Acute appendicitis in overweight patients: the role of preoperative imaging.

BACKGROUND: The diagnosis of acute appendicitis in overweight patients is challenging due to the limited value of the clinical examination. The benefits of ultrasonography and abdominal CT have been studied in the general population, but there is limited data regarding their use in overweight and obese patients with suspected appendicitis. This study analyzes the role of preoperative radiological modalities in overweight patients with suspected appendicitis. METHODS: Retrospective analysis of a prospectively acquired database including 705 patients operated for suspected acute appendicitis. Patients were divided into two groups according to their BMI (BMI ≥25 kg/m(2) (n = 242) and BMI <25 kg/m(2) (n = 463)). The use of preoperative radiological modalities, laboratory findings and outcome parameters were analyzed. RESULTS: Ultrasonography was the preferred radiological assessment in our cohort (68 % in BMI <25 kg/m and 52.4 % in BMI ≥25 kg/m(2)). However, it was non-conclusive in 42 % of overweight as compared to 6 % in patients with a BMI < 25 (p < 0.0001). This difference was particularly obvious between female patients (8 % of non-conclusive US for BMI <25 kg/m(2) vs 52 % for BMI ≥25 kg/m(2), p < 0.0001). Significantly more CT scans were performed in overweight patients (37 % vs. 20 %; p <0.0001). The accuracy of CT did not differ according to BMI (85 % vs. 88 %; p = 0.76). Preoperative radiological imaging did not significantly delay surgery. Laparoscopy was the preferred approach for both groups (98.2 % vs 98.7 %, P = 0.86) with an overall conversion rate of 4 %. The overall rate of negative appendectomy was 10 %. CONCLUSIONS: The role of ultrasonography in patients with BMI ≥25 kg/m(2) with suspected acute appendicitis is questionable due to its high rate of non-conclusive findings. Therefore, abdominal CT scans should be preferred to investigate suspected appendicitis in overweight patient if clinical findings are not conclusive

Variations in water use by a mature mangrove of Avicennia germinans, French Guiana

In the tropical intertidal zones, little is known on water uptake by mangroves. Transpiration rates are generally measured at leaf level, but few studies exist on water use at tree or stand levels. The objective of this study was to measure sap flow in trees of different sizes to appreciate the range of variation in water use that may exist in a site dominated by 80% mature Avicennia germinans. The results showed that from the dry to the wet season the mean water use increased from 3.2 to 5.3 dm3 d−1 in small trees (DBH ∼ 13 cm), from 11.5 to 30.8 dm3 d−1 in medium trees (∼24 cm) and from 40.8 to 64.1 dm3 d−1 in large ones (∼45 cm). Sapwood remained active up to a depth of 8 cm with radial variations within the stem. Weak correlations were obtained with VPD and net radiation. This study confirmed that transpiration was larger under low levels of salinity. Water use at stand level (∼1900 living stems ha−1) was estimated to be in the range of 5.8 to 11.8 m3 ha−1 d−1 according to the season

<i>In</i> <i>vitro </i>regulation of fibroblast growth factor 23 by 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D synthesized by osteocyte-like MC3T3-E1 cells

Fibroblast growth factor 23 (FGF23) is produced and secreted by osteocytes and is essential for maintaining phosphate homeostasis. One of the main regulators of FGF23, 1,25-dihydroxyvitamin D (1,25(OH)2D3), is primarily synthesized in the kidney from 25-hydroxyvitamin D (25(OH)D) by 1α-hydroxylase (encoded by CYP27B1). Hitherto, it is unclear whether osteocytes can convert 25(OH)D and thereby allow for 1,25(OH)2D3 to induce FGF23 production and secretion locally. Here, we differentiated MC3T3-E1 cells toward osteocyte-like cells expressing and secreting FGF23. Treatment with 10-6 M 25(OH)D resulted in conversion of 25(OH)D to 150 pmol/L 1,25(OH)2D3 and increased FGF23 expression and secretion, but the converted amount of 1,25(OH)2D3 was insufficient to trigger an FGF23 response, so the effect on FGF23 was most likely directly caused by 25(OH)D. Interestingly, combining phosphate with 25(OH)D resulted in a synergistic increase in FGF23 expression and secretion, likely due to activation of additional signaling pathways by phosphate. Blockage of the vitamin D receptor (VDR) only partially abolished the effects of 25(OH)D or 25(OH)D combined with phosphate on Fgf23, while completely inhibiting the upregulation of cytochrome P450 family 24 subfamily A member 1 (Cyp24a1), encoding for 24-hydroxylase. RNA sequencing and in silico analyses showed that this could potentially be mediated by the nuclear receptors Retinoic Acid Receptor β (RARB) and Estrogen Receptor 2 (ESR2). Taken together, we demonstrate that osteocytes are able to convert 25(OH)D to 1,25(OH)2D3, but this is insufficient for FGF23 activation, implicating a direct effect of 25(OH)D in the regulation of FGF23, which occurs at least partially independent from its cognate VDR. Moreover, phosphate and 25(OH)D synergistically increase expression and secretion of FGF23, which warrants investigating consequences in patients receiving a combination of vitamin D analogues and phosphate supplements. These observations help us to further understand the complex relations between phosphate, vitamin D, and FGF23.</p

Biophysical Measurements of Cells, Microtubules, and DNA with an Atomic Force Microscope

Atomic force microscopes (AFMs) are ubiquitous in research laboratories and have recently been priced for use in teaching laboratories. Here we review several AFM platforms (Dimension 3000 by Digital Instruments, EasyScan2 by Nanosurf, ezAFM by Nanomagnetics, and TKAFM by Thorlabs) and describe various biophysical experiments that could be done in the teaching laboratory using these instruments. In particular, we focus on experiments that image biological materials and quantify biophysical parameters: 1) imaging cells to determine membrane tension, 2) imaging microtubules to determine their persistence length, 3) imaging the random walk of DNA molecules to determine their contour length, and 4) imaging stretched DNA molecules to measure the tensional force.Comment: 29 page preprint, 7 figures, 1 tabl

Compounded perturbations in coastal areas: contrasting responses to nutrient enrichment and the regime of storm-related disturbance depend on life-history traits

1. Natural systems are exposed to compounded perturbations, whose changes in temporal variance can be as important as those in mean intensity for shaping the structure of assemblages. Specifically, climate-related physical disturbances and nutrient inputs due to natural and/or anthropogenic activities occur concomitantly, but experimental tests of the simultaneous effects of changes in the regime of more than one perturbation are generally lacking. Filling this gap is the key to understand ecological responses of natural assemblages to climate-related change in the intensity and temporal patterning of physical disturbance combined with other global stressors. 2. Responses to factorial manipulations of nutrient enrichment, mean intensity and temporal variability in storm-like mechanical disturbance were examined, using benthic assemblages of tide-pools as model system. 3. Response variables were mean abundance values and temporal variances of taxa with different life-traits. Consistent negative effects of disturbance intensity were observed for the mean cover of long-living taxa (algal canopies and the polychaete Sabellaria alveolata), whose temporal fluctuations were also reduced by more severe mechanical stress. More resilient taxa (ephemeral algae, mostly green of the genus Ulva) increased under enriched conditions, particularly when low-intensity events were irregularly applied over time. Opposite effects of disturbance intensity depending on nutrient availability occurred on filamentous algae (e.g. red of the genus Ceramium). This was probably due to the fact that, although nutrient enrichment stimulated the abundance of both algal groups, when this condition was combined with relatively mild physical disturbance the competitively superior ephemeral green algae tended to become dominant over filamentous red algae. The same did not occur under high intensity of disturbance since it likely damaged large, foliose fronds of Ulva-like forms more than small, filamentous fronds of Ceramium-like forms. Grazers were positively affected by nutrients, likely responding indirectly to more food available. 4. A direct relationship between the mean abundance of most organisms and their temporal fluctuations was documented. However, all organisms persisted throughout the study, even under experimental conditions associated to the largest temporal variation in their abundance, likely due to their ability to resist to/quickly recover from, the applied perturbations. Therefore, in systems with great recovery abilities of dominant organisms (e.g. rocky intertidal, grasslands), effects of traits of the regime of disturbance and nutrient enrichment may modulate the fluctuations of populations not through the elimination and substitution of species, but through changes in relative abundances of the same species. This contrasts with the theory that temporal variation in abundance would be directly related to the risk of local extinction. Present findings enable more accurate predictions of the consequences of climatic and non-climatic scenarios on the biodiversity of marine and terrestrial systems sharing analogous functional traits of organisms. Future more intense physical disturbances are expected to exert negative effects on slow-growing/recovering species (e.g. habitat-formers) irrespectively of the temporal patterning of the same disturbances and nutrient inputs. On the contrary, more resistant species (e.g. encrusting algae on rocky shores or below-ground vegetation in grasslands) are expected to benefit from intense physical disturbance. Species whose abundance is more directly related to the availability of nutrients (e.g. filamentous and ephemeral algae or herbs) are expected to generally increase under enriched conditions, but their ability to eventually become dominant would depend on their ability to grow fast and attain cover large enough to overwhelm any possible control of concomitant disturbance intensity on their abundance. If, such as in the present examined system, virtually all organisms can persist, over the temporal scale of the experiment, under any combination of physical disturbance and nutrient availability, the resulting overall diversity is not predicted to change drastically. Nevertheless, low-intensity events evenly distributed and high-intensity events irregularly distributed appear as the conditions supporting the highest richness of taxa, independently of the availability of nutrients

Organic phosphate but not inorganic phosphate regulates Fgf23 expression through MAPK and TGF-ꞵ signaling

One of the main regulators of phosphate homeostasis is fibroblast growth factor 23 (FGF23), secreted by osteocytes. The effects of organic versus inorganic dietary phosphate on this homeostasis are unclear. This study used MC3T3-E1 FGF23-producing cells to examine the transcriptomic responses to these phosphates. Most importantly, the expression and secretion of FGF23 were only increased in response to organic phosphate. Gene ontology terms related to a response to environmental change were only enriched in cells treated with organic phosphate while cells treated with inorganic phosphate were enriched for terms associated with regulation of cellular phosphate metabolism. Inhibition of MAPK signaling diminished the response of Fgf23 to organic phosphate, suggesting it activates FGF23. TGF-β signaling inhibition increased Fgf23 expression after the addition of organic phosphate, while the negative TGF-β regulator Skil decreased this response. In summary, the observed differential response of FGF23-producing to phosphate types may have consequences for phosphate homeostasis.</p

Advances in MASELTOV – Serious Games in a Mobile Ecology of Services for Social Inclusion and Empowerment of Recent Immigrants

Immigration imposes a range of challenges with the risk of social exclusion from the information society (Halfman 1998), such as, getting into communication with the local society and understanding the culture of their host nation. Failure to address these challenges can lead to difficulties in the frame of integrating into the society of the host country, leading to fragmented communities and a range of social issues. As part of a comprehensive suite of services for immigrants, the European project seeks to provide both practical tools and learning services via mobile devices, providing a readily usable resource for immigrants. We introduce recent results, such as the game-based learning aspect of the MASELTOV project is introduced, with the rationale behind its design presented. In doing so, the benefits and implications of mobile platforms and emergent data capture techniques for game-based learning are discussed, as are methods for putting engaging gameplay at the forefront of the experience whilst relying on rich data capture and analysis to provide an effective learning solution