Uveitis presenting with iris bombe in a patient with HIV: the importance of multi-disciplinary management — a case study

This case study concerns a 53-year-old female presenting to an eye-hospital in London with uveitis, on a background of well-controlled HIV. After investigation, no cause for the uveitis was found other than the HIV itself, and the patient was treated with immunosuppressants. Because of the nature of her underlying HIV infection, help was sought from HIV specialists, who gave advice on the management, including alteration of corticosteroid dosing due to the risk of drug-interactions between her uveitis and HIV treatments. Of particular concern was the risk of cytochrome P450 3A inhibition by cobicistat and the potential for iatrogenic Cushing syndrome through elevated steroid doses. This case is used as an example to highlight the importance of the multi-disciplinary team in the management ofcomplex conditions, as well as to add to the literature in support of the HIV virus itself as a cause of uveitis

Five-dimensional SYM from undeformed ABJM

We expand undeformed ABJM theory around the vacuum solution that was found in arxiv:0909.3101. This solution can be interpreted as a circle-bundle over a two-dimensional plane with a singularity at the origin. By imposing periodic boundary conditions locally far away from the singularity, we obtain a local fuzzy two-torus over which we have a circle fibration. By performing fluctuation analysis we obtain five-dimensional SYM with the precise value on the coupling constant that we would obtain by compactifying multiple M5 branes on the vacuum three-manifold. In the resulting SYM theory we also find a coupling to a background two-form.Comment: 23 page

Submaximal exercise pulmonary gas exchange in left heart disease patients with different forms of pulmonary hypertension.

JOURNAL ARTICLECopyright © 2015 Elsevier Inc. All rights reserved.BACKGROUND: We determined whether pulmonary gas exchange indices during submaximal exercise are different in heart-failure (HF) patients with combined post- and pre-capillary pulmonary hypertension (PPC-PH) vs. HF patients with isolated post-capillary PH (IPC-PH) or no-PH. METHODS & RESULTS: Pulmonary hemodynamics and pulmonary gas exchange were assessed during rest and submaximal exercise in 39 HF patients undergoing right-heart catheterization. Post-hemodynamic evaluation, patients were classified as having no-PH (n=11), IPC-PH (n=12) or PPC-PH (n=16). At an equivalent oxygen consumption, end-tidal CO2 (PETCO2) and arterial oxygen saturation (SaO2) were greater in no-PH and IPC-PH vs. PPC-PH patients (36.1±3.2 vs. 31.7±4.5 vs. 26.2±4.7 mmHg and 97±2 vs. 96 ±3 vs. 91±1%, respectively). Conversely, dead-space ventilation (VD/VT) and the ventilatory equivalent for carbon dioxide (V̇E/V̇CO2 ratio) were lower in no-PH and IPC-PH vs. PPC-PH patients (0.37±0.05 vs. 0.38±0.04 vs. 0.47±0.03 and 38±5 vs. 42±8 vs. 51±8, respectively). The exercise-induced change in VD/VT, V̇E/V̇CO2 ratio and PETCO2 correlated significantly with the change in mean pulmonary arterial pressure, diastolic pressure difference and transpulmonary pressure gradient in PPC-PH patients only. CONCLUSION: Noninvasive pulmonary gas exchange indices during submaximal exercise are different in HF patients with combined post-and pre-capillary PH compared to patients with isolated post-capillary PH or no-PH.NIHAmerican Heart Associatio

The effect of autonomous and controlled motivation on self‐control performance and the acute cortisol response

Autonomously regulated self-control typically does not reduce over time as much, compared with self-control underpinned by controlled motivation. The proposed study tested whether an acute stress response is implicated in this process. Utilizing a framework grounded in self-determination theory, this study examined whether participants' motivational regulation would influence repeated self-control performance and acute stress levels, measured by the stress hormone cortisol. A single-blind randomized experimental design incorporating two motivational conditions (autonomous regulation and controlled regulation) tested these hypotheses. Participants (female = 28; male = 11; Mage = 22.33) performed three sequential self-control tasks; a modified Stroop task followed by two "wall sit" postural persistence tasks. Salivary cortisol was measured at baseline and after each of the wall sits. A repeated measures ANCOVA unexpectedly revealed that participants in the controlled regulation condition recorded greater wall sit performance in the first and second wall sits, compared with the autonomous condition. A repeated measures ANCOVA also revealed a significant quadratic interaction for cortisol. Controlled regulation was associated with an increase, and autonomous regulation condition a decrease, in cortisol that subsided at timepoint two. Results imply autonomous motivation facilitates an adaptive stress response. Performance on the self-control tasks was contrary to expectations, but may reflect short-term performance benefits of controlled motivation

Multi-organ quantitative MRI for the assessment of liver disease - A whole much more than the sum of its parts

Background & Aims Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit vs. harm for therapies. Our aim was to establish the feasibility of magnetic resonance imaging (MRI) to assess changes in Compensated Cirrhosis (CC), and relate this to disease severity and future liver-related outcomes (LROs). Methods A total of 60 patients with CC, 40 healthy volunteers and 7 patients with decompensated cirrhosis were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T1 longitudinal relaxation time, heart rate, cardiac index, and volume assessment of the liver, spleen and kidneys. We explored the association between MRI parameters and disease severity, analysing differences in baseline MRI parameters in the 11 (18%) patients with CC who experienced future LROs. Results In the liver, compositional changes were reflected by increased T1 in progressive disease (p <0.001) and an increase in liver volume in CC (p = 0.006), with associated progressive reduction in liver (p <0.001) and splenic (p <0.001) perfusion. A significant reduction in renal cortex T1 and increase in cardiac index and superior mesenteric arterial blood flow was seen with increasing disease severity. Baseline liver T1 (p = 0.01), liver perfusion (p <0.01), and renal cortex T1 (p <0.01) were significantly different in patients with CC who subsequently developed negative LROs. Conclusions MRI enables the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement for a contrast agent. MRI parameters of liver T1, renal T1, hepatic and splenic perfusion, and superior mesenteric arterial blood flow were related to the risk of LROs. Lay summary This study assesses the changes to structure, blood flow and perfusion that occur in the key organs (liver, spleen and kidney) associated with severe liver disease (Compensated Cirrhosis), using magnetic resonance imaging. The magnetic resonance imaging measures which changed with disease severity and were related to negative liver-related clinical outcomes are described

The relationship between multidimensional motivation and endocrine-related responses: a systematic review

Multidimensional motivational theories postulate that the type of motivation is as important as the quantity of motivation, with implications for human functioning and well-being. An extensive amount of research has explored how constructs contained within these theories relate to the activation of the endocrine system. However, research is fragmented across several theories, and determining the current state of the science is complicated. In line with contemporary trends for theoretical integration, this systematic review aims to evaluate the association between multidimensional motivational constructs and endocrine-related responses to determine which theories are commonly used and what inferences can be made. Forty-one studies were identified incorporating five distinct motivation theories and multiple endocrine-related responses. There was evidence across several theories that high-quality motivation attenuated the cortisol response in evaluative environments. There was also evidence that motivational needs for power and affiliation were associated with lower and higher levels of salivary immunoglobulin A, respectively. The need for power may play a role in increasing testosterone when winning a contest; however, this evidence was not conclusive. Overall, this review can shape the future integration of motivational theories by characterizing the nature of physiological responses to motivational processes and examining the implications for well-being

Use of Caval Subtraction 2D Phase-Contrast MR Imaging to Measure Total Liver and Hepatic Arterial Blood Flow: Preclinical Validation and Initial Clinical Translation

Purpose To validate caval subtraction two-dimensional (2D) phase-contrast magnetic resonance (MR) imaging measurements of total liver blood flow (TLBF) and hepatic arterial fraction in an animal model and evaluate consistency and reproducibility in humans. Materials and Methods Approval from the institutional ethical committee for animal care and research ethics was obtained. Fifteen Sprague-Dawley rats underwent 2D phase-contrast MR imaging of the portal vein (PV) and infrahepatic and suprahepatic inferior vena cava (IVC). TLBF and hepatic arterial flow were estimated by subtracting infrahepatic from suprahepatic IVC flow and PV flow from estimated TLBF, respectively. Direct PV transit-time ultrasonography (US) and fluorescent microsphere measurements of hepatic arterial fraction were the standards of reference. Thereafter, consistency of caval subtraction phase-contrast MR imaging-derived TLBF and hepatic arterial flow was assessed in 13 volunteers (mean age, 28.3 years ± 1.4) against directly measured phase-contrast MR imaging PV and proper hepatic arterial inflow; reproducibility was measured after 7 days. Bland-Altman analysis of agreement and coefficient of variation comparisons were undertaken. Results There was good agreement between PV flow measured with phase-contrast MR imaging and that measured with transit-time US (mean difference, -3.5 mL/min/100 g; 95% limits of agreement [LOA], ±61.3 mL/min/100 g). Hepatic arterial fraction obtained with caval subtraction agreed well with those with fluorescent microspheres (mean difference, 4.2%; 95% LOA, ±20.5%). Good consistency was demonstrated between TLBF in humans measured with caval subtraction and direct inflow phase-contrast MR imaging (mean difference, -1.3 mL/min/100 g; 95% LOA, ±23.1 mL/min/100 g). TLBF reproducibility at 7 days was similar between the two methods (95% LOA, ±31.6 mL/min/100 g vs ±29.6 mL/min/100 g). Conclusion Caval subtraction phase-contrast MR imaging is a simple and clinically viable method for measuring TLBF and hepatic arterial flow. Online supplemental material is available for this article

On right conjugacy closed loops of twice prime order

The right conjugacy closed loops of order 2p, where p is an odd prime, are classified up to isomorphism.Comment: Clarified definitions, added some remarks and a tabl