulations might be a possible solution to explain this reversed radial trend.« less

Stress Increases Peripheral Axon Growth and Regeneration through Glucocorticoid Receptor-Dependent Transcriptional Programs

PubMed Central

Alexander, Jessica K.; Madalena, Kathryn M.; Motti, Dario; Quach, Tam; Zha, Alicia; Webster Marketon, Jeanette

2017-01-01

Abstract Stress and glucocorticoid (GC) release are common behavioral and hormonal responses to injury or disease. In the brain, stress/GCs can alter neuron structure and function leading to cognitive impairment. Stress and GCs also exacerbate pain, but whether a corresponding change occurs in structural plasticity of sensory neurons is unknown. Here, we show that in female mice (Mus musculus) basal GC receptor (Nr3c1, also known as GR) expression in dorsal root ganglion (DRG) sensory neurons is 15-fold higher than in neurons in canonical stress-responsive brain regions (M. musculus). In response to stress or GCs, adult DRG neurite growth increases through mechanisms involving GR-dependent gene transcription. In vivo, prior exposure to an acute systemic stress increases peripheral nerve regeneration. These data have broad clinical implications and highlight the importance of stress and GCs as novel behavioral and circulating modifiers of neuronal plasticity. PMID:28828403

Relevance of chronic stress and the two faces of microglia in Parkinson’s disease

PubMed Central

Herrera, Antonio J.; Espinosa-Oliva, Ana M.; Carrillo-Jiménez, Alejandro; Oliva-Martín, María J.; García-Revilla, Juan; García-Quintanilla, Alberto; de Pablos, Rocío M.; Venero, José L.

2015-01-01

This review is aimed to highlight the importance of stress and glucocorticoids (GCs) in modulating the inflammatory response of brain microglia and hence its potential involvement in Parkinson’s disease (PD). The role of inflammation in PD has been reviewed extensively in the literature and it is supposed to play a key role in the course of the disease. Historically, GCs have been strongly associated as anti-inflammatory hormones. However, accumulating evidence from the peripheral and central nervous system have clearly revealed that, under specific conditions, GCs may promote brain inflammation including pro-inflammatory activation of microglia. We have summarized relevant data linking PD, neuroinflamamation and chronic stress. The timing and duration of stress response may be critical for delineating an immune response in the brain thus probably explain the dual role of GCs and/or chronic stress in different animal models of PD. PMID:26321913

Male germ cells support long-term propagation of Zika virus.

PubMed

Robinson, Christopher L; Chong, Angie C N; Ashbrook, Alison W; Jeng, Ginnie; Jin, Julia; Chen, Haiqi; Tang, Elizabeth I; Martin, Laura A; Kim, Rosa S; Kenyon, Reyn M; Do, Eileen; Luna, Joseph M; Saeed, Mohsan; Zeltser, Lori; Ralph, Harold; Dudley, Vanessa L; Goldstein, Marc; Rice, Charles M; Cheng, C Yan; Seandel, Marco; Chen, Shuibing

2018-05-29

Evidence of male-to-female sexual transmission of Zika virus (ZIKV) and viral RNA in semen and sperm months after infection supports a potential role for testicular cells in ZIKV propagation. Here, we demonstrate that germ cells (GCs) are most susceptible to ZIKV. We found that only GCs infected by ZIKV, but not those infected by dengue virus and yellow fever virus, produce high levels of infectious virus. This observation coincides with decreased expression of interferon-stimulated gene Ifi44l in ZIKV-infected GCs, and overexpression of Ifi44l results in reduced ZIKV production. Using primary human testicular tissue, we demonstrate that human GCs are also permissive for ZIKV infection and production. Finally, we identified berberine chloride as a potent inhibitor of ZIKV infection in both murine and human testes. Together, these studies identify a potential cellular source for propagation of ZIKV in testes and a candidate drug for preventing sexual transmission of ZIKV.

B cell–derived IL-6 initiates spontaneous germinal center formation during systemic autoimmunity

PubMed Central

Arkatkar, Tanvi

2017-01-01

Recent studies have identified critical roles for B cells in triggering autoimmune germinal centers (GCs) in systemic lupus erythematosus (SLE) and other disorders. The mechanisms whereby B cells facilitate loss of T cell tolerance, however, remain incompletely defined. Activated B cells produce interleukin 6 (IL-6), a proinflammatory cytokine that promotes T follicular helper (TFH) cell differentiation. Although B cell IL-6 production correlates with disease severity in humoral autoimmunity, whether B cell–derived IL-6 is required to trigger autoimmune GCs has not, to our knowledge, been addressed. Here, we report the unexpected finding that a lack of B cell–derived IL-6 abrogates spontaneous GC formation in mouse SLE, resulting in loss of class-switched autoantibodies and protection from systemic autoimmunity. Mechanistically, B cell IL-6 production was enhanced by IFN-γ, consistent with the critical roles for B cell–intrinsic IFN-γ receptor signals in driving autoimmune GC formation. Together, these findings identify a key mechanism whereby B cells drive autoimmunity via local IL-6 production required for TFH differentiation and autoimmune GC formation. PMID:28899868

Dysregulated stress signal sensitivity and inflammatory disinhibition as a pathophysiological mechanism of stress-related chronic fatigue.

PubMed

Strahler, Jana; Skoluda, Nadine; Rohleder, Nicolas; Nater, Urs M

2016-09-01

Chronic stress and its subsequent effects on biological stress systems have long been recognized as predisposing and perpetuating factors in chronic fatigue, although the exact mechanisms are far from being completely understood. In this review, we propose that sensitivity of immune cells to glucocorticoids (GCs) and catecholamines (CATs) may be the missing link in elucidating how stress turns into chronic fatigue. We searched for in vitro studies investigating the impact of GCs or CATs on mitogen-stimulated immune cells in chronically stressed or fatigued populations, with 34 original studies fulfilling our inclusion criteria. Besides mixed cross-sectional findings for stress- and fatigue-related changes of GC sensitivity under basal conditions or acute stress, longitudinal studies indicate a decrease with ongoing stress. Research on CATs is still scarce, but initial findings point towards a reduction of CAT sensitivity under chronic stress. In the long run, resistance of immune cells to stress signals under conditions of chronic stress might translate into self-maintaining inflammation and inflammatory disinhibition under acute stress, which in turn lead to fatigue. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Disturbances of cerebral perfusion in patients with bacterial meningoencephalitis].

PubMed

Garlicki, Aleksander; Podsiadło-Kleinrok, Beata; Bociaga-Jasik, Monika; Kleinrok, Krzysztof; Tomik, Barbara

2003-01-01

The investigations were done in acute and reconvalescent phase in 34 patients with bacterial meningoencephalitis. Neurologic condition, degree of the brain injury on the basis of Glasgow Coma Scale (GCS), protein level and pleocytosis in cerebrospinal fluid (CSF), and regional cerebral blood flow on dynamic computed tomography (CT) were assessed. The brain blood flow was measured in the white matter of the frontal and occipital horns of lateral ventricles, symmetrically in both hemispheres. Statistically significant reduction of the brain perfusion in acute phase of illness was improved. In reconvalescent phase normalisation of the brain blood supply was observed. 56% of patients had changes of consciousness. There was no significant correlation between these symptoms and parameters describing blood supply. The rest of patients had neurologic abnormalities: seizure, pyramidal syndrome, injury of the central nerves due to the reduction of blood flow in selected regions of the brain. Patients who aggregated low GCS score had high inflow of the blood. In patients who were in better condition, inflow was smaller. High pleocytosis in CSF was associated with small blood inflow and perfusion in investigated regions of the brain. Whereas high protein concentration correlated with higher inflow and increase in regional perfusion. We consider, that the brain blood supply correlate with intensification of inflammatory response in CSF.

Traumatic brain injuries from work accidents: a retrospective study.

PubMed

Salem, A M O; Jaumally, B A; Bayanzay, K; Khoury, K; Torkaman, A

2013-07-01

The United Arab Emirates is a rapidly developing country with recent expansion in construction and manufacturing. To investigate the occurrence and outcomes following occupational traumatic brain injury (TBI) requiring hospital admission. Records for all TBI cases admitted to an Abu Dhabi hospital between 2005 and 2009 were reviewed. Data on mechanisms of occupational injuries, Glasgow Coma Scale (GCS) on admission and Glasgow Outcome Scale (GOS) on follow-up, were analysed. Of 581 TBI cases reviewed, 56 (10%) cases were reported as occupational by either the patient or the informant accompanying the patient. All cases were male migrants, and 63% were aged 25-44. Falls accounted for 63% of cases, falling objects 34% and motor vehicle collisions 4%. Median GCS score was 13 for all cases. Median hospital stay was 7.5 days. Intensive care unit admission data were available in 47 cases, of which 34% (16) were admitted with a median stay of 5 days. GOS data were available in 95% (53) of cases, with good recovery in 81% cases, moderate-to-severe disability in 11% of cases and death in 8% (4) cases. Occupational TBI requiring hospitalization is most frequently due to falls and falling objects, with potentially grave consequences. This study further highlights the urgent need to implement preventative measures to improve construction worker safety.

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial.

PubMed

de Jong, Pascal H P; Hazes, Johanna M; Buisman, Leander R; Barendregt, Pieternella J; van Zeben, Derkjen; van der Lubbe, Peter A; Gerards, Andreas H; de Jager, Mike H; de Sonnaville, Peter B J; Grillet, Bernard A; Luime, Jolanda J; Weel, Angelique E A M

2016-12-01

To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM. iTDT was more cost-effective and had better worker productivity compared with iMM. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The globular cluster-dark matter halo connection

NASA Astrophysics Data System (ADS)

Boylan-Kolchin, Michael

2017-12-01

I present a simple phenomenological model for the observed linear scaling of the stellar mass in old globular clusters (GCs) with z = 0 halo mass in which the stellar mass in GCs scales linearly with progenitor halo mass at z = 6 above a minimum halo mass for GC formation. This model reproduces the observed MGCs-Mhalo relation at z = 0 and results in a prediction for the minimum halo mass at z = 6 required for hosting one GC: Mmin(z = 6) = 1.07 × 109 M⊙. Translated to z = 0, the mean threshold mass is Mhalo(z = 0) ≈ 2 × 1010 M⊙. I explore the observability of GCs in the reionization era and their contribution to cosmic reionization, both of which depend sensitively on the (unknown) ratio of GC birth mass to present-day stellar mass, ξ. Based on current detections of z ≳ 6 objects with M1500<-17, values of ξ > 10 are strongly disfavoured; this, in turn, has potentially important implications for GC formation scenarios. Even for low values of ξ, some observed high-z galaxies may actually be GCs, complicating estimates of reionization-era galaxy ultraviolet luminosity functions and constraints on dark matter models. GCs are likely important reionization sources if 5 ≲ ξ ≲ 10. I also explore predictions for the fraction of accreted versus in situ GCs in the local Universe and for descendants of systems at the halo mass threshold of GC formation (dwarf galaxies). An appealing feature of the model presented here is the ability to make predictions for GC properties based solely on dark matter halo merger trees.

Morphometry of Hilar Ectopic Granule Cells in the Rat

PubMed Central

Pierce, Joseph P.; McCloskey, Daniel P.; Scharfman, Helen E.

2014-01-01

Granule cell (GC) neurogenesis in the dentate gyrus (DG) does not always proceed normally. After severe seizures (e.g., status epilepticus [SE]) and some other conditions, newborn GCs appear in the hilus. Hilar ectopic GCs (EGCs) can potentially provide insight into the effects of abnormal location and seizures on GC development. Additionally, hilar EGCs that develop after SE may contribute to epileptogenesis and cognitive impairments that follow SE. Thus, it is critical to understand how EGCs differ from normal GCs. Relatively little morphometric information is available on EGCs, especially those restricted to the hilus. This study quantitatively analyzed the structural morphology of hilar EGCs from adult male rats several months after pilocarpineinduced SE, when they are considered to have chronic epilepsy. Hilar EGCs were physiologically identified in slices, intracellularly labeled, processed for light microscopic reconstruction, and compared to GC layer GCs, from both the same post-SE tissue and the NeuroMorpho database (normal GCs). Consistently, hilar EGC and GC layer GCs had similar dendritic lengths and field sizes, and identifiable apical dendrites. However, hilar EGC dendrites were topologically more complex, with more branch points and tortuous dendritic paths. Three-dimensional analysis revealed that, remarkably, hilar EGC dendrites often extended along the longitudinal DG axis, suggesting increased capacity for septotemporal integration. Axonal reconstruction demonstrated that hilar EGCs contributed to mossy fiber sprouting. This combination of preserved and aberrant morphological features, potentially supporting convergent afferent input to EGCs and broad, divergent efferent output, could help explain why the hilar EGC population could impair DG function. PMID:21344409

The SLUGGS survey: globular cluster kinematics in a `double sigma' galaxy - NGC 4473

NASA Astrophysics Data System (ADS)

Alabi, Adebusola B.; Foster, Caroline; Forbes, Duncan A.; Romanowsky, Aaron J.; Pastorello, Nicola; Brodie, Jean P.; Spitler, Lee R.; Strader, Jay; Usher, Christopher

2015-09-01

NGC 4473 is a so-called double sigma (2σ) galaxy, i.e. a galaxy with rare, double peaks in its 2D stellar velocity dispersion. Here, we present the globular cluster (GC) kinematics in NGC 4473 out to ˜10Re (effective radii) using data from combined Hubble Space Telescope/Advanced Camera for Surveys and Subaru/Suprime-Cam imaging and Keck/Deep Imaging Multi-Object Spectrograph. We find that the 2σ nature of NGC 4473 persists up to 3Re, though it becomes misaligned to the photometric major axis. We also observe a significant offset between the stellar and GC rotation amplitudes. This offset can be understood as a co-addition of counter-rotating stars producing little net stellar rotation. We identify a sharp radial transition in the GC kinematics at ˜4Re suggesting a well defined kinematically distinct halo. In the inner region (<4Re), the blue GCs rotate along the photometric major axis, but in an opposite direction to the galaxy stars and red GCs. In the outer region (>4Re), the red GCs rotate in an opposite direction compared to the inner region red GCs, along the photometric major axis, while the blue GCs rotate along an axis intermediate between the major and minor photometric axes. We also find a kinematically distinct population of very red GCs in the inner region with elevated rotation amplitude and velocity dispersion. The multiple kinematic components in NGC 4473 highlight the complex formation and evolutionary history of this 2σ galaxy, as well as a distinct transition between the inner and outer components.

Guidance and Control Software Project Data - Volume 1: Planning Documents

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J. (Editor)

2008-01-01

The Guidance and Control Software (GCS) project was the last in a series of software reliability studies conducted at Langley Research Center between 1977 and 1994. The technical results of the GCS project were recorded after the experiment was completed. Some of the support documentation produced as part of the experiment, however, is serving an unexpected role far beyond its original project context. Some of the software used as part of the GCS project was developed to conform to the RTCA/DO-178B software standard, "Software Considerations in Airborne Systems and Equipment Certification," used in the civil aviation industry. That standard requires extensive documentation throughout the software development life cycle, including plans, software requirements, design and source code, verification cases and results, and configuration management and quality control data. The project documentation that includes this information is open for public scrutiny without the legal or safety implications associated with comparable data from an avionics manufacturer. This public availability has afforded an opportunity to use the GCS project documents for DO-178B training. This report provides a brief overview of the GCS project, describes the 4-volume set of documents and the role they are playing in training, and includes the planning documents from the GCS project. Volume 1 contains five appendices: A. Plan for Software Aspects of Certification for the Guidance and Control Software Project; B. Software Development Standards for the Guidance and Control Software Project; C. Software Verification Plan for the Guidance and Control Software Project; D. Software Configuration Management Plan for the Guidance and Control Software Project; and E. Software Quality Assurance Activities.

Guidance and Control Software Project Data - Volume 3: Verification Documents

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J. (Editor)

2008-01-01

The Guidance and Control Software (GCS) project was the last in a series of software reliability studies conducted at Langley Research Center between 1977 and 1994. The technical results of the GCS project were recorded after the experiment was completed. Some of the support documentation produced as part of the experiment, however, is serving an unexpected role far beyond its original project context. Some of the software used as part of the GCS project was developed to conform to the RTCA/DO-178B software standard, "Software Considerations in Airborne Systems and Equipment Certification," used in the civil aviation industry. That standard requires extensive documentation throughout the software development life cycle, including plans, software requirements, design and source code, verification cases and results, and configuration management and quality control data. The project documentation that includes this information is open for public scrutiny without the legal or safety implications associated with comparable data from an avionics manufacturer. This public availability has afforded an opportunity to use the GCS project documents for DO-178B training. This report provides a brief overview of the GCS project, describes the 4-volume set of documents and the role they are playing in training, and includes the verification documents from the GCS project. Volume 3 contains four appendices: A. Software Verification Cases and Procedures for the Guidance and Control Software Project; B. Software Verification Results for the Pluto Implementation of the Guidance and Control Software; C. Review Records for the Pluto Implementation of the Guidance and Control Software; and D. Test Results Logs for the Pluto Implementation of the Guidance and Control Software.

Medical geology in the framework of the sustainable development goals.

PubMed

Bundschuh, Jochen; Maity, Jyoti Prakash; Mushtaq, Shahbaz; Vithanage, Meththika; Seneweera, Saman; Schneider, Jerusa; Bhattacharya, Prosun; Khan, Nasreen Islam; Hamawand, Ihsan; Guilherme, Luiz R G; Reardon-Smith, Kathryn; Parvez, Faruque; Morales-Simfors, Nury; Ghaze, Sara; Pudmenzky, Christa; Kouadio, Louis; Chen, Chien-Yen

2017-03-01

Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of "medical geology" assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs. Copyright © 2016 Elsevier B.V. All rights reserved.

Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial.

PubMed

Vignon, Philippe; Dequin, Pierre-François; Renault, Anne; Mathonnet, Armelle; Paleiron, Nicolas; Imbert, Audrey; Chatellier, Delphine; Gissot, Valérie; Lhéritier, Gwenaelle; Aboyans, Victor; Prat, Gwenael; Garot, Denis; Boulain, Thierry; Diehl, Jean-Luc; Bressollette, Luc; Delluc, Aurélien; Lacut, Karine

2013-05-01

Venous thromboembolism (VTE) is a frequent and serious problem in intensive care units (ICU). Anticoagulant treatments have demonstrated their efficacy in preventing VTE. However, when the bleeding risk is high, they are contraindicated, and mechanical devices are recommended. To date, mechanical prophylaxis has not been rigorously evaluated in any trials in ICU patients. In this multicenter, open-label, randomized trial with blinded evaluation of endpoints, we randomly assigned 407 patients with a high risk of bleeding to receive intermittent pneumatic compression (IPC) associated with graduated compression stockings (GCS) or GCS alone for 6 days during their ICU stay. The primary endpoint was the occurrence of a VTE between days 1 and 6, including nonfatal symptomatic documented VTE, or death due to a pulmonary embolism, or asymptomatic deep vein thrombosis detected by ultrasonography systematically performed on day 6. The primary outcome was assessed in 363 patients (89.2%). By day 6, the incidence of the primary outcome was 5.6% (10 of 179 patients) in the IPC + GCS group and 9.2% (17 of 184 patients) in the GCS group (relative risk 0.60; 95% confidence interval 0.28-1.28; p = 0.19). Tolerance of IPC was poor in only 12 patients (6.0%). No intergroup difference in mortality rate was observed. With the limitation of a low statistical power, our results do not support the superiority of the combination of IPC + GCS compared to GCS alone to prevent VTE in ICU patients at high risk of bleeding.

Imaging and quantifying ganglion cells and other transparent neurons in the living human retina.

PubMed

Liu, Zhuolin; Kurokawa, Kazuhiro; Zhang, Furu; Lee, John J; Miller, Donald T

2017-11-28

Ganglion cells (GCs) are fundamental to retinal neural circuitry, processing photoreceptor signals for transmission to the brain via their axons. However, much remains unknown about their role in vision and their vulnerability to disease leading to blindness. A major bottleneck has been our inability to observe GCs and their degeneration in the living human eye. Despite two decades of development of optical technologies to image cells in the living human retina, GCs remain elusive due to their high optical translucency. Failure of conventional imaging-using predominately singly scattered light-to reveal GCs has led to a focus on multiply-scattered, fluorescence, two-photon, and phase imaging techniques to enhance GC contrast. Here, we show that singly scattered light actually carries substantial information that reveals GC somas, axons, and other retinal neurons and permits their quantitative analysis. We perform morphometry on GC layer somas, including projection of GCs onto photoreceptors and identification of the primary GC subtypes, even beneath nerve fibers. We obtained singly scattered images by: ( i ) marrying adaptive optics to optical coherence tomography to avoid optical blurring of the eye; ( ii ) performing 3D subcellular image registration to avoid motion blur; and ( iii ) using organelle motility inside somas as an intrinsic contrast agent. Moreover, through-focus imaging offers the potential to spatially map individual GCs to underlying amacrine, bipolar, horizontal, photoreceptor, and retinal pigment epithelium cells, thus exposing the anatomical substrate for neural processing of visual information. This imaging modality is also a tool for improving clinical diagnosis and assessing treatment of retinal disease. Copyright © 2017 the Author(s). Published by PNAS.

Corruption of the dentate gyrus by "dominant" granule cells: Implications for dentate gyrus function in health and disease.

PubMed

Scharfman, Helen E; Myers, Catherine E

2016-03-01

The dentate gyrus (DG) and area CA3 of the hippocampus are highly organized lamellar structures which have been implicated in specific cognitive functions such as pattern separation and pattern completion. Here we describe how the anatomical organization and physiology of the DG and CA3 are consistent with structures that perform pattern separation and completion. We then raise a new idea related to the complex circuitry of the DG and CA3 where CA3 pyramidal cell 'backprojections' play a potentially important role in the sparse firing of granule cells (GCs), considered important in pattern separation. We also propose that GC axons, the mossy fibers, already known for their highly specialized structure, have a dynamic function that imparts variance--'mossy fiber variance'--which is important to pattern separation and completion. Computational modeling is used to show that when a subset of GCs become 'dominant,' one consequence is loss of variance in the activity of mossy fiber axons and a reduction in pattern separation and completion in the model. Empirical data are then provided using an example of 'dominant' GCs--subsets of GCs that develop abnormally and have increased excitability. Notably, these abnormal GCs have been identified in animal models of disease where DG-dependent behaviors are impaired. Together these data provide insight into pattern separation and completion, and suggest that behavioral impairment could arise from dominance of a subset of GCs in the DG-CA3 network. Copyright © 2015 Elsevier Inc. All rights reserved.

Green tea extract with polyethylene glycol-3350 reduces body weight and improves glucose tolerance in db/db and high-fat diet mice.

PubMed

Park, Jae-Hyung; Choi, Yoon Jung; Kim, Yong Woon; Kim, Sang Pyo; Cho, Ho-Chan; Ahn, Shinbyoung; Bae, Ki-Cheor; Im, Seung-Soon; Bae, Jae-Hoon; Song, Dae-Kyu

2013-08-01

Green tea extract (GTE) is regarded to be effective against obesity and type 2 diabetes, but definitive evidences have not been proven. Based on the assumption that the gallated catechins (GCs) in GTE attenuate intestinal glucose and lipid absorption, while enhancing insulin resistance when GCs are present in the circulation through inhibiting cellular glucose uptake in various tissues, this study attempted to block the intestinal absorption of GCs and prolong their residence time in the lumen. We then observed whether GTE containing the nonabsorbable GCs could ameliorate body weight (BW) gain and glucose intolerance in db/db and high-fat diet mice. Inhibition of the intestinal absorption of GCs was accomplished by co-administering the nontoxic polymer polyethylene glycol-3350 (PEG). C57BLKS/J db/db and high-fat diet C57BL/6 mice were treated for 4 weeks with drugs as follows: GTE, PEG, GTE+PEG, voglibose, or pioglitazone. GTE mixed with meals did not have any ameliorating effects on BW gain and glucose intolerance. However, the administration of GTE plus PEG significantly reduced BW gain, insulin resistance, and glucose intolerance, without affecting food intake and appetite. The effect was comparable to the effects of an α-glucosidase inhibitor and a peroxisome proliferator-activated receptor-γ/α agonist. These results indicate that prolonging the action of GCs of GTE in the intestinal lumen and blocking their entry into the circulation may allow GTE to be used as a prevention and treatment for both obesity and obesity-induced type 2 diabetes.

EBV+ and MSI Gastric Cancers Harbor High PD-L1/PD-1 Expression and High CD8+ Intratumoral Lymphocytes

PubMed Central

De Rosa, Simona; Tibiletti, Maria Grazia; Magnoli, Francesca; Vanoli, Alessandro; Sessa, Fausto; Chiaravalli, Anna Maria

2018-01-01

Both EBV+ and MSI gastric cancers (GCs) have high lymphoid infiltration which is rare in MSS/EBV− cancers. PD-L1/PD-1 interaction leads to a down-regulated immune response and it is one of the most promising targets for gastric cancer immunotherapy. PD-L1/PD-1 and CD8 expression were immunohistochemically investigated in a series of 169 FFPE GCs, including 33 EBV+, 59 MSI and 77 MSS/EBV− cases. PD-L1 membrane immunoreactivity in more than 5% of tumor cells was present in 31/169 GCs and was associated with high levels of CD8 intraepithelial lymphocytes (TILs; p < 0.001). PD-L1+ cases were mainly poorly differentiated (71%), intestinal type (85%) and high lymphoid response (HLR; 90%) tumors. PD-L1 expression was only present in EBV⁺ (46%), MSI (24%) and rare MSS/EBV− (3%) GCs with high CD8+ TILs (p < 0.001). Despite being associated with a better prognosis both in the whole series (p < 0.05) and in the MSI subset, PD-L1 is not an independent prognostic factor. PD-L1 gene amplification was detected in 3/17 cases, including 2/7 EBV+ and 1/8 MSI GC. PD-1⁺ TILs were significantly higher in EBV⁺ than MSI and MSS/EBV− cases. PD-L1/PD-1 pathway is selectively activated in HLR GCs and could be considered an emerging therapeutic target, particularly for EBV and MSI GCs. PMID:29614789

Association between expression of cumulus expansion markers and real-time proliferation of porcine follicular granulosa cells in a primary cell culture model.

PubMed

Ciesiółka, S; Budna, J; Bryja, A; Kranc, W; Chachuła, A; Dyszkiewicz-Konwińska, M; Piotrowska, H; Bukowska, D; Antosik, P; Bruska, M; Brüssow, K P; Nowicki, M; Zabel, M; Kempisty, B

2016-01-01

Folliculogenesis is a compound process that involves both ovarian follicle growth and oocyte development, which is tightly attached to the follicular wall. During this process, cells that form the follicle structure undergo substantial morphological and molecular modifications that finally lead to differentiation and specialization of ovarian follicular cells. The differentiation of ovarian cells encompasses formation of follicle, which is composed of theca (TCs), mural granulosa (GCs), and cumulus cells (CCs). It was previously hypothesized that GCs and CCs represent undifferentiated and highly specialized follicular cells, respectively, which may have similar primordial cell origins. In this study, we investigated the expression pattern of cumulus expansion markers such as COX2, HAS2, PTX3, and TSG6 in porcine GCs during short-term, in vitro culture. We hypothesized that these genes may display an important function in GCs in relation to cellular real-time proliferation. The expression pattern of COX2, HAS2, PTX3, and TSG6 was evaluated after using RT-qPCR in relation to confocal microscopy observations of protein expression and distribution during real-time proliferation of porcine follicular GCs. The COX2 and HAS2 mRNAs were highly expressed after 120 h of in vitro culture (IVC), whereas PTX3 and TSG6 mRNAs were increased during the first 24-48 h of IVC (P less than 0.001, P less than 0.01). Conversely, all of the encoded proteins were highly expressed after 144-168 h of IVC as compared to other culture periods (P less than 0.001, P less than 0.01). When analyzing the realtime proliferation of GCs in vitro, we observed a logarithmic increase of cell proliferation between 0 h and 120 h of IVC. However, after 120-168 h of IVC, the cells reached the lag phase of proliferation. Since it is well accepted that porcine GCs undergo luteinization shortly after 24-48 h of IVC, the expression pattern of investigated genes indicated that Cox2 and Has2 are independent from the LH surge, but their increased levels may be upregulated by cell proliferation in vitro. Moreover, higher expression of PTX3 and TSG6 during first 24 h and/or 48 h of IVC suggested that their levels are accompanied by porcine GCs luteinization process.

Management issues with exogenous steroid therapy

PubMed Central

Patt, Hiren; Bandgar, Tushar; Lila, Anurag; Shah, Nalini

2013-01-01

Glucocorticoids (GCs) are extensively used for various inflammatory and autoimmune disorders, but long term use of these agents is not without complications. Almost every GC formulations (e.g. oral, topical, inhaled, etc.) can cause systemic side effects. It can range from minor side effects (e.g. weight gain) to life-threatening effects (e.g. adrenal suppression, sepsis, etc.), which may require immediate intervention. Therefore, the decision to institute steroid therapy always requires careful consideration of the relative risk and benefit in each patient. The objectives of this study are to discuss monitoring of patients on GCs and management of the complications of GCs. PMID:24910822

Autophagy in Drosophila ovaries is induced by starvation and is required for oogenesis.

PubMed

Barth, J M I; Szabad, J; Hafen, E; Köhler, K

2011-06-01

Autophagy, an evolutionarily conserved lysosome-mediated degradation, promotes cell survival under starvation and is controlled by insulin/target of rapamycin (TOR) signaling. In Drosophila, nutrient depletion induces autophagy in the fat body. Interestingly, nutrient availability and insulin/TOR signaling also influence the size and structure of Drosophila ovaries, however, the role of nutrient signaling and autophagy during this process remains to be elucidated. Here, we show that starvation induces autophagy in germline cells (GCs) and in follicle cells (FCs) in Drosophila ovaries. This process is mediated by the ATG machinery and involves the upregulation of Atg genes. We further demonstrate that insulin/TOR signaling controls autophagy in FCs and GCs. The analysis of chimeric females reveals that autophagy in FCs, but not in GCs, is required for egg development. Strikingly, when animals lack Atg gene function in both cell types, ovaries develop normally, suggesting that the incompatibility between autophagy-competent GCs and autophagy-deficient FCs leads to defective egg development. As egg morphogenesis depends on a tightly linked signaling between FCs and GCs, we propose a model in which autophagy is required for the communication between these two cell types. Our data establish an important function for autophagy during oogenesis and contributes to the understanding of the role of autophagy in animal development.

The correlation between the sizes of globular cluster systems and their host dark matter haloes

NASA Astrophysics Data System (ADS)

Hudson, Michael J.; Robison, Bailey

2018-07-01

The sizes of entire systems of globular clusters (GCs) depend not only on the formation and destruction histories of the GCs themselves but also on the assembly, merger, and accretion history of the dark matter (DM) haloes that they inhabit. Recent work has shown a linear relation between total mass of GCs in the GC system and the mass of its host DM halo, calibrated from weak lensing. Here, we extend this to GC system sizes, by studying the radial density profiles of GCs around galaxies in nearby galaxy groups. We find that radial density profiles of the GC systems are well fit with a de Vaucouleurs profile. Combining our results with those from the literature, we find tight relationship (˜0.2 dex scatter) between the effective radius of the GC system and the virial radius (or mass) of its host DM halo, for haloes with masses greater than ˜1012 M⊙. The steep non-linear dependence of this relationship (R_{ {e, GCS}} ∝ R_{200}^{2.5 - 3} ∝ M_{200}^{0.8 - 1}) is currently not well understood, but is an important clue regarding the assembly history of DM haloes and of the GC systems that they host.

Effects of luteinizing hormone and human chorionic gonadotropin on corpus luteum cells in a spheroid cell culture system.

PubMed

Walz, A; Keck, C; Weber, H; Kissel, C; Pietrowski, D

2005-09-01

The human corpus luteum (CL) is a highly vascularized, temporarily active endocrine gland and consists mainly of granulosa cells (GCs), theca cells (TCs), and endothelial cells (ECs). Its cyclic growth and development takes place under the influence of gonadotropic hormones. If pregnancy does occur, human chorionic gonadotropin (hCG) takes over the function of luteinizing hormone (LH) and, in contrast to LH, extends the functional life span of the CL. In this study, we investigated the effects of hCG and LH in a spheroidal cell culture model of CL development. Our data indicate that GCs secrete factors under the control of hCG that increase sprout formation of EC-spheroids. We demonstrate that the most prominent of these factors is VEGF-A. Furthermore, we found that both LH and hCG decrease sprout formation of GC-spheroids. After forming EC-GC coculture spheroids and consequently bringing GCs and ECs in close contact, sprouting increased under the influence of hCG, however not under LH. These experiments provide evidence for an hCG dependent functional switch in the GCs after coming in contact with ECs. Moreover, it demonstrates the considerably different effects of hCG and LH on GCs although their signaling is transmitted via the same receptor.

Death after discharge: predictors of mortality in older brain-injured patients.

PubMed

Peck, Kimberly A; Calvo, Richard Y; Sise, C Beth; Johnson, Jeffrey; Yen, Jessica W; Sise, Michael J; Dunne, Casey E; Badiee, Jayraan; Shackford, Steven R; Lobatz, Michael A

2014-12-01

Older patients with traumatic brain injury (TBI) may be at high risk of death after hospitalization. The purpose of this study was to characterize long-term mortality of older TBI patients who survived to discharge. We hypothesized that predictors of postdischarge mortality differed from those of inpatient mortality. A retrospective cohort study was performed on TBI patients older than 55 years admitted to our Level I trauma center between July 1, 2006, and December 31, 2011. Postdischarge deaths were identified by matching patient data with local vital records up to December 31, 2011, when data collection was terminated (censoring). Patients were categorized by age, comorbidities, history of preinjury anticoagulant/prescription antiplatelet agent therapy, injury severity indices, initial TBI type, prehospital living status, discharge location, and discharge condition. The effect of risk factors on postdischarge mortality was evaluated by Cox proportional hazards modeling. Of 353 patients, 322 (91.2%) survived to discharge. Postdischarge mortality was 19.8% (n = 63) for the study period. Of the postdischarge deaths, 54.0% died within 6 months of discharge, and 68.3% died within 1 year. Median days to death after discharge or censoring were 149 and 410, respectively. Factors associated with death after discharge included age, preinjury anticoagulant use, higher number of Charlson comorbidities, discharge to a long-term care facility, and severe disability. Factors related to injury severity (i.e., Injury Severity Score [ISS], initial Glasgow Coma Scale [GCS] score) and preinjury prescription antiplatelet agent use, previously found to predict inpatient death, did not predict postdischarge mortality. Older TBI patients who survive to discharge have a significant risk of death within 1 year. Predictors of postdischarge mortality and inpatient death differ. Death after discharge is largely a function of overall health status. Monitoring health status and continued aggressive management of comorbidities after discharge may be essential in determining long-term outcomes. Epidemiologic study, level III.

Effect of inhaled and systemic glucocorticoid treatment on CD4+ regulatory and effector T cells in a mouse model of allergic asthma.

PubMed

Zuśka-Prot, Monika; Maślanka, Tomasz

2017-04-01

To achieve a better understanding of mechanisms underlying the anti-asthmatic action of inhaled and systemic glucocorticoids (GCs) and to provide more data regarding the risk of a negative effect of inhaled GCs on CD4 + T cells, a study was conducted on the effect of ciclesonide and methylprednisolone on CD4 + effector (Teff), regulatory (Treg) and resting (Trest) T cells within respiratory and extra-respiratory tissues in a mouse model of allergic asthma. The study indicated that one, and possibly a key mechanism, underlying the anti-asthmatic action of inhaled and systemic GCs is the prevention of the activation and clonal expansion of CD4 + Teff cells in the mediastinal lymph nodes (MLNs), which consequently prevents infiltration of the lungs with CD4 + Teff cells. The beneficial effects of GCs in asthma treatment were not mediated through increased recruitment of Treg cells into the MLNs and lungs and/or local generation of Treg cells. The results demonstrated that inhaled and systemic GCs induced comparable depletion of normal CD4 + Teff, Trest and Treg cells in the MLNs, head and neck lymph nodes and peripheral blood. Furthermore, inhaled, but not systemic GC therapy, led to the loss of these cells in the lungs. Thus, the study suggests that inhaled GC therapy may not be safer at all than systemic one with respect to the adverse effect on CD4 + T cells present within and outside the respiratory tract. Moreover, administration of inhaled GCs can produce negative effects on lung-residing CD4 + T cells. Copyright © 2017 Elsevier B.V. All rights reserved.

Active Management of Integrated Geothermal-CO2 Storage Reservoirs in Sedimentary Formations

DOE Data Explorer

Buscheck, Thomas A.

2012-01-01

Active Management of Integrated Geothermal–CO2 Storage Reservoirs in Sedimentary Formations: An Approach to Improve Energy Recovery and Mitigate Risk: FY1 Final Report The purpose of phase 1 is to determine the feasibility of integrating geologic CO2 storage (GCS) with geothermal energy production. Phase 1 includes reservoir analyses to determine injector/producer well schemes that balance the generation of economically useful flow rates at the producers with the need to manage reservoir overpressure to reduce the risks associated with overpressure, such as induced seismicity and CO2 leakage to overlying aquifers. Based on a range of well schemes, techno-economic analyses of the levelized cost of electricity (LCOE) are conducted to determine the economic benefits of integrating GCS with geothermal energy production. In addition to considering CO2 injection, reservoir analyses are conducted for nitrogen (N2) injection to investigate the potential benefits of incorporating N2 injection with integrated geothermal-GCS, as well as the use of N2 injection as a potential pressure-support and working-fluid option. Phase 1 includes preliminary environmental risk assessments of integrated geothermal-GCS, with the focus on managing reservoir overpressure. Phase 1 also includes an economic survey of pipeline costs, which will be applied in Phase 2 to the analysis of CO2 conveyance costs for techno-economics analyses of integrated geothermal-GCS reservoir sites. Phase 1 also includes a geospatial GIS survey of potential integrated geothermal-GCS reservoir sites, which will be used in Phase 2 to conduct sweet-spot analyses that determine where promising geothermal resources are co-located in sedimentary settings conducive to safe CO2 storage, as well as being in adequate proximity to large stationary CO2 sources.

A rational use of glucocorticoids in patients with early arthritis has a minimal impact on bone mass

PubMed Central

2010-01-01

Introduction Glucocorticoid (GC)-induced osteoporosis is a frequent complication in patients with rheumatoid arthritis. However, little information exists about the consequences of GC use in patients with early arthritis. Here we describe the variables underlying the use of GC in early arthritis, as well as its effect on bone-mineral density. Methods Data from 116 patients in our early arthritis register were analyzed (90 women; median age, 52.5 years, interquartile range (IQR, 38.5-66); 6-month median disease duration at entry (IQR, 4-9)). In this register, the clinical and treatment information was recorded systematically, including the cumulative GC dose. Lumbar spine, hip, and forearm bone-mineral density (BMD) measurements were performed at entry and after a 2-year follow-up. A multivariate analysis was performed to establish the variables associated with the use of GCs, as well as those associated with variations in BMD. Results Of the patients with early arthritis studied, 67% received GCs during the 2-year follow-up. GCs were more frequently prescribed to elderly patients, those with higher basal disease activity and disability, and patients with positive rheumatoid factor. When adjusted for these variables, GCs were less frequently prescribed to female patients. The use of GCs was associated with an increase of BMD in the ultradistal region of the forearm, although it induced a significant loss of BMD in the medial region of the forearm. No relevant effect of GC was noted on the BMD measured at other locations. Conclusions The frequent use of GCs as a "bridge therapy" in patients with early arthritis does not seem to be associated with relevant loss of bone mass. Moreover, cumulative GC administration might be associated with an increase of juxtaarticular BMD. PMID:20331862

Study of conjunctival flora in anophthalmic patients: influence on the comfort of the socket.

PubMed

Toribio, Alvaro; Marrodán, Teresa; Fernández-Natal, Isabel; Martínez-Blanco, Honorina; Rodríguez-Aparicio, Leandro; Ferrero, Miguel Á

2017-08-01

To investigate the relationship between conjunctival flora and comfort of the socket in anophthalmic patients. A cross-sectional clinical study including 60 patients with unilateral anophthalmia who wear a prosthetic eye. From each patient three microbiological samples were taken from the lower conjunctival sac (healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Samples from a randomized subgroup of 29 patients were measured by spectrophotometry at 540 nm after 48 h of growth, to determine their microbial density (MD). The grade of comfort of the socket (GCS) of each patient was established by a questionnaire. Epidemiological and clinical data of the anophthalmic socket and artificial eye care of each patient were also collected. MD decreased in healthy eyes (0.213 ± 0.201, P = 0.004) compared with the pre-prosthesis (0.402 ± 0.323) and retro-prosthesis (0.438 ± 0.268) samples. Pre-prosthesis MD correlated with retro-prosthesis MD (R = 0.401, P = 0.031) and healthy eye MD (R = 0.482, P = 0.008), and it was also related to poor GCS (P = 0.017). Aerobic Gram-negative bacteria in retro-prosthesis samples of patients with poor GCS was higher than in patients with good or fair GCS (P = 0.008). In the same samples, coagulase-negative staphylococci proportion (excluding S. epidermidis) increased in patients with good GCS (P = 0.030). Socket microflora is related to GCS. Increased pathogenic flora, especially Gram-negative bacteria, and high MD are related to discomfort, while coagulase-negative staphylococci (other than S. epidermidis) are associated with comfort.

Guidance and Control Software Project Data - Volume 4: Configuration Management and Quality Assurance Documents

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J. (Editor)

2008-01-01

The Guidance and Control Software (GCS) project was the last in a series of software reliability studies conducted at Langley Research Center between 1977 and 1994. The technical results of the GCS project were recorded after the experiment was completed. Some of the support documentation produced as part of the experiment, however, is serving an unexpected role far beyond its original project context. Some of the software used as part of the GCS project was developed to conform to the RTCA/DO-178B software standard, "Software Considerations in Airborne Systems and Equipment Certification," used in the civil aviation industry. That standard requires extensive documentation throughout the software development life cycle, including plans, software requirements, design and source code, verification cases and results, and configuration management and quality control data. The project documentation that includes this information is open for public scrutiny without the legal or safety implications associated with comparable data from an avionics manufacturer. This public availability has afforded an opportunity to use the GCS project documents for DO-178B training. This report provides a brief overview of the GCS project, describes the 4-volume set of documents and the role they are playing in training, and includes configuration management and quality assurance documents from the GCS project. Volume 4 contains six appendices: A. Software Accomplishment Summary for the Guidance and Control Software Project; B. Software Configuration Index for the Guidance and Control Software Project; C. Configuration Management Records for the Guidance and Control Software Project; D. Software Quality Assurance Records for the Guidance and Control Software Project; E. Problem Report for the Pluto Implementation of the Guidance and Control Software Project; and F. Support Documentation Change Reports for the Guidance and Control Software Project.

Hepatitis B virus-related mortality in rheumatoid arthritis patients undergoing long-term low-dose glucocorticoid treatment: A population-based study.

PubMed

Yang, Sheng-Shun; Hung, Chin-Tun; Li, Shu-Fen; Lee, Horng-Mo; Chung, Yueh-Chin; Chen, Hsin-Hua; Chang, Shu-Chuan

2017-09-04

Glucocorticoids (GC) are commonly used in rheumatoid arthritis (RA) patients which bears a risk of hepatitis B virus (HBV) reactivation. The purpose of this study was to investigate the risk of HBV-related mortality under long-term low-dose GCs in Taiwanese RA patients. We retrospectively analyzed 45,423 RA patients using National Health Insurance Research Database from January 1999 to December 2011. Of them, 2204 patients had the diagnosis of HBV and were classified into four groups according to GCs regimens. Outcome comparison by Cox model analysis for liver-related mortality was performed. In this cohort, 90.5% were older than 40. One hundred and five patients had been treated with short-term large-dose GCs (Group A); 862 patients received GCs ≥20 mg/day for ≥3 days or a variable dose but did not meet Group C criteria (Group B); 689 patients were continuously treated with low-dose (<20 mg/day) GCs for ≥3 months for at least one session (Group C); and 548 patients had never been exposed to GCs (Group D). Two hundred and sixty-one patients had been exposed to antiviral agents, which was significantly higher in Group C. Fifty-eight patients (2.63%) died of acute hepatic failure, while no statistically significant difference between each groups (p = 0.074). Groups C and D comparison by two-sample test showed that long-term low-dose GC treatment was not associated with liver-related death after adjusting for malignancy. Long-term low-dose GC treatment was not associated with liver-related mortality in RA with concomitant HBV patients probably due to commonly applied antiviral therapy by rheumatologists. Copyright © 2017. Published by Elsevier B.V.

Pityriasis Rosea, Gianotti-Crosti Syndrome, Asymmetric Periflexural Exanthem, Papular-Purpuric Gloves and Socks Syndrome, Eruptive Pseudoangiomatosis, and Eruptive Hypomelanosis: Do Their Epidemiological Data Substantiate Infectious Etiologies?

PubMed Central

Zawar, Vijay; Sciallis, Gabriel F.; Kempf, Werner; Lee, Albert

2016-01-01

Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR), Gianotti-Crosti syndrome (GCS), asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE), papular-purpuric gloves and socks syndrome (PPGSS), and eruptive pseudo-angiomatosis (EP). Eruptive hypomelanosis (EH) is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future. PMID:27103975

Limits on runaway growth of intermediate mass black holes from advanced LIGO

NASA Astrophysics Data System (ADS)

Kovetz, Ely D.; Cholis, Ilias; Kamionkowski, Marc; Silk, Joseph

2018-06-01

There is growing evidence that intermediate-mass black holes (IMBHs), defined here as having a mass in the range M =500 -105 M⊙ , are present in the dense centers of certain globular clusters (GCs). Gravitational waves from their mergers with other IMBHs or with stellar BHs in the cluster are mostly emitted in frequencies ≲10 Hz , which unfortunately is out of reach for current ground-based observatories such as advanced LIGO (aLIGO). Nevertheless, we show that aLIGO measurements can be used to efficiently probe one of the possible formation mechanisms of IMBHs in GCs, namely a runaway merger process of stellar seed BHs. In this case, aLIGO will be sensitive to the lower-mass rungs of the merger ladder, ranging from the seed BH mass to masses ≳50 - 300 M⊙ , where the background from standard mergers is expected to be very low. Assuming this generic IMBH formation scenario, we calculate the mass functions that correspond to the limiting cases of possible merger trees. Based on estimates for the number density of GCs and taking into account the instrumental sensitivity, we show that current observations do not effectively limit the occupation fraction focc of IMBHs formed by runaway mergers of stellar BHs in GCs. However, we find that if runaway mergers occur steadily throughout the lifetimes of GCs (as opposed to happening mainly early in their lifetimes), then a six-year run of aLIGO at design sensitivity will be able to probe down to focc≲3 % at a 99.9% confidence level, either finding evidence for this formation mechanism, or necessitating others if the fraction of GCs that harbor IMBHs is higher.

Milky Way globular cluster metallicity and low-mass X-ray binaries: the red giant influence

NASA Astrophysics Data System (ADS)

Vulic, N.; Barmby, P.; Gallagher, S. C.

2018-02-01

Galactic and extragalactic studies have shown that metal-rich globular clusters (GCs) are approximately three times more likely to host bright low-mass X-ray binaries (LMXBs) than metal-poor GCs. There is no satisfactory explanation for this metallicity effect. We tested the hypothesis that the number density of red giant branch (RGB) stars is larger in metal-rich GCs, and thus potentially the cause of the metallicity effect. Using Hubble Space Telescope photometry for 109 unique Milky Way GCs, we investigated whether RGB star density was correlated with GC metallicity. Isochrone fitting was used to calculate the number of RGB stars, which were normalized by the GC mass and fraction of observed GC luminosity, and determined density using the volume at the half-light radius (rh). The RGB star number density was weakly correlated with metallicity [Fe/H], giving Spearman and Kendall Rank test p-values of 0.000 16 and 0.000 21 and coefficients rs = 0.35 and τ = 0.24, respectively. This correlation may be biased by a possible dependence of rh on [Fe/H], although studies have shown that rh is correlated with Galactocentric distance and independent of [Fe/H]. The dynamical origin of the rh-metallicity correlation (tidal stripping) suggests that metal-rich GCs may have had more active dynamical histories, which would promote LMXB formation. No correlation between the RGB star number density and metallicity was found when using only the GCs that hosted quiescent LMXBs. A complete census of quiescent LMXBs in our Galaxy is needed to further probe the metallicity effect, which will be possible with the upcoming launch of eROSITA.

NGC 6535: the lowest mass Milky Way globular cluster with a Na-O anti-correlation? Cluster mass and age in the multiple population context

NASA Astrophysics Data System (ADS)

Bragaglia, A.; Carretta, E.; D'Orazi, V.; Sollima, A.; Donati, P.; Gratton, R. G.; Lucatello, S.

2017-11-01

To understand globular clusters (GCs) we need to comprehend how their formation process was able to produce their abundance distribution of light elements. In particular, we seek to figure out which stars imprinted the peculiar chemical signature of GCs. One of the best ways is to study the light-element anti-correlations in a large sample of GCs that are analysed homogeneously. As part of our spectroscopic survey of GCs with FLAMES, we present here the results of our study of about 30 red giant member stars in the low-mass, low-metallicity Milky Way cluster NGC 6535. We measured the metallicity (finding [Fe/H] =-1.95, rms = 0.04 dex in our homogeneous scale) and other elements of the cluster and, in particular, we concentrate here on O and Na abundances. These elements define the normal Na-O anti-correlation of classical GCs, making NGC 6535 perhaps the lowest mass cluster with a confirmed presence of multiple populations. We updated the census of Galactic and extragalactic GCs for which a statement on the presence or absence of multiple populations can be made on the basis of high-resolution spectroscopy preferentially, or photometry and low-resolution spectroscopy otherwise; we also discuss the importance of mass and age of the clusters as factors for multiple populations. Based on observations collected at ESO telescopes under programme 093.B-0583.Table 2 is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/607/A44

Roles of methyltrienolone (R1881) in AKTs and AR expression patterns of cultured granulosa-lutein cells.

PubMed

Nekoonam, Saeid; Naji, Mohammad; Mortezaee, Keywan; Amidi, Fardin

2018-05-11

AR-mediated androgen signaling plays a key role in female reproductive system. Granulosa-lutein cells (GCs) are the main sites for expression of androgen receptor (AR). There is also a close relation between AKT signaling and AR. Here, we assayed the role for a synthetic AR ligand methyltrienolone (R1881) in expressions of AKTs and AR. Controlled ovarian hyperstimulation (COH) was performed in 20 normal women. Mural GCs were isolated by filtration method, cultured, and passaged. Then, the cells were starved for 48 h with 10% charcoal stripped FBS. The cells were then treated with R1881, bicalutamide (AR blocker), LY294002 (PI3K/AKT pathway blocker), and combination of them for 48 h. Finally, GCs were evaluated for quantitative real-time PCR analysis of AKT1, AKT2, AKT3, and AR, and also Western blot assessment of total AKT and phosphorylated AKT (p-AKT) [Ser473 and Thr308]. Addition of R1881 to the GCs culture showed high expressions of AKT1, AKT2, and AKT3 (P ≤ 0.05 vs LY294002 group and bicalutamide group). Expressions of AKT1 and AKT2 were decreased in the GCs under exposure to bicalutamide or LY294002 (P ≤ 0.05 vs R1881). AKT1, AKT2, and AKT3 showed decreased rates of expressions in the LY294002 + bicalutamide group (P ≤ 0.05 vs R1881). AR, total AKT and p-AKT showed no significant differences between groups. Our findings indicate that 46 h exposure with R1881 could affect AKTs expressions in the GCs of pre-ovulatory phase, but it cannot promote AR expression and AKTs activation. © 2018 Wiley Periodicals, Inc.

Activation of the sigma receptor 1 modulates AMPA receptor-mediated light-evoked excitatory postsynaptic currents in rat retinal ganglion cells.

PubMed

Liu, Lei-Lei; Deng, Qin-Qin; Weng, Shi-Jun; Yang, Xiong-Li; Zhong, Yong-Mei

2016-09-22

Sigma receptor (σR), a unique receptor family, is classified into three subtypes: σR1, σR2 and σR3. It was previously shown that σR1 activation induced by 1μM SKF10047 (SKF) suppressed N-methyl-d-aspartate (NMDA) receptor-mediated responses of rat retinal ganglion cells (GCs) and the suppression was mediated by a distinct Ca(2+)-dependent phospholipase C (PLC)-protein kinase C (PKC) pathway. In the present work, using whole-cell patch-clamp techniques in rat retinal slice preparations, we further demonstrate that SKF of higher dosage (50μM) significantly suppressed AMPA receptor (AMPAR)-mediated light-evoked excitatory postsynaptic currents (L-EPSCs) of retinal ON-type GCs (ON GCs), and the effect was reversed by the σR1 antagonist BD1047, suggesting the involvement of σR1. The SKF (50μM) effect was unlikely due to a change in glutamate release from bipolar cells, as suggested by the unaltered paired-pulse ratio (PPR) of AMPAR-mediated EPSCs of ON GCs. SKF (50μM) did not change L-EPSCs of ON GCs when the G protein inhibitor GDP-β-S or the protein kinase G (PKG) inhibitor KT5823 was intracellularly infused. Calcium imaging further revealed that SKF (50μM) did not change intracellular calcium concentration in GCs and persisted to suppress L-EPSCs when intracellular calcium was chelated by BAPTA. The SKF (50μM) effect was intact when protein kinase A (PKA) and phosphatidylinostiol (PI)-PLC signaling pathways were both blocked. We conclude that the SKF (50μM) effect is Ca(2+)-independent, PKG-dependent, but not involving PKA, PI-PLC pathways. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

Actions of glucocorticoids at a seasonal baseline as compared to stress-related levels in the regulation of periodic life processes.

PubMed

Landys, Meta M; Ramenofsky, Marilyn; Wingfield, John C

2006-09-01

For decades, demands associated with the predictable life-history cycle have been considered stressful and have not been distinguished from stress that occurs in association with unpredictable and life-threatening perturbations in the environment. The recent emergence of the concept of allostasis distinguishes behavioral and physiological responses to predictable routines as opposed to unpredictable perturbations, and allows for their comparison within one theoretical framework. Glucocorticosteroids (GCs) have been proposed as important mediators of allostasis, as they allow for rapid readjustment and support of behavior and physiology in response to predictable and unpredictable demands (allostatic load). Much work has already been done in defining GC action at the high concentrations that accompany life-threatening perturbations. However, less is known about the role of GCs in relation to daily and seasonal life processes. In this review, we summarize the known behavioral and physiological effects of GCs relating to the predictable life-history cycle, paying particular attention to feeding behavior, locomotor activity and energy metabolism. Although we utilize a comparative approach, emphasis is placed on birds. In addition, we briefly review effects of GCs at stress-related concentrations to test the hypothesis that different levels of GCs play specific and distinct roles in the regulation of life processes and, thus, participate in the promotion of different physiological states. We also examine the receptor types through which GC action may be mediated and suggest mechanisms whereby different GC concentrations may exert their actions. In conclusion, we argue that biological actions of GCs at "non-stress" seasonal concentrations play a critical role in the adjustment of responses that accompany predictable variability in the environment and demand more careful consideration in future studies.

The influence of various therapeutic regimens on early clinical and laboratory response and outcome of children with secondary hemophagocytic lymphohistiocytosis

PubMed Central

Gietka, Piotr; Książyk, Janusz B.; Machaczka, Maciej

2016-01-01

Introduction Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening syndrome of severe hyperinflammation which is often triggered by infection or autoimmune disease (macrophage activation syndrome – MAS). The aim of our study was to assess the frequency of sHLH/MAS in children treated in our institution and to compare the effectiveness of various therapeutic interventions. Material and methods Between 2005 and 2013, 24 children (age: 1–17 years) were consecutively treated for sHLH/MAS. Therapy was based on glucocorticoids (GCs) in high or standard doses (hd-GCs or sd-GCs), intravenous immunoglobulin (IVIG), and cyclosporin A (CyA). A comparison of selected laboratory and clinical parameters during the first 72 h of treatment and after a week from the last intervention applied in the first 72 h after diagnosis was performed retrospectively. Results The majority of patients (14/24, 58%) suffered from sHLH/MAS in the course of an autoimmune disease (12 patients diagnosed with a systemic form of juvenile idiopathic arthritis). We found with a confidence level of 95% that the application of hd-GCs in the first 24 h caused rapid alleviation of fever, reduction of hepatosplenomegaly, and an increase in thrombocytes and s-fibrinogen concentrations. The use of combination therapy with hd-GCs, IVIG, and CyA in the first 72 h caused a faster increase in s-fibrinogen. All patients survived and were alive at the follow-up of 1–8 years. Conclusions The results indicate that treatment of sHLH/MAS based on hd-GCs, CyA and IVIG is an effective therapy in children. PMID:29379544

Time trend and risk factors of avascular bone necrosis in patients with systemic lupus erythematosus.

PubMed

Tse, Sau Mei; Mok, Chi Chiu

2017-06-01

Objectives The objective of this paper is to study the time trend and risk factors of avascular bone necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Methods Between 1999 and 2014, patients who fulfilled the ACR criteria for SLE and developed symptomatic AVN were identified from our cohort database and compared with those without AVN, matched for age, sex and SLE duration. The standardized incidence ratios (SIRs) of AVN in different SLE age groups were calculated from data derived from our hospital registry and population census. Risk factors for AVN were studied by logistic regression, adjusted by a propensity score for ever use of high-dose glucocorticoids (GCs). Results Fifty-five SLE patients with AVN and 220 SLE patients without AVN were studied. There were 104 AVN sites involved, with the hips being most commonly affected (82%). The point prevalence of AVN in our SLE cohort was 7.4%. The SIRs of AVN in our SLE patients were 131 (86.6-199; p < 0.001) and 56.0 (34.3-91.4; p < 0.001), respectively, in the periods 1995-2004 and 2005-2014. In both decades, the age-stratified SIR was highest in the youngest age group (<19 years). AVN patients were more likely to be treated with GCs and had received a significantly higher cumulative dose of prednisolone since SLE diagnosis (16.5 vs 10.7 grams; p = 0.001). The SLE damage score (excluding AVN) was also significantly higher in AVN than non-AVN patients (2.5 vs 0.4; p < 0.001). Logistic regression revealed that preceding septic arthritis of the involved joint (odds ratio (OR) 17.7 (1.5-205); p = 0.02), cushingoid body habitus (OR 2.4 (1.1-5.2); p = 0.04), LDL cholesterol level (OR 1.4 (1.0-1.9); p = 0.04), maximum daily dose of prednisolone (OR 6.4 (1.2-33.3); p = 0.03) and cumulative dose of prednisolone received in the first six months of the first lupus flare (OR 1.3 (1.0-1.8); p = 0.046) were independently associated with AVN. Conclusions AVN is prevalent in SLE, particularly in younger patients. The use of GCs remains the strongest independent risk factor. A trend of reduction in the SIR of AVN in our SLE patients is observed over the past two decades.

Association between trends in clinical variables and outcome in intensive care patients with faecal peritonitis: analysis of the GenOSept cohort.

PubMed

Tridente, Ascanio; Clarke, Geraldine M; Walden, Andrew; Gordon, Anthony C; Hutton, Paula; Chiche, Jean-Daniel; Holloway, Paul A H; Mills, Gary H; Bion, Julian; Stüber, Frank; Garrard, Christopher; Hinds, Charles

2015-05-05

Patients admitted to intensive care following surgery for faecal peritonitis present particular challenges in terms of clinical management and risk assessment. Collaborating surgical and intensive care teams need shared perspectives on prognosis. We aimed to determine the relationship between dynamic assessment of trends in selected variables and outcomes. We analysed trends in physiological and laboratory variables during the first week of intensive care unit (ICU) stay in 977 patients at 102 centres across 16 European countries. The primary outcome was 6-month mortality. Secondary endpoints were ICU, hospital and 28-day mortality. For each trend, Cox proportional hazards (PH) regression analyses, adjusted for age and sex, were performed for each endpoint. Trends over the first 7 days of the ICU stay independently associated with 6-month mortality were worsening thrombocytopaenia (mortality: hazard ratio (HR) = 1.02; 95% confidence interval (CI), 1.01 to 1.03; P < 0.001) and renal function (total daily urine output: HR =1.02; 95% CI, 1.01 to 1.03; P < 0.001; Sequential Organ Failure Assessment (SOFA) renal subscore: HR = 0.87; 95% CI, 0.75 to 0.99; P = 0.047), maximum bilirubin level (HR = 0.99; 95% CI, 0.99 to 0.99; P = 0.02) and Glasgow Coma Scale (GCS) SOFA subscore (HR = 0.81; 95% CI, 0.68 to 0.98; P = 0.028). Changes in renal function (total daily urine output and renal component of the SOFA score), GCS component of the SOFA score, total SOFA score and worsening thrombocytopaenia were also independently associated with secondary outcomes (ICU, hospital and 28-day mortality). We detected the same pattern when we analysed trends on days 2, 3 and 5. Dynamic trends in all other measured laboratory and physiological variables, and in radiological findings, changes in respiratory support, renal replacement therapy and inotrope and/or vasopressor requirements failed to be retained as independently associated with outcome in multivariate analysis. Only deterioration in renal function, thrombocytopaenia and SOFA score over the first 2, 3, 5 and 7 days of the ICU stay were consistently associated with mortality at all endpoints. These findings may help to inform clinical decision making in patients with this common cause of critical illness.

The Crystal Structure of GCAP3 Suggests Molecular Mechanism of GCAP–linked Cone Dystrophies

PubMed Central

Stephen, Ricardo; Palczewski, Krzysztof; Sousa, Marcelo C.

2014-01-01

Summary Absorption of light by visual pigments initiates the phototransduction pathway that results in degradation of the intracellular pool of cyclic–GMP (cGMP). This hydrolysis promotes the closing of cGMP–gated cation channels and consequent hyperpolarization of rod and cone photoreceptor cell membranes. Guanylate Cyclase Activating Proteins (GCAPs) are a family of proteins that regulate retinal guanylate cyclase (GC) activity in a Ca2+–dependent manner. At high [Ca2+], typical of the dark–adapted state (~500 nM), GCAPs inhibit retinal GCs. At the low [Ca2+] (~50 nM) that occur after the closing of cGMP-gated channels, GCAPs activate retinal GCs to replenish dark–state cGMP levels. Here, we report the crystal structure of unmyristoylated human GCAP3 with Ca2+ bound. GCAP3 is an EF–hand Ca2+–binding protein with Ca2+ bound to EF2, 3 and 4, while Ca2+ binding to EF–hand 1 is disabled. GCAP3 contains two domains with the EF–hand motifs arranged in a tandem array similar to GCAP2 and members of the recoverin subfamily of Ca2+–binding proteins. Residues not involved in Ca2+ binding, but conserved in all GCAPs, cluster around EF1 in the N–terminal domain and may represent the interface with GCs. Five point mutations in the closely related GCAP1 have been linked to the etiology of cone dystrophies. These residues are conserved in GCAP3 and the structure suggests important roles for these amino acids. We present a homology model of GCAP1 based on GCAP3 that offers insight into the molecular mechanism underlying the autosomal dominant cone dystrophies produced by GCAP1 mutations. PMID:16626734

Long-term consequences of a short-term hypergravity load in a snail model

NASA Astrophysics Data System (ADS)

Martynova, Marina G.; Shabelnikov, Sergej V.; Bystrova, Olga A.

2015-07-01

Here we focused on the dynamic processes in the snail at different time after short-term hypergravity load (STHL) by monitoring the state of neuroendocrine and immune systems, the nucleic acid synthesis levels in the atrial cells, and the behaviour of the atrial granular cells (GCs). We observed that immediately after centrifugation (14 g for 15 min) in the snail haemolymph concentration of dopamine and noradrenaline (measured by high-performance liquid chromatography) and the number of circulating haemocytes and their proliferative activity (estimated by the direct cell counting and [3H]thymidine incorporation, respectively) increased significantly, whereas the concentration of adrenaline decreased. Twenty-four hours after STHL, the levels of catecholamines and haemocytes returned to their control values. In the atrial epicardial and endothelial cells, a notable drop of transcription activity (evaluated by [3H]uridine autoradiography) from the baseline in the immediate post-STHL period was followed by its gradual increase reaching a maximum at the day 5 and subsequent decrease to control value by the day 10. In endothelial cells, DNA-synthesizing activity (evaluated by [3H]thymidine autoradiography) equal to zero before and just after STHL, increased significantly at the day 5, and decreased by the day 10. The atrial GCs underwent total degranulation. Formed as a result small ungranulated cells exhibited DNA synthesis. Afterwards, most probably, the GCs divided and regranulated. One month after STHL the GC population had been restored. Overall, STHL has triggered an immediate reaction of the neuroendocrine and immune systems and initiated long-lasting processes at a cellular level, which included alterations in activity of nucleic acid syntheses in the epicardial and endothelial cells and remodelling of the GC population in the atrium.

The crystal structure of GCAP3 suggests molecular mechanism of GCAP-linked cone dystrophies.

PubMed

Stephen, Ricardo; Palczewski, Krzysztof; Sousa, Marcelo C

2006-06-02

Absorption of light by visual pigments initiates the phototransduction pathway that results in degradation of the intracellular pool of cyclic-GMP (cGMP). This hydrolysis promotes the closing of cGMP-gated cation channels and consequent hyperpolarization of rod and cone photoreceptor cell membranes. Guanylate cyclase-activating proteins (GCAPs) are a family of proteins that regulate retinal guanylate cyclase (GC) activity in a Ca2+-dependent manner. At high [Ca2+], typical of the dark-adapted state (approximately 500 nM), GCAPs inhibit retinal GCs. At the low [Ca2+] (approximately 50 nM) that occurs after the closing of cGMP-gated channels, GCAPs activate retinal GCs to replenish dark-state cGMP levels. Here, we report the crystal structure of unmyristoylated human GCAP3 with Ca2+ bound. GCAP3 is an EF-hand Ca2+-binding protein with Ca2+ bound to EF2, 3 and 4, while Ca2+ binding to EF-hand 1 is disabled. GCAP3 contains two domains with the EF-hand motifs arranged in a tandem array similar to GCAP2 and members of the recoverin subfamily of Ca2+-binding proteins. Residues not involved in Ca2+ binding, but conserved in all GCAPs, cluster around EF1 in the N-terminal domain and may represent the interface with GCs. Five point mutations in the closely related GCAP1 have been linked to the etiology of cone dystrophies. These residues are conserved in GCAP3 and the structure suggests important roles for these amino acids. We present a homology model of GCAP1 based on GCAP3 that offers insight into the molecular mechanism underlying the autosomal dominant cone dystrophies produced by GCAP1 mutations.

Persistent Simian Immunodeficiency Virus Infection Drives Differentiation, Aberrant Accumulation, and Latent Infection of Germinal Center Follicular T Helper Cells

PubMed Central

Xu, Huanbin; Wang, Xiaolei; Malam, Naomi; Aye, Pyone P.; Alvarez, Xavier; Lackner, Andrew A.

2015-01-01

ABSTRACT CD4+ follicular T helper (Tfh) cells play a prominent role in humoral immune responses, but the mechanisms of their accumulation and infection in AIDS remain unclear. Here we found that germinal center (GC) Tfh cells, defined here as CXCR5+ PD-1HIGH CD4+ T cells, do not express the HIV coreceptor CCR5 yet serve as a latent reservoir in GCs. With disease progression, an expansion of GC Tfh cells is accompanied by increases in dysfunctional CD8+ T cells. In contrast, Tfh precursor (CXCR5− CD4+ T) cells in lymph nodes do express CCR5 and differentiate into GC Tfh cells following interleukin-6 (IL-6) and IL-21 stimulation, and viral DNA is detectable in fully differentiated GC Tfh cells ex vivo. This suggests that SIV-infected GC Tfh cells may be derived from Tfh precursor cell subsets that become infected in marginal zones and then migrate into GCs as fully mature GC Tfh cells that serve as persistent virus reservoirs. These findings suggest that viral persistence in lymph nodes drives compensatory differentiation, aberrant accumulation, and latent infection of GC Tfh cells, resulting in marked impairment of humoral immune responses. IMPORTANCE Generation of antibodies that can effectively eliminate viruses requires interactions of B cells with highly specialized T cells in GCs of lymphoid tissues called follicular T helper cells. Here we show that in simian immunodeficiency virus infection, these cells are initially infected in a precursor stage that leads to alterations in their homing, accumulation, and function that may be responsible for the inability of human immunodeficiency virus-infected patients to generate effective antibody responses. PMID:26608323

Persistent Simian Immunodeficiency Virus Infection Drives Differentiation, Aberrant Accumulation, and Latent Infection of Germinal Center Follicular T Helper Cells.

PubMed

Xu, Huanbin; Wang, Xiaolei; Malam, Naomi; Aye, Pyone P; Alvarez, Xavier; Lackner, Andrew A; Veazey, Ronald S

2016-02-01

CD4(+) follicular T helper (Tfh) cells play a prominent role in humoral immune responses, but the mechanisms of their accumulation and infection in AIDS remain unclear. Here we found that germinal center (GC) Tfh cells, defined here as CXCR5(+) PD-1(HIGH) CD4(+) T cells, do not express the HIV coreceptor CCR5 yet serve as a latent reservoir in GCs. With disease progression, an expansion of GC Tfh cells is accompanied by increases in dysfunctional CD8(+) T cells. In contrast, Tfh precursor (CXCR5(-) CD4(+) T) cells in lymph nodes do express CCR5 and differentiate into GC Tfh cells following interleukin-6 (IL-6) and IL-21 stimulation, and viral DNA is detectable in fully differentiated GC Tfh cells ex vivo. This suggests that SIV-infected GC Tfh cells may be derived from Tfh precursor cell subsets that become infected in marginal zones and then migrate into GCs as fully mature GC Tfh cells that serve as persistent virus reservoirs. These findings suggest that viral persistence in lymph nodes drives compensatory differentiation, aberrant accumulation, and latent infection of GC Tfh cells, resulting in marked impairment of humoral immune responses. Generation of antibodies that can effectively eliminate viruses requires interactions of B cells with highly specialized T cells in GCs of lymphoid tissues called follicular T helper cells. Here we show that in simian immunodeficiency virus infection, these cells are initially infected in a precursor stage that leads to alterations in their homing, accumulation, and function that may be responsible for the inability of human immunodeficiency virus-infected patients to generate effective antibody responses. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Recent improvements of reactor physics codes in MHI

NASA Astrophysics Data System (ADS)

Kosaka, Shinya; Yamaji, Kazuya; Kirimura, Kazuki; Kamiyama, Yohei; Matsumoto, Hideki

2015-12-01

This paper introduces recent improvements for reactor physics codes in Mitsubishi Heavy Industries, Ltd(MHI). MHI has developed a new neutronics design code system Galaxy/Cosmo-S(GCS) for PWR core analysis. After TEPCO's Fukushima Daiichi accident, it is required to consider design extended condition which has not been covered explicitly by the former safety licensing analyses. Under these circumstances, MHI made some improvements for GCS code system. A new resonance calculation model of lattice physics code and homogeneous cross section representative model for core simulator have been developed to apply more wide range core conditions corresponding to severe accident status such like anticipated transient without scram (ATWS) analysis and criticality evaluation of dried-up spent fuel pit. As a result of these improvements, GCS code system has very wide calculation applicability with good accuracy for any core conditions as far as fuel is not damaged. In this paper, the outline of GCS code system is described briefly and recent relevant development activities are presented.

Mapping out the origins of compact stellar systems

NASA Astrophysics Data System (ADS)

Romanowsky, Aaron J.; Brodie, Jean P.; SAGES Collaboration

2017-03-01

We present a suite of extragalactic explorations of the origins and nature of globular clusters (GCs) and ultra-compact dwarfs (UCDs), and the connections between them. An example of GC metallicity bimodality is shown to reflect underlying, distinct metal-poor and metal-rich stellar halo populations. Metallicity-matching methods are used to trace the birth sites and epochs of GCs in giant E/S0s, pointing to clumpy disk galaxies at z ~ 3 for the metal-rich GCs, and to a combination of accreted and in-situ formation modes at z ~ 5-6 for the metal-poor GCs. An increasingly diverse zoo of compact stellar systems is being discovered, including objects that bridge the gaps between UCDs and faint fuzzies, and between UCDs and compact ellipticals. Many of these have properties pointing to origins as the stripped nuclei of larger galaxies, and a smoking-gun example is presented of an ω Cen-like star cluster embedded in a tidal stream.

Adaptive capacity of geographical clusters: Complexity science and network theory approach

NASA Astrophysics Data System (ADS)

Albino, Vito; Carbonara, Nunzia; Giannoccaro, Ilaria

This paper deals with the adaptive capacity of geographical clusters (GCs), that is a relevant topic in the literature. To address this topic, GC is considered as a complex adaptive system (CAS). Three theoretical propositions concerning the GC adaptive capacity are formulated by using complexity theory. First, we identify three main properties of CAS s that affect the adaptive capacity, namely the interconnectivity, the heterogeneity, and the level of control, and define how the value of these properties influence the adaptive capacity. Then, we associate these properties with specific GC characteristics so obtaining the key conditions of GCs that give them the adaptive capacity so assuring their competitive advantage. To test these theoretical propositions, a case study on two real GCs is carried out. The considered GCs are modeled as networks where firms are nodes and inter-firms relationships are links. Heterogeneity, interconnectivity, and level of control are considered as network properties and thus measured by using the methods of the network theory.

Recent improvements of reactor physics codes in MHI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kosaka, Shinya, E-mail: shinya-kosaka@mhi.co.jp; Yamaji, Kazuya; Kirimura, Kazuki

2015-12-31

This paper introduces recent improvements for reactor physics codes in Mitsubishi Heavy Industries, Ltd(MHI). MHI has developed a new neutronics design code system Galaxy/Cosmo-S(GCS) for PWR core analysis. After TEPCO’s Fukushima Daiichi accident, it is required to consider design extended condition which has not been covered explicitly by the former safety licensing analyses. Under these circumstances, MHI made some improvements for GCS code system. A new resonance calculation model of lattice physics code and homogeneous cross section representative model for core simulator have been developed to apply more wide range core conditions corresponding to severe accident status such like anticipatedmore » transient without scram (ATWS) analysis and criticality evaluation of dried-up spent fuel pit. As a result of these improvements, GCS code system has very wide calculation applicability with good accuracy for any core conditions as far as fuel is not damaged. In this paper, the outline of GCS code system is described briefly and recent relevant development activities are presented.« less

Generalized Chirp Scaling Combined with Baseband Azimuth Scaling Algorithm for Large Bandwidth Sliding Spotlight SAR Imaging

PubMed Central

Yi, Tianzhu; He, Zhihua; He, Feng; Dong, Zhen; Wu, Manqing

2017-01-01

This paper presents an efficient and precise imaging algorithm for the large bandwidth sliding spotlight synthetic aperture radar (SAR). The existing sub-aperture processing method based on the baseband azimuth scaling (BAS) algorithm cannot cope with the high order phase coupling along the range and azimuth dimensions. This coupling problem causes defocusing along the range and azimuth dimensions. This paper proposes a generalized chirp scaling (GCS)-BAS processing algorithm, which is based on the GCS algorithm. It successfully mitigates the deep focus along the range dimension of a sub-aperture of the large bandwidth sliding spotlight SAR, as well as high order phase coupling along the range and azimuth dimensions. Additionally, the azimuth focusing can be achieved by this azimuth scaling method. Simulation results demonstrate the ability of the GCS-BAS algorithm to process the large bandwidth sliding spotlight SAR data. It is proven that great improvements of the focus depth and imaging accuracy are obtained via the GCS-BAS algorithm. PMID:28555057

Hilar granule cells of the mouse dentate gyrus: effects of age, septotemporal location, strain, and selective deletion of the proapoptotic gene BAX.

PubMed

Bermudez-Hernandez, Keria; Lu, Yi-Ling; Moretto, Jillian; Jain, Swati; LaFrancois, John J; Duffy, Aine M; Scharfman, Helen E

2017-09-01

The dentate gyrus (DG) principal cells are glutamatergic granule cells (GCs), and they are located in a compact cell layer. However, GCs are also present in the adjacent hilar region, but have been described in only a few studies. Therefore, we used the transcription factor prospero homeobox 1 (Prox1) to quantify GCs at postnatal day (PND) 16, 30, and 60 in a common mouse strain, C57BL/6J mice. At PND16, there was a large population of Prox1-immunoreactive (ir) hilar cells, with more in the septal than temporal hippocampus. At PND30 and 60, the size of the hilar Prox1-ir cell population was reduced. Similar numbers of hilar Prox1-expressing cells were observed in PND30 and 60 Swiss Webster mice. Prox1 is usually considered to be a marker of postmitotic GCs. However, many Prox1-ir hilar cells, especially at PND16, were not double-labeled with NeuN, a marker typically found in mature neurons. Most hilar Prox1-positive cells at PND16 co-expressed doublecortin (DCX) and calretinin, markers of immature GCs. Double-labeling with a marker of actively dividing cells, Ki67, was not detected. These results suggest that, surprisingly, a large population of cells in the hilus at PND16 are immature GCs (Type 2b and Type 3 cells). We also asked whether hilar Prox1-ir cell numbers are modifiable. To examine this issue, we conditionally deleted the proapoptotic gene BAX in Nestin-expressing cells at a time when there are numerous immature GCs in the hilus, PND2-8. When these mice were examined at PND60, the numbers of Prox1-ir hilar cells were significantly increased compared to control mice. However, deletion of BAX did not appear to change the proportion that co-expressed NeuN, suggesting that the size of the hilar Prox1-expressing population is modifiable. However, deleting BAX, a major developmental disruption, does not appear to change the proportion that ultimately becomes neurons.

The effects of the environmental antiandrogen vinclozolin on the induction of granulosa cell apoptosis during follicular atresia in pigs.

PubMed

Knet, Malgorzata; Tabarowski, Zbigniew; Slomczynska, Maria; Duda, Malgorzata

2014-06-01

The aim of this study was to investigate whether the androgens testosterone and dihydrotestosterone (DHT) and the antiandrogenic fungicide vinclozolin (Vnz) exert proapoptotic effects on porcine granulosa cells (GCs), and to examine the roles of these compounds in follicular atresia. Granulosa cells isolated from pig follicles were cultured for 24 hours, and then exposed to 0.1 μM testosterone, 0.1 μM DHT, 14 μM Vnz, or the equivalent concentrations of testosterone and Vnz or DHT and Vnz for a further 24 hours. Apoptosis and necrosis of the GCs were determined via Hoechst staining and flow cytometry analyses of annexin V-stained cells. Whole porcine follicles were also exposed to the same compounds and combinations of compounds for 24 hours. The sections were stained with hematoxylin and eosin for morphologic assessments, and a Terminal deoxynucleotidyl Transferase Biotyn-dUTP Nick-End Labeling (TUNEL) assay was performed to determine the number of apoptotic cells. The progesterone and estradiol concentrations secreted into the culture media by isolated GCs and follicles were also measured. Exposure to the androgens resulted in an increased number of apoptotic GCs both in vitro and in the organotypic model. Vinclozolin exposure increased and decreased the number of necrotic and apoptotic GCs, respectively. Furthermore, compared with control follicles, those exposed to testosterone, DHT, or Vnz displayed enhanced atresia, and coadministration of Vnz attenuated the promotive effect of these androgens on atresia. Estradiol secretion was stimulated by the combination of testosterone and Vnz, whereas exposure to Vnz alone reduced it. Progesterone production declined after the combined addition of androgens and the antiandrogen. In summary, Vnz caused massive necrosis of GCs in vitro and induced apoptosis of GCs in whole follicles. The androgens testosterone and DHT enhanced these effects. The results presented here suggest that selective destruction of porcine follicles is a serious consequence of exposure to Vnz, and may lead to premature ovarian failure in affected animals. Copyright © 2014 Elsevier Inc. All rights reserved.

Surface Compositions of Red Giant Stars in Globular Clusters

NASA Astrophysics Data System (ADS)

Cheng, Eric; Lau, Marie; Smith, Graeme; Chen, Brian

2018-01-01

Globular clusters (GCs) are excellent “laboratories” to study the formation and evolution of our galaxy. In order to understand, more specifically, the chemical compositions and stellar evolution of the stars in GCs, we ask whether or not deep internal mixing occurs in red giants or if in fact the compositions come from the primordial interstellar medium or previous generations of stars. It has been discovered that as a star evolves up the red giant branch, the surface carbon abundance decreases, which is evidence of deep internal mixing. We questioned whether these processes also affect O or Na abundance as a star evolves. We collected measurement data of red giants from GCs out of academic journals and sorted the data into catalogs. Then, we plotted the catalogs into figures, comparing surface O and Na each with stellar luminosity. Statistical tests were ran to quantify the amount of correlation between the variables. Out of 27 GCs, we concluded that eight show a positive correlation between Na and luminosity, and two show a negative correlation between O and luminosity. Properties of GCs were compared to determine if chemical distribution in stars depends on GCs as the self-enrichment scenario suggests. We created histograms of sodium distribution to test for bimodality to examine if there are separate trends in each GC. In six GCs, two different sequences of red giants appear for Na versus luminosity, suggesting evidence that the depth of mixing may differ among each red giant in a GC. This study has provided new evidence that the changing chemical abundances on the surfaces of red giants can be due to stellar evolutionary effects and deep internal mixing, which may not necessarily depend on the GC and may differ in depth among each red giant. Through this study, we learn more about stellar evolution which will eventually help us understand the origins of our universe. Most of this work was carried out by high school students working under the auspices of the Science Internship Program (SIP) at UC Santa Cruz.

The Survey of Centaurus A's Baryonic Structures (SCABS) - II. The extended globular cluster system of NGC 5128 and its nearby environment

NASA Astrophysics Data System (ADS)

Taylor, Matthew A.; Puzia, Thomas H.; Muñoz, Roberto P.; Mieske, Steffen; Lançon, Ariane; Zhang, Hongxin; Eigenthaler, Paul; Bovill, Mia Sauda

2017-08-01

New wide-field u΄g΄r΄I΄z΄ Dark Energy Camera observations centred on the nearby giant elliptical galaxy NGC 5128 covering ˜21 deg2 are used to compile a new catalogue of ˜3200 globular clusters (GCs). We report 2404 newly identified candidates, including the vast majority within ˜140 kpc of NGC 5128. We find evidence for a transition at a galactocentric radius of Rgc ≈ 55 kpc from GCs 'intrinsic' to NGC 5128 to those likely to have been accreted from dwarf galaxies or that may transition to the intragroup medium of the Centaurus A galaxy group. We fit power-law surface number density profiles of the form Σ _{N, R_gc}∝ R_gc^Γ and find that inside the transition radius, the red GCs are more centrally concentrated than the blue, with Γinner, red ≈ -1.78 and Γinner, blue ≈ -1.40, respectively. Outside this region both profiles flatten, more dramatically for the red GCs (Γouter, red ≈ -0.33) compared to the blue (Γouter, blue ≈ -0.61), although the former is more likely to suffer contamination by background sources. The median (g΄ - z΄)0 = 1.27 mag colour of the inner red population is consistent with arising from the amalgamation of two giant galaxies each less luminous than present-day NGC 5128. Both inwards and outwards of the transition radius, we find the fraction of blue GCs to dominate over the red GCs, indicating a lively history of minor mergers. Assuming the blue GCs to originate primarily in dwarf galaxies, we model the population required to explain them, while remaining consistent with NGC 5128's present-day spheroid luminosity. We find that several dozen dwarfs of luminosities Ldw, V ≃ 106-9.3 LV, ⊙, following a Schechter luminosity function with a faint-end slope of -1.50 ≲ α ≲ -1.25 is favoured, many of which may have already been disrupted in NGC 5128's tidal field.

The old man and the C-spine fracture: Impact of halo vest stabilization in patients with blunt cervical spine fractures.

PubMed

Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Schroeppel, Thomas J; Fabian, Timothy C; Croce, Martin A

2016-01-01

Placement of a halo vest for cervical spine fractures is presumed to be less morbid than operative fixation. However, restrictions imposed by the halo vest can be detrimental, especially in older patients. The purpose of this study was to evaluate the impact of halo vest placement on outcomes by age in patients with cervical spine fractures without spinal cord injury. All patients with blunt cervical spine fractures managed over an 18-year period were identified. Those with spinal cord injury and severe traumatic brain injury were excluded. Patients were stratified by age, sex, halo vest, injury severity, and severity of shock. Outcomes included intensive care unit length of stay, ventilator days, ventilator-associated pneumonia, functional status, and mortality. Multivariable logistic regression was performed to determine whether halo vest was an independent predictor of mortality in older patients. A total of 3,457 patients were identified: 69% were male, with a mean Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) score of 19 and 13, respectively. Overall mortality was 5.3%. One hundred seventy-nine patients were managed with a halo vest, 133 of those 54 years and older and 46 of those younger than 54 years. Both mortality (13% vs. 0%, p < 0.001) and intensive care unit length of stay (4 days vs. 2 days, p = 0.02) were significantly increased in older patients despite less severe injury (admission GCS score of 15 vs. 14 and ISS of 14 vs. 17, p = 0.03). Multivariable logistic regression identified halo vest as an independent predictor of mortality after adjusting for injury severity and severity of shock (odds ratio, 2.629; 95% confidence interval, 1.056-6.543) in older patients. The potential risk of operative stabilization must be weighed against that of halo vest placement for older patients with cervical spine fractures following blunt trauma. Patient age should be strongly considered before placement of a halo vest for cervical spine stabilization. Therapeutic study, level IV.

Software requirements: Guidance and control software development specification

NASA Technical Reports Server (NTRS)

Withers, B. Edward; Rich, Don C.; Lowman, Douglas S.; Buckland, R. C.

1990-01-01

The software requirements for an implementation of Guidance and Control Software (GCS) are specified. The purpose of the GCS is to provide guidance and engine control to a planetary landing vehicle during its terminal descent onto a planetary surface and to communicate sensory information about that vehicle and its descent to some receiving device. The specification was developed using the structured analysis for real time system specification methodology by Hatley and Pirbhai and was based on a simulation program used to study the probability of success of the 1976 Viking Lander missions to Mars. Three versions of GCS are being generated for use in software error studies.

The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning.

PubMed

Kim, Y S; Cha, Y S; Kim, M S; Kim, H J; Lee, Y S; Youk, H; Kim, H I; Kim, O H; Cha, K-C; Kim, H; Lee, K H; Hwang, S O

2018-06-01

Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). No previous study has determined whether early use of diffusion-weighted magnetic resonance imaging (DWI) can predict which patients will develop DNS in the acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 17-month period. All included patients with acute CO poisoning underwent DWI to evaluate brain injury within 72 h after CO exposure. DWI was evaluated as follows: (1) presence of pathology, (2) number of pathologies, (3) asymmetry, and (4) location of pathology. Patients were divided into two groups. The DNS group was composed of patients with delayed sequelae, while the non-DNS group included patients with no sequelae. A total of 102 patients with acute CO poisoning were finally enrolled in this study. DNS developed in 10 patients (9.8%). Between the DNS group and the non-DNS group, presence of pathology on DWI and initial Glasgow Coma Scale (GCS) showed significant difference. There was also a statistical difference between the non-DNS group and DNS group in terms of CO exposure time, troponin I, rhabdomyolysis, acute kidney injury, and pneumonia. The presence of pathology in DWI and initial GCS (cutoff: <12) at the emergency department served as an early predictors of DNS.

Probing the outer limits of a galactic halo - deep imaging of exceptionally remote globular clusters in M31

NASA Astrophysics Data System (ADS)

Mackey, Dougal

2011-10-01

Globular clusters {GCs} are fossil relics from which we can obtain critical insights into the formation and growth of galaxies. As part of the ongoing Pan-Andromeda Archaeological Survey {PAndAS} we have discovered a group of exceptionally remote GCs in the M31 halo, spanning a range in projected galactocentric distance of 85-145 kpc. Here we apply for deep ACS imaging of 13 such targets, which will allow us to study their constituent stellar populations, line-of-sight distances, and structural parameters. Our measurements will facilitate the use of these GCs as a unique set of probes of the exceptionally remote halo of a large disk galaxy, opening up a completely new area of parameter space to observational constraint. Comparing the properties of our targets with more centrally-located objects will provide a much clearer picture of the M31 GC population than is presently available, while comparison with the outermost Milky Way GCs will further elucidate well-known disparities between the two systems and offer vital clues to differences in their assembly. In addition, our measurements will substantially augment a broad swathe of science that is presently underway - including probing the dark mass distribution in M31 at very large radii, and investigating the detailed chemical composition of M31 GCs via high-resolution integrated-light spectroscopy.

Interleukin-2-induced survival of natural killer (NK) cells involving phosphatidylinositol-3 kinase-dependent reduction of ceramide through acid sphingomyelinase, sphingomyelin synthase, and glucosylceramide synthase.

PubMed

Taguchi, Yoshimitsu; Kondo, Tadakazu; Watanabe, Mitsumasa; Miyaji, Michihiko; Umehara, Hisanori; Kozutsumi, Yasunori; Okazaki, Toshiro

2004-11-15

Interleukin 2 (IL-2) rescued human natural killer (NK) KHYG-1 cells from apoptosis along with a reduction of ceramide. Conversely, an increase of ceramide inhibited IL-2-rescued survival. IL-2 deprivation-induced activation of acid sphingomyelinase (SMase) and inhibition of glucosylceramide synthase (GCS) and sphingomyelin synthase (SMS) were normalized by IL-2 supplementation. A phosphatidyl inositol-3 (PI-3) kinase inhibitor, LY294002, inhibited IL-2-rescued survival, but a mitogen-activated protein kinase inhibitor, PD98059, and an inhibitor of Janus tyrosine kinase/signal transducer and activator of transcription pathway, AG490, did not. LY294002 inhibited IL-2-induced reduction of ceramide through activation of acid SMase and inhibition of GCS and SMS, suggesting the positive involvement of PI-3 kinase in ceramide reduction through enzymatic regulation. Indeed, a constitutively active PI-3 kinase enhanced growth rate and ceramide reduction through inhibition of acid SMase and activation of GCS and SMS. Further, LY294002 inhibited IL-2-induced changes of transcriptional level as well as mRNA and protein levels in acid SMase and GCS but did not affect the stability of the mRNAs. These results suggest that PI-3 kinase-dependent reduction of ceramide through regulation of acid SMase, GCS, and SMS plays a role in IL-2-rescued survival of NK cells.

Graduated Compression Stockings for Runners: Friend, Foe, or Fake?

PubMed Central

Bovenschen, H. Jorn; te Booij, Mariëlle; van der Vleuten, Carine J. M.

2013-01-01

Objective: To assess the effect of graduated compression stockings (GCS) on lower leg volume and leg complaints in runners during and after exercise. Design: Cross-sectional study. Setting: Radboud University Nijmegen Medical Centre and an outdoor running track in Nijmegen, The Netherlands. Patients or Other Participants: Thirteen Dutch trained recreational runners. Intervention(s): Participants used a GCS on 1 leg during running. Main Outcome Measures: (1) Lower leg volume of both legs was measured at baseline, directly after running, and at 5 minutes and 30 minutes after running using a validated perometer. (2) Leg complaints were reported on questionnaires at set intervals. Results: (1) In both experiments, the legs with GCS showed a reduction in mean (± SEM) leg volume directly after running, as compared with the leg without GCS: −14.1 ± 7.6 mL (P = .04) for the 10-km running track and −53.5 ± 17.8 mL (P = .03) for the maximum exercise test. This effect was not observed at 5 and 30 minutes after running. (2) No differences in leg complaints were reported in either experiment. Conclusions: The GCS prevented an increase in leg volume just after the running exercise. However, this result was not accompanied by a reduction in subjective questionnaire-reported leg complaints. The practical consequences of the present findings need further study. PMID:23672387

Study of Remote Globular Cluster Satellites of M87

NASA Astrophysics Data System (ADS)

Sahai, Arushi; Shao, Andrew; Toloba, Elisa; Guhathakurta, Puragra; Peng, Eric W.; Zhang, Hao

2017-01-01

We present a sample of “orphan” globular clusters (GCs) with previously unknown parent galaxies, which we determine to be remote satellites of M87, a massive elliptical galaxy at the center of the Virgo Cluster of Galaxies. Because GCs were formed in the early universe along with their original parent galaxies, which were cannibalized by massive galaxies such as M87, they share similar age and chemical properties. In this study, we first confirm that M87 is the adoptive parent galaxy of our orphan GCs using photometric and spectroscopic data to analyze spatial and velocity distributions. Next, we increase the signal-to-noise ratio of our samples’ spectra through a process known as coaddition. We utilize spectroscopic absorption lines to determine the age and metallicity of our orphan GCs through comparison to stellar population synthesis models, which we then relate to the GCs’ original parent galaxies using a mass-metallicity relation. Our finding that remote GCs of M87 likely developed in galaxies with ~1010 solar masses implies that M87’s outer halo is formed of relatively massive galaxies, serving as important parameters for developing theories about the formation and evolution of massive galaxies.This research was funded in part by NASA/STScI and the National Science Foundation. Most of this work was carried out by high school students working under the auspices of the Science Internship Program at UC Santa Cruz.

Neutralization of B. anthracis toxins during ex vivo phagocytosis.

PubMed

Tarasenko, Olga; Scott, Ashley; Jones, April; Soderberg, Lee; Alusta, Pierre

2013-07-01

Glycoconjugates (GCs) are recognized as stimulation and signaling agents, affecting cell adhesion, activation, and growth of living organisms. Among GC targets, macrophages are considered ideal since they play a central role in inflammation and immune responses against foreign agents. In this context, we studied the effects of highly selective GCs in neutralizing toxin factors produced by B. anthracis during phagocytosis using murine macrophages. The effects of GCs were studied under three conditions: A) prior to, B) during, and C) following exposure of macrophages to B. anthracis individual toxin (protective antigen [PA], edema factor [EF], lethal factor [LF] or toxin complexes (PA-EF-LF, PA-EF, and PA-LF). We employed ex vivo phagocytosis and post-phagocytosis analysis including direct microscopic observation of macrophage viability, and macrophage activation. Our results demonstrated that macrophages are more prone to adhere to GC-altered PA-EF-LF, PA-EF, and PA-LF toxin complexes. This adhesion results in a higher phagocytosis rate and toxin complex neutralization during phagocytosis. In addition, GCs enhance macrophage viability, activate macrophages, and stimulate nitric oxide (NO) production. The present study may be helpful in identifying GC ligands with toxin-neutralizing and/or immunomodulating properties. In addition, our study could suggest GCs as new targets for existing vaccines and the prospective development of vaccines and immunomodulators used to combat the effects of B. anthracis.

Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?

PubMed

Benedict, Leo Andrew; Paulus, Jessica K; Rideout, Leslie; Chwals, Walter J

2014-01-01

To assess whether pediatric trauma patients initially evaluated at referring institutions met Massachusetts statewide trauma field triage criteria for stabilization and immediate transfer to a Pediatric Trauma Center (PTC) without pre-transfer CT imaging. A 3-year retrospective cohort study was completed at our level 1 PTC. Patients with CT imaging at referring institutions were classified according to a triage scheme based on Massachusetts statewide trauma field triage criteria. Demographic data and injury profile characteristics were abstracted from patient medical records and our pediatric trauma registry. A total of 262 patients with 413 CT scans were reviewed from 2008 to 2011. 172 patients scanned (66%, 95% CI: 60%, 71%) met criteria for immediate transfer to a pediatric trauma center. Notably, 110 scans (27% of the total performed at referring institutions) were duplicated within four hours upon arrival to our PTC. GCS score <14 (45%) was the most common requirement for transfer, and CT scan of the head was the most frequent scan obtained (53%). The majority of pediatric trauma patients were subjected to CT scans at referring institutions despite meeting Massachusetts trauma triage guidelines that call for stabilization and immediate transfer to a pediatric trauma center without any CT imaging. © 2014.

Cerebral fat embolism and the "starfield" pattern: a case report.

PubMed

Aravapalli, Amit; Fox, James; Lazaridis, Christos

2009-11-19

Nearly all long-bone fractures are accompanied by some form of fat embolism. The rare complication of clinically significant fat embolism syndrome, however, occurs in only 0.9-2.2% of cases. The clinical triad of fat embolism syndrome consists of respiratory distress, altered mental status, and petechial rash. Cerebral fat embolism causes the neurologic involvement seen in fat embolism syndrome. A 19-year-old African-American male was admitted with gunshot wounds to his right hand and right knee. He had diffuse hyperactive deep tendon reflexes, bilateral ankle clonus and decerebrate posturing with a Glasgow Coma Scale (GCS) score of 4T. Subsequent MRI of the brain showed innumerable punctate areas of restricted diffusion consistent with "starfield" pattern. On a 10-week follow up he has a normal neurological examination and he is discharged home. Despite the severity of the neurologic insult upon initial presentation, the majority of case reports on cerebral fat embolism illustrate that cerebral dysfunction associated with cerebral fat embolism is reversible. When neurologic deterioration occurs in the non-head trauma patient, then a systemic cause such as fat emboli should be considered. We describe a patient with non-head trauma who demonstrated the classic "starfield" pattern on diffusion-weighted MRI imaging.

Generalized chaos synchronization theorems for bidirectional differential equations and discrete systems with applications

NASA Astrophysics Data System (ADS)

Ji, Ye; Liu, Ting; Min, Lequan

2008-05-01

Two constructive generalized chaos synchronization (GCS) theorems for bidirectional differential equations and discrete systems are introduced. Using the two theorems, one can construct new chaos systems to make the system variables be in GCS. Five examples are presented to illustrate the effectiveness of the theoretical results.

Risk factors for injury acute renal in patients with severe trauma and its effect on mortality.

PubMed

Baitello, André Luciano; Marcatto, Gustavo; Yagi, Roberto Kaoru

2013-01-01

The studies which associated acute kidney injury (AKI) and trauma emerged during the Second World War, and since then we have seen a progressive evolution of healthcare aiming at AKI prevention. However, establishing the risk factors for post-trauma AKI development remains crucial and may help reduce this complication. This study aims at identifying risk factors vis-à-vis the development of AKI in patients with severe trauma and its impact on mortality. This is a retrospective study of 75 patients with severe trauma. Six were taken off because they arrived at the hospital past the point of resuscitation. The variables considered were age, gender, trauma severity according to the Injury Severity Score (ISS) and the Glasgow Coma Scale (GCS), trauma mechanism, mean blood pressure upon admission, fluid replacement in the first 24 hours, serum creatinine levels, use of nephrotoxic antibiotics, length of hospital stay, need for ICU admission and mortality. The prevalence of AKI in severe trauma patients was 17.3%, and the factors associated with ARF in this sample were Head Injury and GCS < 10. Mortality, length of hospital stay and the need for ICU were significantly higher in patients who developed AKI. The identification of these risk factors is of paramount importance for the development of care strategies for patients suffering from severe trauma, for the prevention of acute kidney injury and the associated high mortality.

Evaluation of the Coaches Educators training implementation of the PAPA project: A comparison between Norway and France.

PubMed

Van Hoye, A; Larsen, T; Sovik, M; Wold, B; Heuzé, J-P; Samdal, O; Ommundsen, Y; Sarrazin, P

2015-10-01

This study cross-culturally compares the implementation process of the Empowering Coaching™ training program to grassroots coaches (GCs) by trained Coach Educators (CEs) from the Promoting Adolescent Physical Activity project in Norway and France. This program targets children's health through coach training to create a more positive environment. Using the RE-AIM framework, indicators of implementation processes at staff level were defined for adoption, implementation, and maintenance. CEs (n = 18) were interviewed about their professional use of the training, and video-filmed delivering the intervention trial workshops. GCs (n = 185) responded to a questionnaire after the workshops. Results showed that CEs were keen to participate in this project (16/18; 89%), to stay involved (12/16; 75%), and to diffuse the principles after the research project (12/12; 100%). CE training seemed effective as results indicated that CEs applied the principles of the program during the workshops and covered a high degree of the content (78%). Cross-cultural differences were found as the French Football Federation CE dropped out of the program, as Norwegian CEs delivered the content with higher fidelity and had higher enjoyment and pace scores than French CEs. More indicators are needed to use the RE-AIM framework for cross-cultural comparison. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Association between serum levels of caspase-cleaved cytokeratin-18 and early mortality in patients with severe spontaneous intracerebral hemorrhage.

PubMed

Lorente, Leonardo; Martín, María M; Pérez-Cejas, Antonia; Ramos, Luis; Argueso, Mónica; Solé-Violán, Jordi; Cáceres, Juan J; Jiménez, Alejandro; García-Marín, Victor

2018-04-16

Apoptotic changes after cerebral hemorrhage in brain samples of humans have been found. Caspase-cleaved cytokeratin (CCCK)-18 could be detected in the bloodstream during apoptosis. Higher circulating CCCK-18 levels have been associated with 6-month mortality in patients with basal ganglia hemorrhage. The aim of our study was to determine whether there is an association between serum CCCK-18 levels and early mortality of spontaneous intracerebral hemorrhage (SIH) patients. We performed an observational, prospective and multicentre study. There were included patients with severe SIH defined as Glasgow Coma Scale (GCS) lower than 9. We determined serum CCCK-18 levels at the severe SIH diagnosis moment. We found that non-surviving SIH patients (n = 46) showed lower GCS, and higher serum CCCK-18 levels and APACHE-II score than survivor ones (n = 54). In ROC analysis was found that the area under the curve of serum CCCK-18 levels for 30-day mortality prediction was 90% (95% CI 82-95%; p < 0.001). In the multiple logistic regression analysis, we found an association between serum CCCK-18 levels and 30-day mortality (OR 1.034; 95% CI 1.013-1.055; p = 0.002). The novel finding of our study was that there is an association between high serum CCCK-18 levels and 30-day mortality in severe SIH patients.

Optimal therapy and prospects for new medicines in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).

PubMed

Pagnoux, Christian; Groh, Matthieu

2016-10-01

The prevalence of eosinophilic granulomatosis with polyangiitis (EGPA; previously known as Churg-Strauss syndrome) is lower than that of other antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV's), and only a few randomized controlled trials have been conducted for this rare disease. However, recent international efforts have helped delineate the best treatment approach. At present, EGPA conventional therapy is by default similar to that of other AAVs. Limited, non-severe EGPA can initially be treated with glucocorticoids (GCs) alone. Patients with life-threatening manifestations and/or major organ involvement must receive a combination of GCs and an immunosuppressant, mainly cyclophosphamide. Remission can be achieved in >85% of patients with these first-line treatments, but vasculitis relapses occur in more than one-third of patients, and about 85% cannot stop GC treatment because of GC-dependent asthma and/or ENT manifestations. A few biologic agents, including rituximab or mepolizumab, are now under investigation after interesting preliminary results. Expert commentary: Treatment for EGPA still has several unmet needs. Several biologic agents are now under investigation in randomized controlled trials, but a few others should be considered soon. Their benefit should be demonstrated for devising more EGPA-tailored therapeutic strategies (ideally GC-free).

Paracrine Regulation of Steroidogenesis in Theca Cells by Granulosa Cells Derived from Mouse Preantral Follicles.

PubMed

Liu, Xiaoqiang; Qiao, Pengyun; Jiang, Aifang; Jiang, Junyi; Han, Haiyan; Wang, Li; Ren, Chune

2015-01-01

Interaction partners of follicular cells play a significant role in steroidogenesis, follicular formation, and development. Androgen secreted by theca cells (TCs) can initiate follicle development and ovulation and provide precursor materials for estrogen synthesis. Therefore, studies on ovarian microenvironment will not only lead to better understanding of the steroidogenesis but also have clinical significance for ovarian endocrine abnormalities such as hyperandrogenism in polycystic ovary syndrome (PCOS). This study applied the Transwell coculture model to investigate if the interaction between granulosa and theca cells may affect androgen production in theca cells. Concentrations of testosterone and androstenedione in the spent medium were measured by radioimmunoassay and enzyme linked immunosorbent assay, respectively. The results show that the coculture with granulosa cells (GCs) increases steroidogenesis in TCs. In addition, testosterone and androstenedione productions in response to LH stimulation were also increased in the coculture model. Significantly increased mRNA expressions of steroidogenic enzymes (Star, Cyp11a1, Cyp17a1, and Hsd3b2) were observed in the cocultured TCs. Thus, GCs were capable of promoting steroidogenesis and LH responsiveness in TCs. This study provided a basis for further exploration of ovarian endocrine mechanism and pathologies.

History and trends of bioactive glass-ceramics.

PubMed

Montazerian, Maziar; Dutra Zanotto, Edgar

2016-05-01

The interest around bioactive glass-ceramics (GCs) has grown significantly over the last two decades due to their appropriate biochemical and mechanical properties. The intense research effort in this field has led to some new commercial products for biomedical applications. This review article begins with the basic concepts of GC processing and development via controlled heat treatments of monolithic pieces or sinter-crystallization of powdered glasses. We then go on to describe the processing, properties, and applications of some commercial bioactive GCs and discuss selected valuable reported researches on several promising types of bioactive GCs. The article finishes with a section on open relevant research directions for bioactive GC development. © 2016 Wiley Periodicals, Inc.

Predictions of Gamma-ray Emission from Globular Cluster Millisecond Pulsars Above 100 MeV

NASA Technical Reports Server (NTRS)

Venter, C.; de Jaker, O.C.; Clapson, A.C.

2009-01-01

The recent Fermi detection of the globular cluster (GC) 47 Tucanae highlighted the importance of modeling collective gamma-ray emission of millisecond pulsars (MSPs) in GCs. Steady flux from such populations is also expected in the very high energy (VHE) domain covered by ground-based Cherenkov telescopes. We present pulsed curvature radiation (CR) as well as unpulsed inverse Compton (IC) calculations for an ensemble of MSPs in the GCs 47 Tucanae and Terzan 5. We demonstrate that the CR from these GCs should be easily detectable for Fermi, while constraints on the total number of MSps and the nebular B-field may be derived using the IC flux components.

DO INTERMEDIATE-MASS BLACK HOLES EXIST IN GLOBULAR CLUSTERS?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Mou-Yuan; Jin, Ya-Ling; Gu, Wei-Min

2013-10-20

The existence of intermediate-mass black holes (IMBHs) in globular clusters (GCs) remains a crucial problem. Searching for IMBHs in GCs reveals a discrepancy between radio observations and dynamical modelings: the upper mass limits constrained by radio observations are systematically lower than that of dynamical modelings. One possibility for such a discrepancy is that, as we suggest in this work, there exist outflows in accretion flows. Our results indicate that, for most sources, current radio observations cannot rule out the possibility that IMBHs may exist in GCs. In addition, we adopt an M-dot -L{sub R} relation to revisit this issue, whichmore » confirms the results obtained by the fundamental plane relation.« less

Recent developments for the Large Binocular Telescope Guiding Control Subsystem

NASA Astrophysics Data System (ADS)

Golota, T.; De La Peña, M. D.; Biddick, C.; Lesser, M.; Leibold, T.; Miller, D.; Meeks, R.; Hahn, T.; Storm, J.; Sargent, T.; Summers, D.; Hill, J.; Kraus, J.; Hooper, S.; Fisher, D.

2014-07-01

The Large Binocular Telescope (LBT) has eight Acquisition, Guiding, and wavefront Sensing Units (AGw units). They provide guiding and wavefront sensing capability at eight different locations at both direct and bent Gregorian focal stations. Recent additions of focal stations for PEPSI and MODS instruments doubled the number of focal stations in use including respective motion, camera controller server computers, and software infrastructure communicating with Guiding Control Subsystem (GCS). This paper describes the improvements made to the LBT GCS and explains how these changes have led to better maintainability and contributed to increased reliability. This paper also discusses the current GCS status and reviews potential upgrades to further improve its performance.

Flexible Delivery as a "Whole-Organisation": What Does This Mean in Practice?

ERIC Educational Resources Information Center

Henry, John; Wakefield, Lyn

A research project called Support Services for Flexible Delivery was commissioned by the Australian organization TAFE (technical and further education) Frontiers. Since 1995, the project has been conducted by using a research approach called the Generalizations from Case Studies (GCS) research method. The GCS method was developed, tested, and…

Glucocorticoids enhance muscle endurance and ameliorate Duchenne muscular dystrophy through a defined metabolic program.

PubMed

Morrison-Nozik, Alexander; Anand, Priti; Zhu, Han; Duan, Qiming; Sabeh, Mohamad; Prosdocimo, Domenick A; Lemieux, Madeleine E; Nordsborg, Nikolai; Russell, Aaron P; MacRae, Calum A; Gerber, Anthony N; Jain, Mukesh K; Haldar, Saptarsi M

2015-12-08

Classic physiology studies dating to the 1930s demonstrate that moderate or transient glucocorticoid (GC) exposure improves muscle performance. The ergogenic properties of GCs are further evidenced by their surreptitious use as doping agents by endurance athletes and poorly understood efficacy in Duchenne muscular dystrophy (DMD), a genetic muscle-wasting disease. A defined molecular basis underlying these performance-enhancing properties of GCs in skeletal muscle remains obscure. Here, we demonstrate that ergogenic effects of GCs are mediated by direct induction of the metabolic transcription factor KLF15, defining a downstream pathway distinct from that resulting in GC-related muscle atrophy. Furthermore, we establish that KLF15 deficiency exacerbates dystrophic severity and muscle GC-KLF15 signaling mediates salutary therapeutic effects in the mdx mouse model of DMD. Thus, although glucocorticoid receptor (GR)-mediated transactivation is often associated with muscle atrophy and other adverse effects of pharmacologic GC administration, our data define a distinct GR-induced gene regulatory pathway that contributes to therapeutic effects of GCs in DMD through proergogenic metabolic programming.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dalessandro, E.; Lapenna, E.; Mucciarelli, A.

We used a combination of optical and near-UV Hubble Space Telescope photometry and FLAMES/ESO-VLT high-resolution spectroscopy to characterize the stellar content of the old and massive globular cluster (GC) NGC 121 in the Small Magellanic Cloud (SMC). We report on the detection of multiple stellar populations, the first case in the SMC stellar cluster system. This result enforces the emerging scenario in which the presence of multiple stellar populations is a distinctive-feature of old and massive GCs regardless of the environment, as far as the light-element distribution is concerned. We find that second-generation (SG) stars are more centrally concentrated thanmore » first-generation (FG) ones. More interestingly, at odds with what is typically observed in Galactic GCs, we find that NGC 121 is the only cluster so far to be dominated by FG stars that account for more than 65% of the total cluster mass. In the framework where GCs were born with 90%–95% of FG stars, this observational finding would suggest that either NGC 121 experienced a milder stellar mass-loss with respect to Galactic GCs or it formed a smaller fraction of SG stars.« less

Three-dimensional culture of buffalo granulosa cells in hanging drop mimics the preovulatory follicle stage.

PubMed

Yadav, Monica; Agrawal, Himanshu; Pandey, Mamta; Singh, Dheer; Onteru, Suneel K

2018-03-01

Granulosa cell (GC) culture models mimicking the intrafollicular environment are limited. Such models have a great potential in reproductive toxicity studies. The buffalo, a monovulatory species like humans, could be a better model than polyovulatory rodents. Therefore, we targeted the development and characterization of three-dimensional (3D) culture systems for buffalo GCs. The GCs from small ovarian follicles (SF) maintained the CYP19 gene expression for 144 hr in a 2D culture system. Hence, GCs from SF were cultured directly in 3D using hanging drop and Poly-([2-hydroxyethyl methacrylate]) (polyHEMA) methods in the DMEM media containing 1 ng/ml FSH and 10 ng/ml IGF-1 for 144 hr. The expression profile of nine GC-specific transcripts; CYP19, TNFAIP6, AMH, PTI, NR4A1, FSHR, RUNX, LHR, and COX2/PTGS2; revealed that 3D-spheroids developed in hanging drop method maintained the GC phenotype of preovulatory follicles. Therefore, hanging drop method is a best method for culturing GCs to mimic the intrafollicular environment. © 2017 Wiley Periodicals, Inc.

Longitudinal course of eating disorders after transsexual treatment: a report of two cases.

PubMed

Hiraide, Maiko; Harashima, Saki; Yoneda, Ryo; Otani, Makoto; Kayano, Mami; Yoshiuchi, Kazuhiro

2017-01-01

Several reports have been published on patients with gender dysphoria and eating disorders. However, there have been few reports on the longitudinal course of eating disorders after gender reassignment surgery (GRS)/gender confirmation surgery (GCS). We report two Japanese cases of transsexual persons with eating disorders who underwent GRS/GCS, one male-to-female (MtF) and one female-to-male (FtM). Case 1 was a 35-year MtF person who had a 14-year-course of bulimia nervosa that developed after GRS. Case 2 was a 35-year FtM person with anorexia nervosa who underwent GCS 9 years before. We found that the treatment of our transsexual patients influenced the course of their eating disorders for a long period, which could be attributable partly to the cultural situation in Japan, an East Asian country. It is possible that many gender identity problems and identity problems in general persist even after surgery and treatment; therefore, continual clinical support should be provided for patients with gender dysphoria and eating disorders even after hormonal therapy or GRS/GCS.

Effect of glucocorticosteroid treatment on ovalbumin-induced IgE-mediated immediate and late allergic response in guinea pig.

PubMed

Andersson, P; Brange, C; von Kogerer, B; Sonmark, B; Stahre, G

1988-01-01

The effect of glucocorticosteroid (GCS) treatment on ovalbumine-induced IgE-mediated immediate and late allergic response was studied in sensitized guinea pigs. The results show that the GCS budesonide (BUD) inhibits the allergen-induced IgE-mediated immediate and late bronchial obstruction. The effect on the early reaction is correlated to the inhibition of leukotrienes and histamine release. The importance of mediator release inhibition for the antianaphylactic effect of GCS is discussed. In examining the effect on the late reaction, it was found that BUD had to be present during the early reaction but did not inhibit the early reaction. Furthermore, the effect on the late reaction was correlated to the inhibition of vascular leakage but not to the infiltration of inflammatory cells as examined in bronchoalveolar lavage. The results indicate that some triggering factors important for the development of the late reaction are released during the early reaction. Inhibition of the release of that factor or the activation of inflammatory cells by that factor might be the mechanism behind the antiinflammatory activities of GCS.

The Ages of 55 Globular Clusters as Determined Using an Improved \\Delta V^HB_TO Method along with Color-Magnitude Diagram Constraints, and Their Implications for Broader Issues

NASA Astrophysics Data System (ADS)

VandenBerg, Don A.; Brogaard, K.; Leaman, R.; Casagrande, L.

2013-10-01

Ages have been derived for 55 globular clusters (GCs) for which Hubble Space Telescope Advanced Camera for Surveys photometry is publicly available. For most of them, the assumed distances are based on fits of theoretical zero-age horizontal-branch (ZAHB) loci to the lower bound of the observed distributions of HB stars, assuming reddenings from empirical dust maps and metallicities from the latest spectroscopic analyses. The age of the isochrone that provides the best fit to the stars in the vicinity of the turnoff (TO) is taken to be the best estimate of the cluster age. The morphology of isochrones between the TO and the beginning part of the subgiant branch (SGB) is shown to be nearly independent of age and chemical abundances. For well-defined color-magnitude diagrams (CMDs), the error bar arising just from the "fitting" of ZAHBs and isochrones is ≈ ± 0.25 Gyr, while that associated with distance and chemical abundance uncertainties is ~ ± 1.5-2 Gyr. The oldest GCs in our sample are predicted to have ages of ≈13.0 Gyr (subject to the aforementioned uncertainties). However, the main focus of this investigation is on relative GC ages. In conflict with recent findings based on the relative main-sequence fitting method, which have been studied in some detail and reconciled with our results, ages are found to vary from mean values of ≈12.5 Gyr at [Fe/H] <~ - 1.7 to ≈11 Gyr at [Fe/H] >~ -1. At intermediate metallicities, the age-metallicity relation (AMR) appears to be bifurcated: one branch apparently contains clusters with disk-like kinematics, whereas the other branch, which is displaced to lower [Fe/H] values by ≈0.6 dex at a fixed age, is populated by clusters with halo-type orbits. The dispersion in age about each component of the AMR is ~ ± 0.5 Gyr. There is no apparent dependence of age on Galactocentric distance (R G) nor is there a clear correlation of HB type with age. As previously discovered in the case of M3 and M13, subtle variations have been found in the slope of the SGB in the CMDs of other metal-poor ([Fe/H] <~ - 1.5) GCs. They have been tentatively attributed to cluster-to-cluster differences in the abundance of helium. Curiously, GCs that have relatively steep "M13-like" SGBs tend to be massive systems, located at small R G, that show the strongest evidence of in situ formation of multiple stellar populations. The clusters in the other group are typically low-mass systems (with 2-3 exceptions, including M3) that, at the present time, should not be able to retain the matter lost by mass-losing stars due either to the development of GC winds or to ram-pressure stripping by the halo interstellar medium. The apparent separation of the two groups in terms of their present-day gas retention properties is difficult to understand if all GCs were initially ~20 times their current masses. The lowest-mass systems, in particular, may have never been massive enough to retain enough gas to produce a significant population of second-generation stars. In this case, the observed light element abundance variations, which are characteristic of all GCs, were presumably present in the gas out of which the observed cluster stars formed.

STAR FORMATION HISTORY OF THE MILKY WAY HALO TRACED BY THE OOSTERHOFF DICHOTOMY AMONG GLOBULAR CLUSTERS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jang, Sohee; Lee, Young-Wook, E-mail: ywlee2@yonsei.ac.kr

2015-06-22

In our recent investigation of the Oosterhoff dichotomy in the multiple population paradigm, we have suggested that the RR Lyrae variables in the globular clusters (GCs) of Oosterhoff groups I, II, and III are produced mostly by first, second, and third generation stars (G1, G2, and G3), respectively. Here we show, for the first time, that the observed dichotomies in the inner and outer halo GCs can be naturally reproduced when these models are extended to all metallicity regimes, while maintaining reasonable agreements in the horizontal-branch type versus [Fe/H] correlations. In order to achieve this, however, specific star formation historiesmore » are required for the inner and outer halos. In the inner halo GCs, the star formation commenced and ceased earlier with a relatively short formation timescale between the subpopulations (∼0.5 Gyr), while in the outer halo, the formation of G1 was delayed by ∼0.8 Gyr with a more extended timescale between G1 and G2 (∼1.4 Gyr). This is consistent with the dual origin of the Milky Way halo. Despite the difference in detail, our models show that the Oosterhoff period groups observed in both outer and inner halo GCs are all manifestations of the “population-shift” effect within the instability strip, for which the origin can be traced back to the two or three discrete episodes of star formation in GCs.« less

Gemini Spectra of Star Clusters in the Spiral Galaxy M101

NASA Astrophysics Data System (ADS)

Simanton-Coogan, Lesley A.; Chandar, Rupali; Miller, Bryan; Whitmore, Bradley C.

2017-12-01

We present low resolution, visible light spectra of 41 star clusters in the spiral galaxy M101, taken with the Gemini/GMOS instrument. We measure Lick indices for each cluster and compare with BaSTI models to estimate their ages and metallicities. We also measure the line-of-sight velocities. We find that 25 of the clusters are fairly young massive clusters (YMCs) with ages of hundreds of millions of years, and 16 appear to be older, globular clusters (GCs). There are at least four GCs with best-fit ages of ≈1–3 Gyr and eight with best-fit ages of ≈5–10 Gyr. The mean metallicity of the YMCs is [Fe/H] ≈ ‑0.1 and for the GCs is [Fe/H] ≈ ‑0.9. We find a near-continuous spread in both age and metallicity for our sample, which may indicate that M101 had a more-or-less continuous history of cluster and star formation. From the kinematics, we find that the YMCs rotate with the H I gas fairly well, while the GCs do not. We cannot definitively say whether the GCs sampled here lie in an inner halo, thick disk, or bulge/psuedobulge component, although given the very small bulge in M101, the last seems unlikely. The kinematics and ages of the YMCs suggest that M101 may have undergone heating of its disk or possibly a continuous merger/accretion history for the galaxy.

K2 and M4: A Unique Opportunity to Unlock the Mysteries of Globular Clusters

NASA Astrophysics Data System (ADS)

Kuehn, Charles A.; Stello, Dennis; Campbell, Simon; Drury, Jason; de Silva, Gayandhi; Maclean, Ben; Bedding, Timothy R.; Huber, Daniel

2016-01-01

One of the most exciting opportunities presented by K2 is the ability to study variable stars in globular clusters (GCs). The K2 observations allow us to perform ensemble asteroseismology of a population that is much older than that in the open clusters in the original Kepler field. This should help us answer long-standing questions concerning mass loss on the red giant branch and the spread in masses along the horizontal branch. By combining the asteroseismic data with chemical tagging of sub-populations from spectroscopy, we hope to better constrain stellar evolution models and potentially shed some light on the formation history of GCs. The very crowded nature of stars in GCs poses a challenge, however, due to Kepler's large pixels. M4, observed during K2's campaign 2, presents an excellent opportunity to study GCs with a combination of K2 and ground-based data. M4 is one of the two nearest GCs and thus should appear less crowded and brighter; in fact M4 is likely the only GC whose horizontal branch stars, other than RR Lyraes, will be accessible with K2. We discuss our method of obtaining photometry for the stars in M4 and present sample lightcurves for different classes of oscillating stars in the cluster. We also discuss efforts to use ground-based observations to increase the utility of the K2 dataset.

Luteogenic Hormones Act through a Vascular Endothelial Growth Factor-Dependent Mechanism to Up-Regulate α5β1 and αvβ3 Integrins, Promoting the Migration and Survival of Human Luteinized Granulosa Cells

PubMed Central

Rolaki, Alexandra; Coukos, George; Loutradis, Dimitris; DeLisser, Horace M.; Coutifaris, Christos; Makrigiannakis, Antonis

2007-01-01

The formation of the corpus luteum (CL) is critical for the establishment of a successful pregnancy. After ovulation, the CL develops from the remnants of the ovulated ovarian follicle. This process, which involves varying cell-matrix interactions, is poorly characterized. To understand the role and potential regulation of cell-matrix interactions in the formation of the CL, we investigated the expression and activity of the matrix protein fibronectin (FN) and several of its integrin receptors on luteinized granulosa cells (GCs). In situ, FN and several FN-binding integrins were detected around luteinizing GCs during the early luteal phase, although expression declined in the late luteal phase. In vitro, GCs released FN, and stimulation of these cells with human chorionic gonadotropin increased the surface expression of FN, α5β1, and αvβ3. Up-regulation of these proteins on GCs was reproduced by stimulation with vascular endothelial growth factor (VEGF) and was inhibited by anti-VEGF antibody. Lastly, expression of α5β1 and αvβ3 mediated adhesion to FN, facilitated migration, and prevented apoptosis. These data suggest that in vivo luteogenic hormones, in part through a VEGF-dependent mechanism, stimulate selected integrin-matrix adhesive interactions that promote the motility and survival of GCs and thus contribute to the formation and preservation of the CL. PMID:17456762

Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996-2010). A population cross-sectional survey study.

PubMed

Di Saverio, Salomone; Gambale, Giorgio; Coccolini, Federico; Catena, Fausto; Giorgini, Eleonora; Ansaloni, Luca; Amadori, Niki; Coniglio, Carlo; Giugni, Aimone; Biscardi, Andrea; Magnone, Stefano; Filicori, Filippo; Cavallo, Piergiorgio; Villani, Silvia; Cinquantini, Francesco; Annicchiarico, Massimo; Gordini, Giovanni; Tugnoli, Gregorio

2014-01-01

Our experience in trauma center management increased over time and improved with development of better logistics, optimization of structural and technical resources. In addition recent Government policy in safety regulations for road traffic accident (RTA) prevention, such compulsory helmet use (2000) and seatbelt restraint (2003) were issued with aim of decreasing mortality rate for trauma. The evaluation of their influence on mortality during the last 15 years can lead to further improvements. In our level I trauma center, 60,247 trauma admissions have been recorded between 1996 and 2010, with 2183 deaths (overall mortality 3.6 %). A total of 2,935 trauma patients with ISS >16 have been admitted to Trauma ICU and recorded in a prospectively collected database (1996-2010). Blunt trauma occurred in 97.1 % of the cases, whilst only 2.5 % were penetrating. A retrospective review of the outcomes was carried out, including mortality, cause of death, morbidity and length of stay (LOS) in the intensive care unit (ICU), with stratification of the outcome changes through the years. Age, sex, mechanism, glasgow coma scale (GCS), systolic blood pressure (SBP), respiratory rate (RR), revised trauma score (RTS), injury severity score (ISS), pH, base excess (BE), as well as therapeutic interventions (i.e., angioembolization and number of blood units transfused in the first 24 h), were included in univariate and multivariate analyses by logistic regression of mortality predictive value. Overall mortality through the whole period was 17.2 %, and major respiratory morbidity in the ICU was 23.3 %. A significant increase of trauma admissions has been observed (before and after 2001, p < 0.01). Mean GCS (10.2) increased during the period (test trend p < 0.05). Mean age, ISS (24.83) and mechanism did not change significantly, whereas mortality rate decreased showing two marked drops, from 25.8 % in 1996, to 18.3 % in 2000 and again down to 10.3 % in 2004 (test trend p < 0.01). Traumatic brain injury (TBI) accounted for 58.4 % of the causes of death; hemorrhagic shock was the death cause in 28.4 % and multiple organ failure (MOF)/sepsis in 13.2 % of the patients. However, the distribution of causes of death changed during the period showing a reduction of TBI-related and increase of MOF/sepsis (CTR test trend p < 0.05). Significant predictors of mortality in the whole group were year of admission (p < 0.05), age, hemorrhagic shock and SBP at admission, ISS and GCS, pH and BE (all p < 0.01). In the subgroup of patients that underwent emergency surgery, the same factors confirmed their prognostic value and remained significant as well as the adjunctive parameter of total amount of blood units transfused (p < 0.05). Surgical time (mean 71 min) showed a significant trend towards reduction but did not show significant association with mortality (p = 0.06). Mortality of severe trauma decreased significantly during the last 15 years as well as mean GCS improved whereas mean ISS remained stable. The new safety regulations positively influenced incidence and severity of TBI and seemed to improve the outcomes. ISS seems to be a better predictor of outcome than RTS.