Diabetic Ketoacidosis—A Review of Cases at a University Medical Center

Twenty-five cases of diabetic ketoacidosis were studied retrospectively with respect to clinical characteristics and results of therapy. In this series (as with all 88 patients admitted in the last five years with a diagnosis of diabetic ketoacidosis) there were no deaths. Infection was found to be the most common precipitating event, documented by physical findings and cultures in one-third of these cases.In about two-thirds of the cases, electrocardiograms which were read as abnormal on admission reverted to normal after therapy.In all patients serum potassium levels decreased from admission values; one patient became symptomatically hypokalemic.Low serum potassium levels on admission and early vigorous bicarbonate therapy are emphasized as major predisposing factors of symptomatic hypokalemia. None of the patients had overt hyperosmolar coma, lactic acidosis or cerebral edema during therapy.     

Effect of plaque compositions on fractional flow reserve in a fluid–structure interaction analysis

Biomechanics and Modeling in Mechanobiology - Coronary artery disease involves the reduction of blood flow to the myocardium due to atherosclerotic plaques. The findings of myocardial ischemia may...     

Characteristics and Trends of Pediatric Traumatic Brain Injuries Treated at a Large Pediatric Medical Center in China, 2002–2011

Background

Pediatric traumatic brain injuries (TBIs) have not been well studied in China. This study investigated characteristics and trends of hospitalized TBIs sustained by Chinese children.

Methods and Findings

We analyzed 2002–2011 hospitalized TBI patients (0–17 years of age) treated at a large pediatric medical center in China. TBIs were defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes. We examined age patterns across external causes of TBIs. We reported the trend of traffic-related TBIs for each year from 2002 to 2011. Of 4,230 TBI patients, 67.1% (95% CI: 65.4%–68.8%) were city residents and 28.8% (95% CI: 26.3%–31.3%) came from rural villages. Males had disproportionately more TBIs than females (65.2% vs. 34.8%). Falls, struck by/against objects, and traffic collisions were the top three external causes of TBIs for all age groups. Falls were the leading cause of TBI for all ages but peaked at 2 years of age. There were 125 TBIs in 0–2 year olds (5.9% of all TBIs in this age group) that were caused by suspected child abuse. Suspected child abuse was significantly more likely to occur in 0–1 year olds. The proportion of traffic -related TBIs increased significantly from 12.99% in 2002 to 19.68% in 2008 but dropped each subsequent year until it reached a level of 8.91% in 2011.

Conclusions

Our study confirms that falls, struck by/against objects and traffic collisions are the top external causes of TBIs in Chinese children. When compared with national data from the developed countries, gender patterns are similar, but the ranking of external causes is different. This is the first study to highlight the important role of suspected child abuse in causing TBIs in infants in China. TBIs caused by child abuse warrant further research and government attention as a social and medical problem in China.     

Clinical and scientific progress related to the interface between cardiology and psychology: lessons learned from 35 years of experience at the Thoraxcenter of the Erasmus Medical Center in Rotterdam

In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body part in need of repair, combined with the understanding that the heart and mind interact to affect health. The present selective review addresses the broad range of contributions of 35 years of psychology to clinical cardiology and cardiovascular research with a focus on research, teaching, psychological screening and patient care. The review ends with lessons to be learned and challenges for the future with respect to improving the care and management of patients with heart disease in order to enhance secondary prevention and the role of behavioural and psychological factors in this endeavour.     

Going with the flow? Threatened species management and legislation in the face of climate change

Summary   The potential impacts of climate change on threatened species, populations and communities are considered. It is suggested that minor changes to legislation will be required to address the consequences of movement of threatened species but that threatened species legislation will remain relevant as an important tool for prioritizing conservation actions. The importance of taking proactive steps now to permit future movement of species and communities across fragmented landscapes is emphasized.     

Conservation tool or threatening process? management implications of interactions of cattle with vegetation and land at the Vale of Belvoir reserve

A recently purchased private reserve of high conservation value has been grazed in summer by cattle since the early nineteenth century. We ask whether the cattle are causing continuing damage and whether they are necessary to maintain any conservation values. We used five‐year‐old exclosures to determine the effects of cattle on wetland vegetation, mapped damage to soils and landforms and mapped cattle dung deposition in relation to the distributions of rare and threatened plant species. Cattle impacts on wetland plants were minor. Cattle damage to landforms by pugging and bank collapse was frequent near unfenced water bodies. Rare and threatened species were largely on well‐drained ground, while cattle dung was concentrated in wetlands and near water bodies. We conclude that cattle grazing is impacting some conservation values and is not necessary for conservation purposes. Destocking should be accompanied by careful monitoring of threatened plant populations. If necessary, alternative planned disturbances can provide regeneration niches for rare and threatened plants.     

Medical Disease or Moral Defect? Stigma Attribution and Cultural Models of Addiction Causality in a University Population

This study examines the knowledge individuals use to make judgments about persons with substance use disorder. First, we show that there is a cultural model of addiction causality that is both shared and contested. Second, we examine how individuals’ understanding of that model is associated with stigma attribution. Research was conducted among undergraduate students at the University of Alabama. College students in the 18–25 age range are especially at risk for developing substance use disorder, and they are, perhaps more than any other population group, intensely targeted by drug education. The elicited cultural model includes different types of causes distributed across five distinct themes: Biological, Self-Medication, Familial, Social, and Hedonistic. Though there was cultural consensus among respondents overall, residual agreement analysis showed that the cultural model of addiction causality is a multicentric domain. Two centers of the model, the moral and the medical, were discovered. Differing adherence to these centers is associated with the level of stigma attributed towards individuals with substance use disorder. The results suggest that current approaches to substance use education could contribute to stigma attribution, which may or may not be inadvertent. The significance of these results for both theory and the treatment of addiction are discussed.     

Molecular Epidemiology of Clostridium difficile at a Medical Center in Taiwan: Persistence of Genetically Clustering of A?B+ Isolates and Increase of A+B+ Isolates

Introduction

We investigated the changing trend of various toxigenic Clostridium difficile isolates at a 3 500-bed hospital in Taiwan. Genetic relatedness and antimicrobial susceptibility of toxigenic C. difficile isolates were also examined.

Methods

A total of 110 non-repeat toxigenic C. difficile isolates from different patients were collected between 2002 and 2007. Characterization of the 110 toxigenic isolates was performed using agar dilution method, multilocus variable-number tandem-repeat analysis (MLVA) genotyping, tcdC genotyping, and toxinotyping.

Results

Among the 110 toxigenic isolates studied, 70 isolates harbored tcdA and tcdB (A⁺B⁺) and 40 isolates harbored tcdB only (A⁻B⁺). The annual number of A⁺B⁺ isolates considerably increased over the 6-year study (P = 0.055). A total of 109 different MLVA genotypes were identified, in which A⁺B⁺ isolates and A⁻B⁺ isolates were differentiated into two genetic clusters with similarity of 17.6%. Twenty-four (60%) of the 40 A⁻B⁺ isolates formed a major cluster, MLVA-group 1, with a similarity of 85%. Seven (6.4%) resistant isolates were identified, including two metronidazole-resistant and five vancomycin-resistant isolates.

Conclusions

This study indicated a persistence of a MLVA group 1 A⁻B⁺ isolates and an increase of A⁺B⁺ isolates with diverse MLVA types. Moreover, C. difficile isolates with antimicrobial resistance to metronidazole or vancomycin were found to have emerged. Continuous surveillance is warranted to understand the recent situation and control the further spread of the toxigenic C. difficile isolates, especially among hospitalized patients.     

Pine and mistletoes: how to live with a leak in the water flow and storage system?

The mistletoe, Viscum album, living on Scots pine (Pinus sylvestris) has been reported barely to regulate its transpiration and thus heavily to affect the gas exchange of its host. The extent of this mistletoe effect and its underlying mechanism has, so far, only been partially analysed. In this study, pine branches with different mistletoe infestation levels were investigated by sap flow gauges and analysed with a modelling approach to identify the mistletoe-induced stomatal regulation of pine and its consequences for the water and carbon balances of the tree. It was found that Viscum album barely regulates its stomata and that pines consequently compensate for the additional water loss of mistletoes by closing their own stomata. Despite the reduced stomatal aperture of the needles, the total water loss of branches with mistletoes increased. Furthermore, the increasingly closed stomata reduced carbon assimilation for the pine. Such a negative effect of the mistletoes on pine's stomatal conductance and carbon gain was particularly strong during dry periods. Our study therefore suggests that mistletoe-induced stomatal closure is a successful mechanism against dying from hydraulic failure in the short term but increases the risk of carbon starvation in the long term. With the current conditions in Valais, Switzerland, a tree with more than about 10-20% of its total leaf area attributable to mistletoes is at the threshold of keeping a positive carbon balance. The currently increasing mistletoe abundance, due to increasing mean annual temperatures, is therefore accelerating the ongoing pine decline in many dry inner-Alpine valleys.     

Detection of EBV and HHV6 in the Brain Tissue of Patients with Rasmussen’s Encephalitis

Rasmussen’s encephalitis (RE) is a rare pediatric neurological disorder, and the exact etiology is not clear. Viral infection may be involved in the pathogenesis of RE, but conflicting results have reported. In this study, we evaluated the expression of both Epstein-Barr virus (EBV) and human herpes virus (HHV) 6 antigens in brain sections from 30 patients with RE and 16 control individuals by immunohistochemistry. In the RE group, EBV and HHV6 antigens were detected in 56.7% (17/30) and 50% (15/30) of individuals, respectively. In contrast, no detectable EBV and HHV6 antigen expression was found in brain tissues of the control group. The co-expression of EBV and HHV6 was detected in 20.0% (6/30) of individuals. In particular, a 4-year-old boy had a typical clinical course, including a medical history of viral encephalitis, intractable epilepsy, and hemispheric atrophy. The co-expression of EBV and HHV6 was detected in neurons and astrocytes in the brain tissue, accompanied by a high frequency of CD8⁺ T cells. Our results suggest that EBV and HHV6 infection and the activation of CD8⁺ T cells are involved in the pathogenesis of RE.     

Increased Oxidative Stress in the Proximal Stomach of Patients with Barrett’s Esophagus and Adenocarcinoma of the Esophagus and Esophagogastric Junction

OBJECTIVES: Oxidative stress (OS) is an essential element in the pathogenesis of Barrett’s esophagus (BE) and its transformation to adenocarcinoma (EAC). The state of OS in the proximal stomach of patients with BE and EAC is unknown. Isoprostanes are a specific marker of OS not previously used to determine OS from BE/EAC tissue samples. PATIENTS AND METHODS: OS was measured in 42 patients with BE (n = 9), EAC (n = 9), or both (n = 24) and 15 control patients. A STAT-8-Isoprostane EIA Kit served to identify 8-Isoprostanes (8-IP), and a Glutathione Assay Kit was used to measure glutathione reduced form (GSH) and glutathione oxidized form. An OxiSelect Oxidative DNA Damage ELISA Kit (8-OHdG) served to measure 8-OH-deoxyguanosine. RESULTS: The 8-IP (P = .039) and 8-OHdG (P = .008) levels were higher, and the GSH level lower (P = .031), in the proximal stomach of the study group than in that of the controls. Helicobacter pylori infection was present in 8% of the study patients. CONCLUSIONS: In the proximal stomach of BE and EAC patients, OS was elevated and antioxidative capacity was reduced. This finding suggests that the gastroesophageal reflux causing BE also induces oxidative stress in the proximal stomach and may contribute to the development of cancer in the proximal stomach and gastric cardia.     

Mechanography performance tests and their association with sarcopenia,falls and impairment in the activities of daily living – a pilot cross-sectional study in 293 older adults

Objectives:

Muscle mass and muscle power considerably decline with aging. The aim of the present study was to determine the association between muscular function using mechanography and sarcopenia, falls and impairment in the activities of daily living (ADL) in a sample of 293 community-dwelling women and men aged 60-85 years in Berlin, Germany.

Methods:

Muscle function was determined by muscle power per body mass in vertical countermovement jumps (2LJP_rel) and the chair rising test (CRTP_rel) on a force plate. Sarcopenia status was assessed by estimating appendicular muscle mass with dual-X-ray absorptiometry. Self-reported ADL impairment and falls in the last 12 months were determined.

Results:

ADL impairment was significantly correlated with all performance tests but not with muscle mass. The 2LJP_rel (OR 0.88, 95%-CI 0.79-0.98), the Esslinger Fitness Index (EFI) (OR 0.97, 95%-CI 0.94-1.00) and the maximal velocity of the CRT (OR 0.70, 95%-CI 0.53-0.93) remained significant correlates for sarcopenia independent of age in men but not in women. The EFI could differentiate female individuals who had past fall events (OR 0.96, 95%-CI 0.93-0.98).

Conclusion:

The results of the present study highlight the importance of assessing muscle power in older individuals as a relevant correlate for functional decline.     

Selective Molecular Alterations in the Autophagy Pathway in Patients with Lewy Body Disease and in Models of α-Synucleinopathy

Background

Lewy body disease is a heterogeneous group of neurodegenerative disorders characterized by α-synuclein accumulation that includes dementia with Lewy bodies (DLB) and Parkinson''s Disease (PD). Recent evidence suggests that impairment of lysosomal pathways (i.e. autophagy) involved in α-synuclein clearance might play an important role. For this reason, we sought to examine the expression levels of members of the autophagy pathway in brains of patients with DLB and Alzheimer''s Disease (AD) and in α-synuclein transgenic mice.

Methodology/Principal Findings

By immunoblot analysis, compared to controls and AD, in DLB cases levels of mTor were elevated and Atg7 were reduced. Levels of other components of the autophagy pathway such as Atg5, Atg10, Atg12 and Beclin-1 were not different in DLB compared to controls. In DLB brains, mTor was more abundant in neurons displaying α-synuclein accumulation. These neurons also showed abnormal expression of lysosomal markers such as LC3, and ultrastructural analysis revealed the presence of abundant and abnormal autophagosomes. Similar alterations were observed in the brains of α-synuclein transgenic mice. Intra-cerebral infusion of rapamycin, an inhibitor of mTor, or injection of a lentiviral vector expressing Atg7 resulted in reduced accumulation of α-synuclein in transgenic mice and amelioration of associated neurodegenerative alterations.

Conclusions/Significance

This study supports the notion that defects in the autophagy pathway and more specifically in mTor and Atg7 are associated with neurodegeneration in DLB cases and α-synuclein transgenic models and supports the possibility that modulators of the autophagy pathway might have potential therapeutic effects.     

Dynamic changes in the distribution and time course of blood–brain barrier-permeative nitroxides in the mouse head with EPR imaging: visualization of blood flow in a mouse model of ischemia

Electron paramagnetic resonance (EPR) imaging using nitroxides as redox-sensitive probes is a powerful, noninvasive method that can be used under various physiological conditions to visualize changes in redox status that result from oxidative damage. Two blood–brain barrier-permeative nitroxides, 3-hydroxymethyl-2,2,5,5-tetramethylpyrrolidine-1-oxyl (HMP) and 3-methoxycarbonyl-2,2,5,5-tetramethylpyrrolidine-1-yloxy (MCP), have been widely used as redox-sensitive probes in the brains of small animals, but their in vivo distribution and properties have not yet been analyzed in detail. In this study, a custom-made continuous-wave three-dimensional (3D) EPR imager was used to obtain 3D EPR images of mouse heads using MCP or HMP. This EPR imager made it possible to take 3D EPR images reconstructed from data from 181 projections acquired every 60 s. Using this improved EPR imager and magnetic resonance imaging, the distribution and reduction time courses of HMP and MCP were examined in mouse heads. EPR images of living mice revealed that HMP and MCP have different distributions and different time courses for entering the brain. Based on the pharmacokinetics of the reduction reactions of HMP and MCP in the mouse head, the half-lives of HMP and MCP were clearly and accurately mapped pixel by pixel. An ischemic mouse model was prepared, and the half-life of MCP was mapped in the mouse head. Compared to the half-life in control mice, the half-life of MCP in the ischemic model mouse brain was significantly increased, suggesting a shift in the redox balance. This in vivo EPR imaging method using BBB-permeative MCP is a useful noninvasive method for assessing changes in the redox status in mouse brains under oxidative stress.     

Serum levels of IL-32 in patients with coronary artery disease and its relationship with the serum levels of IL-6 and TNF-α

Molecular Biology Reports - The coronary artery disease (CAD) is a chronic inflammatory disease caused by atherosclerosis, in which arteries become clogged due to plaque formation, fat...     

Analysis of the N-Acetyltransferase 2 Gene Polymorphism in the Patients with Chronic Obstructive Pulmonary Disease and in Populations of the Volga–Ural Region

Restriction fragment-length polymorphism of the gene coding for N-acetyltransferase 2 (NAT2) was typed in populations of the Volga–Ural region (Bashkirs, Tatars, Chuvashes, Udmurts, and Russians) as well as in patients with chronic obstructive pulmonary disease (COPD) and in healthy individuals. Rapid and slow acetylator phenotypes were determined based on the presence or absence of the KpnI, TaqI, and BamHI restriction endonuclease recognition sites. The proportion of slow acetylators in the populations examined varied from 40.00% in Bashkirs to 64.15% in Chuvashes with statistically significant difference between these two ethnic groups (² = 5.7; P = 0.02). Overall, in the Volga–Ural populations slow acetylators represented 56.25% of the subjects examined. This value was similar to those presented in other studies of Caucasoid populations. In the COPD patients a statistically significant decrease of the slow acetylator frequency to 48.28% compared to healthy individuals (62.18%) was observed (² = 4.60; P = 0.036). The data obtained suggest a possible association between the drug resistance in the COPD patients with the rapid acetylator phenotype, which can lead to the development of the chronic form of the disease.     

Rethinking the Response to Emerging Microbes: Vaccines and Therapeutics in the Ebola Era—a Conference at Harvard Medical School

Harvard Medical School convened a meeting of biomedical and clinical experts on 5 March 2015 on the topic of “Rethinking the Response to Emerging Microbes: Vaccines and Therapeutics in the Ebola Era,” with the goals of discussing the lessons from the recent Ebola outbreak and using those lessons as a case study to aid preparations for future emerging infections. The speakers and audience discussed the special challenges in combatting an infectious agent that causes sporadic outbreaks in resource-poor countries. The meeting led to a call for improved basic medical care for all and continued support of basic discovery research to provide the foundation for preparedness for future outbreaks in addition to the targeted emergency response to outbreaks and targeted research programs against Ebola virus and other specific emerging pathogens.     

Seasonal Dynamics of the Airborne Bacterial Community and Selected Viruses in a Children’s Daycare Center

Children’s daycare centers appear to be hubs of respiratory infectious disease transmission, yet there is only limited information about the airborne microbial communities that are present in daycare centers. We have investigated the microbial community of the air in a daycare center, including seasonal dynamics in the bacterial community and the presence of specific viral pathogens. We collected filters from the heating, ventilation, and air conditioning (HVAC) system of a daycare center every two weeks over the course of a year. Amplifying and sequencing the 16S rRNA gene revealed that the air was dominated by Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes that are commonly associated with the human skin flora. Clear seasonal differences in the microbial community were not evident; however, the community structure differed when the daycare center was closed and unoccupied for a 13-day period. These results suggest that human occupancy, rather than the environment, is the major driver in shaping the microbial community structure in the air of the daycare center. Using PCR for targeted viruses, we detected a seasonal pattern in the presence of respiratory syncytial virus that included the period of typical occurrence of the disease related to the virus; however, we did not detect the presence of adenovirus or rotavirus at any time.