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Abstract The lymphatic system consists of a vessel network lined by specialized lymphatic endothelial cells (LECs) that are responsible for tissue fluid homeostasis and immune cell trafficking. The mechanisms for organ-specific LEC responses to environmental cues are not well understood. We found robust lymphangiogenesis during influenza A virus infection in the adult mouse lung. We show that the number of LECs increases twofold at 7 days post-influenza infection (dpi) and threefold at 21 dpi, and that lymphangiogenesis is preceded by lymphatic dilation. We also show that the expanded lymphatic network enhances fluid drainage to mediastinal lymph nodes. Using EdU labeling, we found that a significantly higher number of pulmonary LECs are proliferating at 7 dpi compared to LECs in homeostatic conditions. Lineage tracing during influenza indicates that new pulmonary LECs are derived from preexisting LECs rather than non-LEC progenitors. Lastly, using a conditional LEC-specific YAP/TAZ knockout model, we established that lymphangiogenesis, fluid transport and the immune response to influenza are independent of YAP/TAZ activity in LECs. These findings were unexpected, as they indicate that YAP/TAZ signaling is not crucial for these processes.

Summary: Macrophages are critical for maintenance and repair of mucosal tissues. While functionally distinct subtypes of macrophage are known to have important roles in injury response and repair in the lungs, little is known about macrophages in the proximal conducting airways. Single-cell RNA sequencing and flow cytometry demonstrated murine tracheal macrophages are largely monocyte-derived and are phenotypically distinct from lung macrophages at homeostasis. Following sterile airway injury, monocyte-derived macrophages are recruited to the trachea and activate a pro-regenerative phenotype associated with wound healing. Animals lacking the chemokine receptor CCR2 have reduced numbers of circulating monocytes and tracheal macrophages, deficient pro-regenerative macrophage activation and defective epithelial repair. Together, these studies indicate that recruitment and activation of monocyte-derived tracheal macrophages is CCR2-dependent and is required for normal airway epithelial regeneration.

The respiratory system, which includes the trachea, airways, and distal alveoli, is a complex multi-cellular organ that intimately links with the cardiovascular system to accomplish gas exchange. In this review and as members of the NIH/NHLBI-supported Progenitor Cell Translational Consortium, we discuss key aspects of lung repair and regeneration. We focus on the cellular compositions within functional niches, cell-cell signaling in homeostatic health, the responses to injury, and new methods to study lung repair and regeneration. We also provide future directions for an improved understanding of the cell biology of the respiratory system, as well as new therapeutic avenues.

The lymphatic system consists of a vessel network lined by specialized lymphatic endothelial cells (LECs) that are responsible for tissue fluid homeostasis and immune cell trafficking. The mechanisms for organ-specific LEC responses to environmental cues are not well understood. We found robust lymphangiogenesis during influenza A virus infection in the adult mouse lung. We show that the number of LECs increases twofold at 7 days post-influenza infection (dpi) and threefold at 21 dpi, and that lymphangiogenesis is preceded by lymphatic dilation. We also show that the expanded lymphatic network enhances fluid drainage to mediastinal lymph nodes. Using EdU labeling, we found that a significantly higher number of pulmonary LECs are proliferating at 7 dpi compared to LECs in homeostatic conditions. Lineage tracing during influenza indicates that new pulmonary LECs are derived from preexisting LECs rather than non-LEC progenitors. Lastly, using a conditional LEC-specific YAP/TAZ knockout model, we established that lymphangiogenesis, fluid transport and the immune response to influenza are independent of YAP/TAZ activity in LECs. These findings were unexpected, as they indicate that YAP/TAZ signaling is not crucial for these processes. [ABSTRACT FROM AUTHOR]

The presence of green roofs in urban areas improves the energy efficiency of buildings; contributes to the capture of CO2, decreasing pollution; and improves the appearance of cities, increasing their sustainability. Additionally, green roofs must include plant species with low requirements and maintenance, and thus, succulent species could be useful in Mediterranean semi-arid regions. In this work, the thermal inertia and the effect of different succulent species as thermal barriers on mitigating the increase in temperature inside experimental compartments were studied in comparison to conventional covers used in the Spanish Mediterranean for a whole year. In general, green covers were more efficient than conventional ones for controlling temperature. Thus, temperatures under green covers were up to 8 °C lower than conventional covers and 3–5 °C lower than the ambient temperature at noon on summer days. Furthermore, significant differences were found between green covers. Thus, despite having high thermal inertia, Aptenia cordifolia showed the worst temperature records, while Aeonium arboreum was the most efficient at mitigating temperature changes both on cold winter nights and hot summer days—even better than Sedum spp., a usual succulent used commercially. Our results demonstrate that succulent species are efficient materials to use as green covers to improve thermal conditions in buildings in Mediterranean cities. This also suggests that the mixture of succulent species (i.e., not only made of Sedum spp.) with different colors and textures could beautify green roofs without compromising their energy efficiency.

Lung regeneration occurs in a variety of adult mammals after surgical removal of one lung (pneumonectomy). Previous studies of murine post-pneumonectomy lung growth have identified regenerative “hotspots” in subpleural alveolar ducts; however, the cell-types participating in this process remain unclear. To identify the single cells participating in post-pneumonectomy lung growth, we used laser microdissection, enzymatic digestion and microfluidic isolation. Single-cell transcriptional analysis of the murine alveolar duct cells was performed using the C1 integrated fluidic circuit (Fluidigm) and a custom PCR panel designed for lung growth and repair genes. The multi-dimensional data set was analyzed using visualization software based on the tSNE algorithm. The analysis identified 6 cell clusters; 1 cell cluster was present only after pneumonectomy. This post-pneumonectomy cluster was significantly less transcriptionally active than 3 other clusters and may represent a transitional cell population. A provisional cluster identity for 4 of the 6 cell clusters was obtained by embedding bulk transcriptional data into the tSNE analysis. The transcriptional pattern of the 6 clusters was further analyzed for genes associated with lung repair, matrix production, and angiogenesis. The data demonstrated that multiple cell-types (clusters) transcribed genes linked to these basic functions. We conclude that the coordinated gene expression across multiple cell clusters is likely a response to a shared regenerative microenvironment within the subpleural alveolar ducts.

La dextrocardia es una rara anomalía cardiaca congénita. Aunque la incidencia de enfermedad coronaria es similar a la población en general, son pocos los casos documentados en la literatura. La disposición anatómica en esta anomalía constituye un desafío a la hora de planificar la técnica quirúrgica y los injertos a utilizar, como lo describen los casos presentados. Presentamos el caso de un paciente varón de 73 años de edad, con enfermedad coronaria de 2 vasos que fue sometido a una cirugía de revascularización arterial completa, sin circulación extracorpórea y sin modificaciones significativas de la técnica convencional.

ObjectivesThe mesothelium, the surface layer of the heart, lung, bowel, liver, and tunica vaginalis, is a complex tissue implicated in organ-specific diseases and regenerative biology; however, the mechanism of mesothelial repair after surgical injury is unknown. Previous observations indicated seeding of denuded mesothelium by free-floating mesothelial cells may contribute to mesothelial healing. In this study, we investigated the prevalence of mesothelial cells in pleural fluid during the 7 days following pulmonary surgery.Study designFlow cytometry was employed to study pleural fluid of 45 patients after lung resection or transplantation. We used histologically validated mesothelial markers (CD71 and WT1) to estimate the prevalence of mesothelial cells.ResultsThe viability of pleural fluid cells approached 100%. Leukocytes and mesothelial cells were identified in the pleural fluid within the first week after surgery. The leukocyte concentration was relatively stable at all time points. In contrast, mesothelial cells, identified by CD71 and WT1 peaked on POD3. The broad expression of CD71 molecule in postoperative pleural fluid suggests that many of the free-floating non-leukocyte cells were activated or proliferative mesothelial cells.ConclusionWe demonstrated that pleural fluid post lung surgery is a source of mesothelial cells; most of these cells appear to be viable and, as shown by CD71 staining, activated mesothelial cells. The observed peak of mesothelial cells on POD3 is consistent with a potential reparative role of free-floating mesothelial cells after pulmonary surgery.

In many mammals, including rodents and humans, removal of one lung results in the compensatory growth of the remaining lung; however, the mechanism of compensatory lung growth is unknown. Here, we investigated the changes in morphology and phenotype of pleural cells after pneumonectomy. Between days 1 and 3 after pneumonectomy, cells expressing α-smooth muscle actin (SMA), a cytoplasmic marker of myofibroblasts, were significantly increased in the pleura compared to surgical controls (p < .01). Scanning electron microscopy of the pleural surface 3 days post-pneumonectomy demonstrated regions of the pleura with morphologic features consistent with epithelial-mesenchymal transition (EMT); namely, cells with disrupted intercellular junctions and an acquired mesenchymal (rounded and fusiform) morphotype. To detect the migration of the transitional pleural cells into the lung, a biotin tracer was used to label the pleural mesothelial cells at the time of surgery. By post-operative day 3, image cytometry of post-pneumonectomy subpleural alveoli demonstrated a 40-fold increase in biotin+ cells relative to pneumonectomy-plus-plombage controls (p < .01). Suggesting a similar origin in space and time, the distribution of cells expressing biotin, SMA, or vimentin demonstrated a strong spatial autocorrelation in the subpleural lung (p < .001). We conclude that post-pneumonectomy compensatory lung growth involves EMT with the migration of transitional mesothelial cells into subpleural alveoli.

Glasshouses in Mediterranean areas are mainly used for experimental or nursery purposes and the production of high value ornamental species. In addition, glasshouses may be covered by dust and other particles in these areas as rainfalls are relatively scarce. Consequently, the quality of photosynthetically active radiation (PAR) may be affected. In the present experiment we evaluated the effect of dirt on the PAR spectrum in glasshouses in Valencia (Spain), compared to glasshouses submitted to suitable maintenance and washing. Photosynthetic Photon Flux Density (PPFD) measurements were done in March 2017 at 13h, and visible, UV-C and near infrared regions were recorded with a portable spectrometer. PPFD maximum values differed depending on the spectral region and glass conditions, with higher values corresponding to the visible region. Thus, clean glass showed values of 609, 588 and 423 μmol/m2s for PPFDR, PPFDG and PPFDB, respectively and 436 and 34 μmol/m2s for PPFDIR and PPFDUV. In comparison to clean glass, dirty glass decreased PPFD in all regions, particularly UV and blue region.

Tipa (Tipuana tipu) is a common tree in gardens and carparks, although the shading effect of its canopy must be still characterised to assess the decrease of temperature and quality of irradiance. This work is a preliminary study aimed to assess the effect of shading of tree canopies on the diffuse irradiance pattern received at the soil level in comparison to other conditions. The shade provided by a group of Tipa trees, located at the Universitat Politècnica de València (Valencia, Spain), was evaluated in this experiment and compared to cloudy days and direct sun. Photosynthetic Photon Flux Density (PPFD) and red/near infrared ratios were recorded with a portable spectrometer. Measurements were recorded in January and February 2017, at 10h, 13h and 16h. Depending on the region of the spectrum and time of the day, PPFD values ranged from 0.05 to 0.42, 0.40 to 1.14, and 0.94 to 3.90 μmol·m-2·s-1, for Tipa shade, cloudy days and direct sun, respectively. The spectral analysis of PPFD in cloudy days revealed maximum values in the green region and minimum at near infrared region, while maximum PPFD for tipa shade was mostly found at near infrared, revealing higher importance of this spectral region compared to cloudy days.

The presence of green roofs in urban areas improves the energy efficiency of buildings; contributes to the capture of CO2, decreasing pollution; and improves the appearance of cities, increasing their sustainability. Additionally, green roofs must include plant species with low requirements and maintenance, and thus, succulent species could be useful in Mediterranean semi-arid regions. In this work, the thermal inertia and the effect of different succulent species as thermal barriers on mitigating the increase in temperature inside experimental compartments were studied in comparison to conventional covers used in the Spanish Mediterranean for a whole year. In general, green covers were more efficient than conventional ones for controlling temperature. Thus, temperatures under green covers were up to 8 °C lower than conventional covers and 3–5 °C lower than the ambient temperature at noon on summer days. Furthermore, significant differences were found between green covers. Thus, despite having high thermal inertia, Aptenia cordifolia showed the worst temperature records, while Aeonium arboreum was the most efficient at mitigating temperature changes both on cold winter nights and hot summer days—even better than Sedum spp., a usual succulent used commercially. Our results demonstrate that succulent species are efficient materials to use as green covers to improve thermal conditions in buildings in Mediterranean cities. This also suggests that the mixture of succulent species (i.e., not only made of Sedum spp.) with different colors and textures could beautify green roofs without compromising their energy efficiency. [ABSTRACT FROM AUTHOR]

existen distintos protocolos de fast-track que persiguen la extubación del paciente en el quirófano y una mínima estancia en unidad de vigilancia intensiva (UVI). Este estudio analiza de forma retrospectiva la viabilidad y la seguridad de la extubación inmediata tras cirugía cardíaca. Material y métodos: se analizan 502 pacientes consecutivos no seleccionados intervenidos de cirugía cardíaca desde septiembre de 2009 a octubre de 2010, con la intención en todos ellos de ser extubados en el quirófano. Para ello se empleó un protocolo anestésico basado en el uso de agentes de vida media ultracorta. La edad media fue de 64,7 años (rango 25–88 años), siendo 170 de ellos mujeres. El EuroSCORE logístico medio era de 8,17 (rango 0,88–66,6). Resultados: se logró extubar en el quirófano dentro de los primeros 15 min tras el cierre de la piel a 485 pacientes (96,6%). Como factores predictores significativos de fallo en la extubación o necesidad de reintubación se identificaron la ventilación mecánica previa, el tiempo de circulación extracorpórea (CEC), la disfunción renal preoperatoria y la necesidad de nitratos endovenosos antes de la cirugía. La mortalidad hospitalaria fue del 5,8%. La estancia media en unidad de cuidados intensivos (UCI) fue 2,6 días (rango 1–74 días). La estancia hospitalaria media fue de 9,9 días (rango 3–78 días). Conclusiones: la extubación en el quirófano de forma rutinaria en pacientes sometidos a cirugía cardíaca es viable y segura. La necesidad de reintubación o reingreso en UCI es baja. Contribuye a la recuperación precoz del paciente y disminuye los tiempos de estancia y consumo de recursos hospitalarios.

En 1998 se modificaron en nuestro centro los objetivos de cirugía de revascularización coronaria con el fin de obtener una revascularización completa, con resultados duraderos, con baja morbimortalidad, pocas complicaciones postoperatorias y una estancia corta. Desde esa fecha se ha ido progresando en diferentes técnicas y protocolos para conseguir estos fines. estudiar los resultados a corto y medio plazo de 1.800 pacientes consecutivos intervenidos de cirugía coronaria sin bomba (OPCAB) y analizar los resultados, en el contexto nacional y europeo, de la revascularización. Material y métodos: estudio retrospectivo de 1.800 pacientes intervenidos de forma consecutiva, desde 1998 a diciembre de 2011, de OPCAB, en los que se ha utilizado la arteria radial en 560 pacientes, doble mamaria en 1.502 pacientes, con comprobación de flujos, técnica de fast-track y extubación en quirófano. Resultados: el 32,9% de los pacientes tenían más de 70 años. El EuroSCORE I medio fue de 4,86. En el 66,6% el número de injertos fue tres o superior. Se realizó revascularización arterial total en 1.069 pacientes. El porcentaje de pacientes con revascularización arterial fue incrementándose con la experiencia, habiéndose conseguido en los últimos años el 93%. La mortalidad hospitalaria ha oscilado, en estos años, ente el 0,9–2,9, con una media de 2,1%. Se extubaron en quirófano el 98% de los pacientes, con una estancia media de 24,9 h en unidad de cuidados intensivos (UCI). Conclusión: en un servicio con entrenamiento adecuado se consigue obtener una cirugía de revascularización arterial completa con baja morbimortalidad y corta estancia.

La prótesis St. Jude Trifecta es una válvula biológica aórtica de pericardio bovino. Su diseño incluye el anclaje de las hojas de pericardio en el exterior del stent, permitiendo mayor área de apertura y excelentes gradientes medios en todos sus tamaños. Evaluar las características hemodinámicas de la prótesis Trifecta en el postoperatorio precoz. Considerar su técnica de implantación y estudiar los resultados clínicos y ecocardiográficos a corto plazo de más de 100 pacientes. Material y métodos: Estudio prospectivo en 108 pacientes, intervenidos entre julio de 2010 – octubre de 2011. En el 51% de los pacientes se realizó sustitución valvular aórtica aislada y en el 49% asociada a otro procedimiento. Se realizó ecocardiografía de control antes del alta en todos los pacientes. Resultados: La edad media fue de 71 años. El EuroSCORE I medio del 9,52. La media de los gradientes medios fue de 9,14 mmHg (19 mm), 8,34 mmHg (21 mm), 6,18 mmHg (23 mm), 7,13 mmHg (25 mm) y 4,85 mmHg (27 mm). La media del índice de área efectiva fue de 1,06 cm2/m2 (19 mm), 1,14 cm2/m2 (21 mm), 1,16 cm2/m2 (23 mm), 1,06 cm2/m2 (25 mm) y 0,81 cm2/m2 (27 mm). El tiempo medio de cuidados intensivos fue de 48,24 h. Conclusión: En nuestra experiencia inicial, la válvula Trifecta ha mostrado una técnica de implantación segura con buenos resultados hemodinámicos al alta.

Los protocolos de fast-track en cirugía coronaria sin circulación extracorpórea (CEC) son ampliamente utilizados en muchos centros. Sin embargo, no hemos encontrado nada publicado al respecto en la cirugía de la aorta ascendente. Este estudio analiza de forma retrospectiva la viabilidad y la seguridad de la extubación inmediata tras cirugía de la raíz aórtica, de la aorta ascendente o del cayado aórtico. Material y métodos: Se aplicaron los protocolos de ultra fast-track que diariamente empleamos en la cirugía coronaria sin bomba en aquellos pacientes programados para cirugía de la aorta ascendente. Desde enero de 2008 hasta diciembre de 2009, 54 pacientes consecutivos no seleccionados fueron intervenidos de cirugía de sustitución de la raíz aórtica, de la aorta ascendente o del cayado, con la intención en todos ellos de ser extubados en el quirófano. En veinte de ellos (37%) se realizó parada cardiocirculatoria con hipotermia moderada (28 °C) y perfusión cerebral anterógrada. Once (24,4%) presentaban cirugía cardíaca previa. El EuroSCORE estándar medio era de 7,5 (rango 5-12). Resultados: Se logró extubar en el quirófano dentro de los primeros 15 min tras el cierre de la piel a 51 pacientes (94,4%). Tres de estos pacientes (5,88%) fueron reintubados dentro de las primeras 24 h, todos ellos debido a reintervención por sangrado excesivo. La mortalidad hospitalaria fue del 1,8% en un paciente debido a un cuadro de isquemia intestinal. No se observaron complicaciones respiratorias. La estancia media en unidad de cuidados intensivos (UCI) fue de 26,5 h (rango 16-72 h). Las causas de fallo en la extubación inmediata o de reintubación fueron la inestabilidad hemodinámica y el ritmo elevado de sangrado en el momento del cierre esternal. El uso de parada cardiocirculatoria no fue un predictor significativo de ventilación mecánica prolongada. Conclusiones: La extubación inmediata en pacientes sometidos a cirugía de aorta ascendente es viable y segura, incluso en pacientes intervenidos con parada cardiocirculatoria. La necesidad de reintubación es rara, y está relacionada con el sangrado. Facilita la deambulación precoz y disminuye el tiempo de estancia en UCI.

Este vídeo pretende mostrar la técnica de implantación de una nueva prótesis aórtica stentless: ATS 3F. Material y métodos: Se muestra el implante de la válvula ATS 3F de 23 mm en un varón de 80 años, en clase funcional II de la New York Heart Association(NYHA), diagnosticado de estenosis aórtica grave (área valvular 0,85 cm2, gradiente pico de 107,5 de 69 mmHg), resaltando los puntos clave de la implantación: aortotomía, elección del tamaño, sutura del anillo y colocación de los arbotantes. Resultados: En el ecocardiograma transesofágico, a la salida de circulación extracorpórea no se observó insuficiencia aórtica. El quinto día postoperatorio se realizó ecocardiograma transtorácico, objetivándose un gradiente pico de 10 mmHg. Siguiendo esta técnica, desde noviembre de 2004 hasta marzo de 2009, se han implantado 52 bioprótesis ATS 3F, sin insuficiencia aórtica residual, ni fuga paravalvular en el momento de la implantación, requiriendo únicamente reintervención en un paciente por endocarditis. Conclusiones: La bioprótesis ATS 3F es una prótesis stentless de pericardio equino, con diseño tubular semejante a la válvula fetal, con gran superficie de coaptación, diseñada para funcionar como una válvula nativa. Nuestra técnica de implantación de bioprótesis ATS 3F stentless es segura, fácilmente reproducible y consiguiendo excelentes resultados hemodinámicos.

Living through a pandemic and social upheaval suggests the importance of revisiting the intersections of the art and activism of Felix Gonzalez-Torres and Gregg Bordowitz. These artists’ works express their experiences of living through a pandemic and subsequent social change and draw out key human rights themes. The works’ materials, poetics, and invitations to interact offer opportunities for audiences to reflect on complex and ethically relevant social and cultural dynamics that surface during global crises, such as negotiating personal and collective interests, the politics of touch and coexistence, and cultivating resilience and strength. [ABSTRACT FROM AUTHOR]

The propagation of a free massless scalar field in a 1 + 1 -dimensional Minkowski space modeling, a wormhole is considered. The wormhole model consists on two timelike trajectories, which represent the entrance and the exit of the wormhole, connected via some transfer function that specifies how incoming modes that reach the entrance are transferred to the exit. We find that particles and energy fluxes are generically produced except for transfer functions that represent global conformal transformations. We consider several examples involving exit trajectories which are asymptotically inertial, asymptotically null, and also involving a faster-than-light motion to illustrate the peculiarities of the emitted energy fluxes and quantum correlations. [ABSTRACT FROM AUTHOR]

Plants use visible light and part of adjacent ultraviolet and near infrared regions for photosynthesis. Crop protection coverings enable plant cultivation in areas or seasons not suitable open field. However, the use of covering materials is a detriment to solar irradiance, which may decrease the photosynthetic rate. Here, the effect of two different covering materials, tempered glass and white polyethylene mesh, on solar irradiance was compared to open field (control) under real farming conditions. Relative irradiance (RI) and photosynthetic photon flux density (PPFD) were recorded along 380-780 nm wavelength spectrums in the two conditions at 10:00 h and 13:00 h. Also the efficiency of Capsicum peppers in capturing solar irradiance was evaluated in leaves as the reflectance of both RI and PPFD under the mentioned growing conditions. Low differences in RI among the three conditions were found, and the lowest values corresponded to glasshouse conditions. Differences were more obvious in PPFD and, compared to open field, both mesh greenhouse and glasshouse conditions provoked remarkable decreases in all the spectral bands, 50-55% and 75-80% respectively. Covering materials also differed on the ratio of reflected PPFD and incident PPFD. Glasshouse plants displayed the highest reflectance at both 10:00 h and 13:00 h (0.05-0.20), followed by mesh greenhouse (0.05-0.10), suggesting that glasshouse conditions might decrease the photosynthesis rate due to both PPFD decrease and reflectance, although the effect of polyethylene mesh should not be disregarded as it also decreases considerably PPFD. Our results have important implications for the physiology and the productivity of crops under different covering materials. [ABSTRACT FROM AUTHOR]

Pulmonary "air leaks," typically the result of pleural injury caused by lung surgery or chest trauma, result in the accumulation of air in the pleural space (pneumothorax). Air leaks are a major source of morbidity and prolonged hospitalization after pulmonary surgery. Previous work has demonstrated structural heteropolysaccharide (pectin) binding to the mouse pleural glycocalyx. The similar lectin‐binding characteristics and ultrastructural features of the human and mouse pleural glycocalyx suggested the potential application of these polymers in humans. To investigate the utility of pectin‐based polymers, we developed a simulacrum using freshly obtained human pleura. Pressure‐decay leak testing was performed with an inflation maneuver that involved a 3 s ramp to a 3 s plateau pressure; the inflation was completely abrogated after needle perforation of the pleura. Using nonbiologic materials, pressure‐decay leak testing demonstrated an exponential decay with a plateau phase in materials with a Young's modulus less than 5. In human pleural testing, the simulacrum was used to test the sealant function of four mixtures of pectin‐based polymers. A 50% high‐methoxyl pectin and 50% carboxymethylcellulose mixture demonstrated no sealant failures at transpleural pressures of 60 cmH2O. In contrast, pectin mixtures containing 50% low‐methoxyl pectin, 50% amidated low‐methoxyl pectins, or 100% carboxymethylcellulose demonstrated frequent sealant failures at transpleural pressures of 40–50 cmH2O (p < 0.001). Inhibition of sealant adhesion with enzyme treatment, dessication and 4°C cooling suggested an adhesion mechanism dependent upon polysaccharide interpenetration. We conclude that pectin‐based heteropolysaccharides are a promising air‐tight sealant of human pleural injuries. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 799–806, 2019. [ABSTRACT FROM AUTHOR]

Lophophora williamsii is an ornamental slow growth cactus highly appreciated by cacti growers and hobbyists. Its demand is often satisfied through illegal collection of wild plants and many populations are threatened with extinction. Thus, an efficient in vitro protocol without plant growth regulators will be of great interest for conservation purposes of this cactus. Eight different germination media, combining Murashige and Skoog medium (MS, full and half-strength), sucrose (20 and 30 g L −1 ) and agar (8 and 10 g L −1 ), were used to study germination rate, number of seedlings with areoles and initial seedling development. Germination rates among culture media only differed significantly in the first 14 days after sowing (DAS), reaching 67–75% at the end of the assay (49 DAS). Remarkable interactions among media components were detected, and 20 g L −1 sucrose and 8 g L −1 agar combination gave the highest performance for both size and number of areoles. Following germination assay, a growth assay was conducted during 105 days using three growth media (GrM) at different sucrose concentration (15, 30 and 45 g L −1 ) to evaluate the increase in seedling size and number of areoles. Regardless of their initial size, 15 g L −1 sucrose provided the best results for both traits. Size increase was higher in the 4–5 mm seedling group, while increase in areoles was greater in 2-3 mm seedlings. It was possible to develop an in vitro protocol, in absence of plant growth regulators, which allows maximizing L. williamsii germination and growth during its first stages of development, which may increase the availability of plants in the market and avoid exhaustion of wild populations. Furthermore, plants grown ex situ could be reintroduced in endangered natural populations. [ABSTRACT FROM AUTHOR]

Continuous exposures to ultraviolet radiation can lead to harmful effects on human skin. Professional drivers may spend more than 8 h per day inside a vehicle. This study describes an analysis of the UVER (erythemal ultraviolet radiation) received by a driver and passenger inside a vehicle. A three-door Peugeot 206 was used for the study. VioSpor Blue Line dosimeters (with a response profile close to that of human skin) were used to measure the erythematic dose of UV radiation (able to produce erythema on human skin). Four dosimeters were placed in the driver's position and another four in the passenger's position. Daily irradiance was analyzed for a day in April using PMA radiometers. The measurements were obtained on relatively clear days from February to December 2009 between 9:30 A.M. and 3 P.M. Additionally, a prediction was made of the time required to produce an erythema on the driver's skin. UVER exposure, in some of the driver's positions, exceeds the Exposure Limits given by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Skin protection measures should be taken into account by professional drivers to prevent the harmful effects of UVER radiation. [ABSTRACT FROM AUTHOR]

A contribution of pulmonary blood distension to alveolar opening was first proposed more than 100 years ago. To investigate the contribution of blood distension to lung mechanics, we studied control mice (normal perfusion), mice after exsanguination (absent perfusion) and mice after varying degrees of parenchymal resection (supra-normal perfusion). On inflation, mean tracheal pressures were higher in the bloodless mouse (4.0 ± 2.5 cm H2O); however, there was minimal difference between conditions on deflation (0.7 ± 0.9 cm H2O). To separate the peripheral and central mechanical effects of blood volume, multi-frequency lung impedance data was fitted to the constant-phase model. The presence or absence of blood had no effect on central airway resistance (p > .05). In contrast, measures of tissue damping (G), tissue elastance (H) and hysteresivity (η) demonstrated a significant increase in bloodless mice relative to control mice (p < .001). After varying amount of surgical resection and associated supra-normal perfusion of the remaining lung, there was an increase in G and H. Although the absolute difference in G and H increased with the amount of parenchymal resection, the proportional contribution of blood was identical in all conditions. The presence of blood in the pulmonary vasculature resulted in a constant 64 ± 5% reduction in tissue damping (G) and a 55 ± 4% reduction in tissue elastance (H). This nearly-constant contribution of blood to lung hysteresivity was only reduced by positive end-expiratory pressure (PEEP). To identify a distinct structural subset of vessels in the lung potentially contributing to these observations, vascular casting and scanning electron microscopy of the lung demonstrated morphologically distinct vascular rings at the alveolar opening. Our results suggest that intravascular blood distension, likely attributable to a subset of vessels in the alveolar entrance ring, contributes a measurable scaffolding effect to the functional recruitment of the peripheral lung. [ABSTRACT FROM PUBLISHER]

In many mammals, including rodents and humans, removal of one lung results in the compensatory growth of the remaining lung; however, the mechanism of compensatory lung growth is unknown. Here, we investigated the changes in morphology and phenotype of pleural cells after pneumonectomy. Between days 1 and 3 after pneumonectomy, cells expressing α-smooth muscle actin (SMA), a cytoplasmic marker of myofibroblasts, were significantly increased in the pleura compared to surgical controls (p < .01). Scanning electron microscopy of the pleural surface 3 days post-pneumonectomy demonstrated regions of the pleura with morphologic features consistent with epithelial-mesenchymal transition (EMT); namely, cells with disrupted intercellular junctions and an acquired mesenchymal (rounded and fusiform) morphotype. To detect the migration of the transitional pleural cells into the lung, a biotin tracer was used to label the pleural mesothelial cells at the time of surgery. By post-operative day 3, image cytometry of post-pneumonectomy subpleural alveoli demonstrated a 40-fold increase in biotin+ cells relative to pneumonectomy-plus-plombage controls (p < .01). Suggesting a similar origin in space and time, the distribution of cells expressing biotin, SMA, or vimentin demonstrated a strong spatial autocorrelation in the subpleural lung (p < .001). We conclude that post-pneumonectomy compensatory lung growth involves EMT with the migration of transitional mesothelial cells into subpleural alveoli. [ABSTRACT FROM AUTHOR]

In many mammals, including humans, removal of one lung (pneumonectomy) results in the compensatory growth of the remaining lung. Compensatory growth involves not only an increase in lung size, but also an increase in the number of alveoli in the peripheral lung; however, the process of compensatory neoalveolarization remains poorly understood. Here, we show that the expression of -smooth muscle actin (SMA)--a cytoplasmic protein characteristic of myofibroblasts--is induced in the pleura following pneumonectomy. SMA induction appears to be dependent on pleural deformation (stretch) as induction is prevented by plombage or phrenic nerve transection (P < 0.001). Within 3 days of pneumonectomy, the frequency of SMA+ cells in subpleural alveolar ducts was significantly increased (P < 0.01). To determine the functional activity of these SMA+ cells, we isolated regenerating alveolar ducts by laser microdissection and analyzed individual cells using microfluidic single-cell quantitative PCR. Single cells expressing the SMA (Acta2) gene demonstrated significantly greater transcriptional activity than endothelial cells or other discrete cell populations in the alveolar duct (P < 0.05). The transcriptional activity of the Acta2+ cells, including expression of TGF signaling as well as repair-related genes, suggests that these myofibroblast-like cells contribute to compensatory lung growth. [ABSTRACT FROM AUTHOR]

The critical care management of pleural air leaks can be challenging in all patients, but particularly in patients on mechanical ventilation. To investigate the effect of central airway pressure and pleural pressure on pulmonary air leaks, we studied orotracheally intubated mice with pleural injuries. We used clinically relevant variables – namely, airway pressure and pleural pressure – to investigate flow through peripheral air leaks. The model studied the pleural injuries using a pressure‐decay maneuver. The pressure‐decay maneuver involved a 3 sec ramp to 30 cmH20 followed by a 3 sec breath hold. After pleural injury, the pressure‐decay maneuver demonstrated a distinctive airway pressure time history. Peak inflation was followed by a rapid decrease to a lower plateau phase. The decay phase of the inflation maneuver was influenced by the injury area. The rate of pressure decline with multiple injuries (28 ± 8 cmH20/sec) was significantly greater than a single injury (12 ± 3 cmH2O/sec) (P < 0.05). In contrast, the plateau phase pressure was independent of injury surface area, but dependent upon transpulmonary pressure. The mean plateau transpulmonary pressure was 18 ± 0.7 cm H2O. Finally, analysis of the inflation ramp demonstrated that nearly all volume loss occurred at the end of inflation (P < 0.001). We conclude that the air flow through peripheral lung injuries was greatest at increased lung volumes and limited by peripheral airway closure. In addition to suggesting an intrinsic mechanism for limiting flow through peripheral air leaks, these findings suggest the utility of positive end‐expiratory pressure and negative pleural pressure to maintain lung volumes in patients with pleural injuries.

Life care planners (LCPs) who provide expert witness testimony must provide their professional opinions within a certain degree of life care planning probability or essentially a 51% chance or greater likelihood of the good or service occurring. In cases involving spinal cord injury (SCI), such opinions become complicated when attempting to include the costs of future secondary complications (SCs) that may or may not have a consistent body of empirical support and/or several physician specialists supporting the probability of occurrence. The present study surveyed 243 life care planners (LCPs), life care planning physiatrists (physiatrist LCPs), and non-life care planning physiatrists (physiatrist non-LCPs) in ascertaining their professional opinions regarding 13 SCs among individuals with a SCI, based upon level of injury. Results revealed that LCPs and physiatrist LCPs generally endorsed higher ratings for SCs in comparison to physiatrist non-LCPs. Life care planning in the legal arena is an adversarial specialization where LCP opinions are often contested by opposing attorneys and their retained experts when the opposition's report(s) are perceived as unreasonably leaning in one direction (e.g., too costly to fund without validation). Being qualified and certified/licensed as an expert witness in any discipline is a privilege that carries with it a code of ethics and standards of practice (e.g., International Academy of Life Care Planners, n.d.). Triers of fact typically expect an impartial and objective set of opinions based upon a reliable and valid methodology from the expert which is generally supported by peers in that profession (Field, 2000; Hoyt & Aalberts, 2001; Johnston & Sartwelle, 2013). Expert witnesses who provide testimony must base their opinions on a certain degree of life-care planning probability, which is defined in the legal arena as a 51% or greater chance of occurring. Prior to 1993, this practice was not present as experts from various disciplines provided testimony they opined as probable, but there were no laws or litmus test required to determine reliability (Field, 2000; Hoyt & Aalberts, 2001). It was not until the 1993 Daubert v. Merrill Dow Pharmaceuticals and later the 1999 Kumho Tire Company v. Carmichael rulings that expert witnesses had to comply with stricter guidelines when proffering their opinions (Hoyt & Aalberts, 2001; Rutkin, 1999). After these rulings, experts were required to demonstrate that their opinions were generally accepted in their field, were subjected to peer-review publication, and employed a reliable methodology to arrive at their conclusions. In most expert witness disciplines, there appears to be a gray area where opposing experts do not always agree. Attorneys from both sides will often only retain an opposing expert when they perceive the life care plan developed by the opposing side is lacking in reasonableness, overall conclusions, and cost. Marini (2012) described the possibility versus probability dilemma life care planners face regarding when to include costs for yet-to-be determined future medical complications and when this is inappropriate. As Marini (2012) argued, some life care planners may "cherry pick" one or two studies in support of their opinions while ignoring the larger body of literature that does not. As noted earlier, the gray area exists when opposing experts cite different literature to support their opinions. Deutsch and Sawyer (1997) previously established a protocol for identifying and documenting potential medical complications that are yet-to-be determined. They stated that possible complication costs should not be included in a life care plan if they are not deemed probable to occur. Physician experts are also supposed to provide generally accepted opinions in their field. However, it is unknown as to whether their opinions have been scrutinized with the same rigor as non-physician life care planners (Marini, 2012). The purpose of the present study was to investigate the ratings of SCs among life care planners and physiatrists to provide those operating as a LCP with empirical support for cost inclusion in a plan when a SC reaches the probability threshold. In addition, we sought to examine whether differences occurred among physiatrists and LCPs when they provided their expert opinions of the likelihood of SCs occurring among people with a SCI. According to the 1993 Daubert and 1999 Kumho rulings, costs may be included if the empirical literature supports the prevalence of such occurrences with a 51% or greater frequency. However, as demonstrated through a comprehensive literature review by Ysasi et al. (2016), research on SCs among individuals with a SCI is often outdated; therefore, the research addressing the 13 secondary complications outlined in this research was long overdue. [ABSTRACT FROM AUTHOR]

As the projected growth of Latinos in the United States is substantially high and unemployment rates significantly low, the need exists for rehabilitation professionals to be aware of factors affecting successful employment outcomes. Subsequently, self-concept has been considered a contributing factor affecting employment outcomes, although varying results exist. In view of job placement services often provided through vocational rehabilitation (VR) agencies and/or community rehabilitation programs (CRP), this study investigated the relationship of various self-concept variables and academic/work concept as measured by the Tennessee Self Concept Scale 2 (TSCS2) with job placement practice. Results indicated significant relationships among Identity and Satisfaction, and Academic/Work self-concept. In addition, Family, Physical, and Identity self-concepts were positively correlated with number of days in job placement services prior to employment. Implications for rehabilitation professionals, and future research are discussed. [ABSTRACT FROM AUTHOR]

The professional opinions of physiatrists were collected to ascertain the likelihood of occurrence, frequency of hospitalization, and treatment required as a direct result of 13 secondary complications (SCs) of two otherwise healthy males in their mid-20s, one with a C5-C6 tetraplegia and the other with T6 paraplegia spinal cord injury. Physiatrists responded to our online survey and overall, a general consensus was found among practitioners. Descriptive statistics was implemented with details outlining the frequency, mean, standard deviations, and the probability (51% or greater) versus possibility (50% or less) of SC occurrence is provided. Implications for life care planners and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

The specialization of life care planning continues to evolve through empirical research and periodic standards of practice symposiums. Within this evolution, the need exists towards advancing the profession through the creation of a universal and standardized approach among all who operate within the field of life care planning regarding when/when not to include secondary complication costs into a life care plan. Opposing life care planners (LCPs) are sometimes millions of dollars apart in projected costs, often generally attributed to the inclusion of such costs which may be possible (<51%) but not probable (>51%) from a life care planning certainty threshold. The current study surveyed two groups requesting their professional opinions on the frequency of occurrence for 12 most commonly occurring SCs following SCI. The two groups included 71 Physiatrist Non-LCPs (i.e., physiatrists not involved in life care planning) and 46 Physiatrist LCPs (i.e., physiatrists involved in conducting life care plans or who acted as a consultant). Results reveal physiatrist LPCs generally endorsed higher frequency ratings of SCs than Physiatrist Non-LCPs. Both groups reported a general consensus towards SCs as more likely to occur when lack of preventative health measures are not taken. Implications for life care planners are discussed. [ABSTRACT FROM AUTHOR]