Effects of Cardiac Structural Remodelling During Heart Failure on Cardiac Excitation – Insights from a Heterogeneous 3D Model of the Rabbit Atria

Heart failure is a leading cause of morbidity and mortality in the western world. One of the effects of heart failure is the structural remodelling of cardiac tissue, including tissue dilation and development of fibrosis. It is therefore important to study these changes and their effect on cardiac activity, in order to gain a better understanding of the underlying mechanisms in arrhythmogenesis, which will hopefully enable us to develop better treatments for heart failure. In this study we developed biophysically detailed models of the rabbit atria for normal and heart failure conditions. These models were used to study the effects of structural remodelling of heart failure on cardiac excitation wave conduction. Anatomical reconstructions of the control and heart failure hearts were based on contrast enhanced micro-CT imaging. Fibre orientation was extracted from the control and heart failure datasets. Effects of heart failure geometry on the activation pattern of atrial excitation waves were analyzed. It was found that atrial activation time increased from the control to the heart failure case in both isotropic and anisotropic conditions, which is attributed primarily to the dilation of tissue caused by heart failure

Long distance biotic dispersal of tropical seagrass seeds by marine mega-herbivores

Terrestrial plants use an array of animals as vectors for dispersal, however little is known of biotic dispersal of marine angiosperms such as seagrasses. Our study in the Great Barrier Reef confirms for the first time that dugongs (Dugong dugon) and green sea turtles (Chelonia mydas) assist seagrass dispersal. We demonstrate that these marine mega-herbivores consume and pass in faecal matter viable seeds for at least three seagrass species (Zostera muelleri, Halodule uninervis and Halophila decipiens). One to two seagrass seeds per g DW of faecal matter were found during the peak of the seagrass reproductive season (September to December), with viability on excretion of 9.13% ± 4.61% (SE). Using population estimates for these mega-herbivores, and data on digestion time (hrs), average daily movement (km h) and numbers of viable seagrass seeds excreted (per g DW), we calculated potential seagrass seed dispersal distances. Dugongs and green sea turtle populations within this region can disperse >500,000 viable seagrass seeds daily, with a maximum dispersal distance of approximately 650 km. Biotic dispersal of tropical seagrass seeds by dugongs and green sea turtles provides a large-scale mechanism that enhances connectivity among seagrass meadows, and aids in resilience and recovery of these coastal habitats

The novel design of an energy efficient superconductor-based series reactor for installation at a grid connected research site

This paper proposes the development of a superconducting series reactor (SSR) as an alternative to traditionally employed technologies and superconducting fault current limiters when managing fault levels on the electrical power grid. By utilizing superconducting tape, which has negligible resistance, in the construction of a series reactor, it is proposed that fault level mitigation could be achieved in a more energy efficient manner. Once constructed the SSR will be installed and tested at a grid-connected power engineering research site, and the proposed impact of this installation is firstly simulated using Reticmaster® power system simulation software. Design parameters for the prototype SSR are then calculated enabling the total cost of the modifications and prototype SSR to be determined. A desktop SSR was also constructed and tested as a pre-cursor to the prototype construction to confirm functionality and design and was found to be up to four times more energy efficient as the equivalent copper reactor. Finally, the calorimetric method of power loss determination was investigated and experimentally shown to be a viable alternative to the traditional electrical method of power loss determination. In the past, the relatively cheap cost of electricity in South Africa had favoured the installation of poor power efficiency devices that required a lower initial capital investment. With increasing energy costs and a focus on carbon emission reductions, the development of the SSR augurs a new era in power system engineering in which designs are proposed considering both total lifecycle costs and energy efficiency. Design proposal for the first superconducting power device in Africa Alternative to less efficient fault current management technologies currently employed Construction and testing of a desktop superconducting series reactor Verification of the calorimetric method for power loss determination

A Prospective Longitudinal Study of the Clinical Outcomes from Cryptococcal Meningitis following Treatment Induction with 800 mg Oral Fluconazole in Blantyre, Malawi

Introduction: Cryptococcal meningitis is the most common neurological infection in HIV infected patients in Sub Saharan Africa, where gold standard treatment with intravenous amphotericin B and 5 flucytosine is often unavailable or difficult to administer. Fluconazole monotherapy is frequently recommended in national guidelines but is a fungistatic drug compromised by uncertainty over optimal dosing and a paucity of clinical end-point outcome data. Methods: From July 2010 until March 2011, HIV infected adults with a first episode of cryptococcal meningitis were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Patients were treated with oral fluconazole monotherapy 800 mg daily, as per national guidelines. ART was started at 4 weeks. Outcomes and factors associated with treatment failure were assessed 4, 10 and 52 weeks after fluconazole initiation. Results: Sixty patients were recruited. 26/60 (43%) died by 4 weeks. 35/60 (58.0%) and 43/56 (77%) died or failed treatment by 10 or 52 weeks respectively. Reduced consciousness (Glasgow Coma Score ,14 of 15), moderate/severe neurological disability (modified Rankin Score .3 of 5) and confusion (Abbreviated Mental Test Score ,8 of 10) were all common at baseline and associated with death or treatment failure. ART prior to recruitment was not associated with better outcomes. Conclusions: Mortality and treatment failure from cryptococcal meningitis following initiation of treatment with 800 mg oral fluconazole is unacceptably high. To improve outcomes, there is an urgent need for better therapeutic strategies and point-of-care diagnostics, allowing earlier diagnosis before development of neurological deficit

Ischemic stroke as a complication of cryptococcal meningitis and immune reconstitution inflammatory syndrome: a case report.

BACKGROUND: Cryptococcal meningitis remains the leading cause of adult meningitis in Sub-Saharan Africa. Immune Reconstitution Inflammatory Syndrome (IRIS) following anti-retroviral therapy (ART) initiation is an important complication. Here we report the first documented case of a IRIS reaction presenting as an ischemic stroke. CASE PRESENTATION: A 38 year old newly diagnosed HIV-infected, ART naive Malawian male presented to a tertiary referral hospital in Blantyre, Malawi with a 2 week history of headache. A diagnosis of cryptococcal meningitis was made and the patient was started on 1200 mg fluconazole once daily and flucytosine 25 mg/kg four times daily as part of the Advancing Cryptococcal Treatment for Africa (ACTA) clinical trial. There was an initial clinical and microbiological response to anti-fungal treatment and anti-retroviral therapy was started at week 4. The patient re-presented 16 days later with recurrence of headache, fever, and a sudden onset of left sided weakness in the context of rapid immune reconstitution; peripheral CD4 count had increased from a baseline of 29 cells/μl to 198 cells/μl. Recurrence of cryptococcal meningitis was excluded through CSF examination and fungal culture. Magnetic Resonance Imaging (MRI) of the brain demonstrated multi-focal DWI (diffusion weighted imaging) positive lesions consistent with an ischemic stroke. Given the temporal relationship to ART initiation, these MRI findings in the context of sterile CSF with raised CSF protein and a rapid immune reconstitution, following an earlier favorable response to treatment is most consistent with a paradoxical Immune Reconstitution Inflammatory Syndrome. CONCLUSIONS: Stroke is an increasing cause of morbidity and mortality amongst HIV infected persons. Ischemic stroke is a recognized complication of cryptococcal meningitis in the acute phase and is thought to be mediated by an infectious vasculitis. This is the first time an ischemic stroke has been described as part of a paradoxical IRIS reaction. This report adds to the spectrum of clinical IRIS presentations recognized and highlights to clinicians the potential complications encountered at ART initiation in severely immunocompromised patients

Six-Month Mortality among HIV-Infected Adults Presenting for Antiretroviral Therapy with Unexplained Weight Loss, Chronic Fever or Chronic Diarrhea in Malawi.

In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART). We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy

Transcriptomic and Epigenetic Regulation of Disuse Atrophy and the Return to Activity in Skeletal Muscle

Physical inactivity and disuse are major contributors to age-related muscle loss. Denervation of skeletal muscle has been previously used as a model with which to investigate muscle atrophy following disuse. Although gene regulatory networks that control skeletal muscle atrophy after denervation have been established, the transcriptome in response to the recovery of muscle after disuse and the associated epigenetic mechanisms that may function to modulate gene expression during skeletal muscle atrophy or recovery have yet to be investigated. We report that silencing the tibialis anterior muscle in rats with tetrodotoxin (TTX)—administered to the common peroneal nerve—resulted in reductions in muscle mass of 7, 29, and 51% with corresponding reductions in muscle fiber cross-sectional area of 18, 42, and 69% after 3, 7, and 14 d of TTX, respectively. Of importance, 7 d of recovery, during which rodents resumed habitual physical activity, restored muscle mass from a reduction of 51% after 14 d TTX to a reduction of only 24% compared with sham control. Returning muscle mass to levels observed at 7 d TTX administration (29% reduction). Transcriptome-wide analysis demonstrated that 3714 genes were differentially expressed across all conditions at a significance of P ≤ 0.001 after disuse-induced atrophy. Of interest, after 7 d of recovery, the expression of genes that were most changed during TTX had returned to that of the sham control. The 20 most differentially expressed genes after microarray analysis were identified across all conditions and were cross-referenced with the most frequently occurring differentially expressed genes between conditions. This gene subset included myogenin (MyoG), Hdac4, Ampd3, Trim63 (MuRF1), and acetylcholine receptor subunit α1 (Chrna1). Transcript expression of these genes and Fboxo32 (MAFbx), because of its previously identified role in disuse atrophy together with Trim63 (MuRF1), were confirmed by real-time quantitative RT-PCR, and DNA methylation of their promoter regions was analyzed by PCR and pyrosequencing. MyoG, Trim63 (MuRF1), Fbxo32 (MAFbx), and Chrna1 demonstrated significantly decreased DNA methylation at key time points after disuse-induced atrophy that corresponded with significantly increased gene expression. Of importance, after TTX cessation and 7 d of recovery, there was a marked increase in the DNA methylation profiles of Trim63 (MuRF1) and Chrna1 back to control levels. This also corresponded with the return of gene expression in the recovery group back to baseline expression observed in sham-operated controls. To our knowledge, this is the first study to demonstrate that skeletal muscle atrophy in response to disuse is accompanied by dynamic epigenetic modifications that are associated with alterations in gene expression, and that these epigenetic modifications and gene expression profiles are reversible after skeletal muscle returns to normal activity

Potential health impacts of heavy metals on HIV-infected population in USA.

Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes

Modelling the impact of tidal range energy on species communities

Tidal energy has the potential to form a key component of the energy production in a number of countries, including the UK. Nonetheless, the deployment of tidal energy systems is associated with potential environmental impacts as prime resource sites often coincide with unique ecosystems inhabited by sensitive organisms. Previous studies have generally focused on the hydrodynamic impact of tidal energy schemes, i.e. how schemes alter the flow dynamics and sedimentary transport processes. Whilst these efforts are key in understanding environmental impacts, there is no straightforward step for translating sediment to faunal changes. Species distribution models offer methods to quantitatively predict certain possible impacts of tidal energy extraction. The River Severn is a distinguished candidate region for tidal energy in the UK featuring sites under stringent ecological protection regulations. We examine the impact of a proposed Severn tidal barrage on 14 species via the linking of hydrodynamic modelling to species distribution models. Through a selection of species that are linked via a simple food web system we extrapolate changes in prey species to the respective predator species. We show that species at lower trophic levels would be adversely affected by the barrage, but higher trophic level organisms increase in possible habitable area. Once food web relationships are acknowledged this increase in habitat area decreases, but is still net positive. Overall, all 14 species were affected, with most gaining in distribution area, and only four losing distribution area within the Severn Estuary. We conclude that a large-scale tidal barrage may have detrimental and complex impacts on species distribution, altering food web dynamics and altering food availability in the Severn Estuary. The methodology outlined herein can be transferred to the assessment and optimisation of prospective projects globally to aide in the sustainable introduction of the technology