Inflammation predicts accelerated brachial arterial wall changes in patients with recent-onset rheumatoid arthritis

Introduction Patients with recent-onset rheumatoid arthritis (RA) have impaired brachial artery endothelial function compared with controls matched for age, sex and cardiovascular risk factors. The present study examined endothelium-dependent (flow-mediated dilatation (FMD)) and independent (glyceryl trinitrate (GTN)-mediated dilatation (GMD)) structural responses in early RA patients, and determined progress over one year

Cutaneous metastases from cholangiocarcinoma following percutaneous transhepatic biliary drainage: Case report and literature review

AbstractPercutaneous transhepatic biliary drainage (PTBD) is commonly used in the management of cholangiocarcioma. Major and minor complications of PTBD such as cholangitis, haemorrhage and catheter dislocation are well documented. A lesser reported complication are cutaneous metastases following PTBD for cholangiocarcinoma.We report a case of a 79 year old man who presented with right upper quadrant pain, jaundice and weight loss, with dilated intra-hepatic bile ducts on imaging. The cytology results from a sample taken during endoscopic retrograde cholangiopancreatography were highly suspicious of cholangiocarcioma. A PTBD was subsequently performed and bilateral metal biliary stents were placed without external drainage. Five months after the PTBD he was found to have a hard nodule under the PTBD puncture site. The nodule was excised and the histology confirmed a cholangiocarcinoma metastasis.A review of the literature identified twelve cases of cutaneous metastases from cholangiocarcinoma, following PTBD. In addition, tumour seeding along the catheter tract following PTBD, with metastatic deposits on the abdominal wall, peritoneoum, chest wall, pleural space, and liver parenchyma have also been reported.Health care professionals should be aware of this rare complication and offer appropriate management options to patients

Anti-inflammatory Activity of the Plant Cannabis sativa (L) Petrolium Ether Extract in Albino Rats

In this study the plant Cannabis sativa seeds petroleum oil extract was investigated for anti- inflammatory activity on albino rats. The inflammation was firstly obtained by using carrageenan suspension 0.1 ml of 10% saline injected at the sub – plantar region of the left limb for inducing a local acute oedema. A decreased in oedema size was reported after 24 hours for the rats pretreated with carrageenan30 minutes before injection with suspension( 4.56, 0.59 and 0.93 for control, 1ml/kg per day and 0.5ml/kg per day groups given C. sativa seed extracts respectively.), compared to Indomethacin standard antiinflammatory drug which reported a decrease in oedema size diameter to 0.55mm, which indicated an increase inhibition percentages were reported for the different pretreated groups 0.00, 87.03, 79.56 and 87.91 including the comparative Indomethacin treated groups of rats respectively. On the other hand, the post-treated groups of rats (given C. sativa oil extract after 30 minutes of injection of suspension) showed a similar results for maximum concentration 1 ml/day of C. sativa oil extract in comparison to the standard drug. Hence, such results recommend the prospect focus for the preventive medication use of the extract. The study also highlights no significant changes for serum and protein of the blood taken from rats of the experiments. Although there were significant decrease in lymphocyte and neutrophil, but the changes were not significant. Indomethacin was given to the rats used for a comparative drug (10mg/kg). Moreover, the drug indomethacin used as a comparative parameter showed similar results in comparison to the extract, hence wise the reported results may be recommended for use as anti-inflammatory agent and should be explored more to formulate drug on basis of its activity

A novel widespread cryptic species and phylogeographic patterns within several giant clam species (Cardiidae: Tridacna) from the Indo-Pacific Ocean

Giant clams (genus Tridacna) are iconic coral reef animals of the Indian and Pacific Oceans, easily recognizable by their massive shells and vibrantly colored mantle tissue. Most Tridacna species are listed by CITES and the IUCN Redlist, as their populations have been extensively harvested and depleted in many regions. Here, we survey Tridacna crocea and Tridacna maxima from the eastern Indian and western Pacific Oceans for mitochondrial (COI and 16S) and nuclear (ITS) sequence variation and consolidate these data with previous published results using phylogenetic analyses. We find deep intraspecific differentiation within both T. crocea and T. maxima. In T. crocea we describe a previously undocumented phylogeographic division to the east of Cenderawasih Bay (northwest New Guinea), whereas for T. maxima the previously described, distinctive lineage of Cenderawasih Bay can be seen to also typify western Pacific populations. Furthermore, we find an undescribed, monophyletic group that is evolutionarily distinct from named Tridacna species at both mitochondrial and nuclear loci. This cryptic taxon is geographically widespread with a range extent that minimally includes much of the central Indo-Pacific region. Our results reinforce the emerging paradigm that cryptic species are common among marine invertebrates, even for conspicuous and culturally significant taxa. Additionally, our results add to identified locations of genetic differentiation across the central Indo-Pacific and highlight how phylogeographic patterns may differ even between closely related and co-distributed species

Toward Sustainable Use of Space : Economic, Technological, and Legal Perspectives

During the last few years, the amount of space debris has been frequently mentioned as a potential risk to current and future space operations. The purpose of this article was to describe the discussions held at the First Sustainable Space Economy Workshop held in Finland 2019. The workshop gathered together experts with economic, legal, regulatory, technological, and environmental backgrounds, with an aim of discussing the sustainable use of space from all these perspectives. As an outcome of these discussions, we find that two concepts, satellite sustainability footprint and orbital capacity, should be introduced at an international level. The satellite sustainability footprint measures how likely the satellite stays healthy and operating, without causing risks to self or others. The orbit capacity is essentially an integral of the footprint over an orbit, and it determines how many satellites of different footprints could be launched to the same orbit. In addition, in this article, we discuss how to realize such concepts within the current normative framework. The authors suggest both top-down and bottom-up approaches, necessitating negotiations within an intergovernmental framework and with the relevant space actors. The most important finding of the workshop and this article, however, is that different space-related fields and experts having diverse backgrounds should continuously discuss in a constructive and informal manner to realize the sustainable utilization of space in practice. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Outcomes of Treated Hypertension at Age 80 and Older: Cohort Analysis of 79,376 Individuals

This is the final version of the article. Available from Wiley via the DOI in this record.OBJECTIVES: To estimate outcomes according to attained blood pressure (BP) in the oldest adults treated for hypertension in routine family practice. DESIGN: Cohort analysis of primary care inpatient and death certificate data for individuals with hypertension. SETTING: Primary care practices in England (Clinical Practice Research Datalink). PARTICIPANTS: Individuals aged 80 and older taking antihypertensive medication and free of dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure at baseline. MEASUREMENTS: Outcomes were mortality, cardiovascular events, and fragility fractures. Systolic BP (SBP) was grouped in 10-mmHg increments from less than 125 to 185 mmHg or more (reference 145–154 mmHg). RESULTS: Myocardial infarction hazards increased linearly with increasing SBP, and stroke hazards increased for SBP of 145 mmHg or greater, although lowest mortality was in individuals with SBP of 135 to 154 mmHg. Mortality of the 13.1% of patients with SBP less than 135 mmHg was higher than that of the reference group (Cox hazard ratio=1.25, 95% confidence interval=1.19–1.31; equating to one extra death per 12.6 participants). This difference in mortality was consistent over short- and long-term follow-up; adjusting for diastolic BP did not change the risk. Incident heart failure rates were higher in those with SBP less than 125 mmHg than in the reference group. CONCLUSION: In routine primary care, SBP less than 135 mmHg was associated with greater mortality in the oldest adults with hypertension and free of selected potentially confounding comorbidities. Although important confounders were accounted for, observational studies cannot exclude residual confounding. More work is needed to establish whether unplanned SBPs less than 135 mmHg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care.This work was supported in part by the National Institute for Health Research (NIHR) School for Public Health Research Ageing Well programme

Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK

These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri-operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone-producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin-releasing hormone secretion by the hypothalamus (failure of the regulatory centres). Patients taking physiological replacement doses of corticosteroids for either primary or secondary adrenal insufficiency are at significant risk of adrenal crisis and must be given stress doses of hydrocortisone during the peri-operative period. Many more patients other than those with adrenal and hypothalamic-pituitary causes of adrenal failure are receiving glucocorticoids as treatment for other medical conditions. Daily doses of prednisolone of 5 mg or greater in adults and 10-15 mg.m-2 hydrocortisone equivalent or greater in children may result in hypothalamo-pituitary-adrenal axis suppression if administered for 1 month or more by oral, inhaled, intranasal, intra-articular or topical routes; this chronic administration of glucocorticoids is the most common cause of secondary adrenal suppression, sometimes referred to as tertiary adrenal insufficiency. A pragmatic approach to adrenal replacement during major stress is required; considering the evidence available, blanket recommendations would not be appropriate, and it is essential for the clinician to remember that adrenal replacement dosing following surgical stress or illness is in addition to usual steroid treatment. Patients with previously undiagnosed adrenal insufficiency sometimes present for the first time following the stress of surgery. Anaesthetists must be familiar with the symptoms and signs of acute adrenal insufficiency so that inadequate supplementation or undiagnosed adrenal insufficiency can be detected and treated promptly. Delays may prove fatal

The Case for Space Environmentalism

The shell bound by the Karman line at a height of 80 to 100km above the Earth's surface, and Geosynchronous Orbit, at 36,000km, is defined as the orbital space surrounding the Earth. It is within this region, and especially in Low Earth Orbit (LEO), where environmental issues are becoming urgent because of the rapid growth of the anthropogenic space object population, including satellite "mega-constellations". In this Perspective, we summarise the case that the orbital space around the Earth should be considered an additional ecosystem, and so subject to the same care and concerns and the same broad regulations as, for example, the oceans and the atmosphere. We rely on the orbital space environment by looking through it as well as by working within it. Hence, we should consider damage to professional astronomy, public stargazing and the cultural importance of the sky, as well as the sustainability of commercial, civic and military activity in space. Damage to the orbital space environment has problematic features in common with other types of environmental issue. First, the observed and predicted damage is incremental and complex, with many contributors. Second, whether or not space is formally and legally seen as a global commons, the growing commercial exploitation of what may appear a "free" resource is in fact externalising the true costs.Comment: 19 pages, 6 figures. To be published in Nature Astronomy April 22nd 2022. For consistency with Nature policy, the version posted here is the final submitted author text. The final version is available at the DOI below, and differs slightly in wordin

Mesoscopic spin confinement during acoustically induced transport

Long coherence lifetimes of electron spins transported using moving potential dots are shown to result from the mesoscopic confinement of the spin vector. The confinement dimensions required for spin control are governed by the characteristic spin-orbit length of the electron spins, which must be larger than the dimensions of the dot potential. We show that the coherence lifetime of the electron spins is independent of the local carrier densities within each potential dot and that the precession frequency, which is determined by the Dresselhaus contribution to the spin-orbit coupling, can be modified by varying the sample dimensions resulting in predictable changes in the spin-orbit length and, consequently, in the spin coherence lifetime.Comment: 10 pages, 2 figure

Mediastinal extension of a complicated pancreatic pseudocyst; a case report and literature review

BACKGROUND: Mediastinal pancreatic pseudocyst is a rare complication of acute or chronic pancreatitis. CASE PRESENTATION: This case report describes the management of a difficult case of pancreatic pseudocyst with a mediastinal extension in a patient having chronic pancreatitis. Different management strategies were used until complete resolution of this complex pseudocyst occurred using open surgical cystogastrostomy. CONCLUSION: Despite the availablity of different minimally invasive techniques to treat pancreatic pseudocysts, management of complex mediastinal pseudocyst may still require open surgical drainage procedures