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• Use of liver allografts with moderate macrosteatosis is controversial. • Uncertainty is in large part owing to heterogeneity is pretransplant biopsy assessment. • Outcomes of macrosteatotic livers graded at a single institution are reported. • Moderate macrosteatosis is a strong predictor of early mortality. • Patients who survive past 90 days can have acceptable long-term outcomes. Liver transplantation is the most effective treatment for end-stage liver disease (ESLD). Whether moderately macrosteatotic livers (30%-60%) represent a risk for worsened graft function is controversial. The uncertainty, in large part, is owing to the heterogeneous steatosis grading. Our aim was to determine the short- and long-term outcomes of moderately macrosteatotic allografts that were graded according to a standardized institutional protocol. We performed a retrospective analysis of transplants performed between 1994 and 2014. All patients with allografts biopsied pretransplantation were included. Relevant donor and recipient variable were recorded. Moderately macrosteatotic livers were compared with mildly macrosteatotic and nonsteatotic livers. Primary outcomes of interest were patient survival at 90 days, 1 year, and 5 years. Cox regression analyses were carried out to compare survival between the 2 groups. We compared 65 allografts with moderate macrosteatosis and 810 with no or mild macrosteatosis. Patients with moderately macrosteatotic allografts were 2.69 times as likely to die within the first 90 days after transplant (75.1% vs 91.6% survival) after adjusting for donor age, donor race, recipient age, recipient race, recipient body mass index, recipient diabetes, presence of hepatocellular carcinoma, days on waitlist, Model for End-Stage Liver Disease (MELD) score at transplantation, cold ischemia time. However, for recipients who survive 90 days, moderately macrosteatotic allografts had comparable long-term survival. Our study shows that moderate macrosteatosis is a strong predictor of early but not late mortality. Further studies are needed to distinguish the specific cohort of patients for whom moderately macrosteatotic allografts will lead to acceptable outcomes. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract Decades of research reveal that MDM2 participates in cellular processes ranging from macro-molecular metabolism to cancer signaling mechanisms. Two recent studies uncovered a new role for MDM2 in mitochondrial bioenergetics. Through the negative regulation of NDUFS1 (NADH:ubiquinone oxidoreductase 75 kDa Fe-S protein 1) and MT-ND6 (NADH dehydrogenase 6), MDM2 decreases the function and efficiency of Complex I (CI). These observations propose several important questions: (1) Where does MDM2 affect CI activity? (2) What are the cellular consequences of MDM2-mediated regulation of CI? (3) What are the physiological implications of these interactions? Here, we will address these questions and position these observations within the MDM2 literature. [ABSTRACT FROM AUTHOR]

We investigated re-establishment of fungal communities on eight former colliery sites in South Wales following revegetation 22–27 y earlier. Regraded bare coal-spoil was seeded to sheep-grazed grasslands, with saplings planted into coal-spoil for woodlands. Metabarcoding (28S rRNA, D1 region) of soil fungal populations showed that woodland and grassland habitats were clearly divergent but edaphic variables only weakly affected fungal community structure. Root-associated basidiomycetes dominated all habitats, with ectomycorrhizal fungi more abundant in woodlands and Clavariaceae/Hygrophoraceae (‘CHEG’ fungi) in grasslands. The composition of coal-spoil grassland communities resembled that of a typical upland grassland site, suggesting that propagule immigration was not a limiting factor. However, fungal biomass (ergosterol) was 3-fold lower, reflecting high bulk density and poor structure. Re-establishment of fungal communities in coal-spoil soils represents an important barometer of restoration success. From a fungal conservation perspective, such sites represent important refugia for waxcap fungi subject to habitat loss from agricultural intensification. [ABSTRACT FROM AUTHOR]

Summary The mechanisms of somatic cell reprogramming have been revealed at multiple levels. However, the lack of tools to monitor different reactive oxygen species (ROS) has left their distinct signals and roles in reprogramming unknown. We hypothesized that mitochondrial flashes (mitoflashes), recently identified spontaneous bursts of mitochondrial superoxide signaling, play a role in reprogramming. Here we show that the frequency of mitoflashes transiently increases, accompanied by flash amplitude reduction, during the early stages of reprogramming. This transient activation of mitoflashes at the early stage enhances reprogramming, whereas sustained activation impairs reprogramming. The reprogramming-promoting function of mitoflashes occurs via the upregulation of Nanog expression that is associated with decreases in the methylation status of the Nanog promoter through Tet2 occupancy. Together our findings provide a previously unknown role for superoxide signaling mediated epigenetic regulation in cell fate determination. [ABSTRACT FROM AUTHOR]

Purpose: Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications.Methods: The Statewide Planning and Research Cooperative System was queried for elective esophagectomy, gastrectomy, and pancreatectomy for malignancy in NY State from 2001 to 2013. Bivariate and hierarchical logistic regression analyses were performed to assess the factors associated with receiving a perioperative allogeneic red blood cell transfusion. Additional multivariable analysis examined the relationship between transfusion and infectious complications.Results: Among 14,875 patients who underwent upper GI cancer resection, 32 % of patients received a perioperative blood transfusion. After controlling for patient, surgeon, and hospital-level factors, significant variation in transfusion rates was present across both surgeons (p < 0.0001) and hospitals (p < 0.0001). Receipt of a blood transfusion was also independently associated with wound infection (OR = 1.68, 95% CI = 1.47 and 1.91), pneumonia (OR = 1.98, 95% CI = 1.74 and 2.26), and sepsis (OR = 2.49, 95% CI = 2.11 and 2.94).Conclusion: Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates. [ABSTRACT FROM AUTHOR]

Abstract: Objective: While nonalcoholic fatty liver disease (NAFLD) is associated with the metabolic syndrome, it is not known if NAFLD plays an independent role in the atherogenic dyslipidemia phenotype. Methods and results: The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based prospective cohort study of adults free of clinical cardiovascular disease at enrollment. We tested for a relationship between NAFLD, defined as a liver/spleen (L/S) attenuation ratio of <1 on a non-contrast cardiac CT scan, and multiple measures of fasting serum lipoprotein size, cholesterol and particle concentrations. NAFLD was present in 569 (17%) of 3362 participants. After adjustment for multiple metabolic risk factors, adiposity and measures of insulin resistance (HOMA-IR), NAFLD was independently associated with higher fasting serum triglycerides and lower serum HDL-C. Despite a lack of association with LDL-C, NAFLD was associated with higher LDL particle concentration and lower LDL particle size. Modeling the L/S ratio as a continuous variable, a severity dependent association was observed between atherogenic lipoprotein abnormalities and NAFLD. Conclusion: In a large, multi-ethnic, gender balanced cohort, CT-diagnosed NAFLD was associated with the atherogenic dyslipidemia phenotype in a dose dependent fashion. These relationships persisted after adjustment for several metabolic risk factors and HOMA-IR, suggesting a possible independent pathophysiologic role between NAFLD and dyslipidemia. [Copyright &y& Elsevier]

Background: There is a paucity of quality data on the effects of chronic kidney disease in abdominal surgery. The aim of this study was to define the risk and outcome predictors of bowel resection in stage 5 chronic kidney disease using a large national clinical database. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from years 2005-2010 for major bowel resection in dialysis-dependent patients. Patient demographics, preoperative risk factors, and intraoperative variables were evaluated. Primary endpoints were mortality and morbidity after 30 days. Predictors of outcome were assessed by multivariate regression. Results: The study included 1,685 patients with chronic kidney disease undergoing bowel resection. Overall mortality and morbidity were 27.5 and 58.3 %, respectively. Acute presentation was the strongest predictor of mortality (OR 2.39, CI 1.54-3.72, p < 0.001). Other predictors of mortality included hypoalbuminemia (OR 2.12, CI 1.39-3.24, p < 0.001), pulmonary comorbidity (OR 2.25, CI 1.67-3.03, p < 0.001), and cardiac comorbidity (OR 1.54, CI 1.16-2.05, p = 0.003). Conclusion: This study demonstrates that bowel resection in patients with chronic kidney disease confers a high mortality risk. Preoperative optimization of comorbid conditions may reduce mortality after bowel resection in dialysis-dependent patients. In addition, laparoscopy was associated with a reduction in postoperative morbidity suggesting that it should be used preferentially. [ABSTRACT FROM AUTHOR]

Introduction: Compared to subcutaneous fat, visceral fat is more metabolically active, leading to chronic inflammation and tumorigenesis. The aim of this study is to describe the effect of visceral obesity on colorectal cancer outcomes using computed tomography (CT) imaging to measure visceral fat. Materials and Methods: We conducted a retrospective chart review of patients who underwent surgical resection for colorectal cancer. Visceral fat volume was measured by preoperative CT scans. Final analysis was performed by stratifying patients based on oncologic stage. Results: Two hundred nineteen patients met the inclusion criteria, 111 viscerally obese and 108 nonobese. Body mass index (BMI) weakly correlated with visceral fat volume measurements ( R = 0.304). Whereas obese patients had no difference in survival when categorizing obesity by BMI, categorizing based on visceral fat volume resulted in significant differences in stage II and stage III patients. In stage II cancer, viscerally obese patients had a nearly threefold decrease in disease-free survival (hazard ratio (HR) = 2.72; 95 % confidence interval (CI) = 1.21, 6.10). In stage III cancer, viscerally obese patients had a longer time to recurrence (HR = 0.39; 95 % CI = 0.16, 0.99). Conclusion: This study shows that viscerally obese patients with stage II colorectal cancer are at higher risk for poor outcomes and should be increasingly considered for adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain affects both men and women; there are probably common mechanisms that involve the central nervous system. In many cases, the symptoms may be localised to a single end organ. However, the involvement of the central nervous system may result in a complex regional pain syndrome affecting the whole pelvis and as a consequence, multiple-organ symptomatology. The initial trigger may be relatively benign but a predisposed individual may develop a range of significant sensory and efferent functional abnormalities. Stimuli not normally reaching threshold may be perceived and normal sensations may be magnified to become dysphoric or painful. Problems of emptying viscera and maintaining continence may occur. Significant musculoskeletal disability may arise as well as abnormalities of the autonomic nervous system. There is an association with systemic disorders. Also, psychological, behavioural, sexual and social problems arise. In the chronic pelvic pain syndromes, treatment of the end organ has a limited role, and multidisciplinary as well as interdisciplinary management is essential. [Copyright &y& Elsevier]

Abstract: Background: Ischemic and non-ischemic cardiomyopathy (ICM and NICM) both cause heart failure, but the different etiologies may result in differences in management and outcome, which were explored in this study. Methods: Cohort study of 168 consecutive patients (90 ICM, 78 NICM) recruited from a tertiary referral heart failure clinic followed for 40±19 months. Results: Patients with ICM were older than NICM with worse NYHA functional state but similar left ventricular ejection fraction (LVEF) and dimensions at baseline. Similar proportions (>80%) in both groups were on a beta-blocker and angiotensin-converting-enzyme inhibitor and/or angiotensin-II-receptor blocker (ACE inhibitor±ARB) by end of study. Mean LVEF improved in both groups over time (27.3±11.9% vs. 33.1±12.6%, p <0.05). Overall 40-month mortality was 17%. In univariate analysis of patients <80 years old, ICM, NYHA class, serum creatinine, ACE inhibitor±ARB, and amiodarone use were predictors of mortality, but only serum creatinine was significant in multivariate analysis, with a 2.9-fold relative risk of death (95%CI, 1.34–6.42, p <0.01) for creatinine ≥120 μmol/L compared to <120 μmol/L. Conclusions: Mortality of patients with cardiomyopathy remains high and is strongly related to serum creatinine. NICM patients were younger and showed greater improvement in symptoms and left ventricular function in long-term follow-up. [Copyright &y& Elsevier]

Abstract: Klippel-Trenaunay syndrome (KTS) is a triad of cutaneous hemangiomas, varicose veins, and localized hypertrophy of soft tissue and bone. Orthopedic surgical intervention may be required for the management of localized limb-length discrepancy or joint arthropathy, especially in the lower limb. We describe the management of a 33-year-old patient with a diagnosis of KTS and severe knee arthropathy. After treatment with a posterostabilized, cemented total knee arthroplasty, his range of motion was improved and at 5 years follow-up the clinical outcome was good. We are not aware of any previous reports on the prosthetic management of knee arthropathy in KTS. Precise preoperative diagnosis and analysis of the vascular abnormalities must be undertaken and the case discussed with vascular surgical colleagues as part of the preoperative planning process. [Copyright &y& Elsevier]

Abstract: Background: The increasing prevalence of chronic heart failure is affecting patients'' longevity, quality of life, and health resources, despite advances in management. Recognizing and treating comorbid illnesses is critical. Risk factors such as hypertension and diabetes are treated, but less importance is placed on the role of sleep apnea in heart failure. Methods and Results: There is a discrepancy between the growing evidence on the potential adverse influence of sleep apnea on heart failure (and vice versa) and incorporating its treatment as part of the management strategy for chronic heart failure. Apneic episodes during sleep can lead to profound disturbances to the sympathetic and parasympathetic nervous system. Conclusions: This review explores the impact of sleep disordered breathing in patients with chronic heart failure, focusing on the autonomic nervous system. [Copyright &y& Elsevier]

Abstract: The distribution and abundance of pink bollworm (Pectinophora gossypiella Saunders (PBW)) in cotton in Arizona and California was examined using a validated weather-driven, physiologically based demographic model of cotton and PBW integrated into a geographic information system (GIS). Survival of diapause larvae during winter as affected by low temperatures is a key factor determining the range of PBW. Winter survival was estimated using data from Gutierrez et al. (Can. Entomol. 109 (1977) 1457) and Venette et al. (Environ. Entomol. 29 (5) (2000) 1018). The model was run continuously over the period 1 January 1995 to 31 December 2003 using observed weather data from 121 locations. Three output variables were mapped as measures of PBW persistence: over-winter survival of diapause PBW larvae, cumulative daily PBW larval densities over the season, and the number of diapause larvae produced during the season. The distribution of pink bollworm is predicted to be restricted to the relatively frost-free cotton growing areas of Arizona and Southern California where it currently reaches pest status. The model predicts that extension of PBW''s range into the Central Valley of California is unlikely. The analysis questions the efficacy of an ongoing area-wide effort to prevent the establishment of PBW in the Central Valley of California. Four global warming scenarios were examined to estimate the effects on the potential geographic range of PBW. Average observed daily temperatures were increased 1.0, 1.5, 2.0 or 2.5 °C, respectively, in the four scenarios. Scenarios with average increases of 1.5–2.5 °C predicted that the range of PBW would expand into the Central Valley of California and the severity of the pest would greatly increase in areas of current infestation. [Copyright &y& Elsevier]

• The types of suicide- and non-suicide-related emotions on Twitter were examined. • Suicide-related tweets were found to contain a higher proportion of fear, sadness, and negative emotions. • The proposed approach was found to perform better than several existing approaches for classifying suicide tweets. Expression of emotion is an indicator that can contribute to the detection of mental health-related disorders. Suicide causes death to many people around the globe, and despite the suicide prevention strategies that have been employed over the years, only a few studies have explored the role of emotions in predicting suicidal behavior on social media platforms. This study explored the role of emotions from Twitter messages in detecting suicide-related content. We extracted and analyzed the characteristics of Twitter users' sentiment and behavior response (anger, fear, sadness, joy, positive, and negative) using NRC Affect Intensity Lexicon and SentiStrength techniques. A semi-supervised learning method was applied using the YATSI classifier or "Yet Another Two-Stage Idea" to efficiently recognize suicide-related tweets. The results showed that tweets associated with suicide content were exclusively related to fear, sadness, and negative sentiments. The classification results showed the potential of emotions in facilitating the detection of suicide-related content online. Our findings offer valuable insights into ongoing research on the prevention of suicide risk and other mental-related disorders on Twitter. The proposed mechanism can contribute to the development of clinical decision support systems that deal with evidence-based guidelines and generate customized recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite advances in medical therapy, sleep disordered breathing (SDB) remains highly prevalent in chronic heart failure (CHF). The impact of severity of SDB on sympathovagal balance, central hemodynamic responses and cardiopulmonary functional status in these patients is uncertain. Methods: Thirteen patients with stable CHF (mean age±10 years; 12 NYHA Class II, 1 Class III) identified with SDB (apnoea–hypopnoea index [AHI] ≥5) by polysomnography underwent echocardiography, standard hemodynamic and functional assessment, heart rate variability analysis and treadmill cardiopulmonary testing. Results: Mean AHI of study cohort was 32±19, with predominant hypopnoea. Anthropomorphic measurements of obesity correlated positively with increasing AHI severity (p <0.05). NYHA functional class, 6-minute walk distance, measures of left ventricular systolic and diastolic function, serum brain natriuretic peptide levels, cardiac output and VO2peak at baseline did not differ with SDB severity. Although SDB severity did not impact on VE/VCO2-slope, patients in the highest AHI tertile (AHI>35) demonstrated significantly greater respiratory effort (VE), despite similar VO2peak during exercise. Increasing SDB severity was associated with higher resting and post-exercise heart rates, reduced heart rate variability, and possibly slower post-exercise heart rate recovery, consistent with autonomic imbalance. Conclusions: SDB severity was most closely associated with the degree of autonomic dysfunction, and abnormal ventilatory response during and post-exercise in a group of stable ambulant patients with similar severity of CHF on contemporary therapy. [Copyright &y& Elsevier]

Abstract: Background and aim: Understanding the influence of gender in heart failure allows for better treatment. This study described the gender differences in heart failure patients and their response to therapy. Methods: Consecutive patients (116 men vs. 52 women) from 1997 to 2002 were recruited from a single heart failure unit. Mean follow-up was 40±19 months. Results: Mean age was 68±12 years; left ventricular ejection fraction (LVEF) 27±12%. Women had higher mean LVEF, left ventricular end-diastolic diameter, and worse New York Heart Association (NYHA) functional class at baseline compared to men, while age, body mass index, blood pressure, estimated glomerular filtration rate and other co-morbidities did not differ significantly. Fewer women remained on angiotensin-converting-enzyme inhibitors while angiotensin-II-receptor blockers use increased significantly. By the end of the study, both genders exhibited similar magnitude of improvements in LVEF, cardiac dimensions, hemodynamics and mean NYHA functional class. In multivariate analysis, NYHA functional class was the strongest predictor of mortality: patients with NYHA class III/IV at baseline had 2.4-fold increased mortality risk compared to those in NYHA class I/II (95% CI 1.09–5.51, p =0.03). For men, functional class at baseline was the strongest predictor of mortality while for women, it was age at baseline. Conclusions: In a contemporary tertiary referral heart failure clinic, women were observed to have better LVEF, but worse NYHA functional class than men. Both genders exhibited functional and hemodynamic improvements with only minor differences in their medical therapies. Predictors of mortality differed between the genders. [Copyright &y& Elsevier]