A standardised nutritional drink as a test meal for the 13 C mixed triglyceride breath test for pancreatic exocrine insufficiency:A randomised, two-arm crossover comparative study

BACKGROUND: The 13 C mixed triglyceride breath test (13 C MTGT) is a diagnostic test for pancreatic exocrine insufficiency (PEI). It is poorly standardised with much heterogeneity of the test meal, the commonest being toast and butter. A standardised oral nutritional supplement that could be easily transported, stored and made up would be valuable for making this test accessible outside of specialist centres.METHODS: A prospective, randomised, two-arm crossover study of different test meals was carried out in 14 healthy controls. The 13 C MTGT was performed in identical conditions on two separate days. Two test meals were given in random order, either standard (toast and butter) or novel (oral nutritional supplement), with 250 mg of 13 C-labelled mixed triglyceride incorporated. Breath samples were taken postprandially to calculate cumulative percentage dose recovery (cPDR) of 13 C at 6 h.RESULTS: All 14 participants completed both arms of the study with no protocol deviations. The mean cPDR was 39.39% (standard deviation [SD] 5.19) for the standard test meal and 39.93% (SD 5.20) for the novel test meal. A one-way repeated measures analysis of variance (ANOVA) found no significant difference in cPDR between the two meals, F(1, 13) = 0.18, p = 0.68 (minimum detectable difference of 0.81 at 80% power).CONCLUSION: This study demonstrates that a standardised oral nutritional supplement can be used without compromising 13 C recovery. Using this test meal provides a standardised dietary stimulus to the pancreas, avoiding possible variation in quantity of dietary components with other test meals. Further, the ease of use of this method would help establish the 13 C MTGT test more widely.</p

Horizontal Vortex Tubes near a Simulated Tornado: Three-Dimensional Structure and Kinematics

Supercell thunderstorms can produce a wide spectrum of vortical structures, ranging from midlevel mesocyclones to small-scale suction vortices within tornadoes. A less documented class of vortices are horizontally-oriented vortex tubes near and/or wrapping about tornadoes, that are observed either visually or in high-resolution Doppler radar data. In this study, an idealized numerical simulation of a tornadic supercell at 100 m grid spacing is used to analyze the three-dimensional (3D) structure and kinematics of horizontal vortices (HVs) that interact with a simulated tornado. Visualizations based on direct volume rendering aided by visual observations of HVs in a real tornado reveal the existence of a complex distribution of 3D vortex tubes surrounding the tornadic flow throughout the simulation. A distinct class of HVs originates in two key regions at the surface: around the base of the tornado and in the rear-flank downdraft (RFD) outflow and are believed to have been generated via surface friction in regions of strong horizontal near-surface wind. HVs around the tornado are produced in the tornado outer circulation and rise abruptly in its periphery, assuming a variety of complex shapes, while HVs to the south-southeast of the tornado, within the RFD outflow, ascend gradually in the updraft.The first author is supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Grant number 88881.129505/2016-01 of the “Programa de Doutorado Pleno no Exterior” (DPE – 3830) under the Brazilian Ministry of Education. The second author is supported NSF Grant AGS-1261776 and NOAA VORTEX-SE Grant NA17OAR4590188. Open Access fees paid for in whole or in part by the University of Oklahoma Libraries.Ye

Palmitoylation of Desmoglein 2 Is a Regulator of Assembly Dynamics and Protein Turnover.

Desmosomes are prominent adhesive junctions present between many epithelial cells as well as cardiomyocytes. The mechanisms controlling desmosome assembly and remodeling in epithelial and cardiac tissue are poorly understood. We recently identified protein palmitoylation as a mechanism regulating desmosome dynamics. In this study, we have focused on the palmitoylation of the desmosomal cadherin desmoglein-2 (Dsg2) and characterized the role that palmitoylation of Dsg2 plays in its localization and stability in cultured cells. We identified two cysteine residues in the juxtamembrane (intracellular anchor) domain of Dsg2 that, when mutated, eliminate its palmitoylation. These cysteine residues are conserved in all four desmoglein family members. Although mutant Dsg2 localizes to endogenous desmosomes, there is a significant delay in its incorporation into junctions, and the mutant is also present in a cytoplasmic pool. Triton X-100 solubility assays demonstrate that mutant Dsg2 is more soluble than wild-type protein. Interestingly, trafficking of the mutant Dsg2 to the cell surface was delayed, and a pool of the non-palmitoylated Dsg2 co-localized with lysosomal markers. Taken together, these data suggest that palmitoylation of Dsg2 regulates protein transport to the plasma membrane. Modulation of the palmitoylation status of desmosomal cadherins can affect desmosome dynamics

Inpatient GHB withdrawal management in an inner-city hospital in Sydney, Australia: a retrospective medical record review

Rationale: Regular consumption of gamma-hydroxybutyrate (GHB) may result in a dependence syndrome that can lead to withdrawal symptoms. There are limited data on medications to manage GHB withdrawal. Objectives: To examine characteristics associated with delirium and discharge against medical advice (DAMA), in the context of implementing a GHB withdrawal management protocol at an inner-city hospital in 2020. Methods: We retrospectively reviewed records (01 January 2017–31 March 2021), and included admissions that were ≥ 18 years of age, admitted for GHB withdrawal, and with documented recent GHB use. Admissions were assessed for demographics, medications administered, features of delirium, ICU admission, and DAMA. Exploratory analyses were conducted to examine factors associated (p < 0.2) with features of delirium and DAMA. Results: We identified 135 admissions amongst 91 patients. Medications administered included diazepam (133 admissions, 98.5%), antipsychotics (olanzapine [70 admissions, 51.9%]), baclofen (114 admissions, 84%), and phenobarbital (8 admissions, 5.9%). Features of delirium were diagnosed in 21 (16%) admissions. Delirium was associated with higher daily GHB consumption prior to admission, while duration of GHB use, time from presentation to first dose of diazepam, and concomitant methamphetamine use were inversely associated with delirium. DAMA occurred amongst 41 (30%) admissions, and was associated with a longer time from presentation to first dose of baclofen, while being female and receiving a loading dose of diazepam were inversely associated. Conclusions: This study adds to the literature in support of the safety and feasibility of diazepam and baclofen for the management of GHB withdrawal. Prospective, randomised trials are required

Comprehensive, long-term evaluation of pancreatic exocrine insufficiency after pancreatoduodenectomy

AIMS: Treatment of pancreatic exocrine insufficiency (PEI) following pancreatoduodenectomy (PD) improves quality of life, clinical outcomes, and survival. However, diagnosing PEI following PD is challenging owing to the difficulties with current tests and often non-specific symptoms. This work aims to quantify the true rate of long-term PEI in patients following a PD.METHODS: Patients underwent a PEI screen approximately one to two years following PD for oncologic indication, including the 13C Mixed triglyceride breath test (13CMTGT), faecal elastase 1 (FE-1) and the PEI Questionnaire (PEI-Q). Four reviewers with expertise in PEI reviewed the results blinded to other decisions to classify PEI status; disagreements were resolved on consensus.RESULTS: 26 patients were recruited. Of those with valid test results, these were indicative of PEI based on pre-specified thresholds for 60 % (15/25) for the 13CMTGT, 82 % (18/22) for FE-1, and 88 % (22/25) for the PEI-Q. After discussion between reviewers, the consensus PEI prevalence was 81 % (95 % CI: 61-93 %; 21/26), with 50 % (N = 13) classified as having severe, 23 % (N = 6) moderate, and 8 % (N = 2) mild PEI.DISCUSSION: Since no ideal test exists for PEI, this collation of diagnostic modalities and blinded expert review was designed to ascertain the true rate of long-term PEI following PD. This required our cohort to survive a year, travel to hospital, and undergo a period of starvation and PERT hold, and therefore there is likely to be recruitment bias towards fitter, younger patients with less aggressive pathology. Despite this, over 80 % were deemed to have PEI, with over 90 % of these being considered moderate or severe.</p

TiO2/MoO2 nanocomposite as anode materials for high power Li-ion batteries with exceptional capacity

Nanoparticles of molybdenum(IV) oxide (MoO 2 ) and a TiO 2 /MoO 2 nanocomposite were synthesised via a continuous hydrothermal synthesis process. Both powders were analysed using XRD, XPS, TEM, and BET and evaluated as active materials in anodes for Li-ion half-cells. Cyclic voltammetry and galvanostatic charge/discharge measurements were carried out in the potential window of 0.1 to 3.0 V vs. Li/Li+. Specific capacities of ca. 350 mAh g -1 were obtained for both materials at low specific currents (0.1 A g -1 ); TiO 2 /MoO 2 composite electrodes showed superior rate behaviour & stability under cycling (compared to MoO 2 ), with stable specific capacities of ca. 265 mAh g -1 at a specific current of 0.5 A g -1 and ca. 150 mAh g -1 after 350 cycles at a specific current of 2.5 A g -1 . The improved performance of the composite material, compared to MoO 2 , was attributed to a smaller particle size, improved stability to volume changes (during cycling), and lower charge transfer resistance during cycling. Li-ion hybrid electrochemical capacitors using TiO 2 /MoO 2 composite anodes and activated carbon (AC) cathodes were evaluated and showed excellent performance with an energy density of 44 Wh kg -1 at a power density of 600 W kg -1

RNA-binding protein CPEB1 remodels host and viral RNA landscapes.

Host and virus interactions occurring at the post-transcriptional level are critical for infection but remain poorly understood. Here, we performed comprehensive transcriptome-wide analyses revealing that human cytomegalovirus (HCMV) infection results in widespread alternative splicing (AS), shortening of 3' untranslated regions (3' UTRs) and lengthening of poly(A)-tails in host gene transcripts. We found that the host RNA-binding protein CPEB1 was highly induced after infection, and ectopic expression of CPEB1 in noninfected cells recapitulated infection-related post-transcriptional changes. CPEB1 was also required for poly(A)-tail lengthening of viral RNAs important for productive infection. Strikingly, depletion of CPEB1 reversed infection-related cytopathology and post-transcriptional changes, and decreased productive HCMV titers. Host RNA processing was also altered in herpes simplex virus-2 (HSV-2)-infected cells, thereby indicating that this phenomenon might be a common occurrence during herpesvirus infections. We anticipate that our work may serve as a starting point for therapeutic targeting of host RNA-binding proteins in herpesvirus infections

CK2 phosphorylation of CMTR1 promotes RNA cap formation and influenza virus infection

Funding: This work was supported by Cancer Research UK core grant number A17196/A31287 to the CRUK Scotland Institute and CTRQQR-2021\100006 to the CRUK Scotland Centre. Research was funded by European Research Council Award 769080 TCAPS, Medical Research Council Senior Fellowship MR/K024213/1, a Lister Research Prize Fellowship, a Wellcome Trust PhD studentship 097462/Z/11/Z, Royal Society Wolfson Research Merit Award WRM\R1\180008, Wellcome Trust Investigator Award 219416/A/19/Z, and Wellcome Trust GRE Centre Award 097945/Z/11/Z.The RNA cap methyltransferase CMTR1 methylates the first transcribed nucleotide of RNA polymerase II transcripts, impacting gene expression mechanisms, including during innate immune responses. Using mass spectrometry, we identify a multiply phosphorylated region of CMTR1 (phospho-patch [P-Patch]), which is a substrate for the kinase CK2 (casein kinase II). CMTR1 phosphorylation alters intramolecular interactions, increases recruitment to RNA polymerase II, and promotes RNA cap methylation. P-Patch phosphorylation occurs during the G1 phase of the cell cycle, recruiting CMTR1 to RNA polymerase II during a period of rapid transcription and RNA cap formation. CMTR1 phosphorylation is required for the expression of specific RNAs, including ribosomal protein gene transcripts, and promotes cell proliferation. CMTR1 phosphorylation is also required for interferon-stimulated gene expression. The cap-snatching virus, influenza A, utilizes host CMTR1 phosphorylation to produce the caps required for virus production and infection. We present an RNA cap methylation control mechanism whereby CK2 controls CMTR1, enhancing co-transcriptional capping.Peer reviewe

Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low levels of IL-12

BACKGROUND: Hyperlactataemia is often associated with a poor outcome in severe malaria in African children. To unravel the complex pathophysiology of this condition the relationship between plasma lactate levels, parasite density, pro- and anti-inflammatory cytokines, and haemozoin-containing leucocytes was studied in children with severe falciparum malarial anaemia. METHODS: Twenty-six children with a primary diagnosis of severe malarial anaemia with any asexual Plasmodium falciparum parasite density and Hb < 5 g/dL were studied and the association of plasma lactate levels and haemozoin-containing leucocytes, parasite density, pro- and anti-inflammatory cytokines was measured. The same associations were measured in non-severe malaria controls (N = 60). RESULTS: Parasite density was associated with lactate levels on admission (r = 0.56, P < 0.005). Moreover, haemozoin-containing neutrophils and IL-12 were strongly associated with plasma lactate levels, independently of parasite density (r = 0.60, P = 0.003 and r = -0.46, P = 0.02, respectively). These associations were not found in controls with uncomplicated malarial anaemia. CONCLUSION: These data suggest that blood stage parasites, haemozoin and low levels of IL-12 may be associated with the development of hyperlactataemia in severe malarial anaemia