Search

Iron is hypothesized to be one of the contributors to cardiovascular disease and its levels in the circulation may correlate with cardiovascular risk. The aim of this study is to investigate the mechanisms that underlie the effects of iron on the barrier function of primary human endothelium. We used Human Umbilical Vein Endothelial Cells (HUVEC) to investigate the effects of Fe3+ using electric cell-substrate impedance sensing, microscopy, western blot and immunofluorescence microscopy. Exposure to Fe3+ caused EC elongation and upregulation of stress-induced proteins. Analysis of barrier function showed a dose-dependent drop in endothelial integrity, which was accompanied by Reactive Oxygen Species (ROS) production and could partly be prevented by ROS scavengers. Inhibition of contractility by the ROCK inhibitor Y27632, showed even more effective rescue of barrier integrity. Using western blot, we detected an increase in expression of the small GTPase RhoB, an inducer of EC contraction, and a small decrease in VE-cadherin, suggestive for an iron-induced stress response. Co-stimulation by TNFα and iron, used to investigate the role of low-grade inflammation, revealed an additive, negative effect on barrier integrity, concomitant with an upregulation of pro-inflammatory markers ICAM-1 and RhoB. Iron induces a response in HUVEC that leads to endothelial activation and a pro-inflammatory state measured by loss of barrier integrity which can be reversed by ROS scavengers, combined with inhibition of contractility. These data suggest that ROS-mediated damage of the vascular endothelium could contribute to the increased cardiovascular risk which is associated with elevated levels of circulating iron. [ABSTRACT FROM AUTHOR]

The Mastcam-Z radiometric calibration targets mounted on the NASA's Perseverance rover proved to be effective in the calibration of Mastcam-Z images to reflectance (I/F) over the first 350 sols on Mars. Mastcam-Z imaged the calibration targets regularly to perform reflectance calibration on multispectral image sets of targets on the Martian surface. For each calibration target image, mean radiance values were extracted for 41 distinct regions of the targets, including patches of color and grayscale materials. Eight strong permanent magnets, placed under the primary target, attracted magnetic dust and repelled it from central surfaces, allowing the extraction of radiance values from eight regions relatively clean from dust. These radiances were combined with reflectances obtained from laboratory measurements, a one-term linear fit model was applied, and the slopes of the fits were retrieved as estimates of the solar irradiance and used to convert Mastcam-Z images from radiance to reflectance. Derived irradiance time series are smoothly varying in line with expectations based on the changing Mars-Sun distance, being only perturbed by a few significant dust events. The deposition of dust on the calibration targets was largely concentrated on the magnets, ensuring a minimal influence of dust on the calibration process. The fraction of sunlight directly hitting the calibration targets was negatively correlated with the atmospheric optical depth, as expected. Further investigation will aim at explaining the origin of a small offset observed in the fit model employed for calibration, and the causes of a yellowing effect affecting one of the calibration targets materials. [ABSTRACT FROM AUTHOR]

Ice sheet processes are often simplified in global climate models as changes in ice sheets have been assumed to occur over long time scales compared to ocean and atmospheric changes. However, numerous observations show an increasing rate of mass loss from the Greenland Ice Sheet and call for comprehensive process-based models to explore its role in climate change. Here, we present a new model system, EC-Earth-PISM, that includes an interactive Greenland Ice Sheet. The model is based on the EC-Earth v2.3 global climate model in which ice sheet surface processes are introduced. This model interacts with the Parallel Ice Sheet Model (PISM) without anomaly or flux corrections. Under pre-industrial climate conditions, the modeled climate and ice sheet are stable while keeping a realistic interannual variability. In model simulations forced into a warmer climate of four times the pre-industrial CO2 concentration, the total surface mass balance decreases and the ice sheet loses mass at a rate of about 500 Gt/year. In the climate warming experiments, the resulting freshwater flux from the Greenland Ice Sheet increases 55% more in the experiments with the interactive ice sheet and the climate response is significantly different: the Arctic near-surface air temperature is lower, substantially more winter sea ice covers the northern hemisphere, and the ocean circulation is weaker. Our results indicate that the melt-albedo feedback plays a key role for the response of the ice sheet and its influence on the changing climate in the Arctic. This emphasizes the importance of including interactive ice sheets in climate change projections. [ABSTRACT FROM AUTHOR]

Aim: To describe the development of HbA1c and BMI over time in Danish children with type 1 diabetes; and to investigate the association between HbA1c and BMI including influence of age, gender, diabetes duration, severe hypoglycaemia and treatment method. Methods: We used the nationwide Danish Registry of Childhood and Adolescent Diabetes, DanDiabKids, including annual registrations of all children with diabetes treated at Danish hospitals. With linear mixed‐effects models and splines we analyzed the HbA1c and BMI development over time as well as the association between HbA1c and BMI including effects of gender, age, disease duration, hypoglycaemia and treatment method. BMI z‐scores were calculated for these analyses. Results: For the period from 2000 to 2018, 6097 children with type 1 diabetes were identified from the DanDiabKids database. The median (interquartile range) HbA1c level was 65 (57–74) mmol/mol (8.1%) and the median BMI z‐score was 0.85 in girls and 0.67 in boys. A non‐linear association was found between HbA1c and BMI z‐score, with the highest BMI z‐score observed for HbA1c values in the range of approximately 60–70 mmol/mol (7.6–6.8%). The association was modified by gender, age and diabetes duration. Severe hypoglycaemia and insulin pump treatment had a small positive impact on BMI z‐score. Conclusion: The association between HbA1c and BMI z‐score was non‐linear, with the highest BMI z‐score being observed for intermediate HbA1c levels; however, specific patterns depended on gender, age and diabetes duration. [ABSTRACT FROM AUTHOR]

Mastcam-Z is a multispectral, stereoscopic imaging investigation on the Mars 2020 mission’s Perseverance rover. Mastcam-Z consists of a pair of focusable, 4:1 zoomable cameras that provide broadband red/green/blue and narrowband 400-1000 nm color imaging with fields of view from 25.6° × 19.2° (26 mm focal length at 283 μrad/pixel) to 6.2° × 4.6° (110 mm focal length at 67.4 μrad/pixel). The cameras can resolve (≥ 5 pixels) ∼0.7 mm features at 2 m and ∼3.3 cm features at 100 m distance. Mastcam-Z shares significant heritage with the Mastcam instruments on the Mars Science Laboratory Curiosity rover. Each Mastcam-Z camera consists of zoom, focus, and filter wheel mechanisms and a 1648 × 1214 pixel charge-coupled device detector and electronics. The two Mastcam-Z cameras are mounted with a 24.4 cm stereo baseline and 2.3° total toe-in on a camera plate ∼2 m above the surface on the rover’s Remote Sensing Mast, which provides azimuth and elevation actuation. A separate digital electronics assembly inside the rover provides power, data processing and storage, and the interface to the rover computer. Primary and secondary Mastcam-Z calibration targets mounted on the rover top deck enable tactical reflectance calibration. Mastcam-Z multispectral, stereo, and panoramic images will be used to provide detailed morphology, topography, and geologic context along the rover’s traverse; constrain mineralogic, photometric, and physical properties of surface materials; monitor and characterize atmospheric and astronomical phenomena; and document the rover’s sample extraction and caching locations. Mastcam-Z images will also provide key engineering information to support sample selection and other rover driving and tool/instrument operations decisions. [ABSTRACT FROM AUTHOR]

The Mastcam-Z Camera is a stereoscopic, multispectral camera with zoom capability on NASA’s Mars-2020 Perseverance rover. The Mastcam-Z relies on a set of two deck-mounted radiometric calibration targets to validate camera performance and to provide an instantaneous estimate of local irradiance and allow conversion of image data to units of reflectance (R∗ or I/F) on a tactical timescale. Here, we describe the heritage, design, and optical characterization of these targets and discuss their use during rover operations. The Mastcam-Z primary calibration target inherits features of camera calibration targets on the Mars Exploration Rovers, Phoenix and Mars Science Laboratory missions. This target will be regularly imaged during flight to accompany multispectral observations of the martian surface. The primary target consists of a gold-plated aluminum base, eight strong hollow-cylinder Sm2Co17 alloy permanent magnets mounted in the base, eight ceramic color and grayscale patches mounted over the magnets, four concentric, ceramic grayscale rings and a central aluminum shadow post (gnomon) painted with an IR-black paint. The magnets are expected to keep the central area of each patch relatively free of Martian aeolian dust. The Mastcam-Z secondary calibration target is a simple angled aluminum shelf carrying seven vertically mounted ceramic color and grayscale chips and seven identical, but horizontally mounted ceramic chips. The secondary target is intended to augment and validate the calibration-related information derived from the primary target. The Mastcam-Z radiometric calibration targets are critically important to achieving Mastcam-Z science objectives for spectroscopy and photometric properties. [ABSTRACT FROM AUTHOR]

SuperCam is a highly integrated remote-sensing instrumental suite for NASA’s Mars 2020 mission. It consists of a co-aligned combination of Laser-Induced Breakdown Spectroscopy (LIBS), Time-Resolved Raman and Luminescence (TRR/L), Visible and Infrared Spectroscopy (VISIR), together with sound recording (MIC) and high-magnification imaging techniques (RMI). They provide information on the mineralogy, geochemistry and mineral context around the Perseverance Rover. The calibration of this complex suite is a major challenge. Not only does each technique require its own standards or references, their combination also introduces new requirements to obtain optimal scientific output. Elemental composition, molecular vibrational features, fluorescence, morphology and texture provide a full picture of the sample with spectral information that needs to be co-aligned, correlated, and individually calibrated. The resulting hardware includes different kinds of targets, each one covering different needs of the instrument. Standards for imaging calibration, geological samples for mineral identification and chemometric calculations or spectral references to calibrate and evaluate the health of the instrument, are all included in the SuperCam Calibration Target (SCCT). The system also includes a specifically designed assembly in which the samples are mounted. This hardware allows the targets to survive the harsh environmental conditions of the launch, cruise, landing and operation on Mars during the whole mission. Here we summarize the design, development, integration, verification and functional testing of the SCCT. This work includes some key results obtained to verify the scientific outcome of the SuperCam system. [ABSTRACT FROM AUTHOR]

Copyright of BJS Open is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the mink industry, feed costs are the largest variable expense and breeding for feed efficient animals is warranted. Implementation of selection for feed efficiency must consider the relationships between feed efficiency and the current selection traits BW and litter size. Often, feed intake (FI) is recorded on a cage with a male and a female and there is sexual dimorphism that needs to be accounted for. Study aims were to (1) model group recorded FI accounting for sexual dimorphism, (2) derive genetic residual feed intake (RFI) as a measure of feed efficiency, (3) examine the relationship between feed efficiency and BW in males (BWM) and females (BWF) and litter size at day 21 after whelping (LS21) in Danish brown mink and (4) investigate direct and correlated response to selection on each trait of interest. Feed intake records from 9574 cages, BW records on 16 782 males and 16 875 females and LS21 records on 6446 yearling females were used for analysis. Genetic parameters for FI, BWM, BWF and LS21 were obtained using a multivariate animal model, yielding sex-specific additive genetic variances for FI and BW to account for sexual dimorphism. The analysis was performed in a Bayesian setting using Gibbs sampling, and genetic RFI was obtained from the conditional distribution of FI given BW using genetic regression coefficients. Responses to single trait selection were defined as the posterior distribution of genetic superiority of the top 10% of animals after conditioning on the genetic trends. The heritabilities ranged from 0.13 for RFI in females and LS21 to 0.59 for BWF. Genetic correlations between BW in both sexes and LS21 and FI in both sexes were unfavorable, and single trait selection on BW in either sex showed increased FI in both sexes and reduced litter size. Due to the definition of RFI and high genetic correlation between BWM and BWF, selection on RFI did not significantly alter BW. In addition, selection on RFI in either sex did not affect LS21. Genetic correlation between sexes for FI and BW was high but significantly lower than unity. The high correlations across sex allowed for selection on standardized averages of animals' breeding values (BVs) for RFI, FI and BW, which yielded selection responses approximately equal to the responses obtained using the sex-specific BVs. The results illustrate the possibility of selecting against RFI in mink with no negative effects on BW and litter size. [ABSTRACT FROM AUTHOR]

Polar cod, Boreogadus saida, is an important part of Arctic and boreal marine ecosystems. Knowledge of polar cod population genetic structuring can provide insight into how the species may respond to environmental change, and allow for establishment of meaningful management units. To examine population genetic structure of B. saida, we analysed nine microsatellite DNA loci in 2269 fish collected at 19 locations across the species' range. Genetic differentiation was detected (FST = 0.01, p < 0.01), which had concordance with geography. A Canada East group consisted of fish collected from Resolute Bay to the Gulf of St. Lawrence. Three additional groups were observed. These consisted of a Canada West group containing specimens from the Canadian Beaufort Sea and Amundsen Gulf, a Europe group containing specimens from the Greenland Sea, Iceland and the Laptev Sea, and a US group consisting of specimens collected in the North Bering, Chukchi and Western Beaufort seas. Very little genetic differentiation was detected within the identified groups. Physical distance, geophysical structure and oceanography all appeared to have the potential to influence levels of genetic divergence. The population genetic structure detected is likely to be important for the response of B. saida to environmental change, and should be considered in management of human activities that may impact this foundational species. [ABSTRACT FROM AUTHOR]

Background: Treatment with thyroid hormones is occasionally used in the management of treatment‐resistant depression. However, the evidence supporting this treatment is not fully established. The aim of this study was to systematically review the literature on the effect of adjunctive thyroid hormone in the management of treatment‐resistant unipolar depression and to provide a pooled estimate of its efficacy. Methods: The study is registered with PROSPERO (reg. no. CRD42018108088) and followed the PRISMA guidelines. Searches were carried out on June 24, 2019, in PubMed, EMBASE, and PsycINFO. Each record was screened independently by at least two reviewers. In instances of discrepancies, consensus was reached upon discussion. Pooled efficacy estimates were calculated based on response rates (decrease of ≥50% on the primary outcome measure) using random effect statistics. Results: The search yielded 1355 records. Based on the screening of these records, we identified 10 studies that met the inclusion criteria (total number of patients = 663). The comparison of response to thyroid hormones vs. placebo resulted in an odds ratio of 1.56 (95% CI: 0.50–4.84). Similarly, the comparison of response to thyroid hormones vs. lithium resulted in an odds ratio of 1.91 (95% CI: 0.85–4.26). Thus, adjunctive therapy with thyroid hormones was not superior to placebo or lithium in the management of treatment‐resistant unipolar depression. Conclusion: According to this review and meta‐analysis, there is not sufficient evidence to support the use of adjunctive thyroid hormones for treatment‐resistant unipolar depression. [ABSTRACT FROM AUTHOR]

In degraded dryland systems, native plant community re‐establishment following disturbance is almost exclusively carried out using seeds, but these efforts commonly fail. Much of this failure can be attributed to the limited understanding of seed dormancy and germination traits.We undertook a systematic classification of seed dormancy of 26 species of annual and perennial forbs and shrubs that represent key, dominant genera used in restoration of the Great Basin ecosystem in the western United States. We examined germination across a wide thermal profile to depict species‐specific characteristics and assessed the potential of gibberellic acid (GA3) and karrikinolide (KAR1) to expand the thermal germination envelope of fresh seeds.Of the tested species, 81% produce seeds that are dormant at maturity. The largest proportion (62%) exhibited physiological (PD), followed by physical (PY, 8%), combinational (PY + PD, 8%) and morphophysiological (MPD, 4%) dormancy classes. The effects of chemical stimulants were temperature‐ and species‐mediated. In general, mean germination across the thermal profile was improved by GA3 and KAR1 for 11 and five species, respectively. We detected a strong germination response to temperature in freshly collected seeds of 20 species. Temperatures below 10 °C limited the germination of all except Agoseris heterophylla, suggesting that in their dormant state, the majority of these species are thermally restricted.Our findings demonstrate the utility of dormancy classification as a foundation for understanding the critical regenerative traits in these ecologically important species and highlight its importance in restoration planning. [ABSTRACT FROM AUTHOR]

Several recent studies from both Greenland and Antarctica have reported significant changes in the water isotopic composition of near‐surface snow between precipitation events. These changes have been linked to isotopic exchange with atmospheric water vapor and sublimation‐induced fractionation, but the processes are poorly constrained by observations. Understanding and quantifying these processes are crucial to both the interpretation of ice core climate proxies and the formulation of isotope‐enabled general circulation models. Here, we present continuous measurements of the water isotopic composition in surface snow and atmospheric vapor together with near‐surface atmospheric turbulence and snow‐air latent and sensible heat fluxes, obtained at the East Greenland Ice‐Core Project drilling site in summer 2016. For two 4‐day‐long time periods, significant diurnal variations in atmospheric water isotopologues are observed. A model is developed to explore the impact of this variability on the surface snow isotopic composition. Our model suggests that the snow isotopic composition in the upper subcentimeter of the snow exhibits a diurnal variation with amplitudes in δ18O and δD of ~2.5‰ and ~13‰, respectively. As comparison, such changes correspond to 10–20% of the magnitude of seasonal changes in interior Greenland snow pack isotopes and of the change across a glacial‐interglacial transition. Importantly, our observation and model results suggest, that sublimation‐induced fractionation needs to be included in simulations of exchanges between the vapor and the snow surface on diurnal timescales during summer cloud‐free conditions in northeast Greenland. Key Points: Data show evidence of isotopic fractionation during vapor exchange between the snow surface and atmosphereModel simulations suggest diurnal variation in the snow surface isotopic compositionWe propose an enhanced effective isotopic exchange between the surface of the snow grain and its interior [ABSTRACT FROM AUTHOR]

The volume-duration relationship using low concentrations of ropivacaine for peripheral nerve blocks is unknown, even though low concentrations of ropivacaine are increasingly used clinically. We investigated the effect of ropivacaine 0.2% on common peroneal nerve block duration. With ethical committee approval, 60 consenting, healthy volunteers were randomly allocated to receive one of five volumes of ropivacaine 0.2% (2.5, 5.0, 10, 15 or 20 ml) administered by ultrasound-guided, catheter-based injection (at 10 ml.min-1 ) near the common peroneal nerve. Our primary outcome was duration of sensory block, defined by insensitivity to a cold stimulus. Our secondary outcome was duration of motor block. Outcomes were assessed every hour from onset of block to complete remission. Intergroup differences were tested using one-way ANOVA followed by regression analyses using the 20 ml intervention group as reference. Block durations varied significantly (p < 0.0001) between groups. Mean (SD) sensory block durations were 9.2 (3.3), 12.5 (3.0), 15.5 (4.4), 17.3 (3.5) and 17.3 (4.6) h. Mean (SD) motor block durations were 3.3 (2.1), 7.2 (2.5), 9.2 (2.2), 12.7 (2.5) and 12.5 (2.5) h. Regression analysis showed that the effect of volume on block duration was progressively smaller with increasing volume, reaching a threshold volume above which there was no effect on nerve block duration (10 ml for sensory block and 15 ml for motor block). We conclude that there is a ceiling effect of increasing volume of ropivacaine 0.2% on both sensory and motor block duration of the common peroneal nerve. [ABSTRACT FROM AUTHOR]

Background: Due to the high incidence of benign lesions in renal masses, numerous studies have been performed to clarify the value of core needle biopsies. The aim of the present study was to describe the complication rate after renal tumor biopsies (RTB), in order to make recommendations on observation after the procedure. Materials and methods: Data from all patients who underwent percutaneous ultrasound-guided RTB between February 2013 and October 2016 due to CT verified solid renal masses were prospectively collected and kept in a well-maintained database. Complications were collected retrospectively and classified according to the Clavien-Dindo (CD) classification system. Results: Data from 224 consecutive patients were retrieved. Thirteen patients underwent unilateral repeat biopsies and three patients underwent bilateral biopsies; thus, a total of 240 procedures were analyzed. A total of 124 patients (51.7%) were discharged within 4 hours after the RTB procedures and 110 patients (45.8%) were discharged within 24 hours. The remaining six patients (2.5%) were hospitalized for more than 1 day, all due to co-morbidities which were unrelated to the procedure. In total, five patients (2.1%) experienced post-biopsy complications: one case of iatrogenic pneumothorax, one case of spontaneously resolving hematuria and three cases of fever. All complications were CD ≤2 and all patients with complications were discharged within 24 hours, except for one patient who was hospitalized for 3 days due to management of bone pain. No correlation was found between the number of biopsies and complication rate. Conclusion: The overall complication rate following ultrasound-guided biopsies of renal tumors was low and all complications were mild. Given the current evidence, it is believed that ultrasound-guided RTB can be done as an outpatient procedure without the need for hospitalization. [ABSTRACT FROM AUTHOR]

Background: Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used.Methods: Within the framework of INFECT project, patients with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study. The goal is to evaluate outcome and characteristics for patients with NSTI and diabetes compared to patients with NSTI without diabetes. The primary outcome is mortality at 90 days after inclusion. Secondary outcomes include days alive and out of ICU and hospital, SAPS II, SOFA score, infectious etiology, amputation, affected body area, and renal replacement therapy. Comparison in mortality between patients with diabetes type 1 and 2 as well as between insulin-treated and non-insulin-treated diabetes patients will be made. Clinical data for diabetic patients with NSTI will be reported.Conclusion: The study will provide important data on patients with NSTI and diabetes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to evaluate the diagnostic accuracy of core biopsy in small renal masses ≤ 4 cm in response to the rising prevalence of renal masses.Methods: Data from 129 consecutive patients who underwent biopsies of solid renal masses of ≤ 4 cm were prospectively collected between September 2014 and January 2017. In cases with inconclusive biopsies, a repeat biopsy was recommended. Histology from surgical specimens was used as gold standard to evaluate the accuracy of renal biopsies.Results: The initial biopsies revealed malignancy in 77 patients (59.7%) and benign histology in 35 patients (27.1%), whereas 17 (13.2%) were inconclusive. Fifty-six patients with malignant histology underwent either partial or radical nephrectomy according to the physicians’ recommendation, while two patients with benign histology requested surgery. In all cases, the biopsy diagnosis was confirmed upon final histopathology. Of the inconclusive cases, six underwent repeat biopsies all with benign histology. Further, three patients opted for immediate partial nephrectomy with benign oncocytoma in two and renal cell carcinoma in the third. The remaining eight patients opted for follow-up CT scans with no sign of progression with a minimum of 6-month follow-up. No biopsy related complications were reported in the first 30 days after RTB. Overall, the treatment strategy changed in 45 of 129 (35%) patients due to biopsy results. This was either due to benign findings or due to the discovery of non-renal cell cancers.Conclusion: Core needle biopsies of solid renal masses ≤ 4 cm have excellent accuracy and may be used to select the correct treatment. Importantly, they may serve to prevent overtreatment of benign tumors. [ABSTRACT FROM AUTHOR]

A magnetic impurity coupled to a superconductor gives rise to a Yu–Shiba–Rusinov (YSR) state inside the superconducting energy gap. With increasing exchange coupling the excitation energy of this state eventually crosses zero and the system switches to a YSR ground state with bound quasiparticles screening the impurity spin by ħ/2. Here we explore indium arsenide (InAs) nanowire double quantum dots tunnel coupled to a superconductor and demonstrate YSR screening of spin-1/2 and spin-1 states. Gating the double dot through nine different charge states, we show that the honeycomb pattern of zero-bias conductance peaks, archetypal of double dots coupled to normal leads, is replaced by lines of zero-energy YSR states. These enclose regions of YSR-screened dot spins displaying distinctive spectral features, and their characteristic shape and topology change markedly with tunnel coupling strengths. We find excellent agreement with a simple zero-bandwidth approximation, and with numerical renormalization group calculations for the two-orbital Anderson model. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the value of standard biochemical coagulation parameters in predicting bleeding, thrombosis and mortality in adult Intensive Care Unit (ICU) patients with haematological malignancies.Methods: We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008-2012. Data were obtained from the clinical chemistry laboratory database and patient files. We graded bleeding according to the World Health Organisation (WHO)-system within 24-h, within 5-days and during the whole ICU stay. We analysed the predictive values of laboratory parameters using multiple logistic regression and receiver operator characteristics (ROC) curves. As we previously have established that platelet count at admission was associated with bleeding, we focused on International Normalised Ratio (INR), activated pro-thrombin time (APTT), anti-thrombin, D-dimer and fibrinogen, and markers of infection (C-reactive protein, pro-calcitonin), kidney function (creatinine) and tissue damage (lactate dehydrogenase (LDH)).Results: We included 116 patients; 66 (57%) had at least one bleeding episode and 11 (9%) patients had at least one thrombotic event. The differences in coagulation values when bleeding compared to baseline values were minor. INR was the only variable we found associated with subsequent bleeding within 24 h from admission to ICU (odds ratio 2.91, 95% CI: 1.01-8.43, P = 0.048). ROC analyses did not show predictive value of any of the other variables with regards to bleeding and none of the variables were associated with thrombosis in adjusted analyses. Increased levels of LDH at admission were associated with increased 7-day and 30-day mortality.Conclusions: Increased INR at admission was associated with a higher rate of bleeding in ICU patients with haematological malignancies. No other biochemical coagulation or other parameter had any association with bleeding, thrombosis or mortality except increased LDH, which at ICU admission was associated with increased 30-day mortality. [ABSTRACT FROM AUTHOR]

Background: The INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating these to patient-important outcomes. With this protocol and statistical analysis plan we describe the methods used to obtain data and the details of the planned analyses.Methods: The INFECT study is a multicentre, prospective observational cohort study. Patients with NSTIs are enrolled in five Scandinavian hospitals, which are all referral centres for NSTIs. The primary outcomes are the descriptive variables of the patients. Secondary outcomes include identification of factors associated with 90-day mortality and amputation; associations between affected body part, maximum skin defect and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and 90-day mortality; 90-day mortality in patients with and without acute kidney injury (AKI) and LRINEC score of six and above or below six; and association between affected body part at arrival and microbiological findings. Exploratory outcomes include univariate analyses of baseline characteristics associations with 90-day mortality. The statistical analyses will be conducted in accordance with the predefined statistical analysis plan.Conclusion: Necrotizing soft tissue infections result in severe morbidity and mortality. The INFECT study will be the largest prospective study in patients with NSTIs to date and will provide important data for clinicians, researchers and policy makers on the characteristics and outcomes of these patients. [ABSTRACT FROM AUTHOR]

A single bout of high-intensity exercise can augment off-line gains in skills acquired during motor practice. It is currently unknown if the type of physical exercise influences the effect on motor skill consolidation. This study investigated the effect of three types of high-intensity exercise following visuomotor skill acquisition on the retention of motor memory in 40 young (25.3 ±3.6 years), able-bodied male participants randomly assigned to one of four groups either performing strength training ( STR), circuit training ( CT), indoor hockey ( HOC) or rest ( CON). Retention tests of the motor skill were performed 1 (R1h) and 24 h (R1d) post acquisition. For all exercise groups, mean motor performance scores decreased at R1h compared to post acquisition ( POST) level; STR ( P = 0.018), CT ( P = 0.02), HOC ( P = 0.014) and performance scores decreased for CT compared to CON ( P = 0.049). Mean performance scores increased from POST to R1d for all exercise groups; STR ( P = 0.010), CT ( P = 0.020), HOC ( P = 0.007) while performance scores for CON decreased ( P = 0.043). Changes in motor performance were thus greater for STR ( P = 0.006), CT ( P < 0.001) and HOC ( P < 0.001) compared to CON from POST to R1d. The results demonstrate that high-intensity, acute exercise can lead to a decrease in motor performance assessed shortly after motor skill practice (R1h), but enhances offline effects promoting long-term retention (R1d). Given that different exercise modalities produced similar positive off-line effects on motor memory, we conclude that exercise-induced effects beneficial to consolidation appear to depend primarily on the physiological stimulus rather than type of exercise and movements employed. [ABSTRACT FROM AUTHOR]

Background: Recently, studies have focused on how to optimize laparoscopic surgical workspace by changes in intra-abdominal pressure, level of muscle relaxation or body position, typically evaluated by surgeons using subjective rating scales. We aimed to validate two rating scales by having surgeons assess surgical workspace in video sequences recorded during laparoscopic surgery.Method: Video sequences were obtained from laparoscopic procedures. Eight experienced surgeons assessed the video sequences on a categorical 5-point scale and a numerical 10-point rating scale. Intraclass correlations coefficients (ICC) and 95% confidence intervals (CI) were calculated for intra- and inter-rater reliability.Results: The 5-point rating scale had an intra-rater ICC of 0.76 (0.69; 0.83) and an inter-rater ICC of 0.57 (0.45; 0.68), corresponding to excellent and fair reliability, respectively. The 10-point scale had an intra-rater ICC of 0.86 (0.82; 0.89) and an inter-rater ICC of 0.54 (0.39; 0.68), corresponding to excellent and fair as well. All surgeons used the full range of the 5-point scale, but only one surgeon used the full range of the 10-point scale.Conclusion: In conclusion, both scales showed excellent intra-rater and fair inter-rater reliability for assessing surgical workspace in laparoscopy. The 5-point surgical rating scale had all categories employed by all surgeons. [ABSTRACT FROM AUTHOR]

Background: Patients in the intensive care unit (ICU) are often anaemic due to blood loss, impaired red blood cell (RBC) production and increased RBC destruction. In some studies, more than half of the patients were treated with RBC transfusion. During storage, the RBC and the storage medium undergo changes, which lead to impaired transportation and delivery of oxygen and may also promote an inflammatory response. Divergent results on the clinical consequences of storage have been reported in both observational studies and randomised trials. Therefore, we aim to gather and review the present evidence to assess the effects of shorter vs. longer storage time of transfused RBCs for ICU patients.Methods: We will conduct a systematic review with meta-analyses and trial sequential analyses of randomised clinical trials, and also include results of severe adverse events from large observational studies. Participants will be adult patients admitted to an ICU and treated with shorter vs. longer stored RBC units. We will systematically search the Cochrane Library, MEDLINE, Embase, BIOSIS, CINAHL and Science Citation Index for relevant literature, and we will follow the recommendation by the Cochrane Collaboration and the Preferred Reporting Items for Systemtic Review and Meta-Analysis (PRISMA)-statement. We will assess the risk of bias and random errors, and we will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to evaluate the overall quality of evidence.Conclusion: We need a high-quality systematic review to summarise the clinical consequences of RBC storage time among ICU patients. [ABSTRACT FROM AUTHOR]

Aim To assess the effect of elevated basal shear stress on angiogenesis in humans and the role of enhanced skeletal muscle capillarization on blood flow and O2 extraction. Methods Limb haemodynamics and O2 extraction were measured at rest and during one-leg knee-extensor exercise (12 and 24 W) in 10 healthy untrained young men before and after 4-week treatment with an α1 receptor-antagonist (Terazosin, 1-2 mg day−1). Corresponding biopsies were taken from the m. vastus lateralis. Results Resting leg blood flow was increased by 57% 6 h following Terazosin treatment ( P < 0.05), while basal capillary-to-fibre ratio was 1.69 ± 0.08 and increased to 1.90 ± 0.08 after treatment ( P < 0.05). Leg O2 extraction during knee-extensor exercise was higher (4-5%; P < 0.05), leg blood flow and venous lactate levels lower (6-7%; P < 0.05), while leg VO2 was not different after Terazosin treatment. Conclusions These results demonstrate that daily treatment with an α-adrenergic receptor blocker induces capillary growth in human skeletal muscle, likely due to increased shear stress. The increase in capillarization resulted in an increased fractional O2 extraction, a lower blood flow and venous lactate levels in the exercising leg. The increase in capillarization, and concomitant functional readouts in the exercising leg, may provide a basis for novel angiotherapy. [ABSTRACT FROM AUTHOR]

We performed a randomised double-blind pilot study in 16 healthy volunteers to investigate the success rate for placing a new suture-method catheter for sciatic nerve block. A catheter was inserted into both legs of volunteers and each was randomly allocated to receive 15 ml lidocaine 2% through the catheter in one leg and 15 ml saline in the other leg. Successful placement of the catheter was defined as a 20% decrease in maximum voluntary isometric contraction for dorsiflexion of the ankle. Secondary outcomes were maximum voluntary isometric contraction for plantar flexion at the ankle, surface electromyography and cold sensation. After return of motor and sensory function, volunteers performed standardised physical exercises; injection of the same study medication was repeated in the same leg and followed by motor and sensory assessments. Fifteen of 16 (94%; 95%CI 72-99%) initial catheter placements were successful. The reduction in maximum voluntary isometric contraction and surface electromyography affected the peroneal nerve more often than the tibial nerve. Eleven of 15 (73%; 95%CI 54-96%) catheters remained functional with motor and sensory block after physical exercise, and the maximal displacement was 5 mm. Catheters with secondary block failure were displaced between 6 and 10 mm. One catheter was displaced 1.8 mm that resulted in a decrease in maximum voluntary isometric contraction of less than 20%. After repeat test injection, 14 of the 16 volunteers had loss of cold sensation. Neither motor nor sensory functions were affected in the legs injected with placebo. We conclude that the suture-method catheter can be placed with a high success rate, but that physical exercise may cause displacement. [ABSTRACT FROM AUTHOR]

Objectives The impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator ( IV- tPA) is sparsely examined. We studied the association between stroke subtype and clinical outcome in magnetic resonance imaging ( MRI)-evaluated patients treated with IV- tPA. Material and methods We conducted a single-center retrospective analysis of MRI-selected stroke patients treated with IV- tPA between 2004 and 2010. The Trial of ORG 10172 in Acute Stroke Treatment criteria were used to establish the stroke subtype by 3 months. The outcomes of interest were a 3-month modified Rankin Scale score of 0-1 (favorable outcome), and early neurological improvement defined as complete remission of neurological deficit or improvement of ≥4 on the National Institute of Health Stroke Scale at 24 h. The outcomes among stroke subtypes were compared with multivariable logistic regression. Results Among 557 patients, 202 (36%) had large vessel disease ( LVD), 153 (27%) cardioembolic stroke ( CE), 109 (20%) small vessel disease, and 93 (17%) were of other or undetermined etiology. Early neurological improvement was present in 313 (56.4%) patients, and 361 (64.8%) patients achieved a favorable outcome. Early neurological improvement and favorable outcome were more likely in CE patients compared with LVD patients (odds ratio ( OR), 2.1 (95% confidence interval, 1.4-3.3), and 2.0 (95% confidence interval, 1.2-3.3), respectively). Conclusions Cardioembolic stroke patients were more likely to achieve early neurological improvement and favorable outcome compared with LVD stroke following MRI-based IV- tPA treatment. This finding may reflect a difference in the effect of IV- tPA among stroke subtypes. [ABSTRACT FROM AUTHOR]

Aim: To evaluate serum thyroglobulin (Tg) level as a marker of the development of thyroid disease when following individuals who received neck irradiation therapy in childhood.Methods: In a non-randomized cross-sectional study Tg was assessed in 172 survivors of childhood cancer 10.8 y (1.9-24) median (range) after diagnosis and 7.9 y (0.9-24.3) median (range) after the end of treatment. The patients were divided into two groups: group 1 included 47 patients who had received irradiation to the neck and group 2 included 125 patients who did not receive irradiation to the neck.Results: Patients who had received irradiation to the neck had significantly higher Tg levels compared with those who did not receive neck irradiation: median 14.0 (1.0-189.0) microg/L vs median 8.8, (0.7-112.2) microg/L (p < 0.001). Six out of seven patients with elevated Tg levels (>70 microg/L) had received neck irradiation. Among these six patients, two patients developed secondary differentiated thyroid cancer and two patients developed benign thyroid neoplasms. None of the patients who had normal levels of Tg developed thyroid cancer.Conclusion: A high Tg level should be a cause for further investigation in the follow-up of individuals who have received irradiation therapy in childhood. [ABSTRACT FROM AUTHOR]

Background: Deep neuromuscular blockade during laparoscopic surgery may provide some clinical benefit. We present the 'Pro-' argument in this paired position paper.Methods: We reviewed recent evidence from a basic database of references which we agreed on with the 'Con-' side, and present this in narrative form. We have shared our analysis and text with the authors of the 'Con-' side of these paired position papers during the preparation of the manuscripts.Results: There are a few low risk of bias studies indicating that use of deep neuromuscular blockade improve surgical conditions and improve patient outcomes such as post-operative pain in laparoscopic surgery.Conclusion: Our interpretation of recent findings is that there is reason to believe that there may be some patient benefit of deep neuromuscular blockade in this context, and more detailed study is needed. [ABSTRACT FROM AUTHOR]

The thermal gradients along indium arsenide nanowires were engineered by a combination of fabricated micro-trenches in the supporting substrate and focused laser irradiation. This allowed local spatial control of thermally activated oxidation reactions of the nanowire on the scale of the diffraction limit. The locality of the oxidation was detected by micro-Raman mapping, and the results were found to be consistent with numerical simulations of the temperature profile. Applying the technique to nanowires in electrical devices the locally oxidizednanowires remained conducting with a lower conductance as expected for an effectively thinner conducting core. [ABSTRACT FROM AUTHOR]

Objective To study the effect of initial simulation-based transvaginal sonography ( TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology ( Ob-Gyn), assessed 2 months into their residency. Methods In a randomized study, new Ob-Gyn residents ( n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance ( n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills ( OSAUS) scale. Results During the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively ( P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001). Conclusion Simulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Although desalination by membrane processes is a possible solution to the problem of freshwater supply, related cost and energy demands prohibit its use on a global scale. Hence, there is an emerging necessity for alternative, energy and cost-efficient methods for water desalination. Cyanobacteria are oxygen-producing, photosynthetic bacteria that actively grow in vast blooms both in fresh and seawater bodies. Moreover, cyanobacteria can grow with minimal nutrient requirements and under natural sunlight. Taking these observations together, a consortium of five British Universities was formed to test the principle of using cyanobacteria as ion exchangers, for the specific removal of Na+and Cl−from seawater. This project consisted of the isolation and characterisation of candidate strains, with central focus on their potential to be osmotically and ionically adaptable. The selection panel resulted in the identification of two Euryhaline strains, one of freshwater (Synechocystissp. Strain PCC 6803) and one of marine origin (Synechococcussp. Strain PCC 7002) (Robert Gordon University, Aberdeen). Other work packages were as follows. Genetic manipulations potentially allowed for the expression of a light-driven, Cl−-selective pump in both strains, therefore, enhancing the bioaccumulation of specific ions within the cell (University of Glasgow). Characterisation of surface properties under different salinities (University of Sheffield), ensured that cell–liquid separation efficiency would be maximised post-treatment, as well as monitoring the secretion of mucopolysaccharides in the medium during cell growth. Work at Newcastle University is focused on the social acceptance of this scenario, together with an assessment of the potential risks through the generation and application of a Hazard Analysis and Critical Control Points plan. Finally, researchers in Imperial College (London) designed the process, from biomass production to water treatment and generation of a model photobioreactor. This multimodal approach has produced promising first results, and further optimisation is expected to result in mass scaling of this process. [ABSTRACT FROM PUBLISHER]

Consumption of poultry meat is considered as one of the main sources of human campylobacteriosis, and there is clearly a need for new surveillance and control measures based on quantitative data on Campylobacter spp. colonization dynamics in broiler chickens. We conducted four experimental infection trials, using four isolators during each infection trial to evaluate colonization of individual broiler chickens by Campylobacter jejuni over time. Individual and pooled faecal samples were obtained at days 4, 7 and 12 post-inoculation (p.i.) and caecal samples at day 12 p.i. There were large differences between broiler chickens in the number of C. jejuni in caecal and faecal material. Faecal samples of C. jejuni ranged from 4·0 to 9·4 log c.f.u./g and from 4·8 to 9·3 log c.f.u./g in the caeca. Faecal c.f.u./g decreased with time p.i. Most variation in c.f.u. for faecal and caecal samples was attributed to broiler chickens and a minor part to isolators, whereas infection trials did not affect the total variance. The results showed that pooled samples within isolators had lower c.f.u./g compared to the arithmetic mean of the individual samples. There was a significant correlation between faecal c.f.u./g at days 4 and 7 p.i., days 7 and 12 p.i. and for caecal and faecal c.f.u./g at day 12 p.i. [ABSTRACT FROM AUTHOR]

Consumption of poultry meat is considered as one of the main sources of human campylobacteriosis, and there is clearly a need for new surveillance and control measures based on quantitative data on Campylobacter spp. colonization dynamics in broiler chickens. We conducted four experimental infection trials, using four isolators during each infection trial to evaluate colonization of individual broiler chickens by Campylobacter jejuni over time. Individual and pooled faecal samples were obtained at days 4, 7 and 12 post-inoculation (p.i.) and caecal samples at day 12 p.i. There were large differences between broiler chickens in the number of C. jejuni in caecal and faecal material. Faecal samples of C. jejuni ranged from 4·0 to 9·4 log c.f.u./g and from 4·8 to 9·3 log c.f.u./g in the caeca. Faecal c.f.u./g decreased with time p.i. Most variation in c.f.u. for faecal and caecal samples was attributed to broiler chickens and a minor part to isolators, whereas infection trials did not affect the total variance. The results showed that pooled samples within isolators had lower c.f.u./g compared to the arithmetic mean of the individual samples. There was a significant correlation between faecal c.f.u./g at days 4 and 7 p.i., days 7 and 12 p.i. and for caecal and faecal c.f.u./g at day 12 p.i. [ABSTRACT FROM AUTHOR]

We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in-plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial placement and then attempted to return them to their original positions. We used ultrasound to evaluate the initial and secondary catheter placements and the spread of injectate around the nerves. In 10 cases, we confirmed catheter position by magnetic resonance imaging. We judged 43/45 initial placements successful and 42/43 secondary placements successful by ultrasound, confirmed in 10/10 cases by magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Objectives: To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). Design: A nationwide cohort study. Setting: Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. Participants: We included 52 565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. Main outcome measures: Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. Results: Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39 677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). Conclusions: In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment. [ABSTRACT FROM AUTHOR]

Background Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery. Methods This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation ( APACHE) II score of at least 10 who were ready to be transferred to the surgical ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. Results In total, 286 patients were included in the modified intention-to-treat analysis. The trial was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310). Conclusion Postoperative intermediate care had no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. Registration number: NCT01209663 (). [ABSTRACT FROM AUTHOR]

Background: Insufflation of the abdomen during laparoscopy improves surgical space, but may cause post-operative shoulder pain. The incidence of shoulder pain is reduced using a lower insufflation pressure, but this may, however, compromise the surgical space. We aimed at investigating whether deep neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy.Methods: Fourteen patients were randomised in an assessor-blinded crossover design. The distance from the sacral promontory to the trocar was measured during deep NMB and without NMB at pneumoperitoneum 8 and 12 mmHg both. Additionally, we assessed surgical conditions while suturing the abdominal fascia using a 4-point subjective rating scale. Deep NMB was established with rocuronium and reversed with sugammadex.Results: At 12 mmHg pneumoperitoneum, deep NMB improved surgical space with a mean of 0.33 cm (95% confidence interval 0.07-0.59) (P=0.01, paired t-test) compared with no NMB. At 8 mmHg pneumoperitoneum deep NMB improved surgical space with a mean of 0.3 cm (95% confidence interval, 0.06-0.54) (P=0.005) compared with no NMB. Deep NMB resulted in significantly better ratings of surgical conditions during suturing of the fascia (P=0.03, Mann-Whitney U-test).Conclusion: Deep NMB enlarged surgical space measured as the distance from the sacral promontory to the trocar. The enlargement, however, was minor and the clinical significance is unknown. Moreover, deep NMB improved surgical conditions when suturing the abdominal fascia. [ABSTRACT FROM AUTHOR]