End-colostomy diverticulitis with parastomal phlegmon: A case report.

Acute colonic diverticulitis is a well-known surgical emergency, which occurs in about 10 percent of patients known for diverticulosis. The case of a 77-year-old woman is reported, with past history of abdominoperineal resection with end-colostomy for low rectal adenocarcinoma, and who developed an acute colonic diverticulitis in a subcutaneous portion of colostomy with parastomal phlegmon. Initial computed tomography imaging demonstrated a significant submucosal parietal edema with local fat tissues infiltration in regard of 3 diverticula. A two-step treatment was decided: first a nonoperative treatment was initiated with 2 weeks antibiotics administration, followed by, 6 weeks after, a segmental resection of the terminal portion of the colon with redo of a new colostomy by direct open approach. Patient was discharged on the second postoperative day without complications. Follow-up at 2 weeks revealed centimetric dehiscence of the stoma, which was managed conservatively until sixth postoperative week by stomatherapists. Treatment of acute diverticulitis with parastomal phlegmon in a patient with end-colostomy could primary be nonoperative. Delayed surgical treatment with segmental colonic resection was proposed to avoid recurrence and potential associated complications

Platelet-derived extracellular vesicles in Huntington's disease.

The production and release of extracellular vesicles (EV) is a property shared by all eukaryotic cells and a phenomenon frequently exacerbated in pathological conditions. The protein cargo of EV, their cell type signature and availability in bodily fluids make them particularly appealing as biomarkers. We recently demonstrated that platelets, among all types of blood cells, contain the highest concentrations of the mutant huntingtin protein (mHtt)-the genetic product of Huntington's disease (HD), a neurodegenerative disorder which manifests in adulthood with a complex combination of motor, cognitive and psychiatric deficits. Herein, we used a cohort of 59 HD patients at all stages of the disease, including individuals in pre-manifest stages, and 54 healthy age- and sex-matched controls, to evaluate the potential of EV derived from platelets as a biomarker. We found that platelets of pre-manifest and manifest HD patients do not release more EV even if they are activated. Importantly, mHtt was not found within EV derived from platelets, despite them containing high levels of this protein. Correlation analyses also failed to reveal an association between the number of platelet-derived EV and the age of the patients, the number of CAG repeats, the Unified Huntington Disease Rating Scale total motor score, the Total Functional Capacity score or the Burden of Disease score. Our data would, therefore, suggest that EV derived from platelets with HD is not a valuable biomarker in HD.The study was funded by an operating grant from the Merck Sharpe & Dohme to F.C. who is also a recipient of a National Researcher career award from the Fonds de Recherche du Québec en santé (FRQS) providing salary support and operating funds. I.S.-A. was supported by a CIHR-Huntington Society of Canada postdoctoral fellowship. R.A.B. and S.L.M. are supported by a National Institute for Health Research (NIHR) award of a Biomedical Research Center to the University of Cambridge and Addenbrooke’s Hospital. E.B. is supported by the Canadian Institutes of Health Research. N.D. MD-MSc. also funded by CIHR and by Canadian Consortium on Neurodegeneration in Aging (CCNA). HLD and JPL hold a Desjardins scholarship from the Fondation du CHU de Québec. HLD hold a bourse d’excellence du Centre Thématique de Recherche en Neurosciences (CTRN) du CHU de Québec. The authors would like to thank all the students and staff who helped with the blood collections in Cambridge, Quebec City and Montreal and importantly, all patients and their families for being so generous with their time in participating to this stud

Late Holocene expansion of Siberian dwarf pine (Pinus pumila) in Kamchatka in response to increased snow cover as inferred from lacustrine oxygen-isotope records

© 2015 Elsevier B.V. Holocene records of cellulose-inferred lake-water δ18O were produced from two lake-sediment sequences obtained in central and northern Kamchatka, Russian Far East. The sediment records share similar fluctuations in δ18O during the interval of ca. 5000-800calyr BP that correspond (inversely) with changes in K+ content of the GISP2 ice-core record from Greenland, a proxy for the relative strength of the Siberian High, suggesting control by climate-related variability in δ18O of regional precipitation. The dramatic expansion of Siberian dwarf pine (Pinus pumila) in northern and central Kamchatka between ca. 5000 and 4000calyr BP, as inferred from pollen records from the same and neighbouring sites, appears to have occurred at a time of progressively declining δ18O of precipitation. This development is interpreted as reflecting a regional cooling trend accompanied by increasing winter snowfall related to gradual intensification of the Siberian High from ca. 5000 to ca. 3000calyr BP. A thicker and more long-lasting snow cover can be assumed to have favoured P. pumila by providing a competitive advantage over other boreal and subalpine tree and shrub species in the region during the later part of the Holocene. These results, which are the first of their kind from Kamchatka, provide novel insight into the Holocene vegetational and climatic development in easternmost Asia, as well as long-term atmospheric circulation dynamics in Beringia

Cerebrovascular and blood-brain barrier impairments in Huntington's disease: Potential implications for its pathophysiology: Vascular impairments in HD

ObjectiveAlthough the underlying cause of Huntington's disease (HD) is well established, the actual pathophysiological processes involved remain to be fully elucidated. In other proteinopathies such as Alzheimer's and Parkinson's diseases, there is evidence for impairments of the cerebral vasculature as well as the blood–brain barrier (BBB), which have been suggested to contribute to their pathophysiology. We investigated whether similar changes are also present in HD.MethodsWe used 3‐ and 7‐Tesla magnetic resonance imaging as well as postmortem tissue analyses to assess blood vessel impairments in HD patients. Our findings were further investigated in the R6/2 mouse model using in situ cerebral perfusion, histological analysis, Western blotting, as well as transmission and scanning electron microscopy.ResultsWe found mutant huntingtin protein (mHtt) aggregates to be present in all major components of the neurovascular unit of both R6/2 mice and HD patients. This was accompanied by an increase in blood vessel density, a reduction in blood vessel diameter, as well as BBB leakage in the striatum of R6/2 mice, which correlated with a reduced expression of tight junction‐associated proteins and increased numbers of transcytotic vesicles, which occasionally contained mHtt aggregates. We confirmed the existence of similar vascular and BBB changes in HD patients.InterpretationTaken together, our results provide evidence for alterations in the cerebral vasculature in HD leading to BBB leakage, both in the R6/2 mouse model and in HD patients, a phenomenon that may, in turn, have important pathophysiological implications. Ann Neurol 2015;78:160–17

Portrait of blood-derived extracellular vesicles in patients with Parkinson's disease.

The production of extracellular vesicles (EV) is a ubiquitous feature of eukaryotic cells but pathological events can affect their formation and constituents. We sought to characterize the nature, profile and protein signature of EV in the plasma of Parkinson's disease (PD) patients and how they correlate to clinical measures of the disease. EV were initially collected from cohorts of PD (n = 60; Controls, n = 37) and Huntington's disease (HD) patients (Pre-manifest, n = 11; manifest, n = 52; Controls, n = 55) - for comparative purposes in individuals with another chronic neurodegenerative condition - and exhaustively analyzed using flow cytometry, electron microscopy and proteomics. We then collected 42 samples from an additional independent cohort of PD patients to confirm our initial results. Through a series of iterative steps, we optimized an approach for defining the EV signature in PD. We found that the number of EV derived specifically from erythrocytes segregated with UPDRS scores corresponding to different disease stages. Proteomic analysis further revealed that there is a specific signature of proteins that could reliably differentiate control subjects from mild and moderate PD patients. Taken together, we have developed/identified an EV blood-based assay that has the potential to be used as a biomarker for PD

Isotopic signals (18O, 2H, 3H) of six major rivers draining the pan-Arctic watershed

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Global Biogeochemical Cycles 26 (2012): GB1027, doi:10.1029/2011GB004159.We present the results of a 4-year collaborative sampling effort that measured δ18O, δ2H values and 3H activities in the six largest Arctic rivers (the Ob, Yenisey, Lena, Kolyma, Yukon and Mackenzie). Using consistent sampling and data processing protocols, these isotopic measurements provide the best available δ2H and 3H estimates for freshwater fluxes from the pan-Arctic watershed to the Arctic Ocean and adjacent seas, which complements previous efforts with δ18O and other tracers. Flow-weighted annual δ2H values vary from −113.3‰ to −171.4‰ among rivers. Annual 3H fluxes vary from 0.68 g to 4.12 g among basins. The integration of conventional hydrological and landscape observations with stable water isotope signals, and estimation of areal yield of 3H provide useful insights for understanding water sources, mixing and evaporation losses in these river basins. For example, an inverse correlation between the slope of the δ18O-δ2H relation and wetland extent indicates that wetlands play comparatively important roles affecting evaporation losses in the Yukon and Mackenzie basins. Tritium areal yields (ranging from 0.760 to 1.695 10−6 g/km2 per year) are found to be positively correlated with permafrost coverage within the studied drainage basins. Isotope-discharge relationships demonstrate both linear and nonlinear response patterns, which highlights the complexity of hydrological processes in large Arctic river basins. These isotope observations and their relationship to discharge and landscape features indicate that basin-specific characteristics significantly influence hydrological processes in the pan-Arctic watershed.Funding for this research was provided by the U.S. National Science Foundation (OPP-0229302), the National Science and Engineering Research Council of Canada (Discovery grant to JJG and IRD fellowship to YY), the U.S. Geological Survey and the Water Resources Division in the Department of Indian Affairs and Northern Development, Canada.2012-09-2

Restored Agricultural Wetlands in central Iowa: Habitat Quality and Amphibian Response

Amphibians are declining throughout the United States and worldwide due, partly, to habitat loss. Conservation practices on the landscape restore wetlands to denitrify tile drainage effluent and restore ecosystem services. Understanding how water quality, hydroperiod, predation, and disease affect amphibians in restored wetlands is central to maintaining healthy amphibian populations in the region. We examined the quality of amphibian habitat in restored wetlands relative to reference wetlands by comparing species richness, developmental stress, and adult leopard frog (Lithobates pipiens) survival probabilities to a suite of environmental metrics. Although measured habitat variables differed between restored and reference wetlands, differences appeared to have sub-lethal rather than lethal effects on resident amphibian populations. There were few differences in amphibian species richness and no difference in estimated survival probabilities between wetland types. Restored wetlands had more nitrate and alkaline pH, longer hydroperiods, and were deeper, whereas reference wetlands had more amphibian chytrid fungus zoospores in water samples and resident amphibians exhibited increased developmental stress. Restored and reference wetlands are both important components of the landscape in central Iowa and maintaining a complex of fish-free wetlands with a variety of hydroperiods will likely contribute to the persistence of amphibians in this landscape

Validation of a new test that assesses functional performance of the upper extremity and neck (FIT-HaNSA) in patients with shoulder pathology

<p>Abstract</p> <p>Background</p> <p>There is a lack of standardized tests that assess functional performance for sustained upper extremity activity. This study describes development of a new test for measuring functional performance of the upper extremity and neck and assesses reliability and concurrent validity in patients with shoulder pathology.</p> <p>Methods</p> <p>A series of developmental tests were conducted to develop a protocol for assessing upper extremity tasks that required multi-level movement and sustained elevation. Kinematics of movement were investigated to inform subtask structure. Tasks and test composition were refined to fit clinical applicability criteria and pilot tested on 5 patients awaiting surgery for shoulder impingement and age-sex matched controls. Test-retest reliability was assessed on 10 subjects. Then a cohort of patients with mild to moderate (n = 17) shoulder pathology and 19 controls (17 were age-sex matched to patients) were tested to further validate the Functional Impairment Test-Hand, and Neck/Shoulder/Arm (FIT-HaNSA) by comparing it to self-reported function and measured strength. The FIT-HaNSA, DASH and SPADI were tested on a single occasion. Impairments in isometric strength were measured using hand-held dynamometry. Discriminative validity was determined by comparing scores to those of age-sex matched controls (n = 34), using ANOVA. Pearson correlations between outcome measures (n = 41) were examined to establish criterion and convergent validity.</p> <p>Results</p> <p>A test protocol based on three five-minute subtasks, each either comprised of moving objects to waist-height shelves, eye-level shelves, or sustained manipulation of overhead nuts/bolts, was developed. Test scores for the latter 2 subtasks (or total scores) were different between controls as compared to either surgical-list patients with shoulder impingement or a variety of milder shoulder pathologies (p < 0.01). Test 1 correlated the highest with the DASH (r = -0.83), whereas Test 2 correlated highest with the SPADI (r = -0.76).</p> <p>Conclusion</p> <p>Initial data suggest the FIT-HaNSA provides valid assessment of impaired functional performance in patients with shoulder pathology. It discriminates between patients and controls, is related to self-reported function, and yet provides distinct information. Longitudinal testing is warranted.</p