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Torso vascular trauma
Vascular injury within the chest or abdomen represents a unique challenge to the pediatric general surgeon, as these life- or limb-threatening injuries are rare and may require emergent treatment. Vascular injury may present as life-threatening hemorrhage, or with critical ischemia from intimal injury, dissection, or thrombosis. Maintaining the skillset and requisite knowledge to address these injuries is of utmost importance for pediatric surgeons that care for injured children, particularly for surgeons practicing in freestanding children's hospitals that frequently do not have adult vascular surgery coverage. The purpose of this review is to provide an overview of torso vascular trauma, with a specific emphasis in rapid recognition of torso vascular injury as well as both open and endovascular management options. Specific injuries addressed include blunt and penetrating mediastinal vascular injury, subclavian injury, abdominal aortic and visceral segment injury, inferior vena cava injury, and pelvic vascular injury. Operative exposure, vascular repair techniques, and damage control options including preperitoneal packing for pelvic hemorrhage are discussed. The role and limitations of endovascular treatment of each of these injuries is discussed, including endovascular stent graft placement, angioembolization for pelvic hemorrhage, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in children
Incidence of and Risk Factors for Sick Sinus Syndrome in the General Population
AbstractBackgroundLittle is known about the incidence of and risk factors for sick sinus syndrome (SSS), a common indication for pacemaker implantation.ObjectivesThis study sought to describe the epidemiology of SSS.MethodsThis analysis included 20,572 participants (mean baseline age 59 years, 43% male) in the ARIC (Atherosclerosis Risk In Communities) study and the CHS (Cardiovascular Health Study), who at baseline were free of prevalent atrial fibrillation and pacemaker therapy, had a heart rate of ≥50 beats/min unless using beta blockers, and were identified as of white or black race. Incident SSS cases were identified by hospital discharge International Classification of Disease-revision 9-Clinical Modification code 427.81 and validated by medical record review.ResultsDuring an average 17 years of follow-up, 291 incident SSS cases were identified (unadjusted rate 0.8 per 1,000 person-years). Incidence increased with age (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.47 to 2.05 per 5-year increment), and blacks had a 41% lower risk of SSS than whites (HR: 0.59; 95% CI: 0.37 to 0.98). Incident SSS was associated with greater baseline body mass index, height, N-terminal pro–B-type natriuretic peptide, and cystatin C, with longer QRS interval, with lower heart rate, and with prevalent hypertension, right bundle branch block, and cardiovascular disease. We project that the annual number of new SSS cases in the United States will increase from 78,000 in 2012 to 172,000 in 2060.ConclusionsBlacks have a lower risk of SSS than whites, and several cardiovascular risk factors were associated with incident SSS. With the aging of the population, the number of Americans with SSS will increase dramatically over the next 50 years
Breakdown of the Central Synapses in C9orf72-Linked ALS/FTD
Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease that leads to the death of motor and cortical neurons. The clinical manifestations of ALS are heterogenous, and efficacious treatments to significantly slow the progression of the disease are lacking. Cortical hyper-excitability is observed pre-symptomatically across disease-causative genetic variants, as well as in the early stages of sporadic ALS, and typically precedes motor neuron involvement and overt neurodegeneration. The causes of cortical hyper-excitability are not yet fully understood but is mainly agreed to be an early event. The identification of the nucleotide repeat expansion (GGGGCC)n in the C9ORF72 gene has provided evidence that ALS and another neurodegenerative disease, frontotemporal dementia (FTD), are part of a disease spectrum with common genetic origins. ALS and FTD are diseases in which synaptic dysfunction is reported throughout disease onset and stages of progression. It has become apparent that ALS/FTD-causative genes, such as C9ORF72, may have roles in maintaining the normal physiology of the synapse, as mutations in these genes often manifest in synaptic dysfunction. Here we review the dysfunctions of the central nervous system synapses associated with the nucleotide repeat expansion in C9ORF72 observed in patients, organismal, and cellular models of ALS and FTD
Intentional research design in implementation science: implications for the use of nomothetic and idiographic assessment
The advancement of implementation science is dependent on identifying assessment strategies that can address implementation and clinical outcome variables in ways that are valid, relevant to stakeholders, and scalable. This paper presents a measurement agenda for implementation science that integrates the previously disparate assessment traditions of idiographic and nomothetic approaches. Although idiographic and nomothetic approaches are both used in implementation science, a review of the literature on this topic suggests that their selection can be indiscriminate, driven by convenience, and not explicitly tied to research study design. As a result, they are not typically combined deliberately or effectively. Thoughtful integration may simultaneously enhance both the rigor and relevance of assessments across multiple levels within health service systems. Background on nomothetic and idiographic assessment is provided as well as their potential to support research in implementation science. Drawing from an existing framework, seven structures (of various sequencing and weighting options) and five functions (Convergence, Complementarity, Expansion, Development, Sampling) for integrating conceptually distinct research methods are articulated as they apply to the deliberate, design-driven integration of nomothetic and idiographic assessment approaches. Specific examples and practical guidance are provided to inform research consistent with this framework. Selection and integration of idiographic and nomothetic assessments for implementation science research designs can be improved. The current paper argues for the deliberate application of a clear framework to improve the rigor and relevance of contemporary assessment strategies
Assigning chemoreceptors to chemosensory pathways in Pseudomonas aeruginosa
In contrast to Escherichia coli, a model organism for chemotaxis that has 5 chemoreceptors and a single chemosensory pathway, Pseudomonas aeruginosa PAO1 has a much more complex chemosensory network, which consists of 26 chemoreceptors feeding into four chemosensory pathways. While several chemoreceptors were rigorously linked to specific pathways in a series of experimental studies, for most of them this information is not available. Thus, we addressed the problem computationally. Protein–protein interaction network prediction, coexpression data mining, and phylogenetic profiling all produced incomplete and uncertain assignments of chemoreceptors to pathways. However, comparative sequence analysis specifically targeting chemoreceptor regions involved in pathway interactions revealed conserved sequence patterns that enabled us to unambiguously link all 26 chemoreceptors to four pathways. Placing computational evidence in the context of experimental data allowed us to conclude that three chemosensory pathways in P. aeruginosa utilize one chemoreceptor per pathway, whereas the fourth pathway, which is the main system controlling chemotaxis, utilizes the other 23 chemoreceptors. Our results show that while only a very few amino acid positions in receptors, kinases, and adaptors determine their pathway specificity, assigning receptors to pathways computationally is possible. This requires substantial knowledge about interacting partners on a molecular level and focusing comparative sequence analysis on the pathway-specific regions. This general principle should be applicable to resolving many other receptor–pathway interactions
Ultrasensitive force and displacement detection using trapped ions
The ability to detect extremely small forces is vital for a variety of
disciplines including precision spin-resonance imaging, microscopy, and tests
of fundamental physical phenomena. Current force-detection sensitivity limits
have surpassed 1 (atto ) through coupling of micro or
nanofabricated mechanical resonators to a variety of physical systems including
single-electron transistors, superconducting microwave cavities, and individual
spins. These experiments have allowed for probing studies of a variety of
phenomena, but sensitivity requirements are ever-increasing as new regimes of
physical interactions are considered. Here we show that trapped atomic ions are
exquisitely sensitive force detectors, with a measured sensitivity more than
three orders of magnitude better than existing reports. We demonstrate
detection of forces as small as 174 (yocto ), with a
sensitivity 390 using crystals of Be
ions in a Penning trap. Our technique is based on the excitation of normal
motional modes in an ion trap by externally applied electric fields, detection
via and phase-coherent Doppler velocimetry, which allows for the discrimination
of ion motion with amplitudes on the scale of nanometers. These experimental
results and extracted force-detection sensitivities in the single-ion limit
validate proposals suggesting that trapped atomic ions are capable of detecting
of forces with sensitivity approaching 1 . We anticipate that
this demonstration will be strongly motivational for the development of a new
class of deployable trapped-ion-based sensors, and will permit scientists to
access new regimes in materials science.Comment: Expanded introduction and analysis. Methods section added. Subject to
press embarg
Tracing PAHs and Warm Dust Emission in the Seyfert Galaxy NGC 1068
We present a study of the nearby Seyfert galaxy NGC 1068 using mid- and far-
infrared data acquired with the IRAC, IRS, and MIPS instruments aboard the
Spitzer Space Telescope. The images show extensive 8 um and 24 um emission
coinciding with star formation in the inner spiral approximately 15" (1 kpc)
from the nucleus, and a bright complex of star formation 47" (3 kpc) SW of the
nucleus. The brightest 8 um PAH emission regions coincide remarkably well with
knots observed in an Halpha image. Strong PAH features at 6.2, 7.7, 8.6, and
11.3 um are detected in IRS spectra measured at numerous locations inside,
within, and outside the inner spiral. The IRAC colors and IRS spectra of these
regions rule out dust heated by the AGN as the primary emission source; the
SEDs are dominated by starlight and PAH emission. The equivalent widths and
flux ratios of the PAH features in the inner spiral are generally consistent
with conditions in a typical spiral galaxy ISM. Interior to the inner spiral,
the influence of the AGN on the ISM is evident via PAH flux ratios indicative
of a higher ionization parameter and a significantly smaller mean equivalent
width than observed in the inner spiral. The brightest 8 and 24 um emission
peaks in the disk of the galaxy, even at distances beyond the inner spiral, are
located within the ionization cones traced by [O III]/Hbeta, and they are also
remarkably well aligned with the axis of the radio jets. Although it is
possible that radiation from the AGN may directly enhance PAH excitation or
trigger the formation of OB stars that subsequently excite PAH emission at
these locations in the inner spiral, the orientation of collimated radiation
from the AGN and star formation knots in the inner spiral could be
coincidental. (abridged)Comment: 20 pages, 11 figures; AJ, accepted; full resolution version available
at http://spider.ipac.caltech.edu/staff/jhhowell/astro/howelln1068.pd
Chiral unitary approach to S-wave meson baryon scattering in the strangeness S=0 sector
We study the S-wave interaction of mesons with baryons in the strangeness S=0
sector in a coupled channel unitary approach. The basic dynamics is drawn from
the lowest order meson baryon chiral Lagrangians. Small modifications inspired
by models with explicit vector meson exchange in the t-channel are also
considered. In addition the pi pi N channel is included and shown to have an
important repercussion in the results, particularly in the isospin 3/2 sector.Comment: 23 pages, LaTeX, 21 figure
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