Management of Colonic Trauma: Six-Year Experience at Henry Ford Hospital

Surgical management of 114 patients with colonic injuries related to trauma who were treated over a six-year period is reviewed. Eighty-three (73%) injuries were secondary to gunshot wounds. Twenty-six patients (24%) had isolated colonic injuries. The majority of patients (60%)) were treated with colostomies: exteriorization of the injury, repair with proximal colostomy, or resection with colostomy and mucous fistula. Exteriorization of repaired colon, primary repair, and resection with primary anastomosis were performed in 40% of the patients. Six patients (5.3%) in our series died, and 24% had complications directly related to the colon injury. Based on this study, no standard method for treatment of colonic trauma is advised. Colostomy is recommended for patients with massive multiple intra-abdominal injuries and gross fecal contamination. In selected patients, primary repair may be performed

Hibernate Container: A Deflated Container Mode for Fast Startup and High-density Deployment in Serverless Computing

Serverless computing is a popular cloud computing paradigm, which requires low response latency to handle on-demand user requests. There are two prominent techniques employed for reducing the response latency: keep fully initialized containers alive (Warm Container) or reduce the new container startup (cold start) latency. This paper presents the 3rd container startup mode: Hibernate Container, which starts faster than the cold start container mode and consumes less memory than the Warm Container mode. Hibernate Container is essentially a "deflated" Warm Container. Its application memory is swapped out to disk, the freed memory is reclaimed and file based mmap memory is cleaned-up. The Hibernate Container's deflated memory is inflated in response to user requests. As Hibernate Container's application is fully initialized, its response latency is less than the cold start mode; and as the application memory is deflated, its memory consumption is less than the Warm Container mode. Additionally, when a Hibernate Container is "woken up" to process a request, the Woken-up Container has similar response latency to Warm Container but less memory consumption because not all the deflated memory needs to be inflated. We implemented the Hibernate technique as part of the open source Quark secure container runtime project and our test demonstrated that Hibernate Container consumes about 7\% to 25\% of the Warm Container memory. All of this results in a higher deployment density, lower latency and appreciable improvements in the overall system performance

Evolutionarily Ancient Association of the FoxJ1 Transcription Factor with the Motile Ciliogenic Program

<div><p>It is generally believed that the last eukaryotic common ancestor (LECA) was a unicellular organism with motile cilia. In the vertebrates, the winged-helix transcription factor FoxJ1 functions as the master regulator of motile cilia biogenesis. Despite the antiquity of cilia, their highly conserved structure, and their mechanism of motility, the evolution of the transcriptional program controlling ciliogenesis has remained incompletely understood. In particular, it is presently not known how the generation of motile cilia is programmed outside of the vertebrates, and whether and to what extent the FoxJ1-dependent regulation is conserved. We have performed a survey of numerous eukaryotic genomes and discovered that genes homologous to <em>foxJ1</em> are restricted only to organisms belonging to the unikont lineage. Using a mis-expression assay, we then obtained evidence of a conserved ability of FoxJ1 proteins from a number of diverse phyletic groups to activate the expression of a host of motile ciliary genes in zebrafish embryos. Conversely, we found that inactivation of a <em>foxJ1</em> gene in <em>Schmidtea mediterranea</em>, a platyhelminth (flatworm) that utilizes motile cilia for locomotion, led to a profound disruption in the differentiation of motile cilia. Together, all of these findings provide the first evolutionary perspective into the transcriptional control of motile ciliogenesis and allow us to propose a conserved FoxJ1-regulated mechanism for motile cilia biogenesis back to the origin of the metazoans.</p> </div

FoxJ1 from <i>T. adhaerens</i> and <i>S. purpuratus</i> are nuclear localized and can regulate the expression of ciliary genes.

<p>Anti-myc antibodies were used to detect Placozoa (A) and sea urchin (B) FoxJ1 (red, white arrow). Nuclei were stained with DAPI (blue). (C) Expression of <i>dynein intermediate chain</i> in the spinal cord (long arrow) and pronephric (kidney) duct (short arrow) of a wild-type zebrafish embryo. The <i>wdr78</i> and <i>efhc1</i> genes are expressed in a similar pattern in wild-type embryos (see <a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1003019#pgen-1003019-g002" target="_blank">Figure 2A</a> and data not shown). Ectopic expression of <i>dynein intermediate chain</i> in embryos ectopically expressing placozoan (D) and sea urchin (E) FoxJ1, respectively. Ectopic expression of <i>wdr78</i> in embryos ectopically expressing placozoan (F) and sea urchin (G) FoxJ1, respectively. Ectopic expression of <i>efhc1</i> in embryos ectopically expressing placozoan (H) and sea urchin (I) FoxJ1, respectively. Mis-expression of the different ciliary genes in D–I is indicated by the arrows. Embryos depicted are at 20 hpf, oriented anterior to the left, dorsal to the top.</p

Zebrafish FoxJ2 and FoxJ3 are unable to induce the expression of ciliary genes.

<p>(A) Expression of <i>efhc1</i> in the spinal cord (long arrow) and pronephric (kidney) duct (short arrow) of a wild-type zebrafish embryo, and in embryos ectopically expressing zebrafish FoxJ2 (B) and FoxJ3 (C), respectively. (D) Expression of <i>spag6</i> in the spinal cord (long arrow) and pronephric (kidney) duct (short arrow) of a wild-type zebrafish embryo, and in embryos ectopically expressing zebrafish FoxJ2 (E) and FoxJ3 (F), respectively. Embryos depicted are at 20 hpf, oriented anterior to the left, dorsal to the top.</p

<i>S. mediterranea foxJ1</i> genes are expressed in ciliated tissues.

<p>Sense control (A) and expression pattern of <i>Smed-foxJ1-4</i> depicted in dorsal (B) and ventral view (E). Sense control (C) and expression pattern of <i>Smed-ift172</i> shown in dorsal (D) and ventral view (F). Expression pattern of <i>Smed-foxJ1-1</i> (G) and expression pattern of <i>Smed-foxJ1-2</i> (H). Arrows in B, G and H denote expression in the dorsal stripe of presumptive ciliated sensory cells. Scale bars: 300 µm for A–F and 200 µm for G–H.</p

<i>S. mediterranea foxJ1-4</i> is required for the differentiation of motile cilia.

<p>(A–C) Control (A), <i>ift172</i>(RNAi) (B) and <i>foxJ1-4</i>(RNAi) worms (C) 14 days after the last RNAi feeding. Worms shown in panels B and C display tissue edema. Scale bar: 1 mm. (D–F) Anti-α-tubulin staining (green) of the multi-ciliated ventral epithelium in control (D), <i>ift172</i>(RNAi) (E) and <i>foxJ1-4</i>(RNAi) worms (F), respectively. The even spacing of nuclei (magenta) characteristic of the ventral epithelium demonstrates epithelial integrity in E and F. Images are single optical sections. Scale bar: 20 µm. (G) <i>foxJ1-4</i> expression is unaffected by control RNAi (<i>dsred</i>). (H) <i>foxJ1-1</i> expression is not altered in a <i>foxJ1-4</i>(RNAi) worm. (I) <i>foxJ1-4</i> expression is substantially reduced in a <i>foxJ1-4</i>(RNAi) worm. Scale bar: 200 µm.</p

List of organisms with an identifiable FoxJ1 based on reverse BLAST and/or phylogenetic analyses.

*<p>Only shown for Fungal Fox proteins.</p

Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT registry.

BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. AIMS This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. METHODS The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. RESULTS Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). CONCLUSION Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events