A Low-Cost Simulation Model for R-Wave Synchronized Atrial Pacing in Pediatric Patients with Postoperative Junctional Ectopic Tachycardia

Background

Postoperative junctional ectopic tachycardia (JET) occurs frequently after pediatric cardiac surgery. R-wave synchronized atrial (AVT) pacing is used to re-establish atrioventricular synchrony. AVT pacing is complex, with technical pitfalls. We sought to establish and to test a low-cost simulation model suitable for training and analysis in AVT pacing.

Methods

A simulation model was developed based on a JET simulator, a simulation doll, a cardiac monitor, and a pacemaker. A computer program simulated electrocardiograms. Ten experienced pediatric cardiologists tested the model. Their performance was analyzed using a testing protocol with 10 working steps.

Results

Four testers found the simulation model realistic; 6 found it very realistic. Nine claimed that the trial had improved their skills. All testers considered the model useful in teaching AVT pacing. The simulation test identified 5 working steps in which major mistakes in performance test may impede safe and effective AVT pacing and thus permitted specific training. The components of the model (exclusive monitor and pacemaker) cost less than $50. Assembly and training-session expenses were trivial.

Conclusions

A realistic, low-cost simulation model of AVT pacing is described. The model is suitable for teaching and analyzing AVT pacing technique.     

Drought’s impact on Ca,Fe, Mg,Mo and S concentration and accumulation patterns in the plants and soil of a Mediterranean evergreen <Emphasis Type="Italic">Quercus </Emphasis><Emphasis Type="Italic">ilex</Emphasis> forest

We conducted a 6-year field manipulation drought experiment in an evergreen Quercus ilex forest where we simulated the drought predicted by GCM and ecophysiological models for the coming decades (an average of 15% soil moisture reduction). We thereby tested the hypothesis that enhanced drought will change Ca, Fe, Mg, Mo and S availability, concentrations and accumulation patterns in Mediterranean ecosystems. The strongest effects of drought occurred in the soil. Drought increased the total soil concentrations of S, the soil extract concentrations of Fe, Mg and S, the Mg saturation in the soil exchangeable complex and tended to increase the percentage base saturation of the soil exchangeable complex. These increased soil concentrations were related to a decrease of plant uptake capacity and not to an increase of soil enzyme activity, which in fact decreased under drier conditions. Drought increased leaf Mg concentrations in the three dominant species although only significantly in Quercus ilex and Arbutus unedo (20 and 14%, respectively). In contrast, drought tended to decrease Ca in Phillyrea latifolia (18%) and Ca and Fe concentrations in the wood of all three species. Drought increased Ca and Fe concentrations in the roots of Quercus ilex (26 and 127%). There was a slight general trend to decrease total biomass accumulation of nutrients that depend on water flux such as Mg, Fe and S. This effect was related to a decrease of soil moisture that reduced soil flow, and to a decrease in photosynthetic capacity, sap flow, transpiration and growth, and therefore plant uptake capacity under drought observed in Quercus ilex and Arbutus unedo. On the contrary, drought increased Mo accumulation in aboveground biomass in Phillyrea latifolia and reduced Mo accumulation in Arbutus unedo by reducing growth and wood Mo concentrations (51%). Phillyrea latifolia showed a great capacity to adapt to drier conditions, with no decrease in growth, an increase of Mo uptake capacity and a decrease in leaf Ca concentration, which was related to a decrease in transpiration under drought. The results indicate asymmetrical changes in species capacity to accumulate these elements, which are likely to produce changes in inter-specific competitive relations among dominant plant species and in their nutritional quality as food sources. The results also indicate that drought tended to decrease nutrient content in aboveground biomass, mainly through the decrease in growth and transpiration of the most sensitive species and caused an increase in the availability of these nutrients in soil. Thus, drought decreased the ecosystem’s capacity to retain Mg, Fe and S, facilitating their loss in torrential rainfalls.     

A TNF receptor 2 selective agonist rescues human neurons from oxidative stress-induced cell death

Tumor necrosis factor (TNF) plays a dual role in neurodegenerative diseases. Whereas TNF receptor (TNFR) 1 is predominantly associated with neurodegeneration, TNFR2 is involved in tissue regeneration and neuroprotection. Accordingly, the availability of TNFR2-selective agonists could allow the development of new therapeutic treatments of neurodegenerative diseases. We constructed a soluble, human TNFR2 agonist (TNC-scTNF(R2)) by genetic fusion of the trimerization domain of tenascin C to a TNFR2-selective single-chain TNF molecule, which is comprised of three TNF domains connected by short peptide linkers. TNC-scTNF(R2) specifically activated TNFR2 and possessed membrane-TNF mimetic activity, resulting in TNFR2 signaling complex formation and activation of downstream signaling pathways. Protection from neurodegeneration was assessed using the human dopaminergic neuronal cell line LUHMES. First we show that TNC-scTNF(R2) interfered with cell death pathways subsequent to H(2)O(2) exposure. Protection from cell death was dependent on TNFR2 activation of the PI3K-PKB/Akt pathway, evident from restoration of H(2)O(2) sensitivity in the presence of PI3K inhibitor LY294002. Second, in an in vitro model of Parkinson disease, TNC-scTNF(R2) rescues neurons after induction of cell death by 6-OHDA. Since TNFR2 is not only promoting anti-apoptotic responses but also plays an important role in tissue regeneration, activation of TNFR2 signaling by TNC-scTNF(R2) appears a promising strategy to ameliorate neurodegenerative processes.     

Criteria Used in Clinical Practice to Guide Immunosuppressive Treatment in Patients with Primary Sclerosing Cholangitis

Background & Aims

Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC.

Methods

This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks.

Results

A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p<0.0001) and a modified histological activity index (mHAI) greater than 3/18 points (HR 3.6, p = 0.0274) were associated with the initiation of IT during the course of PSC. Of note, PSC patients who subsequently received IT differed already at the time of PSC diagnosis from those patients, who did not receive IT during follow-up: they presented with increased levels of IgG (p = 0.004) and more frequently had clinical signs of cirrhosis (p = 0.0002).

Conclusions

This is the first study which investigates the parameters associated with IT in patients with PSC in clinical practice. A simplified AIH score >5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.     

Evidence for the complexity of microRNA-mediated regulation in ovarian cancer: a systems approach

MicroRNAs (miRNAs) are short (～22 nucleotides) regulatory RNAs that can modulate gene expression and are aberrantly expressed in many diseases including cancer. Previous studies have shown that miRNAs inhibit the translation and facilitate the degradation of their targeted messenger RNAs (mRNAs) making them attractive candidates for use in cancer therapy. However, the potential clinical utility of miRNAs in cancer therapy rests heavily upon our ability to understand and accurately predict the consequences of fluctuations in levels of miRNAs within the context of complex tumor cells. To evaluate the predictive power of current models, levels of miRNAs and their targeted mRNAs were measured in laser captured micro-dissected (LCM) ovarian cancer epithelial cells (CEPI) and compared with levels present in ovarian surface epithelial cells (OSE). We found that the predicted inverse correlation between changes in levels of miRNAs and levels of their mRNA targets held for only ～11% of predicted target mRNAs. We demonstrate that this low inverse correlation between changes in levels of miRNAs and their target mRNAs in vivo is not merely an artifact of inaccurate miRNA target predictions but the likely consequence of indirect cellular processes that modulate the regulatory effects of miRNAs in vivo. Our findings underscore the complexities of miRNA-mediated regulation in vivo and the necessity of understanding the basis of these complexities in cancer cells before the therapeutic potential of miRNAs can be fully realized.     

CtBP3/BARS drives membrane fission in dynamin-independent transport pathways

Membrane fission is a fundamental step in membrane transport. So far, the only fission protein machinery that has been implicated in in vivo transport involves dynamin, and functions in several, but not all, transport pathways. Thus, other fission machineries may exist. Here, we report that carboxy-terminal binding protein 3/brefeldin A-ribosylated substrate (CtBP3/BARS) controls fission in basolateral transport from the Golgi to the plasma membrane and in fluid-phase endocytosis, whereas dynamin is not involved in these steps. Conversely, CtBP3/BARS protein is inactive in apical transport to the plasma membrane and in receptor-mediated endocytosis, both steps being controlled by dynamin. This indicates that CtBP3/BARS controls membrane fission in endocytic and exocytic transport pathways, distinct from those that require dynamin.     

A survey of unresolved problems in life cycle assessment

Background, aims, and scope  Life cycle assessment (LCA) stands as the pre-eminent tool for estimating environmental effects caused by products and processes from ‘cradle to grave’ or ‘cradle to cradle.’ It exists in multiple forms, claims a growing list of practitioners, and remains a focus of continuing research. Despite its popularity and codification by organizations such as the International Organization for Standards and the Society of Environmental Toxicology and Chemistry, life cycle assessment is a tool in need of improvement. Multiple authors have written about its individual problems, but a unified treatment of the subject is lacking. The following literature survey gathers and explains issues, problems and problematic decisions currently limiting LCA’s goal and scope definition and life cycle inventory phases. Main features  The review identifies 15 major problem areas and organizes them by the LCA phases in which each appears. This part of the review focuses on the first 7 of these problems occurring during the goal and scope definition and life cycle inventory phases. It is meant as a concise summary for practitioners interested in methodological limitations which might degrade the accuracy of their assessments. For new researchers, it provides an overview of pertinent problem areas toward which they might wish to direct their research efforts. Results and discussion  Multiple problems occur in each of LCA’s four phases and reduce the accuracy of this tool. Considering problem severity and the adequacy of current solutions, six of the 15 discussed problems are of paramount importance. In LCA’s first two phases, functional unit definition, boundary selection, and allocation are critical problems requiring particular attention. Conclusions and recommendations  Problems encountered during goal and scope definition arise from decisions about inclusion and exclusion while those in inventory analysis involve flows and transformations. Foundational decisions about the basis of comparison (functional unit), bounds of the study, and physical relationships between included processes largely dictate the representativeness and, therefore, the value of an LCA. It is for this reason that problems in functional unit definition, boundary selection, and allocation are the most critical examined in the first part of this review.