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Background: Trauma patients present to the emergency department with various injuries. Few injuries can be easily missed during the evaluation of polytrauma patients. We report one such rare injury in a trauma patient.Case Report: We report the case of a 67-year-old man who presented to the emergency department with an alleged history of trauma. He reported severe pain in the lower abdomen, right hip, and right thigh. An x-ray study did not reveal any bony injury, and an extended focused assessment with sonography in trauma was also negative. Point-of-care ultrasound of his right thigh revealed the presence of a Morel-Lavallée lesion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Morel-Lavallée lesions are post-traumatic, closed, degloving injuries that go unnoticed in many polytrauma patients. Emergency physicians should be mindful of this lesion because delay in diagnosis can result in significant complications. [ABSTRACT FROM AUTHOR]

Natriuretic peptides (NPs, B-type natriuretic peptide /BNP and NT-proBNP) are universally used biomarkers with established cut-points to aid in the diagnosis of heart failure (HF). It has been demonstrated that an inverse relationship exists between obesity, defined by the body mass index (BMI), and NPs, such that the application of NPs to diagnostic algorithms in HF remains challenging in overweight and obese patients. Some have advocated that lowering the cut-offs for NPs or using a correction for high BMI may improve the diagnostic accuracy in obese individuals. The inverse relationship of NPs with high BMI is present in both HF with reduced (HFrEF) and with preserved (HFpEF) ejection fraction, although levels tend to be higher in HFrEF. Nevertheless, data from several studies have shown that the prognostic value of NPs is preserved across BMI classes, and that increasing circulating levels of NPs correlate with adverse outcomes including all-cause mortality and HF hospitalizations. While NPs can still be used in diagnosis of HF in obese individuals, lower thresholds and the clinical context should be utilized in decision making. Additionally, given the validated prognostic value even in obesity, NPs can be employed in risk-stratification of individuals with obesity and HF, although there remains limited evidence about use in those with severe obesity (BMI >40 kg/m2). [ABSTRACT FROM AUTHOR]

Cysteine plays a critical role in maintaining normal human metabolism, redox homeostasis, and immune regulation. Despite its functional versatility, cysteine metabolism in the human body is not well understood because of the lack of a robust tool for real-time measurement of cysteine at the cellular and sub-cellular level. In the present study, a genetically encoded nanosensor was developed using Cj0982 protein of Campylobacter jejuni , Enhanced Cyan Fluorescent Protein (ECFP) and Venus. The Cj0982 was sandwiched between ECFP and Venus for the construction of the nanosensor, named as Cys-FS (Cysteine-Fluorescent-Sensor). The Cys-FS is pH stable, specific to cysteine and has an affinity of 1.2 × 10−5 M. A range of affinity mutants were also developed with a cumulative cysteine detection range from 800 nM to 3.5 mM. The Cys-FS nanosensor was expressed in bacterial, yeast and mammalian cells, and the dynamics of cysteine level was measured in living cells using the confocal microscopy. The results showed that the Cys-FS nanosensor successfully monitored the dynamics of cysteine in both prokaryotic and eukaryotic systems without disrupting the cell. Thus, this study presents a novel nanosensor that can measure cysteine in living cells. This nanosensor is minimally invasive and non-toxic. • A genetically encoded FRET based nanosensor was developed for real-time monitoring of cysteine in living cells. • The sensor consists of Cj0982 protein from Campylobacter jejuni flanked by Enhanced Cyan Fluorescent Protein and Venus. • Conformational Change in Cys-FS sensor in presence of cysteine results in modulation of FRET ratio. • The sensor has a highly specific response to cysteine with an in vitro dissociation constant of 1.2 × 10−5 M. • The sensor is appropriate for real-time imaging of cysteine in bacterial, yeast and mammalian cells [ABSTRACT FROM AUTHOR]

Allogeneic stem cell transplantation (alloHCT) remains the only curative option for a variety of hematological malignancies. AlloHCT is being increasingly offered in elderly patients with acceptable transplant related mortality. Umbilical cord blood (UCB) is established as an alternate donor source however some are reluctant to consider its use in elderly patients due to anticipated morbidity. We evaluated outcomes in alternate donor sources, prior to the initiation of haploidentical transplantation at our institution, of matched unrelated donor (MUD) and UCB in elderly patients (median age 64, range 60-74) from 2005-2015. One hundred and eighty four patients were included (MRD: 57; MUD: 69; UCB: 58). Eighty seven underwent myeloablative conditioning (52.7%). There was no difference in acute (aGVHD) or chronic graft versus host disease (cGVHD) between donor sources. ATG was protective for grade III-IV aGVHD (p=0.0498) and high disease risk index per Armand et al predictive of cGVHD (p=0.0496). UCB engraftment was longer for both neutrophils (p=0.005) and platelets (p<0.001) but there was no difference in day 30 or day 100 chimerism. In this very high risk population 70% had either a high disease risk index (53%) or high (>2) comorbidity index (42%) per Sorror et al. There was a trend toward inferior progression free survival (PFS) amongst both UCB (5.50 months; 95% CI 2.83—9.36) and MUD (5.59 months; 95% CI 3.68-17.68) as compared to MRD (18.3 months; 95% CI 8.38-64.79)(Table 1). Compared to MRD, UCB experienced inferior median overall survival (OS) HR 1.877 (95% CI 1.160-3.037) but no difference was seen between UCB and MUD or MUD and MRD in multivariable analysis (Table 1 and 2). The leading cause of death in UCB recipients was infections (40%) followed by relapse (17%). Our experience shows that even in this very high risk elderly cohort, UCB continues to be a viable alternate donor source. Methods to reduce late infectious complications are needed such as new approaches to accelerate T cell engraftment which is currently being explored at our center. [ABSTRACT FROM AUTHOR]

This paper proposes a design process for a high-efficiency micro-gas-turbine (MGT)-based range extender(RE). The study includes a conceptual system design and a detailed design of an MGT RE. This design adopts a two-spool intercooled and recuperated high-speed MGT. The study focuses on the design of a low-pressure (LP) rotor system integrated with an electric generator, where a permanent magnet synchronous generator (PMSG) with a round transversally polarized bar permanent magnet (PM) is selected as a generator type. The turbine and compressor sides of the rotor are supported by dual back-to-back angular contact ball bearings modeled using a detailed five degrees of freedom contact model. The bearing cartridge is supported by squeeze film dampers (SFDs). The SFD that supports the bearings is modeled with a linear spring and an oil-film damper. Simulation results dictate that stresses in the magnet and sleeve vary due to several design parameters, thus time-efficient simulation is strongly required for effective design optimization. Also, the results indicate that the SFD design optimization range leading to acceptable rotordynamics requirements is narrow. • Design process of Micro gas turbine-based range extender systems. • Method for sleeve design to contain high-speed rotating magnets. • Novel rotor configuration supported by ball-bearing cartridges. • Method for the design of squeeze film dampers for the ball bearing cartridge. [ABSTRACT FROM AUTHOR]

This study employs ISORROPIA-II for the evaluation of aerosol acidity and quantification of contributions from chemical species and meteorological parameters to acidity variation in the Indian context. PM 2.5 samples collected during summer (April–July 2018), post-monsoon (September–November 2018), and winter (December 2018–January 2019) from a rural receptor location in the eastern Indo-Gangetic Plain (IGP) were analyzed for ionic species, water-soluble organic carbon (WSOC), and organic and elemental carbon (OC, EC) fractions. This was followed by estimation of the in situ aerosol pH and liquid water content (LWC) using the forward mode of ISORROPIA-II, which is less sensitive to measurement uncertainty compared to the reverse mode, for a K+-Ca2+-Mg2+-NH 4 +-Na+-SO 4 2--NO 3 --Cl--H 2 O system. Aerosol pH was moderately acidic (summer: 2.93 ± 0.67; post-monsoon: 2.67 ± 0.23; winter: 3.15 ± 0.34) and was most sensitive to SO 4 2− and total ammonium (TNH 3) variation. The LWC of aerosol showed an increasing trend from summer (16.6 ± 13.6 μg m−3) through winter (32.9 ± 10.4 μg m−3). With summer as the baseline, the largest changes in aerosol pH during the other seasons was driven by SO 4 2− (ΔpH: −0.70 to −0.82 units), followed by TNH 3 (ΔpH: +0.25 to +0.38 units) with K+ and temperature being significant only during winter (ΔpH: +0.51 and + 0.46 units, respectively). The prevalent acidity regime provided three major insights: i) positive summertime Cl− depletion (49 ± 20%) as a consequence of SO 4 2− substitution increased aerosol pH by 0.03 ± 0.20 units and decreased LWC by 2.4 ± 5.9 μg m−3; ii) the rate of strong acidity (H+ str) neutralization and the [H+ str ]/[SO 4 2−] molar ratio suggested the existence of bounded acidity in ammonium-rich (winter) conditions; and iii) significant correlations between LWC, WSOC, and secondary organics during post-monsoon and winter pointed towards a possible indirect role of WSOC in enhancing LWC of aerosol, thereby increasing pH. Given the inability of proxies such as H+ str and charge ratios to accurately represent aerosol pH as demonstrated here, this study emphasizes the need for rigorous thermodynamic model-based evaluation of aerosol acidity in the Indian scenario. [Display omitted] • ISORROPIA-II derived aerosol pH in the eastern IGP was moderately acidic (2.0–4.5). • SO 4 2− and total ammonium (TNH 3) were the major drivers of aerosol acidity. • Summertime positive Cl− depletion of ∼50% suggested SO 4 2− substitution. • There was evidence of bounded acidity in ammonium-rich (winter) conditions. • LWC and WSOC played significant roles in modulating aerosol pH. [ABSTRACT FROM AUTHOR]