A Medical Red Herring: Cardiomyopathy presenting as Acute Liver Injury

Introduction: Heart failure secondary to cardiomyopathy is a known cause of acute liver injury and in severe cases even progression to liver failure. In the setting of severe transaminase elevation, patients may often be misdiagnosed with primary liver injury secondary to acute viral hepatitis, or drug-induced liver injury. Case Presentation: 32-year-old female 5 months post-partum with no past medical history presented with a 2-week history of nausea, vomiting, abdominal pain, and general malaise. Initial laboratory studies revealed acute liver injury with ALT of 2086, AST of 1880, alkaline phosphatase of 400, an INR of 1.62. She denied any alcohol use, acetaminophen use, or intravenous drug use. On physical exam she had trace lower extremity edema, clear breath sounds bilaterally, strong peripheral pulses, and warm extremities. Her viral hepatitis screen was negative. Abdominal ultrasound showed increased echogenicity, mild ascites, and prominent hepatic veins. Echocardiography was completed which showed an ejection fraction of 21%, hypokinesis of the left ventricle, and severely reduced right ventricular function. Shortly thereafter she developed cardiogenic shock requiring inotropic agents, placement of Impella device, and was eventually listed for a heart transplant. Conclusion: This case highlights the importance of assessing cardiac function in patients with otherwise unexplained liver injury. In the absence of left ventricular symptoms and significantly elevated serum transaminases, patients may undergo in-depth liver evaluation prior to assessment of cardiac function. Prompt recognition of cardiocirculatory failure in such patients may expedite further cardiac workup and timely use of inotropes, hemodynamic support devices, and cardiac transplant evaluation.https://scholarlycommons.henryford.com/merf2020caserpt/1095/thumbnail.jp

Evolutionary History and Novel Biotic Interactions Determine Plant Responses to Elevated CO2 and Nitrogen Fertilization

A major frontier in global change research is predicting how multiple agents of global change will alter plant productivity, a critical component of the carbon cycle. Recent research has shown that plant responses to climate change are phylogenetically conserved such that species within some lineages are more productive than those within other lineages in changing environments. However, it remains unclear how phylogenetic patterns in plant responses to changing abiotic conditions may be altered by another agent of global change, the introduction of non-native species. Using a system of 28 native Tasmanian Eucalyptus species belonging to two subgenera, Symphyomyrtus and Eucalyptus, we hypothesized that productivity responses to abiotic agents of global change (elevated CO2 and increased soil N) are unique to lineages, but that novel interactions with a nonnative species mediate these responses. We tested this hypothesis by examining productivity of 1) native species monocultures and 2) mixtures of native species with an introduced hardwood plantation species, Eucalyptus nitens, to experimentally manipulated soil N and atmospheric CO2. Consistent with past research, we found that N limits productivity overall, especially in elevated CO2 conditions. However, monocultures of species within the Symphyomyrtus subgenus showed the strongest response to N (gained 127% more total biomass) in elevated CO2 conditions, whereas those within the Eucalyptus subgenus did not respond to N. Root:shoot ratio (an indicator of resource use) was on average greater in species pairs containing Symphyomyrtus species, suggesting that functional traits important for resource uptake are phylogenetically conserved and explaining the phylogenetic pattern in plant response to changing environmental conditions. Yet, native species mixtures with E. nitens exhibited responses to CO2 and N that differed from those of monocultures, supporting our hypothesis and highlighting that both plant evolutionary history and introduced species will shape community productivity in a changing world

Real-time label-free imaging of living crystallization-driven self-assembly

The living crystallization-driven self-assembly (CDSA) of semicrystalline block copolymers is a powerful method for the bottom-up construction of uniform polymer microstructures with complex hierarchies. Improving our ability to engineer such complex particles demands a better understanding of precisely how to control the self-assembly process. Here, we apply interferometric scattering microscopy (iSCAT) to deliver real-time observation of individual poly(caprolactone)-based platelet growth. This label-free method enables us to map the role of key reaction parameters on platelet growth rate, size, and morphology. Furthermore, iSCAT provides a contrast mechanism for studying multi-layer platelets, offering new insights into the distribution of polymer compositions within a single platelet

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory

Background There have been recent important advances in conceptualizing and operationalizing involvement in health research and health-care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine – normalized – way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization – definition, enrolment, enactment and appraisal. Method Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory. Findings Twenty-six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co-governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals. Conclusion To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co-governance and dissemination of research processes and findings.This project was funded by the HealthResearch Board, Dublin, Ireland