Computed tomography measures of nutrition in patients with end-stage liver disease provide a novel approach to characterize deficits

Aim Patients with cirrhosis and end-stage liver disease (ESLD) develop severe nutrition deficits that impact on morbidity and mortality. Laboratory measures of nutrition fail to fully assess clinical deficits in muscle mass and fat stores. This study employs computed tomography imaging to assess muscle mass and subcutaneous and visceral fat stores in patients with ESLD. Methods This 1:1 case-control study design compares ESLD patients with healthy controls. Study patients were selected from a database of ESLD patients using a stratified method to assure a representative sample based on age, body mass index (BMI), gender, and model for end-stage liver disease score (MELD). Control patients were trauma patients with a low injury severity score (<10) who had a CT scan during evaluation. Cases and controls were matched for age +/- 5 years, gender, and BMI +/- 2. Results There were 90 subjects and 90 controls. ESLD patients had lower albumin levels (p<0.001), but similar total protein levels (p=0.72). ESLD patients had a deficit in muscle mass (-19%, p<0.001) and visceral fat (-13%, p<0.001), but similar subcutaneous fat (-1%, p=0.35). ESLD patients at highest risk for sarcopenia included those over age 60, BMI< 25.0, and female gender. We found degree of sarcopenia to be independent of MELD score. Conclusions These results support previous research demonstrating substantial nutrition deficits in ESLD patients that are not adequately measured by laboratory testing. Patients with ESLD have significant deficits of muscle and visceral fat stores, but a similar amount of subcutaneous fat

The Spectral Types of White Dwarfs in Messier 4

We present the spectra of 24 white dwarfs in the direction of the globular cluster Messier 4 obtained with the Keck/LRIS and Gemini/GMOS spectrographs. Determining the spectral types of the stars in this sample, we find 24 type DA and 0 type DB (i.e., atmospheres dominated by hydrogen and helium respectively). Assuming the ratio of DA/DB observed in the field with effective temperature between 15,000 - 25,000 K, i.e., 4.2:1, holds for the cluster environment, the chance of finding no DBs in our sample due simply to statistical fluctuations is only 6 X 10^(-3). The spectral types of the ~100 white dwarfs previously identified in open clusters indicate that DB formation is strongly suppressed in that environment. Furthermore, all the ~10 white dwarfs previously identified in other globular clusters are exclusively type DA. In the context of these two facts, this finding suggests that DB formation is suppressed in the cluster environment in general. Though no satisfactory explanation for this phenomenon exists, we discuss several possibilities.Comment: Accepted for Publication in Astrophys. J. 11 pages including 4 figures and 2 tables (journal format

The Masses of Population II White Dwarfs

Globular star clusters are among the first stellar populations to have formed in the Milky Way, and thus only a small sliver of their initial spectrum of stellar types are still burning hydrogen on the main-sequence today. Almost all of the stars born with more mass than 0.8 M_sun have evolved to form the white dwarf cooling sequence of these systems, and the distribution and properties of these remnants uniquely holds clues related to the nature of the now evolved progenitor stars. With ultra-deep HST imaging observations, rich white dwarf populations of four nearby Milky Way globular clusters have recently been uncovered, and are found to extend an impressive 5 - 8 magnitudes in the faint-blue region of the H-R diagram. In this paper, we characterize the properties of these population II remnants by presenting the first direct mass measurements of individual white dwarfs near the tip of the cooling sequence in the nearest of the Milky Way globulars, M4. Based on Gemini/GMOS and Keck/LRIS multiobject spectroscopic observations, our results indicate that 0.8 M_sun population II main-sequence stars evolving today form 0.53 +/- 0.01 M_sun white dwarfs. We discuss the implications of this result as it relates to our understanding of stellar structure and evolution of population II stars and for the age of the Galactic halo, as measured with white dwarf cooling theory.Comment: Accepted for Publication in Astrophys. J. on Aug. 05th, 2009. 19 pages including 9 figures and 2 tables (journal format

Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty

OBJECTIVE: To determine the type and frequency of incidental findings detected on preoperative computed tomography (CT) imaging obtained for robotic-assisted joint replacements and their effect on the planned arthroplasty. MATERIALS AND METHODS: All preoperative CT examinations performed for a robotic-assisted knee or total hip arthroplasty were obtained. This resulted in 1432 examinations performed between September 2016 and February 2020 at our institution. These examinations were initially interpreted by 1 of 9 fellowship-trained musculoskeletal radiologists. Using a diagnosis search, the examination reports were then reviewed to catalog all incidental findings and further classify as significant or non-significant findings. Demographic information was obtained. In those with significant findings, a chart review was performed to record the relevant workup, outcomes, and if the planned arthroplasty was affected. RESULTS: Incidental findings were diagnosed in 740 (51.7%) patients. Of those with incidental findings, 41 (5.5%) were considered significant. A significant finding was more likely to be detected in males (P = 0.007) and on the hip protocol CT (P = 0.014). In 8 patients, these diagnoses resulted in either delay or cancelation of the arthroplasty. A planned total hip arthroplasty was more likely to be altered as compared to a knee arthroplasty (P = 0.018). CONCLUSION: Incidental findings are commonly detected by radiologists on preoperative CT imaging obtained for robotic-assisted joint replacement. Several were valuable findings and resulted in a delay or even cancelation of the planned arthroplasty after the detection of critical diagnoses, which if not identified may have resulted in devastating outcomes

Deep ACS Imaging in the Globular Cluster NGC6397: Dynamical Models

We present N-body models to complement deep imaging of the metal-poor core-collapsed cluster NGC6397 obtained with the Hubble Space Telescope. All simulations include stellar and binary evolution in-step with the stellar dynamics and account for the tidal field of the Galaxy. We focus on the results of a simulation that began with 100000 objects (stars and binaries), 5% primordial binaries and Population II metallicity. After 16 Gyr of evolution the model cluster has about 20% of the stars remaining and has reached core-collapse. We compare the color-magnitude diagrams of the model at this age for the central region and an outer region corresponding to the observed field of NGC6397 (about 2-3 half-light radii from the cluster centre). This demonstrates that the white dwarf population in the outer region has suffered little modification from dynamical processes - contamination of the luminosity function by binaries and white dwarfs with non-standard evolution histories is minimal and should not significantly affect measurement of the cluster age. We also show that the binary fraction of main-sequence stars observed in the NGC6397 field can be taken as representative of the primordial binary fraction of the cluster. For the mass function of the main-sequence stars we find that although this has been altered significantly by dynamics over the cluster lifetime, especially in the central and outer regions, that the position of the observed field is close to optimal for recovering the initial mass function of the cluster stars (below the current turn-off mass). More generally we look at how the mass function changes with radius in a dynamically evolved stellar cluster and suggest where the best radial position to observe the initial mass function is for clusters of any age.Comment: 34 pages, 11 figures, submitted to AJ, companion paper to 0708.403

Artificial Inclusion Environments—Replicating Industry in the Laboratory

The authors present a series of complementary test methods which were developed and used to investigate reactions between high aluminium steel and silica rich inclusions. Non-metallic inclusions (NMIs) cause many defects in the final steel product, therefore the ability to track their size, morphology and composition and correlate this with fundamental reaction kinetics provides important knowledge to support the production of clean quality steel products. Novel steel grades such as TRIP, TWIP and low-density steels have high aluminium contents; aluminium is a readily oxidisable species presenting the potential for instability and excessive reaction with commonly used mould powders that contain silica. A novel combination of techniques including HT-CLSM (High-Temperature Confocal Laser Scanning Microscope), XCT (X-ray computed tomography) and SEM/EDS (scanning electron microscopy/electron dispersive spectroscopy) have been used to study the interaction of entrained mould powder inclusions with steel at high temperatures simulating industrial conditions. This report presents a discussion on the development of techniques and samples to achieve representative and repeatable results that can provide information on the complex chemical and physical interaction phenomena with confidence. Each experimental technique had its own learning points and consequent results. Outcomes presented include possible confirmation of the chemical reaction rate controlling step being aluminium mass transfer; heterogeneous local environmental conditions including fluidity and chemical composition; and occurrence of spontaneous emulsification where the mould powder inclusion breaks apart into a cloud of smaller fragments

Deep ACS Imaging in the Globular Cluster NGC 6397: The Cluster Color Magnitude Diagram and Luminosity Function

We present the CMD from deep HST imaging in the globular cluster NGC 6397. The ACS was used for 126 orbits to image a single field in two colors (F814W, F606W) 5 arcmin SE of the cluster center. The field observed overlaps that of archival WFPC2 data from 1994 and 1997 which were used to proper motion (PM) clean the data. Applying the PM corrections produces a remarkably clean CMD which reveals a number of features never seen before in a globular cluster CMD. In our field, the main sequence stars appeared to terminate close to the location in the CMD of the hydrogen-burning limit predicted by two independent sets of stellar evolution models. The faintest observed main sequence stars are about a magnitude fainter than the least luminous metal-poor field halo stars known, suggesting that the lowest luminosity halo stars still await discovery. At the bright end the data extend beyond the main sequence turnoff to well up the giant branch. A populous white dwarf cooling sequence is also seen in the cluster CMD. The most dramatic features of the cooling sequence are its turn to the blue at faint magnitudes as well as an apparent truncation near F814W = 28. The cluster luminosity and mass functions were derived, stretching from the turn off down to the hydrogen-burning limit. It was well modeled with either a very flat power-law or a lognormal function. In order to interpret these fits more fully we compared them with similar functions in the cluster core and with a full N-body model of NGC 6397 finding satisfactory agreement between the model predictions and the data. This exercise demonstrates the important role and the effect that dynamics has played in altering the cluster IMF.Comment: 43 pages including 4 tables and 12 diagrams. Figures 2 and 3 have been bitmapped. Accepted for publication in the Astronomical Journa

Dynamic Dual-Tracer MRI-Guided Fluorescence Tomography to Quantify Receptor Density In Vivo

The up-regulation of cell surface receptors has become a central focus in personalized cancer treatment; however, because of the complex nature of contrast agent pharmacokinetics in tumor tissue, methods to quantify receptor binding in vivo remain elusive. Here, we present a dual-tracer optical technique for noninvasive estimation of specific receptor binding in cancer. A multispectral MRI-coupled fluorescence molecular tomography system was used to image the uptake kinetics of two fluorescent tracers injected simultaneously, one tracer targeted to the receptor of interest and the other tracer a nontargeted reference. These dynamic tracer data were then fit to a dual-tracer compartmental model to estimate the density of receptors available for binding in the tissue. Applying this approach to mice with deep-seated gliomas that overexpress the EGF receptor produced an estimate of available receptor density of 2.3 ± 0.5 nM (n = 5), consistent with values estimated in comparative invasive imaging and ex vivo studies