Multiple aneurysms in childhood

AbstractArterial aneurysms in children are rare. When present, they are often associated with connective tissue disorders or arteritidies. Idiopathic aneurysms occurring at multiple sites throughout the arterial tree are rare, with only ten cases reported. This report describes a case of multiple arterial aneurysms of uncertain origin involving upper-extremity, extracranial cerebrovascular, aortoiliac, and renal arteries in a 14-year-old boy. The clinical presentation, vascular reconstruction, pathologic findings, and a brief review of the literature are described

Impact of Temperature Relative Humidity and Absolute Humidity on the Incidence of Hospitalizations for Lower Respiratory Tract Infections Due to Influenza, Rhinovirus, and Respiratory Syncytial Virus: Results from Community-Acquired Pneumonia Organization (CAPO) International Cohort Study

Abstract Background: Transmissibility of several etiologies of lower respiratory tract infections (LRTI) may vary based on outdoor climate factors. The objective of this study was to evaluate the impact of outdoor temperature, relative humidity, and absolute humidity on the incidence of hospitalizations for lower respiratory tract infections due to influenza, rhinovirus, and respiratory syncytial virus (RSV). Methods: This was a secondary analysis of an ancillary study of the Community Acquired Pneumonia Organization (CAPO) database. Respiratory viruses were detected using the Luminex xTAG respiratory viral panel. Climate factors were obtained from the National Weather Service. Adjusted Poisson regression models with robust error variance were used to model the incidence of hospitalization with a LRTI due to: 1) influenza, 2) rhinovirus, and 3) RSV (A and/or B), separately. Results: A total of 467 hospitalized patients with LRTI were included in the study; 135 (29%) with influenza, 41 (9%) with rhinovirus, and 27 (6%) with RSV (20 RSV A, 7 RSV B). The average, minimum, and maximum absolute humidity and temperatur e variables were associated with hospitalization due to influenza LRTI, while the relative humidity variables were not. None of the climate variables were associated with hospitalization due to rhinovirus or RSV. Conclusions: This study suggests that outdoor absolute humidity and temperature are associated with hospitalizations due to influenza LRTIs, but not with LRTIs due to rhinovirus or RSV. Understanding factors contributing to the transmission of respiratory viruses may assist in the prediction of future outbreaks and facilitate the development of transmission prevention interventions

Mesenteric artery disease in the elderly

AbstractPurposeThe purpose of this study was to estimate the population-based prevalence of mesenteric artery stenosis (MAS) and occlusion among independent elderly Americans.MethodAs part of an ancillary investigation to the Cardiovascular Health Study (CHS), participants in the Forsyth County, NC cohort had visceral duplex sonography of the celiac arteries and superior mesenteric arteries (SMAs). Critical MAS was defined by celiac peak systolic velocity ≥2.0 m/s and/or SMA peak systolic velocity ≥2.7 m/s. Occlusion of either vessel was defined by lack of a Doppler-shifted signal within the imaged artery. Demographic data, blood pressures, and blood lipid levels were collected as part of the baseline CHS examination. Participants' weights were measured at baseline and before the duplex exam. Univariate tests of association were performed with two-way contingency tables, Student t tests, and Fisher exact tests. Multivariate associations were examined with logistic regression analysis.ResultsA total of 553 CHS participants had visceral duplex sonography technically adequate to define the presence or absence of MAS. The study group had a mean age of 77.2 ± 4.9 years and comprised 63% women and 37% men. Participant race was 76% white and 23% African-American. Ninety-seven participants (17.5%) had MAS. There was no significant difference in age, race, gender, body mass index, blood pressure, cholesterol, or low-density lipoproteins for participants with or without MAS. Forward stepwise variable selection found renal artery stenosis (P = .008; odds ratio [OR], 2.85; 95% confidence interval [CI], 1.31, 6.21) and high-density lipoprotein >40 (P = .02; OR, 3.03; 95% CI, 1.17, 7.81) significantly associated with MAS in a multivariate logistic regression model. Eighty-three of the 97 participants with MAS (15.0% of the cohort) had isolated celiac stenosis. Seven participants (1.3% of the cohort) had combined celiac and SMA stenosis. Five participants (0.9% of the cohort) had isolated SMA stenosis. Two participants (0.4% of the cohort) had celiac occlusion. Considering all participants with MAS, there was no association with weight change. However, SMA stenosis and celiac occlusion demonstrated an independent association with annualized weight loss (P = .028; OR, 1.54; 95% CI, 1.05, 2.26) and with renal artery stenosis (P =.001; OR, 9.48; 95% CI, 2.62, 34.47).ConclusionThis investigation provides the first population-based estimate of the prevalence of MAS among independent elderly Americans. MAS existed in 17.5% of the study cohort. The majority had isolated celiac disease. SMA stenosis and celiac artery occlusion demonstrated a significant and independent association with weight loss and concurrent renal artery disease

Reliability of Unilateral Isometric and Dynamic Leg Press Force and Power

Strength and power are critical components of athletic performance. Athletes commonly perform sport-specific movements off a single leg, but there are few reliable, easily administered unilateral leg force and power assessments. PURPOSE: To determine 1) the reliability of unilateral leg press maximal isometric force (MIF) and peak power tests and 2) the percentage of MIF that elicits unilateral peak power during a dynamic throw. We hypothesized that the tests would be reliable for the assessment of unilateral MIF and peak power and that unilateral peak power would be achieved at 50% of MIF. METHODS: Eighteen apparently healthy, recreationally active adults (17M: 1F; 27.4 ± 5.0 years; 1.78 ± 0.01 m; 93.5 ± 22.5 kg; 3159 ± 807 N bilateral MIF) completed three testing sessions. After a brief standardized warm-up, each subject performed three maximal unilateral isometric leg presses (MIF) with each leg at 90° of knee flexion on a modified leg press sled equipped with a force plate, linear encoder, and magnetic brake. Subsequently, the sled was unlocked and loaded in ascending fashion with 30%, 40%, 50%, 60%, and 70% of MIF; with an initial knee angle of 90°, subjects used maximal effort to throw each load twice, unilaterally, with each leg. Subjects rested and reset for 10-30 s between efforts. Data were sampled at 300 Hz, low pass filtered at 4 Hz, and peak instantaneous power (W) was calculated for each throw using the measured sled force and velocity. Intraclass correlation coefficients (ICC) were computed for the highest force and power repetition at each load across the three sessions. The ICC (95% CI) and peak power output were determined for both right and left legs. ICCs were considered excellent if ≥ 0.95, high if ≥ 0.90, good if ≥ 0.80, fair if ≥ 0.70, poor if ≤ 0.70, and very poor if ≤ 0.40. RESULTS: MIF showed good reliability between sessions [ICC: 0.85 (0.62, 0.94; left leg); 0.86 (0.58, 0.95; right leg)]. Unilateral peak power also showed good to high reliability between sessions across all loads: ICC (left leg) 30%: 0.91 (0.81, 0.96); 40%: 0.91 (0.81, 0.96); 50%: 0.95 (0.88, 0.98); 60%: 0.93 (0.86, 0.97); 70%: 0.81 (0.64, 0.92); (right leg) 30%: 0.95 (0.89, 0.98); 40%: 0.94 (0.87, 0.97); 50%: 0.92 (0.84, 0.97); 60%: 0.92 (0.84, 0.97); 70%: 0.90 (0.80, 0.96). Across all three sessions, peak power by the left leg was achieved at: 30% (11 of 18 participants); 40% (6 of 18); 50% (1 of 18). Peak power by the right leg was achieved at: 30% (13 of 18 participants); 40% (4 of 18); 50% (1 of 18). CONCLUSION: Unilateral leg press MIF and peak power can be reliably assessed with a modified leg press equipped with a force plate, linear encoder, and magnetic brake in a recreationally active population. Sport teams and coaches can use single leg isometric presses and throws as reliable methods to test their athletes’ unilateral force and peak power, respectively, with loads of 30-50% MIF appropriate for peak power measurement

Morally Respectful Listening and its Epistemic Consequences

What does it mean to listen to someone respectfully, that is, insofar as they are due recognition respect? This paper addresses that question and gives the following answer: it is to listen in such a way that you are open to being surprised. A specific interpretation of this openness to surprise is then defended

Predicting 30-Day Mortality in Hospitalized Patients with Community-Acquired Pneumonia Using Statistical and Machine Learning Approaches

Background: Predicting if a hospitalized patient with community-acquired pneumonia (CAP) will or will not survive after admission to the hospital is important for research purposes as well as for institution of early patient management interventions. Although population-level mortality prediction scores for these patients have been around for many years, novel patient-level algorithms are needed. The objective of this study was to assess several statistical and machine learning models for their ability to predict 30-day mortality in hospitalized patients with CAP. Methods: This was a secondary analysis of the University of Louisville (UofL) Pneumonia Study database. Six different statistical and/or machine learning methods were used to develop patientlevel prediction models for hospitalized patients with CAP. For each model, nine different statistics were calculated to provide measures of the overall performance of the models. Results: A total of 3249 unique hospitalized patients with CAP were enrolled in the study, 2743 were included in the model building (training) dataset, while the remaining 686 were included in the testing dataset. From the full population, death at 30-days post discharge was documented in 458 (13.4%) patients. All models resulted in high variation in the ability to predict survivors and non-survivors at 30 days. Conclusions: In conclusion, this study suggests that accurate patient-level prediction of 30-day mortality in hospitalized patients with CAP is difficult with statistical and machine learning approaches. It will be important to evaluate novel variables and other modeling approaches to better predict poor clinical outcomes in these patients to ensure early and appropriate interventions are instituted

Level of Recall Bias Regarding Pneumococcal Vaccination History among Adults Hospitalized with Community-Acquired Pneumonia: Results from the University of Louisville Pneumonia Study

Background: Recall bias is likely to occur in vaccine effectiveness studies using self-reported vaccination history. The validity of patient-reported vaccination status for adults is not well defined. The objective of this study was to evaluate the validity of self-reported pneumococcal vaccination history among patients hospitalized with community-acquired pneumonia (CAP). Methods: Prospective ancillary study of a population-based observational study of hospitalized patients with CAP in the city of Louisville. To be included in the analysis, patients had to (i) be reached by phone 30-days after discharge from the hospital and (ii) report that they remembered whether or not they received a pneumococcal vaccine in the past five years. The vaccination history was classified as 1) Subjective: patient recollection, or 2) Objective: vaccination records from insurance companies or primary care physicians. Results: A total of 2,787 patients who recalled their vaccination history were included in the analysis. Subjective vaccination history was documented to be inaccurate in 1,023 (37%) patients. Conclusions: Our study indicates that in adult patients, self-reported data regarding pneumococcal vaccination is likely to be inaccurate in one out of three patients. This level of recall bias may incorporate a fatal flaw in vaccine effectiveness studies

Calibrative approaches to protein solubility modeling of a mutant series using physicochemical descriptors

A set of physicochemical properties describing a protein of known structure is employed for a calibrative approach to protein solubility. Common hydrodynamic and electrophoretic properties routinely measured in the bio-analytical laboratory such as zeta potential, dipole moment, the second osmotic virial coefficient are first estimated in silico as a function a pH and solution ionic strength starting with the protein crystal structure. The utility of these descriptors in understanding the solubility of a series of ribonuclease Sa mutants is investigated. A simple two parameter model was trained using solubility data of the wild type protein measured at a restricted number of solution pHs. Solubility estimates of the mutants demonstrate that zeta potential and dipole moment may be used to rationalize solubility trends over a wide pH range. Additionally a calibrative model based on the protein’s second osmotic virial coefficient, B22 was developed. A modified DVLO type potential along with a simplified representation of the protein allowed for efficient computation of the second viral coefficient. The standard error of prediction for both models was on the order of 0.3 log S units. These results are very encouraging and demonstrate that these models may be trained with a small number of samples and employed extrapolatively for estimating mutant solubilities

The effects of tea extracts on proinflammatory signaling

BACKGROUND: Skin toxicity is a common side effect of radiotherapy for solid tumors. Its management can cause treatment gaps and thus can impair cancer treatment. At present, in many countries no standard recommendation for treatment of skin during radiotherapy exists. In this study, we explored the effect of topically-applied tea extracts on the duration of radiation-induced skin toxicity. We investigated the underlying molecular mechanisms and compared effects of tea extracts with the effects of epigallocatechin-gallate, the proposed most-active moiety of green tea. METHODS: Data from 60 patients with cancer of the head and neck or pelvic region topically treated with green or black tea extracts were analyzed retrospectively. Tea extracts were compared for their ability to modulate IL-1β, IL-6, IL-8, TNFα and PGE(2 )release from human monocytes. Effects of tea extracts on 26S proteasome function were assessed. NF-κB activity was monitored by EMSAs. Viability and radiation response of macrophages after exposure to tea extracts was measured by MTT assays. RESULTS: Tea extracts supported the restitution of skin integrity. Tea extracts inhibited proteasome function and suppressed cytokine release. NF-κB activity was altered by tea extracts in a complex, caspase-dependent manner, which differed from the effects of epigallocatechin-gallate. Additionally, both tea extracts, as well as epigallocatechin-gallate, slightly protected macrophages from ionizing radiation CONCLUSION: Tea extracts are an efficient, broadly available treatment option for patients suffering from acute radiation-induced skin toxicity. The molecular mechanisms underlying the beneficial effects are complex, and most likely not exclusively dependent on effects of tea polyphenols such as epigallocatechin-gallate

A family of membrane-shaping proteins at ER subdomains regulates pre-peroxisomal vesicle biogenesis

Saccharomyces cerevisiae contains three conserved reticulon and reticulon-like proteins that help maintain ER structure by stabilizing high membrane curvature in ER tubules and the edges of ER sheets. A mutant lacking all three proteins has dramatically altered ER morphology. We found that ER shape is restored in this mutant when Pex30p or its homologue Pex31p is overexpressed. Pex30p can tubulate membranes both in cells and when reconstituted into proteoliposomes, indicating that Pex30p is a novel ER-shaping protein. In contrast to the reticulons, Pex30p is low abundance, and we found that it localizes to subdomains in the ER. We show that these ER subdomains are the sites where most preperoxisomal vesicles (PPVs) are generated. In addition, overproduction or deletion of Pex30p or Pex31p alters the size, shape, and number of PPVs. Our findings suggest that Pex30p and Pex31p help shape and generate regions of the ER where PPV biogenesis occurs