Clostridium difficile colitis in patients after kidney and pancreas-kidney transplantation

Limited data exist about Clostridium difficile colitis (CDC) in solid organ transplant patients. Between 1/1/99 and 12/31/02, 600 kidney and 102 pancreas–kidney allograft recipients were transplanted. Thirty-nine (5.5%) of these patients had CDC on the basis of clinical and laboratory findings. Of these 39 patients, 35 have information available for review. CDC developed at a median of 30 days after transplantation, and the patients undergoing pancreas–kidney transplantation had a slightly higher incidence of CDC than recipients of kidney alone (7.8% vs. 4.5%, P> 0.05). All but one patient presented with diarrhea. Twenty-four patients (64.9%) were diagnosed in the hospital, and CDC occurred during first hospitalization in 14 patients (40%). Treatment was with oral metronidazole (M) in 33 patients (94%)and M + oral vancomycin (M + V) in 2 patients. Eight patients had recurrent CDC, which occurred at a median of 30 days (range 15–314) after the first episode. Two patients (5.7%) developed fulminant CDC, presented with toxic megacolon, and underwent colectomy. One of them died; the other patient survived after colectomy. CDC should be considered as a diagnosis in transplant patients with history of diarrhea after antibiotic use, and should be treated aggressively before the infection becomes complicated

Ketamine Restores Thalamic-Prefrontal Cortex Functional Connectivity in a Mouse Model of Neurodevelopmental Disorder-Associated 2p16.3 Deletion

2p16.3 deletions, involving heterozygous NEUREXIN1 (NRXN1) deletion, dramatically increase the risk of developing neurodevelopmental disorders, including autism and schizophrenia. We have little understanding of how NRXN1 heterozygosity increases the risk of developing these disorders, particularly in terms of the impact on brain and neurotransmitter system function and brain network connectivity. Thus, here we characterize cerebral metabolism and functional brain network connectivity in Nrxn1α heterozygous mice (Nrxn1α+/− mice), and assess the impact of ketamine and dextro-amphetamine on cerebral metabolism in these animals. We show that heterozygous Nrxn1α deletion alters cerebral metabolism in neural systems implicated in autism and schizophrenia including the thalamus, mesolimbic system, and select cortical regions. Nrxn1α heterozygosity also reduces the efficiency of functional brain networks, through lost thalamic “rich club” and prefrontal cortex (PFC) hub connectivity and through reduced thalamic-PFC and thalamic “rich club” regional interconnectivity. Subanesthetic ketamine administration normalizes the thalamic hypermetabolism and partially normalizes thalamic disconnectivity present in Nrxn1α+/− mice, while cerebral metabolic responses to dextro-amphetamine are unaltered. The data provide new insight into the systems-level impact of heterozygous Nrxn1α deletion and how this increases the risk of developing neurodevelopmental disorders. The data also suggest that the thalamic dysfunction induced by heterozygous Nrxn1α deletion may be NMDA receptor-dependent

Herpes simplex virus hepatitis after solid organ transplantation in adults

Twelve patients developed herpes simplex (HSV) hepatitis a median of 18 days after solid organ transplantation. This is earlier than cytomegalovirus hepatitis, which usually occurs 30-40 days after transplantation. Eight recipients (67%) died, and in seven, the diagnosis was made at autopsy or <48 h before death. Clinical manifestations associated with mortality were hypotension, disseminated intravascular coagulation (DIC), metabolic acidosis, gastrointestinal bleeding, and bacteremia. Laboratory abnormalities at diagnosis associated with mortality were high creatinine, low platelet counts, prolonged partial thromboplastin time, and a high percentage of band forms on the blood smear. Disseminated HSV disease was noted in four of six patients who had an autopsy and included involvement of lungs in three and the gastrointestinal tract in three. Five recipients developed DIC and all died. Pathologically, HSV hepatitis has two forms, focal and diffuse. All three patients with diffuse liver pathology died. However, three of seven with focal liver pathology survived with antiviral therapy, which suggests that early diagnosis and treatment may be lifesaving. None of these patients had received prophylactic acyclovir. It is possible that acyclovir prophylaxis may be able to prevent this disease. © 1991 by The University of Chicago

An analysis of observed daily maximum wind gusts in the UK

The greatest attention to the UK wind climatology has focused upon mean windspeeds, despite a knowledge of gust speeds being essential to a variety of users. This paper goes some way to redressing this imbalance by analysing observed daily maximum gust speeds from a 43-station network over the period 1980–2005. Complementing these data are dynamically downscaled reanalysis data, generated using the PRECIS Regional Climate Modelling system, for the period 1959–2001. Inter-annual variations in both the observed and downscaled reanalysis gust speeds are presented, with a statistically significant (at the 95% confidence interval) 5% increase across the network in daily maximum gust speeds between 1959 and the early 1990s, followed by an apparent decrease. The benefit of incorporating dynamically downscaled reanalysis data is revealed by the fact that the decrease in gust speeds since 1993 may be placed in the context of a very slight increase displayed over the longer 1959–2001 period. Furthermore, the severity of individual windstorm events is considered, with high profile recent events placed into the context of the long term record. A daily cycle is identified from the station observations in the timing of the daily maximum gust speeds, with an afternoon peak occurring between 12:00–15:00, exhibiting spatial and intra-annual variations

Tracing Sagittarius Structure with SDSS and SEGUE Imaging and Spectroscopy

We show that the Sagittarius dwarf tidal stream can be traced with very red K/M-giant stars selected from SDSS photometry. A subset of these stars are spectroscopically confirmed with SEGUE and SDSS spectra, and the distance scale of 2MASS and SDSS M giants is calibrated to the RR Lyrae distance scale. The absolute g band magnitude of the K/M-giant stars at the tip of the giant branch is M_g=-1.0. The line-of-sight velocities of the M giant and BHB stars that are spatially coincident with the Sgr dwarf tidal stream are consistent with those of previous authors, reinforcing the need for new models that can explain all of the Sgr tidal debris stream observations. We estimate stellar densities along the tidal tails that can be used to help constrain future models. The K/M-giant, BHB, and F-turnoff stars in the lower surface brightness tidal stream that is adjacent to the main leading Sgr dwarf tidal tail have velocities and metallicities that are similar to those of the stars in the leading tidal tail. The ratio of K/M giants to BHBs and BHBs to F-turnoff stars are also similar for both branches of the leading tidal tail. We show that there is an additional low-metallicity tidal stream near the Sgr trailing tidal tail.Comment: 19 figures, accepted for publication in ApJ, references update

Gender effect on clinical features of achalasia: a prospective study

BACKGROUND: Achalasia is a well-characterized esophageal motor disorder but the rarity of the disease limits performing large studies on its demographic and clinical features. METHODS: Prospectively, 213 achalasia patients (110 men and 103 women) were enrolled in the study. The diagnosis established by clinical, radiographic, and endoscopic as well as manometry criteria. All patients underwent a pre-designed clinical evaluation before and within 6 months after the treatment. RESULTS: Solid dysphagia was the most common clinical symptom in men and women. Chest pain was the only symptom which was significantly different between two groups and was more complained by women than men (70.9% vs. 54.5% P value= 0.03). Although the occurrence of chest pain significantly reduced after treatment in both groups (P < 0.001), it was still higher among women (32% vs. 20.9% P value= 0.04). In both sexes, chest pain did not relate to the symptom duration, LES pressure and type of treatment patients received. Also no significant relation was found between chest pain and other symptoms expressed by men and women before and after treatment. Chest pain was less frequently reported by patients over 56 yrs of age in comparison to those less than 56 yrs (p < 0.05). CONCLUSION: It seems that chest pain is the distinct symptom of achalasia which is affected by sex as well as age and does not relate to the duration of illness, LESP and the type of treatment achalasia patients receive

Evolution of predator dispersal in relation to spatio-temporal prey dynamics : how not to get stuck in the wrong place!

Peer reviewedPublisher PD

Seeking legitimacy through CSR: Institutional Pressures and Corporate Responses of Multinationals in Sri Lanka

Arguably, the corporate social responsibility (CSR) practices of multinational enterprises (MNEs) are influenced by a wide range of both internal and external factors. Perhaps most critical among the exogenous forces operating on MNEs are those exerted by state and other key institutional actors in host countries. Crucially, academic research conducted to date offers little data about how MNEs use their CSR activities to strategically manage their relationship with those actors in order to gain legitimisation advantages in host countries. This paper addresses that gap by exploring interactions between external institutional pressures and firm-level CSR activities, which take the form of community initiatives, to examine how MNEs develop their legitimacy-seeking policies and practices. In focusing on a developing country, Sri Lanka, this paper provides valuable insights into how MNEs instrumentally utilise community initiatives in a country where relationship-building with governmental and other powerful non-governmental actors can be vitally important for the long-term viability of the business. Drawing on neo-institutional theory and CSR literature, this paper examines and contributes to the embryonic but emerging debate about the instrumental and political implications of CSR. The evidence presented and discussed here reveals the extent to which, and the reasons why, MNEs engage in complex legitimacy-seeking relationships with Sri Lankan institutions

Zebrafish Larvae Exhibit Rheotaxis and Can Escape a Continuous Suction Source Using Their Lateral Line

Zebrafish larvae show a robust behavior called rheotaxis, whereby they use their lateral line system to orient upstream in the presence of a steady current. At 5 days post fertilization, rheotactic larvae can detect and initiate a swimming burst away from a continuous point-source of suction. Burst distance and velocity increase when fish initiate bursts closer to the suction source where flow velocity is higher. We suggest that either the magnitude of the burst reflects the initial flow stimulus, or fish may continually sense flow during the burst to determine where to stop. By removing specific neuromasts of the posterior lateral line along the body, we show how the location and number of flow sensors play a role in detecting a continuous suction source. We show that the burst response critically depends on the presence of neuromasts on the tail. Flow information relayed by neuromasts appears to be involved in the selection of appropriate behavioral responses. We hypothesize that caudally located neuromasts may be preferentially connected to fast swimming spinal motor networks while rostrally located neuromasts are connected to slow swimming motor networks at an early age