Acute liver failure following hemodialysis arteriovenous graft placement: a case report

<p>Abstract</p> <p>Introduction</p> <p>Severe high-output cardiac failure is a serious complication of high-flow vascular access requiring immediate intervention. Ischemic hepatitis is defined as a massive increase in serum transaminase levels due to an imbalance between hepatic oxygen supply and demand in the absence of other acute causes of liver damage. It is typically preceded by hypotension, hypoxemia, or both, and occurs mostly in elderly patients with right-sided congestive heart failure.</p> <p>Case presentation</p> <p>We report a fatal case of acute liver failure in an 84-year-old Caucasian man with high-output cardiac failure due to arteriovenous hemodialysis access. The chronological sequence of acute liver failure in the context of vascular access created two days before suggests that ischemic hepatitis was the result of high-output cardiac failure due to vascular access.</p> <p>Conclusions</p> <p>A thorough cardiac assessment should be performed in patients with severe cardiac disease prior to placing an arteriovenous access, and arteriovenous fistula should be the preferred vascular access.</p

Peri- and Postnatal Effects of Prenatal Adenoviral VEGF Gene Therapy in Growth-Restricted Sheep

Uterine artery (UtA) adenovirus vector (Ad)-mediated over-expression of vascular endothelial growth factor (VEGF) enhances uterine blood flow in normal sheep pregnancy and increases fetal growth in the overnourished adolescent sheep model of fetal growth restriction (FGR). Herein we examined its impact on gestation length, neonatal survival, early postnatal growth and metabolism. Singleton-bearing ewes were evenly allocated to receive Ad.VEGF-A165(5 x 10(10)particles/ml, 10 ml, n =17) or Saline (10 ml, n = 16) injected into each UtA at laparotomy (0.6 gestation). Fetal growth was serially monitored (blind) by ultrasound until delivery. Lambs were weighed and blood-sampled weekly and a glucose tolerance test performed (68d postnatal age). Hepatic DNA/RNA was extracted at necropsy (83d postnatal age) to examine methylation status of eight somatotropic axis genes. ITALIC! IGF1mRNA and protein expression were measured by RT-PCR and radioimmunoassay, respectively. All pregnancies remained viable following Ad.VEGF-A165treatment. Fetal abdominal circumference and renal volume were greater in Ad.VEGF-A165versus Saline groups at 21/28 days (p ≤ 0.04) post-injection. At delivery, gestation length (p = 0.07), lamb birthweight (p = 0.08), umbilical girth (p = 0.06) and plasma glucose (p=0.09) tended to be greater in Ad.VEGF-A165treated lambs. Levels of neonatal intervention required to ensure survival was equivalent between groups. Absolute postnatal growth rate (p = 0.02), insulin area-under-the-curve (p = 0.04) and carcass weight at necropsy (p = 0.04) were increased by Ad.VEGF-A165treatment. There was no impact on markers of insulin sensitivity or methylation/expression of key genes involved in somatic growth. Ad.VEGF-A165gene therapy increased fetal growth in a sheep FGR model and lambs continued to thrive during the neonatal and early postnatal period

Goldstini Can Give the Higgs a Boost

Supersymmetric collider phenomenology depends crucially on whether the lightest observable-sector supersymmetric particle (LOSP) decays, and if so, what the LOSP decay products are. For instance, in SUSY models where the gravitino is lighter than the LOSP, the LOSP decays to its superpartner and a longitudinal gravitino via supercurrent couplings. In this paper, we show that LOSP decays can be substantially modified when there are multiple sectors that break supersymmetry, where in addition to the gravitino there are light uneaten goldstini. As a particularly striking example, a bino-like LOSP can have a near 100% branching fraction to a higgs boson and an uneaten goldstino, even if the LOSP has negligible higgsino fraction. This occurs because the uneaten goldstino is unconstrained by the supercurrent, allowing additional operators to mediate LOSP decay. These operators can be enhanced in the presence of an R symmetry, leading to copious boosted higgs production in SUSY cascade decays.Comment: 30 pages, 12 figures; v2: title change, clarifications added, version to appear in JHE

Dynamics of the chiral phase transition from AdS/CFT duality

We use Lorentzian signature AdS/CFT duality to study a first order phase transition in strongly coupled gauge theories which is akin to the chiral phase transition in QCD. We discuss the relation between the latent heat and the energy (suitably defined) of the component of a D-brane which lies behind the horizon at the critical temperature. A numerical simulation of a dynamical phase transition in an expanding, cooling Quark-Gluon plasma produced in a relativistic collision is carried out.Comment: 30 pages, 5 figure

Large Anomalous Hall effect in a silicon-based magnetic semiconductor

Magnetic semiconductors are attracting high interest because of their potential use for spintronics, a new technology which merges electronics and manipulation of conduction electron spins. (GaMn)As and (GaMn)N have recently emerged as the most popular materials for this new technology. While Curie temperatures are rising towards room temperature, these materials can only be fabricated in thin film form, are heavily defective, and are not obviously compatible with Si. We show here that it is productive to consider transition metal monosilicides as potential alternatives. In particular, we report the discovery that the bulk metallic magnets derived from doping the narrow gap insulator FeSi with Co share the very high anomalous Hall conductance of (GaMn)As, while displaying Curie temperatures as high as 53 K. Our work opens up a new arena for spintronics, involving a bulk material based only on transition metals and Si, and which we have proven to display a variety of large magnetic field effects on easily measured electrical properties.Comment: 19 pages with 5 figure

Uteroplacental adenovirus VEGF gene therapy increases fetal growth velocity in growth-restricted sheep pregnancies.

Introduction: Fetal growth restriction (FGR) occurs in ~8% of pregnancies and is a major cause of perinatal mortality and morbidity. There is no effective treatment. FGR is characterised by reduced uterine blood flow (UBF). In normal sheep pregnancies, local uterine artery (UtA) adenovirus (Ad) mediated over-expression of vascular endothelial growth factor (VEGF) increases UBF. Herein we evaluated Ad.VEGF therapy in the overnourished adolescent ewe, an experimental paradigm in which reduced UBF from mid-gestation correlates with reduced lamb birthweight near term. Materials and Methods: Singleton pregnancies were established using embryo transfer in adolescent ewes subsequently offered a high-intake (n=45) or control-intake (n=12) of a complete diet to generate FGR or normal fetoplacental growth, respectively. High-intake ewes were randomised mid-gestation to receive bilateral UtA injections of 5x1011 particles Ad.VEGF-A165 (n=18), control vector Ad.LacZ (n=14) or control saline (n=13). Fetal growth/wellbeing were evaluated using serial ultrasound. UBF was monitored using indwelling flowprobes until necropsy at 0.9 gestation. Vasorelaxation, neovascularisation within the perivascular adventitia and placental mRNA expression of angiogenic factors/receptors were examined using organ bath analysis, anti-vWF immunohistochemistry and qRT-PCR, respectively. Results: Ad.VEGF significantly increased ultrasonographic fetal growth velocity at 3-4 weeks post-injection (p=0.016-0.047). At 0.9 gestation fewer fetuses were markedly growth-restricted (birthweight >2SD below contemporaneous control-intake mean) following Ad.VEGF therapy. There was also evidence of mitigated fetal brain sparing (lower biparietal diameter to abdominal circumference and brain to liver weight ratios). No effects were observed on UBF or neovascularisation, however Ad.VEGF-transduced vessels demonstrated strikingly enhanced vasorelaxation. Placental efficiency (fetal to placental weight ratio) and FLT1/KDR mRNA expression was increased in the maternal but not fetal placental compartments, suggesting downstream effects on placental function. Conclusion: Ad.VEGF gene therapy improves fetal growth in a sheep model of FGR, although the precise mechanism of action remains unclear

Spatio-temporal Models of Lymphangiogenesis in Wound Healing

Several studies suggest that one possible cause of impaired wound healing is failed or insufficient lymphangiogenesis, that is the formation of new lymphatic capillaries. Although many mathematical models have been developed to describe the formation of blood capillaries (angiogenesis), very few have been proposed for the regeneration of the lymphatic network. Lymphangiogenesis is a markedly different process from angiogenesis, occurring at different times and in response to different chemical stimuli. Two main hypotheses have been proposed: 1) lymphatic capillaries sprout from existing interrupted ones at the edge of the wound in analogy to the blood angiogenesis case; 2) lymphatic endothelial cells first pool in the wound region following the lymph flow and then, once sufficiently populated, start to form a network. Here we present two PDE models describing lymphangiogenesis according to these two different hypotheses. Further, we include the effect of advection due to interstitial flow and lymph flow coming from open capillaries. The variables represent different cell densities and growth factor concentrations, and where possible the parameters are estimated from biological data. The models are then solved numerically and the results are compared with the available biological literature.Comment: 29 pages, 9 Figures, 6 Tables (39 figure files in total

Attack Resilience of the Evolving Scientific Collaboration Network

Stationary complex networks have been extensively studied in the last ten years. However, many natural systems are known to be continuously evolving at the local (“microscopic”) level. Understanding the response to targeted attacks of an evolving network may shed light on both how to design robust systems and finding effective attack strategies. In this paper we study empirically the response to targeted attacks of the scientific collaboration networks. First we show that scientific collaboration network is a complex system which evolves intensively at the local level – fewer than 20% of scientific collaborations last more than one year. Then, we investigate the impact of the sudden death of eminent scientists on the evolution of the collaboration networks of their former collaborators. We observe in particular that the sudden death, which is equivalent to the removal of the center of the egocentric network of the eminent scientist, does not affect the topological evolution of the residual network. Nonetheless, removal of the eminent hub node is exactly the strategy one would adopt for an effective targeted attack on a stationary network. Hence, we use this evolving collaboration network as an experimental model for attack on an evolving complex network. We find that such attacks are ineffectual, and infer that the scientific collaboration network is the trace of knowledge propagation on a larger underlying social network. The redundancy of the underlying structure in fact acts as a protection mechanism against such network attacks

Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrolment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.Vestergaard Frandse

Towards Online Multiresolution Community Detection in Large-Scale Networks

The investigation of community structure in networks has aroused great interest in multiple disciplines. One of the challenges is to find local communities from a starting vertex in a network without global information about the entire network. Many existing methods tend to be accurate depending on a priori assumptions of network properties and predefined parameters. In this paper, we introduce a new quality function of local community and present a fast local expansion algorithm for uncovering communities in large-scale networks. The proposed algorithm can detect multiresolution community from a source vertex or communities covering the whole network. Experimental results show that the proposed algorithm is efficient and well-behaved in both real-world and synthetic networks