Salvage endovascular embolization of the left pulmonary artery for recurrent pseudoaneurysm

Background: Pulmonary pseudoaneurysm (PPA) is a potentially lethal complication of lung resection with a high risk of recurrence after endovascular coiling. Case presentation: We report a case in which recurrent hemoptysis due to PPA after left lower lobe sleeve resection was treated by endovascular embolization of the left main pulmonary artery as a salvage treatment. The first hemoptysis was managed by endovascular coil embolization with extracorporeal membrane oxygenation, but refractory hemorrhage occurred 3 months later due to penetration of the endovascular coil into the bronchial anastomosis site. Because left completion pneumonectomy was considered too high risk, the left main pulmonary artery was palliatively embolized using an Amplatzer vascular plug (St. Jude Medical, MN, USA) to totally disrupt the left pulmonary arterial flow. Conclusions: Total embolization of the left main pulmonary artery for repeated PPA rupture may be useful as a palliative treatment in patients unable to tolerate pneumonectomy

Assessment of risk factors related to healthcare-associated methicillin-resistant Staphylococcus aureus infection at patient admission to an intensive care unit in Japan

<p>Abstract</p> <p>Background</p> <p>Healthcare-associated methicillin-resistant <it>Staphylococcus aureus </it>(HA-MRSA) infection in intensive care unit (ICU) patients prolongs ICU stay and causes high mortality. Predicting HA-MRSA infection on admission can strengthen precautions against MRSA transmission. This study aimed to clarify the risk factors for HA-MRSA infection in an ICU from data obtained within 24 hours of patient ICU admission.</p> <p>Methods</p> <p>We prospectively studied HA-MRSA infection in 474 consecutive patients admitted for more than 2 days to our medical, surgical, and trauma ICU in a tertiary referral hospital in Japan. Data obtained from patients within 24 hours of ICU admission on 11 prognostic variables possibly related to outcome were evaluated to predict infection risk in the early phase of ICU stay. Stepwise multivariate logistic regression analysis was used to identify independent risk factors for HA-MRSA infection.</p> <p>Results</p> <p>Thirty patients (6.3%) had MRSA infection, and 444 patients (93.7%) were infection-free. Intubation, existence of open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission, were detected as independent prognostic indicators. Patients with intubation or open wound comprised 96.7% of MRSA-infected patients but only 57.4% of all patients admitted.</p> <p>Conclusions</p> <p>Four prognostic variables were found to be risk factors for HA-MRSA infection in ICU: intubation, open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission. Preemptive infection control in patients with these risk factors might effectively decrease HA-MRSA infection.</p

Epigenetics and Shared Molecular Processes in the Regeneration of Complex Structures

The ability to regenerate complex structures is broadly represented in both plant and animal kingdoms. Although regenerative abilities vary significantly amongst metazoans, cumulative studies have identified cellular events that are broadly observed during regenerative events. For example, structural damage is recognized and wound healing initiated upon injury, which is followed by programmed cell death in the vicinity of damaged tissue and a burst in proliferation of progenitor cells. Sustained proliferation and localization of progenitor cells to site of injury give rise to an assembly of differentiating cells known as the regeneration blastema, which fosters the development of new tissue. Finally, preexisting tissue rearranges and integrates with newly differentiated cells to restore proportionality and function. While heterogeneity exists in the basic processes displayed during regenerative events in different species—most notably the cellular source contributing to formation of new tissue—activation of conserved molecular pathways is imperative for proper regulation of cells during regeneration. Perhaps the most fundamental of such molecular processes entails chromatin rearrangements, which prime large changes in gene expression required for differentiation and/or dedifferentiation of progenitor cells. This review provides an overview of known contributions to regenerative processes by noncoding RNAs and chromatin-modifying enzymes involved in epigenetic regulation

Germline Defects Caused by \u3cem\u3eSmed-boule\u3c/em\u3e RNA-Interference Reveal That Egg Capsule Deposition Occurs Independently of Fertilization, Ovulation, Mating, or the Presence of Gametes in Planarian Flatworms

Few animals are known to lay eggs in the absence of ovulation or copulation, as it is presumably energetically wasteful and subjected to negative selection. Characterization of Smed-boule, a member of the DAZ family of germline RNA-binding proteins, revealed that egg capsule (or capsule) production and deposition occurs independently of the presence of gametes in the planarian flatworm Schmidtea mediterranea. Reduction of Smed-boule expression by RNA-interference (RNAi) causes ablation of spermatogonial stem cells and the inability of ovarian germline stem cells to undergo oogenesis. Although animals subjected to Smed-boule RNAi lose their gametes and become sterile, they continue to lay egg capsules. Production of sterile capsules is even observed in virgin Smed-boule(RNAi) and control planarians maintained in complete isolation, demonstrating that egg production in S. mediterranea occurs independently of ovulation, fertilization, or mating. Evidence suggests that this is a conserved feature amongst Platyhelminthes, and therefore relevant to the pathology and dissemination of parasitic flatworms. These findings demonstrate that Smed-boule functions at different stages during male and female germline stem cell development, and also demonstrate that egg capsule production by planarian flatworms occurs independently of signals produced by mating or ova

Genetic Dissection of the Planarian Reproductive System Through Characterization of Schmidtea Mediterranea Cpeb Homologs

Cytoplasmic polyadenylation is a mechanism of mRNA regulation prevalent in metazoan germ cells; it is largely dependent on Cytoplasmic Polyadenylation Element Binding proteins (CPEBs). Two CPEB homologs were identified in the planarian Schmidtea mediterranea. Smed-CPEB1 is expressed in ovaries and yolk glands of sexually mature planarians, and required for oocyte and yolk gland development. In contrast, Smed-CPEB2 is expressed in the testes and the central nervous system; its function is required for spermatogenesis as well as non-autonomously for development of ovaries and accessory reproductive organs. Transcriptome analysis of CPEB knockdown animals uncovered a comprehensive collection of molecular markers for reproductive structures in S. mediterranea, including ovaries, testes, yolk glands, and the copulatory apparatus. Analysis by RNA interference revealed contributions for a dozen of these genes during oogenesis, spermatogenesis, or capsule formation. We also present evidence suggesting that Smed-CPEB2 promotes translation of Neuropeptide Y-8, a prohormone required for planarian sexual maturation. These findings provide mechanistic insight into potentially conserved processes of germ cell development, as well as events involved in capsule deposition by flatworms

Germline Defects Caused by <i>Smed-boule</i> RNA-Interference Reveal That Egg Capsule Deposition Occurs Independently of Fertilization, Ovulation, Mating, or the Presence of Gametes in Planarian Flatworms

<div><p>Few animals are known to lay eggs in the absence of ovulation or copulation, as it is presumably energetically wasteful and subjected to negative selection. Characterization of <i>Smed-boule</i>, a member of the DAZ family of germline RNA-binding proteins, revealed that egg capsule (or capsule) production and deposition occurs independently of the presence of gametes in the planarian flatworm <i>Schmidtea mediterranea</i>. Reduction of <i>Smed-boule</i> expression by RNA-interference (RNAi) causes ablation of spermatogonial stem cells and the inability of ovarian germline stem cells to undergo oogenesis. Although animals subjected to <i>Smed-boule</i> RNAi lose their gametes and become sterile, they continue to lay egg capsules. Production of sterile capsules is even observed in virgin <i>Smed-boule(RNAi)</i> and control planarians maintained in complete isolation, demonstrating that egg production in <i>S</i>. <i>mediterranea</i> occurs independently of ovulation, fertilization, or mating. Evidence suggests that this is a conserved feature amongst Platyhelminthes, and therefore relevant to the pathology and dissemination of parasitic flatworms. These findings demonstrate that <i>Smed-boule</i> functions at different stages during male and female germline stem cell development, and also demonstrate that egg capsule production by planarian flatworms occurs independently of signals produced by mating or ova.</p></div

<i>Smed-boule</i> encodes for a member of the germline-specific Boule-Like subfamily of proteins.

<p><b>(A)</b> Illustration of human Boule-Like (BOLL) protein architecture, which includes a RNA-recognition motif (RRM; yellow) and a DAZ domain (blue). The amino acid sequence conservation within the RRM of <i>Schmidtea mediterranea</i> and <i>Homo sapiens</i> homologs is shown. <b>(B)</b> Neighbor-joining phylogenetic tree depicting the closer association of Smed-Boule predicted amino acid sequence with members of the Boule-Like (green) subfamily of DAZ proteins, than with members of the DAZ (blue) and DAZ-Like (magenta) subfamilies. Phylogenetic analysis was performed using Clustal Omega with default parameters [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1006030#pgen.1006030.ref044" target="_blank">44</a>] and sequences obtained from NCBI accession NP_932074.1, XP_001169371.2, XP_001086915.2, XP_005640556.1, NP_001095585.1, NP_083543.2, XP_006245003.1, XP_004942650.1, NP_001261614.1, XP_315505.3, NP_001005785.1, XP_001138045.3, XP_002803072.1, NP_034151.3, NP_001102884.1, NP_989549.1, NP_571599.1, NP_989079.1, NP_004072.3, XP_003319020.2, CCD81039, NP_011092, NP_001177740.1. Abbreviations used for species names included <i>Anopheles gambiae</i> (Ag), <i>Bos taurus</i> (Bt), <i>Canis lupus familiaris</i> (Cl), <i>Danio rerio</i> (Dr), <i>Drosophila melanogaster</i> (Dm), <i>Gallus gallus</i> (Gg), <i>Homo sapiens</i> (Hs), <i>Macaca mulatta</i> (Mmul), <i>Mus musculus</i> (Mmus), <i>Pan troglodytes</i> (Pt), <i>Rattus norvegicus</i> (Rn), <i>Saccharomyces cerevisiae</i> (Sc), <i>Schmidtea mediterranea</i> (Smed), <i>Schistosoma mansoni</i> (Sm), and <i>Xenopus tropicalis</i> (Xt). Scale bar represents 0.05 substitutions per amino acid position.</p

<i>Smed-boule</i> is required for maintenance of testicular germ cells, but not for all ovarian germ cells.

<p><b>(A-B)</b> Whole-mount <i>in situ</i> hybridization (ISH) analysis of neoblast and germ cell (GC) distribution through detection of <i>germinal histone H4</i> (<i>gH4</i>) mRNA in planarians subjected to three months of control <b>(A)</b> or <i>Smed-boule</i> <b>(B)</b> RNAi. GCs were detected in the ovary region (pink arrowheads) of both controls <b>(A’)</b> and <i>Smed-boule(RNAi)</i> <b>(B’)</b>. Testicular GCs (blue arrowheads) detected in control samples <b>(A”)</b> were absent in <i>Smed-boule(RNAi)</i> samples <b>(B”)</b>. The fraction of animals displaying the phenotype represented by the image is shown at the bottom-left corner of each frame. Scale bars = 1 mm.</p

<i>Smed-boule</i> expression is restricted to the planarian germline.

<p><b>(A)</b> Simplified depiction of the reproductive anatomy of planarian hermaphrodites. Reproductive organs located dorsally (top) and ventrally (bottom) are illustrated separately. <b>(B-D)</b> <i>Smed-boule</i> expression is detected in testes and ovaries by whole mount <i>in situ</i> hybridization in dorsal <b>(B and D)</b> and ventral <b>(C)</b> views of sexually mature <i>S</i>. <i>mediterranea</i>, respectively. Arrows in <b>(B)</b> indicate individual testis lobes within testes regions found dorsolaterally in the animal. Magnified view of signal from ovaries (open arrowheads) is shown in <b>(C’)</b> inset. <i>Smed-boule</i> expression is also detected in germline stem cells (black arrowheads) of 1 week-old hatchlings in the dorso-lateral region where testes develop <b>(D’)</b>, as well as continuously in maturing animals <b>(D).</b> Scale bars = 1 mm.</p

<i>Smed-boule</i> is required for germline maintenance and production of fertile capsules.

<p><b>(A-I)</b> The reproductive anatomy of RNAi animals monitored in (J-K) was analyzed by whole mount <i>in situ</i> hybridization using <i>synaptotagmin XV</i> <b>(A-C)</b> or <i>surfactant b</i> <b>(G-I)</b> as oocyte and yolk gland markers, respectively (<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1006030#pgen.1006030.s001" target="_blank">S1 Fig</a>). DAPI staining was used to visualize sperm development in the testes <b>(D-F)</b>. The fraction of animals displaying the phenotype represented by the image is shown at the bottom-left corner of each frame. <b>(J-K)</b> Capsule production <b>(J)</b> and hatching <b>(K)</b> from groups of sexually mature planarians subjected to continuous control, <i>Smed-boule</i>, or <i>CPEB1</i> RNAi treatments for three months (first, second, and third month represented by column from left to right in each group). Quantification of the number of capsules laid <b>(J)</b> and the number of fertile capsules <b>(K)</b> show that capsules deposited by <i>Smed-boule(RNAi)</i> animals ceased being fertile and that <i>CPEB1(RNAi)</i> ceased capsule production as a result of RNAi. Asterisks (*) represent statistically significant results compared to controls of same month by unpaired two-tailed <i>t</i>-test (<i>p > 0</i>.<i>05</i>). Scale bars = 1 mm.</p