Adrenal Dysfunction in Hemodynamically Unstable Patients in the Emergency Department

Objective: Adrenal failure, a treatable condition, can have catastrophic consequences if unrecognized in critically ill ED patients. The authors' objective was to prospectively study adrenal function in a case series of hemodynamically unstable (high-risk) patients from a large, urban ED over a 12-month period. Methods: In a prospective manner, critically ill adult patients presenting to the ED were enrolled when presenting with a mean arterial blood pressure ≤60 mm Hg requiring vasopressor therapy for more than one hour after receiving fluid resuscitation (central venous pressure of 12-15 mm Hg or a minimum of 40 mL/kg of crystalloid). Patients were excluded if presenting with hemorrhage, trauma, or AIDS, or if steroids were used within the previous six months. An adrenocorticotropic hormone (ACTH) stimulation test was performed and serum cortisol was measured. Treatment for adrenal insufficiency was not instituted. Results: A total of 57 consecutive patients were studied. Of these, eight (14%) had baseline serum cortisol concentrations of <20 Μg/dL (<552 nmol/L), which was considered adrenal insufficiency (AI). Three additional patients (5%) had subnormal 60-minute post-ACTH-stimulation cortisol responses (<30 Μg/dL) and a delta cortisol ≤9 Μg/dL, which is the difference between the baseline and 60-minute levels. This is functional hypoadrenalism (FH). There were no laboratory abnormalities that distinguished patients with AI or FH from those with preserved adrenal function (PAF). Rates of survival to discharge did not differ between the AI group (7 of 8) and PAF patients (21 of 46; p = 0.052). Conclusions: Adrenal dysfunction is common in high-risk ED patients. Overall, it has a frequency of 19% among a homogeneous population of hemodynamically unstable vasopressor-dependent patients. The effect of physiologic glucocorticoid replacement in this setting remains to be determined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71956/1/j.1553-2712.1999.tb00417.x.pd

Role of the mesoamygdaloid dopamine projection in emotional learning

Amygdala dopamine is crucially involved in the acquisition of Pavlovian associations, as measured via conditioned approach to the location of the unconditioned stimulus (US). However, learning begins before skeletomotor output, so this study assessed whether amygdala dopamine is also involved in earlier 'emotional' learning. A variant of the conditioned reinforcement (CR) procedure was validated where training was restricted to curtail the development of selective conditioned approach to the US location, and effects of amygdala dopamine manipulations before training or later CR testing assessed. Experiment 1a presented a light paired (CS+ group) or unpaired (CS- group) with a US. There were 1, 2 or 10 sessions, 4 trials per session. Then, the US was removed, and two novel levers presented. One lever (CR+) presented the light, and lever pressing was recorded. Experiment 1b also included a tone stimulus. Experiment 2 applied intra-amygdala R(+) 7-OH-DPAT (10 nmol/1.0 A mu l/side) before two training sessions (Experiment 2a) or a CR session (Experiment 2b). For Experiments 1a and 1b, the CS+ group preferred the CR+ lever across all sessions. Conditioned alcove approach during 1 or 2 training sessions or associated CR tests was low and nonspecific. In Experiment 2a, R(+) 7-OH-DPAT before training greatly diminished lever pressing during a subsequent CR test, preferentially on the CR+ lever. For Experiment 2b, R(+) 7-OH-DPAT infusions before the CR test also reduced lever pressing. Manipulations of amygdala dopamine impact the earliest stage of learning in which emotional reactions may be most prevalent

The Reproducibility of a Kinematically-Derived Axis of the Knee versus Digitized Anatomical Landmarks using a Knee Navigation System

Component position is critical to longevity of knee arthroplasties. Femoral component rotation is typically referenced from the transepicondylar axis (TEA), the anterior-posterior (AP) axis or the posterior condylar axis. Other studies have shown high variability in locating the TEA while proposing digitization of other landmarks such as the AP axis as a less-variable reference. This study uses a navigation system to compare the reproducibility of computing a kinematically-derived, navigated knee axis (NKA) to digitizing the TEA and AP axis. Twelve knees from unembalmed cadavers were tested. Four arthroplasty surgeons digitized the femoral epicondyles and the AP axis direction as well as flexed and extended the knee repeatedly to allow for NKA determination. The variance of the NKA axis determined under neutral loading conditions was smaller than the variance of the TEA axis when the kinematics were measured in the closed surgical condition (P<0.001). However, varus, valgus, and internal loading of the leg increased the variability of the NKA. Distraction of the leg during knee flexion and extension preserved the low variability of the NKA. In conclusion, a kinematically-derived NKA under neutral or distraction loading is more reproducible than the TEA and AP axis determined by digitization

Microdevices for extensional rheometry of low viscosity elastic liquids : a review

Extensional flows and the underlying stability/instability mechanisms are of extreme relevance to the efficient operation of inkjet printing, coating processes and drug delivery systems, as well as for the generation of micro droplets. The development of an extensional rheometer to characterize the extensional properties of low viscosity fluids has therefore stimulated great interest of researchers, particularly in the last decade. Microfluidics has proven to be an extraordinary working platform and different configurations of potential extensional microrheometers have been proposed. In this review, we present an overview of several successful designs, together with a critical assessment of their capabilities and limitations

Observations of the GRB Afterglow ATLAS17aeu and Its Possible Association with GW170104

We report the discovery and multiwavelength data analysis of the peculiar optical transient, ATLAS17aeu. This transient was identified in the sky map of the LIGO gravitational wave event GW 170104 by our ATLAS and Pan-STARRS coverage. ATLAS17aeu was discovered 23.1 hr after GW 170104 and rapidly faded over the next three nights, with a spectrum revealing a blue featureless continuum. The transient was also detected as a fading X-ray source by Swift and in the radio at 6 and 15 GHz. The gamma-ray burst GRB 170105A was detected by three satellites 19.04 hr after GW 170104 and 4.10 hr before our first optical detection. We analyze the multiwavelength fluxes in the context of the known GRB population and discuss the observed sky rates of GRBs and their afterglows. We find it statistically likely that ATLAS17aeu is an afterglow associated with GRB 170105A, with a chance coincidence ruled out at the 99% confidence or 2.6 sigma. A long, soft GRB within a redshift range of 1 less than or similar to z less than or similar to 2.9 would be consistent with all the observed multiwavelength data. The Poisson probability of a chance occurrence of GW 170104 and ATLAS17aeu is p = 0.04. This is the probability of a chance coincidence in 2D sky location and in time. These observations indicate that ATLAS17aeu is plausibly a normal GRB afterglow at significantly higher redshift than the distance constraint for GW 170104 and therefore a chance coincidence. However, if a redshift of the faint host were to place it within the GW 170104 distance range, then physical association with GW 170104 should be considered

A SEARCH for AN OPTICAL COUNTERPART to the GRAVITATIONAL-WAVE EVENT GW151226

We present a search for an electromagnetic counterpart of the gravitational-wave source GW151226. Using the Pan-STARRS1 telescope we mapped out 290 square degrees in the optical $i_{P1}$ filter, starting 11.5 hr after the LIGO information release and lasting for an additional 28 days. The first observations started 49.5 hr after the time of the GW151226 detection. We typically reached sensitivity limits of $i_{P1}$ = 20.3–20.8 and covered 26.5% of the LIGO probability skymap. We supplemented this with ATLAS survey data, reaching 31% of the probability region to shallower depths of $m \simeq$ 19. We found 49 extragalactic transients (that are not obviously active galactic nuclei), including a faint transient in a galaxy at 7 Mpc (a luminous blue variable outburst) plus a rapidly decaying M-dwarf flare. Spectral classification of 20 other transient events showed them all to be supernovae. We found an unusual transient, PS15dpn, with an explosion date temporally coincident with GW151226, that evolved into a type Ibn supernova. The redshift of the transient is secure at $z$ = 0.1747 ± 0.0001 and we find it unlikely to be linked, since the luminosity distance has a negligible probability of being consistent with that of GW151226. In the 290 square degrees surveyed we therefore do not find a likely counterpart. However we show that our survey strategy would be sensitive to NS–NS mergers producing kilonovae at $D_L \lesssim$ 100 Mpc, which is promising for future LIGO/Virgo searches.NASA (Grant IDs: NNX08AR22G, NNX12AR65G, NNX14AM74G, NNX12AR55G), EU/FP7-ERC (Grant IDs: 291222, 307260, 320360, 615929), a Weizmann-UK Making Connections Grant, STFC (Ernest Rutherford Fellowship), Alexander von Humboldt Foundation (Sofia Kovalevskaja Award), National Science Foundation (Grant ID: AST-1238877)This is the final version of the article. It first appeared from Institute of Physics Publishing via http://dx.doi.org/10.3847/2041-8205/827/2/L4

How robust is the optimistic update bias for estimating self-risk and population base rates?

Humans hold unrealistically optimistic predictions of what their future holds. These predictions are generated and maintained as people update their beliefs more readily when receiving information that calls for adjustment in an optimistic direction relative to information that calls for adjustment in a pessimistic direction. Thus far this update bias has been shown when people make estimations regarding the self. Here, we examine whether asymmetric belief updating also exists when making estimations regarding population base rates. We reveal that while participants update beliefs regarding risk in the population in an asymmetric manner, such valence-dependent updating of base rates can be accounted for by priors. In contrast, we show that optimistic updating regarding the self is a robust phenomenon, which holds even under different empirical definitions of desirable information

The genomes of two key bumblebee species with primitive eusocial organization

Background: The shift from solitary to social behavior is one of the major evolutionary transitions. Primitively eusocial bumblebees are uniquely placed to illuminate the evolution of highly eusocial insect societies. Bumblebees are also invaluable natural and agricultural pollinators, and there is widespread concern over recent population declines in some species. High-quality genomic data will inform key aspects of bumblebee biology, including susceptibility to implicated population viability threats. Results: We report the high quality draft genome sequences of Bombus terrestris and Bombus impatiens, two ecologically dominant bumblebees and widely utilized study species. Comparing these new genomes to those of the highly eusocial honeybee Apis mellifera and other Hymenoptera, we identify deeply conserved similarities, as well as novelties key to the biology of these organisms. Some honeybee genome features thought to underpin advanced eusociality are also present in bumblebees, indicating an earlier evolution in the bee lineage. Xenobiotic detoxification and immune genes are similarly depauperate in bumblebees and honeybees, and multiple categories of genes linked to social organization, including development and behavior, show high conservation. Key differences identified include a bias in bumblebee chemoreception towards gustation from olfaction, and striking differences in microRNAs, potentially responsible for gene regulation underlying social and other traits. Conclusions: These two bumblebee genomes provide a foundation for post-genomic research on these key pollinators and insect societies. Overall, gene repertoires suggest that the route to advanced eusociality in bees was mediated by many small changes in many genes and processes, and not by notable expansion or depauperation