Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level

Background: Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods: We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol \u3c 8 micrograms/deciliter were assigned to a maintenance group and the others were assigned to the weaning group and steroids were tapered off over 4-6 weeks. Patients were monitored on subsequent office visits for adrenal insufficiency and allograft rejection. Results: Thirty-one patients were enrolled (6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2 ± 4 years for the weaning group and 9.0 ± 4.9 years in the maintenance group (p = 0.6). No cases of rejection were noted, nor did any patient resume steroid treatment following discontinuation. Conclusion: Steroids can be safely discontinued in stable heart transplant patients with an AM serum cortisol ≥ 8 micrograms/deciliter with appropriate outpatient follow-up. In this study, no patient suffered late rejection or clinically noted adrenal insufficiency

The XXL Survey XI: ATCA 2.1 GHz continuum observations

We present 2.1 GHz imaging with the Australia Telescope Compact Array (ATCA) of a 6.5 deg^2 region within the XXM-Newton XXL South field using a band of 1.1-3.1 GHz. We achieve an angular resolution of 4.7" x 4.2" in the final radio continuum map with a median rms noise level of 50 uJy/beam. We identify 1389 radio sources in the field with peak S/N >=5 and present the catalogue of observed parameters. We find that 305 sources are resolved, of which 77 consist of multiple radio components. These number counts are in agreement with those found for the COSMOS-VLA 1.4 GHz survey. We derive spectral indices by a comparison with the Sydney University Molongolo Sky Survey (SUMSS) 843MHz data. We find an average spectral index of -0.78 and a scatter of 0.28, in line with expectations. This pilot survey was conducted in preparation for a larger ATCA program to observe the full 25 deg^2 southern XXL field. When complete, the survey will provide a unique resource of sensitive, wide-field radio continuum imaging with complementary X-ray data in the field. This will facilitate studies of the physical mechanisms of radio-loud and radio-quiet AGNs and galaxy clusters, and the role they play in galaxy evolution. The source catalogue is publicly available online via the XXL Master Catalogue browser and the Centre de Donn\'ees astronomiques de Strasbourg (CDS).Comment: 7 pages, 6 figures. Accepted by A&A 13th October 201

Microvascular Anastomosis Under 3D Exoscope or Endoscope Magnification: A Proof-Of-Concept Study

Background: Extracranial-intracranial bypass is a challenging procedure that requires special microsurgical skills and an operative microscope. The exoscope is a tool for neurosurgical visualization that provides view on a heads-up display similar to an endoscope, but positioned external to the operating field, like a microscope. The authors carried out a proof-of-concept study evaluating the feasibility and effectiveness of performing microvascular bypass using various new exoscopic tools. Methods: We evaluated microsurgical procedures using a three-dimensional (3D) endoscope, hands-free robotic automated positioning two-dimensional (2D) exoscope, and an ocular-free 3D exoscope, including surgical gauze knot tying, surgical glove cutting, placental vessel anastomoses, and rat vessel anastomoses. Image quality, effectiveness, and feasibility of each technique were compared among different visualization tools and to a standard operative microscope. Results: 3D endoscopy produced relatively unsatisfactory resolution imaging. It was shown to be sufficient for knot tying and anastomosis of a placental artery, but was not suitable for anastomosis in rats. The 2D exoscope provided higher resolution imaging, but was not adequate for all maneuvers because of lack of depth perception. The 3D exoscope was shown to be functional to complete all maneuvers because of its depth perception and higher resolution. Conclusion: Depth perception and high resolution at highest magnification are required for microvascular bypass procedures. Execution of standard microanastomosis techniques was unsuccessful using 2D imaging modalities because of depth-perception-related constraints. Microvascular anastomosis is feasible under 3D exoscopic visualization; however, at highest magnification, the depth perception is inferior to that provided by a standard operative microscope, which impedes the procedure

Subcellular localization of MC4R with ADCY3 at neuronal primary cilia underlies a common pathway for genetic predisposition to obesity.

Most monogenic cases of obesity in humans have been linked to mutations in genes encoding members of the leptin-melanocortin pathway. Specifically, mutations in MC4R, the melanocortin-4 receptor gene, account for 3-5% of all severe obesity cases in humans1-3. Recently, ADCY3 (adenylyl cyclase 3) gene mutations have been implicated in obesity4,5. ADCY3 localizes to the primary cilia of neurons 6 , organelles that function as hubs for select signaling pathways. Mutations that disrupt the functions of primary cilia cause ciliopathies, rare recessive pleiotropic diseases in which obesity is a cardinal manifestation 7 . We demonstrate that MC4R colocalizes with ADCY3 at the primary cilia of a subset of hypothalamic neurons, that obesity-associated MC4R mutations impair ciliary localization and that inhibition of adenylyl cyclase signaling at the primary cilia of these neurons increases body weight. These data suggest that impaired signaling from the primary cilia of MC4R neurons is a common pathway underlying genetic causes of obesity in humans

Isolation, identification and diversity of oleaginous yeasts from Kuching, Sarawak, Malaysia

Vincent M, Hung MC, Baran PRM, Azahari AS, Adeni DSA. 2018. Isolation, identification and diversity of oleaginous yeasts from Kuching, Sarawak, Malaysia. Biodiversitas 19: 1266-1272. The present study was performed to isolate, identify and determine the diversity of oleaginous yeasts from various sources in Kuching, Sarawak (Malaysia). Microscopic observations via light and scanning electron microscope (SEM) indicated that the yeast isolates were in sizes ranging from 2-3 µm in width and 4-8 µm in length, typical of most unicellular ascomycotic fungi. Polymerase Chain Reaction (PCR) and molecular identification performed on the yeast isolates, targeting the D1/D2 region of the 26S rDNA, identified 6 yeast species from the 21 isolates, namely Pichia manshurica (5/21), Candida krusei (8/21), Candida parapsilosis (1/21), Pichia guilliermondii (2/21), Clavispora lusitaniae (1/21) and Kluyveromyces marxianus (4/21). All 21 yeast isolates accumulated intracellular lipids when grown in nitrogen-limited medium, as tested via Sudan IV staining. The present study is the first to document the production of lipids bodies in C. krusei, C. parapsilosis, and C. lusitaniae. Further investigations to assess the growth kinetics, lipid production efficiencies and lipids profiles of these oleaginous yeasts may provide insights into the possible utilization of these isolates for a variety of scientific, technical and industrial applications