Retained Laser Fibre Following Endovenous Laser Ablation

IntroductionTo report the breakage and retention of a laser fibre, following endovenous laser ablation (EVLA).Case reportThe great saphenous vein (GSV) of a 57 year-old man was treated with EVLA. During withdrawal, a flash of light was seen from a hole that had burned through the introducer sheath. This device was removed and a second sheath and laser fibre inserted to complete the ablation procedure. A follow-up duplex scan identified a residual length of laser fibre within the GSV that was removed by an additional surgical procedure. A change in laser fibre length had not been identified during the initial procedure.DiscussionThis case highlights the importance of routinely inspecting the sheath and fibre following EVLA to ensure that they have been removed intact

Bathymetric extent of recent trawl damage to the seabed captured by an ROV transect in the Alboran Sea

Bottom trawl fishing is among the most destructive anthropogenic pressures acting on benthic ecosystems, but the full extent of the damage is undocumented because of the limited number of deep-sea observations of impacted regions (e.g., Brennan et al., 2012, 2016). As part of its continuing ocean exploration mission, in 2011, E/V Nautilus conducted a remotely operated vehicle (ROV) survey along a transect in a submarine canyon in the Mediterranean's Alboran Sea off southern Spain at depths ranging from 1,200 m to <300 m (Coleman et al., 2012). This exploration along the South Alboran Ridge offered the opportunity to directly observe with video the bathymetric extent and intensity of recent trawling damage to the seafloor in this area. This dive revealed large furrows running in multiple directions caused by trawl doors scraping across the seabed. Little biological activity was evident in the depth ranges where these scars were observed. The destructive nature of bottom trawl fishing should be viewed with the same public affront as subaerial clear-cutting of forests and strip-mining. The only difference is that the ocean hides trawl damage from the public eye. The more we explore the deep sea, repeatedly map the seafloor with sonar, and observe the seabed and its ecosystems with video captured by ROVs, the greater we can understand the full impacts of trawling

Recommendations for dietary calcium intake and bone health: the role of health literacy

Osteoporosis, a common disease of the skeleton, involves microarchitecturaldeterioration of the bone matrix and depletion of bonemineral; this results in an increased susceptibility to fracture [1]. Postfracture,there is a plethora of financial, personal and psychosocialoutcomes, including reduced mobility, impairment of daily activities,inability to work and loss of confidence [2,3]. A hip fracture has themost severe implications: one in five individuals die within the firstyear, while 60% of individuals who survive a hip fracture still requireassistance to walk one year later, and 33% are totally dependent or areadmitted to a nursing home [2,4]. Bone mass is an important predictorof osteoporosis, and future fracture risk [5], and calcium plays animportant role in normal growth, development and maintenance of theskeleton [6], including providing a dynamic store to maintain theintra- and extra-cellular calcium pools [7]. Calcium homeostasis isregulated by an integrated hormonal system that involves calcitonin,parathyroid hormone (PTH) and the PTH receptor, and 1,25-dihydroxyvitamin D and the vitamin D receptor [7,8], along withserum ionized calcium, and the calcium-sensing receptor [9]. Whenplasma concentrations of ionized calcium fall below optimal levels,bone resorption increases in order to restore the mineral equilibrium

Can social norms explain long-term trends in alcohol use? Insights from inverse generative social science

Social psychological theory posits entities and mechanisms that attempt to explain observable differences in behavior. For example, dual process theory suggests that an agent's behavior is influenced by intentional (arising from reasoning involving attitudes and perceived norms) and unintentional (i.e., habitual) processes. In order to pass the generative sufficiency test as an explanation of alcohol use, we argue that the theory should be able to explain notable patterns in alcohol use that exist in the population, e.g., the distinct differences in drinking prevalence and average quantities consumed by males and females. In this study, we further develop and apply inverse generative social science (iGSS) methods to an existing agent-based model of dual process theory of alcohol use. Using iGSS, implemented within a multi-objective grammar-based genetic program, we search through the space of model structures to identify whether a single parsimonious model can best explain both male and female drinking, or whether separate and more complex models are needed. Focusing on alcohol use trends in New York State, we identify an interpretable model structure that achieves high goodness-of-fit for both male and female drinking patterns simultaneously, and which also validates successfully against reserved trend data. This structure offers a novel interpretation of the role of norms in formulating drinking intentions, but the structure's theoretical validity is questioned by its suggestion that individuals with low autonomy would act against perceived descriptive norms. Improved evidence on the distribution of autonomy in the population is needed to understand whether this finding is substantive or is a modeling artefact

The Critical Role of Spreading Depolarizations in Early Brain Injury: Consensus and Contention

Background: When a patient arrives in the emergency department following a stroke, a traumatic brain injury, or sudden cardiac arrest, there is no therapeutic drug available to help protect their jeopardized neurons. One crucial reason is that we have not identified the molecular mechanisms leading to electrical failure, neuronal swelling, and blood vessel constriction in newly injured gray matter. All three result from a process termed spreading depolarization (SD). Because we only partially understand SD, we lack molecular targets and biomarkers to help neurons survive after losing their blood flow and then undergoing recurrent SD. Methods: In this review, we introduce SD as a single or recurring event, generated in gray matter following lost blood flow, which compromises the Na+/K+ pump. Electrical recovery from each SD event requires so much energy that neurons often die over minutes and hours following initial injury, independent of extracellular glutamate. Results: We discuss how SD has been investigated with various pitfalls in numerous experimental preparations, how overtaxing the Na+/K+ ATPase elicits SD. Elevated K+ or glutamate are unlikely natural activators of SD. We then turn to the properties of SD itself, focusing on its initiation and propagation as well as on computer modeling. Conclusions: Finally, we summarize points of consensus and contention among the authors as well as where SD research may be heading. In an accompanying review, we critique the role of the glutamate excitotoxicity theory, how it has shaped SD research, and its questionable importance to the study of early brain injury as compared with SD theory. © 2022, The Author(s)

Macrophage Ontogeny Underlies Differences in Tumor-Specific Education in Brain Malignancies.

Extensive transcriptional and ontogenetic diversity exists among normal tissue-resident macrophages, with unique transcriptional profiles endowing the cells with tissue-specific functions. However, it is unknown whether the origins of different macrophage populations affect their roles in malignancy. Given potential artifacts associated with irradiation-based lineage tracing, it remains unclear if bone-marrow-derived macrophages (BMDMs) are present in tumors of the brain, a tissue with no homeostatic involvement of BMDMs. Here, we employed multiple models of murine brain malignancy and genetic lineage tracing to demonstrate that BMDMs are abundant in primary and metastatic brain tumors. Our data indicate that distinct transcriptional networks in brain-resident microglia and recruited BMDMs are associated with tumor-mediated education yet are also influenced by chromatin landscapes established before tumor initiation. Furthermore, we demonstrate that microglia specifically repress Itga4 (CD49D), enabling its utility as a discriminatory marker between microglia and BMDMs in primary and metastatic disease in mouse and human

Interrogation of the Microenvironmental Landscape in Brain Tumors Reveals Disease-Specific Alterations of Immune Cells

Brain malignancies encompass a range of primary and metastatic cancers, including low-grade and high-grade gliomas and brain metastases (BrMs) originating from diverse extracranial tumors. Our understanding of the brain tumor microenvironment (TME) remains limited, and it is unknown whether it is sculpted differentially by primary versus metastatic disease. We therefore comprehensively analyzed the brain TME landscape via flow cytometry, RNA sequencing, protein arrays, culture assays, and spatial tissue characterization. This revealed disease-specific enrichment of immune cells with pronounced differences in proportional abundance of tissue-resident microglia, infiltrating monocyte-derived macrophages, neutrophils, and T cells. These integrated analyses also uncovered multifaceted immune cell activation within brain malignancies entailing converging transcriptional trajectories while maintaining disease- and cell-type-specific programs. Given the interest in developing TME-targeted therapies for brain malignancies, this comprehensive resource of the immune landscape offers insights into possible strategies to overcome tumor-supporting TME properties and instead harness the TME to fight cancer

A Hedged Monte Carlo Approach to Real Option Pricing

In this work we are concerned with valuing optionalities associated to invest or to delay investment in a project when the available information provided to the manager comes from simulated data of cash flows under historical (or subjective) measure in a possibly incomplete market. Our approach is suitable also to incorporating subjective views from management or market experts and to stochastic investment costs. It is based on the Hedged Monte Carlo strategy proposed by Potters et al (2001) where options are priced simultaneously with the determination of the corresponding hedging. The approach is particularly well-suited to the evaluation of commodity related projects whereby the availability of pricing formulae is very rare, the scenario simulations are usually available only in the historical measure, and the cash flows can be highly nonlinear functions of the prices.Comment: 25 pages, 14 figure