Visualisation of fingermarks and grab impressions on fabrics. Part 1: gold/zinc vacuum metal deposition

Vacuum metal deposition (VMD) is a highly sensitive technique originally introduced for detecting latent fingermarks on smooth non-porous surfaces such as carrier bags, plastics and glass. The current study explores whether VMD can be used in the examination of clothing from physical and sexual assault cases in order to visualise identifiable fingermark ridge detail and/or palmar flexion crease detail, thus allowing potential areas to be indicated for DNA swabbing and/or to determine the sequence of events. Four different fabrics were utilised during this study – nylon, polyester, polycotton and cotton, along with 15 donors who ranged in their age and propensity to leave fingermarks, from good to medium to poor as determined by results obtained from test runs using paper and plastic carrier bags processed with VMD. Once samples were collected they were kept for a determined time (1, 2, 3, 4, 5, 6, 7, 14, 21 or 28 days) and then treated using the gold/zinc metal VMD process. From the results, it appears that greater ridge detail is visible on the smoother non-porous fabrics, such as nylon whereas on rougher porous fabrics, such as cotton, only empty prints and impressions, rather than any ridge details, were visible. All fabrics did however allow the development of touch marks that could be targeted for DNA taping thus potentially leading to a DNA profile and possible identification of a suspect

Visualisation of fingermarks and grab impressions on dark fabrics using silver vacuum metal deposition

Vacuum metal deposition (VMD) involves the thermal evaporation of metal (silver) in a vacuum, resulting in a uniform layer being deposited on the specimen being treated. This paper examines the use of silver on dark fabrics, thus offering a simpler operation and more obvious colouration to that of the traditional use of gold and zinc metals which must be evaporated separately. The aim of this study was to investigate the effect of fabric type, donor, mark age and method of fingermark deposition on the quality of marks visualised using silver VMD. This was achieved by collecting fingermark deposits from fifteen donors, of both sexes and various ages, by a grab or a press method. Four different fabrics: satin, polyester, polycotton and cotton were studied over a 10 day timeline of 1, 2, 3, 4, 5, 6, 7, 14, 21 and 28 + days. It was found that satin and polyester gave the most positive results, with polyester often producing excellent ridge detail. Cotton and polycotton were less successful with no ridge detail being observed. The donors also had an observable effect on the results obtained probably due to variations in secretions produced or pressures applied during specimen collection. The age of the mark or the method of mark deposition had little influence on the results obtained. Silver VMD is a viable process for visualising marks on certain dark fabrics and has the advantage over gold/zinc VMD in that the marks visualised are light in colour which contrasts well against the dark background

Colorectal Cancer

This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of colorectal cancer, including etiology, screening, pathology, staging, and treatment.https://escholarship.umassmed.edu/cancer_concepts/1015/thumbnail.jp

Enumeration and phenotypical analysis of distinct dendritic cell subsets in psoriatic arthritis and rheumatoid arthritis

Dendritic cells (DCs) comprise heterogeneous subsets of professional antigen-presenting cells, linking innate and adaptive immunity. Analysis of DC subsets has been hampered by a lack of specific DC markers and reliable quantitation assays. We characterised the immunophenotype and functional characteristics of psoriatic arthritis (PsA)-derived and rheumatoid arthritis (RA)-derived myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) to evaluate their potential role in arthritis. Circulating peripheral blood (PB) pDC numbers were significantly reduced in PsA patients (P = 0.0098) and RA patients (P = 0.0194), and mDCs were significantly reduced in RA patients (P = 0.0086) compared with healthy controls. The number of circulating mDCs in RA PB was significantly inversely correlated to C-reactive protein (P = 0.021). The phenotype of both DC subsets in PsA PB and RA PB was immature as compared with healthy controls. Moreover, CD62L expression was significantly decreased on both mDCs (PsA, P = 0.0122; RA, P = 0.0371) and pDCs (PsA, P = 0.0373; RA, P = 0.0367) in PB. Both mDCs and pDCs were present in PsA synovial fluid (SF) and RA SF, with the mDC:pDC ratio significantly exceeding that in matched PB (PsA SF, P = 0.0453; RA SF, P = 0.0082). pDCs isolated from RA SF and PsA SF displayed an immature phenotype comparable with PB pDCs. RA and PsA SF mDCs, however, displayed a more mature phenotype (increased expression of CD80, CD83 and CD86) compared with PB mDCs. Functional analysis revealed that both SF DC subsets matured following toll-like receptor stimulation. pDCs from PB and SF produced interferon alpha and tumour necrosis factor alpha on TLR9 stimulation, but only SF pDCs produced IL-10. Similarly, mDCs from PB and SF produced similar tumour necrosis factor alpha levels to TLR2 agonism, whereas SF mDCs produced more IL-10 than PB controls. Circulating DC subset numbers are reduced in RA PB and PsA PB with reduced CD62L expression. Maturation is incomplete in the inflamed synovial compartment. Immature DCs in SF may contribute to the perpetuation of inflammation via sampling of the inflamed synovial environment, and in situ presentation of arthritogenic antigen

Clinical and Financial Impact of Readmissions Following Colorectal Resection: An Analysis of Predictors, Outcomes, and Cost

Background: Following passage of the Affordable Care Act, 30day readmissions have come under greater scrutiny, with penalties levied for higher than expected readmission rates. We examined risk factors for 30day readmission following colorectal resection and evaluated the financial impact of readmissions on the healthcare system. Methods: The University HealthSystem Consortium Clinical Database was queried for adults undergoing colorectal surgery for cancer, diverticular disease, inflammatory bowel disease, or benign tumors from 2008-2012. Predictors of 30day readmission were assessed with multivariable logistic regression. Additional endpoints included time to readmission, readmission diagnosis, readmission length of stay (LOS), and readmission cost. Results: A total of 70,484 patients met study inclusion criteria, 13.7% (9,632) of which were readmitted within 30 days of discharge. The strongest independent predictors of readmission were: LOS ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and non-home discharge (OR 1.68; 95% CI 1.57-1.81). Of those readmitted, half occurred within 7 days, 13% required ICU care, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was over two times higher ($26,917 v.$13,817; p\u3c0.001) than non-readmitted patients. Compared with late readmissions, those readmitted within 7 days were more likely to have a reoperation (8% v. 4%, p\u3c0.001), be admitted to the ICU (14% vs. 12%, p\u3c0.001), and had a longer median readmission LOS (5d vs. 4d, p\u3c0.001). CONCLUSIONS: 30-day readmissions following colorectal resection occur frequently and incur a significant financial burden on the healthcare system. Highest-risk patients include those with longer LOS, stoma, and non-home discharge. Future studies aimed at targeted interventions may reduce readmissions and curb escalating healthcare costs

A New Look at the Volume and Outcome Relationship in Surgery for Colorectal Cancer

Purpose: Surgeon and hospital factors have a significant impact on treatment outcomes for colorectal cancer (CRC). Limited research has been done to assess cost and quality of treatment by surgeon-volume. We aim to identify the surgeon factors impacting cost and quality of surgical care for CRC. Methods: The University HealthSystem Consortium database was queried for patients who underwent colon resection for cancer from 2008 to 2012. Patients were grouped by surgeon-volume. Outcomes of interest were postoperative complications, ICU admission, readmission rate, inpatient hospital length of stay (LOS) and direct hospital cost. Average surgeon-volume per year was categorized as high (\u3e6) or low (16) based on the distribution of surgeon-volume. Results: 29,972 patients over age 18 were identified for inclusion. 25,426 underwent resection by high-volume surgeons (HVS) and 4,547 by low-volume surgeons (LVS). LVS were more likely to admit patients to the ICU than HVS (21% v 33%, p Conclusions: Surgeons who perform greater than 6 colectomies per year for colon cancer are more likely to use laparoscopy, less likely to admit patients to the ICU, have lower complication and readmission rates, and shorter LOS. Hospital cost is significantly lower in patients operated on by high volume surgeons. As health care costs continue to escalate and health care reform efforts gain momentum, factors leading to high-quality, cost-effective care need to be identified

The NOX toolbox: validating the role of NADPH oxidases in physiology and disease

Reactive oxygen species (ROS) are cellular signals but also disease triggers; their relative excess (oxidative stress) or shortage (reductive stress) compared to reducing equivalents are potentially deleterious. This may explain why antioxidants fail to combat diseases that correlate with oxidative stress. Instead, targeting of disease-relevant enzymatic ROS sources that leaves physiological ROS signaling unaffected may be more beneficial. NADPH oxidases are the only known enzyme family with the sole function to produce ROS. Of the catalytic NADPH oxidase subunits (NOX), NOX4 is the most widely distributed isoform. We provide here a critical review of the currently available experimental tools to assess the role of NOX and especially NOX4, i.e. knock-out mice, siRNAs, antibodies, and pharmacological inhibitors. We then focus on the characterization of the small molecule NADPH oxidase inhibitor, VAS2870, in vitro and in vivo, its specificity, selectivity, and possible mechanism of action. Finally, we discuss the validation of NOX4 as a potential therapeutic target for indications including stroke, heart failure, and fibrosis

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation