Search

It is well established that an elevated potassium level (hyperkalemia) is associated with a risk of adverse events including morbidity, mortality and healthcare system cost. Hyperkalemia is commonly encountered in many chronic conditions including kidney disease, diabetes and heart failure. Furthermore, hyperkalemia may result from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are disease-modifying treatments for these conditions. Therefore, balancing the benefits of optimizing treatment with RAASi while mitigating hyperkalemia is crucial to ensure patients are optimally treated. In this review, we will briefly discuss the definition, causes, epidemiology and consequences of hyperkalemia. The majority of the review will be focused on management of hyperkalemia in the acute and chronic setting, emphasizing contemporary approaches and evolving data on the relevance of dietary restriction and the use of novel potassium binders.

Phosphate rock, pre-concentrated phosphate ore, is the primary raw material for the production of mineral phosphate fertilizer. Phosphate rock is among the fifth most mined materials on earth, and it is also mined and processed to fertilizers in East Africa. Phosphate ore can contain relevant heavy metal impurities such as toxic cadmium and radiotoxic uranium. Prolonged use of phosphate rock powder as a fertilizer and application of mineral fertilizers derived from phosphate rock on agricultural soils can lead to an accumulation of heavy metals that can then pose an environmental risk. This work assesses the uranium concentrations in four major phosphate rocks originating from East Africa and four mineral phosphate fertilizers commonly used in the region. The concentration measurements were performed using energy-dispersive X-ray fluorescence spectrometry. The results showed that the uranium concentration in phosphate rock ranged from as low as 10.7 mg kg−1 (Mrima Hill deposit, Kenya) to as high as 631.6 mg kg−1 (Matongo deposit, Burundi), while the concentrations in phosphate fertilizers ranged from 107.9 for an imported fertilizer to 281.0 mg kg−1 for a local fertilizer produced from Minjingu phosphate rock in Tanzania. In this context, it is noteworthy that the naturally occurring concentration of uranium in the earth crust is between 1.4 and 2.7 mg kg−1 and uranium mines in Namibia commercially process ores with uranium concentrations as low as 100–400 mg kg−1. This study thus confirms that East African phosphate rock, and as a result the phosphate fertilizer produced from it can contain relatively high uranium concentrations. Options to recover this uranium are discussed, and it is recommended that public–private partnerships are established that could develop economically competitive technologies to recover uranium during phosphate rock processing at the deposits with the highest uranium concentrations.

Alcohol intoxication is a prevalent feature of university life and campus sexual assault cases. While previous research has examined how students perceive obvious cases of assault, less is known about how students evaluate more ambiguous sexual scenarios—such as those including two intoxicated individuals. In three survey experiments with college students (N = 990), we examined how manipulating the intoxication (sober vs. drunk) of a man accused of assault (the respondent) influenced perceptions of a hook-up scenario involving an intoxicated woman. Although university policies indicate that respondent intoxication should not influence evaluations of these scenarios, we hypothesized that students would be influenced by cues of respondent intoxication when making judgments of the hook-up and the individuals involved. Students reported that the hook-up was a sexual assault more often when the respondent was sober compared to when he was drunk, and they found sober respondents more responsible for the encounter than drunk respondents. Although effect sizes fluctuated across studies, an internal meta-analysis found evidence of significant (but modest) aggregate effects. Furthermore, perceptions of the respondent’s agency mediated the effects of intoxication on perceptions of respondent responsibility (Studies 2 & 3). We also manipulated whether the respondent should have reasonably known the complainant was drunk (Studies 1 & 2) and whether the complainant or the complainant’s friend reported the incident (Study 3), but these manipulations had little effect on students’ perceptions of the vignettes. We discuss how our findings can guide future research and consider implications of our results for university stakeholders.

The TRPM4 gene codes for a membrane ion channel subunit related to inflammation in the central nervous system. Recent investigation has identified an association between TRPM4 single nucleotide polymorphisms (SNPs) rs8104571 and rs150391806 and increased intracranial (ICP) pressure following traumatic brain injury (TBI). We assessed the influence of these genotypes on clinical outcomes and ICP in TBI patients. We included 292 trauma patients with TBI. DNA extraction and real-time PCR were used for TRPM4 rs8104571 and rs150391806 allele discrimination. Five participants were determined to have the rs8104571 homozygous variant genotype, and 20 participants were identified as heterozygotes; 24 of these 25 participants were African American. No participants had rs150391806 variant alleles, preventing further analysis of this SNP. Genotypes containing the rs8104571 variant allele were associated with decreased Glasgow outcome scale-extended (GOSE) score (P = 0.0231), which was also consistent within our African-American subpopulation (P = 0.0324). Regression analysis identified an association between rs8104571 variant homozygotes and mortality within our overall population (P = 0.0230) and among African Americans (P = 0.0244). Participants with rs8104571 variant genotypes exhibited an overall increase in ICP (P = 0.0077), although a greater frequency of ICP measurements > 25 mmHg was observed in wild-type participants (P =

Minimally invasive inguinal lymphadenectomy (MILND) is safe and feasible, but limited data exist regarding oncologic outcomes.This study performed a multi-institutional retrospective cohort analysis of consecutive MILND performed for melanoma between January 2009 and June 2016. The open ILND (OILND) comparative cohort comprised patients enrolled in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) between December 2004 and March 2014.The pre-defined primary end point was the same-basin regional nodal recurrence, calculated using properties of binomial distribution. Time to events was calculated using the Kaplan-Meier method. The secondary end points were overall survival, progression-free survival, melanoma-specific survival (MSS), and distant metastasis-free survival (DMFS).For all the patients undergoing MILND, the same-basin regional recurrence rate was 4.4 % (10/228; 95 % confidence interval [CI], 2.1-7.9 %): 8.2 % (4/49) for clinical nodal disease and 3.4 % (6/179) for patients with a positive sentinel lymph node (SLN) as the indication. For the 288 patients enrolled in MSLT-II who underwent OILND for a positive SLN, 17 (5.9 %) had regional node recurrence as their first event. After controlling for ulceration, positive LN count and positive non-SLNs at the time of lymphadenectomy, no difference in OS, PFS, MSS or DMFS was observed for patients with a positive SLN who underwent MILND versus OILND.This large multi-institutional experience supports the oncologic safety of MILND for melanoma. The outcomes in this large multi-institutional experience of MILND compared favorably with those for an OILND population during similar periods, supporting the oncologic safety of MILND for melanoma.

Polyploidy and life-strategy transitions between annuality and perenniality often occur in flowering plants. However, the evolutionary propensities of polyploids and the genetic bases of such transitions remain elusive. We assembled chromosome-level genomes of representative perennial species across the genus Glycine including five diploids and a young allopolyploid, and constructed a Glycine super-pangenome framework by integrating 26 annual soybean genomes. These perennial diploids exhibit greater genome stability and possess fewer centromere repeats than the annuals. Biased subgenomic fractionation occurred in the allopolyploid, primarily by accumulation of small deletions in gene clusters through illegitimate recombination, which was associated with pre-existing local subgenomic differentiation. Two genes annotated to modulate vegetative-reproductive phase transition and lateral shoot outgrowth were postulated as candidates underlying the perenniality-annuality transition. Our study provides insights into polyploid genome evolution and lays a foundation for unleashing genetic potential from the perennial gene pool for soybean improvement.

The Sino-Himalaya region is located in the southeast margin of the Qinghai-Tibetan Plateau (QTP) with several Asian rivers in this area, namely the Yarlung Zangbo River (YZR), Salween, Mekong, and Jinshajiang River and their tributaries. All these rivers currently flow independently into the Indian Ocean, the South China Sea (Pacific Ocean) and the East China Sea (Pacific Ocean). In geologic history, however, these rivers flowed southward into the Paleo-Red River (PRR), forming a huge drainage system, which then flowed into the South China Sea. From the end of the Neogene to the beginning of the Quaternary, with further uplift of the QTP, the monsoon climate was formed and strengthened bringing abundant precipitation leading to river erosion, rapid undercutting and a series of river capture events resulting in modern drainage systems and the beheading of the huge PRR. The reorganization of the PRR led to changes in the spatial pattern of river systems, subsequently affecting the geographical distribution of plants in the river valley. This paper reviews the effects of drainage evolution on the genetic structure and geographical pattern of plants in this region, and summarizes the resulting four types of discontinuous distribution patterns observed, namely: (1) the discontinuous distribution pattern between the Three River Valleys (TRV) (Salween, Mekong, Jinshajiang and their tributaries) and the Red River Basin (RRB); (2) the discontinuity between the Yarlung Zangbo River and the TRV–RRB; (3) the discontinuity among the TRV, and (4) the discontinuity between the east and west ends of the QTP. The conclusions from this review, while providing botanical evidence supporting and confirming the drainage evolution in Sino-Himalaya China, are the following: (1) the reorganization of drainage systems made the original continuous distribution pattern discontinuous, forming unique genetic and biogeographical characteristics, promoting the genetic differentiation of species and the formation of new taxa; (2) river capture events link different river systems together, bringing together the genetic diversity of different river valley species, increasing the richness of genetic diversity and the exchange of genes among populations; (3) the reorganization of river systems impacts the evolutionary history of valley plants and shapes their modern distribution patterns.

In this work, we demonstrate for the first time the design and fabrication of microchip electrophoresis devices containing cross-shaped channels and spiral electrodes around the separation channel for microchip electrophoresis and capacitively coupled contactless conductivity detection. The whole device was prepared in a digital light processing-based 3D printer in poly(ethylene glycol) diacrylate resin. Outstanding X-Y resolution of the customized 3D printer ensured the fabrication of 40-μm cross section channels. The spiral channels were filled with melted gallium to form conductive electrodes around the separation channel. We demonstrate the applicability of the device on the separation of sodium, potassium, and lithium cations by microchip electrophoresis. Graphical abstract.

Animals and plants are shifting the timing of key life events in response to climate change, yet despite recent documentation of escalating phenological change, scientists lack a full understanding of how and why phenological responses vary across space and among species. Here, we used over 7 million community-contributed bird observations to derive species-specific, spatially explicit estimates of annual spring migration phenology for 56 bird species across eastern North America. We show that changes in the spring arrival of migratory birds are coarsely synchronized with fluctuations in vegetation green-up and that the sensitivity of birds to plant phenology varied extensively. Bird arrival responded more synchronously with vegetation green-up at higher latitudes, where phenological shifts over time are also greater. Critically, species’ migratory traits explained variation in sensitivity to green-up, with species that migrate more slowly, arrive earlier and overwinter further north showing greater responsiveness to earlier springs. Identifying how and why species vary in their ability to shift phenological events is fundamental to predicting species’ vulnerability to climate change. Such variation in sensitivity across taxa, with long-distance neotropical migrants exhibiting reduced synchrony, may help to explain substantial declines in these species over the last several decades. Citizen-science data on bird observations from eastern North America show that the timing of spring arrival of migratory birds is broadly correlated with fluctuations in vegetation green-up but that the varying sensitivity of different bird species to this phenological event is linked to their different migratory strategies.

Non-contrast magnetic resonance (MR) angiography and MR venography techniques are gaining popularity for vascular imaging because they are faster, more forgiving and less costly compared with contrast-enhanced MR angiography. Non-contrast MR angiography also avoids gadolinium deposition, which is especially important in imaging children. Non-contrast MR angiography has an array of specific applications for numerous clinical indications. This review summarizes the non-contrast MR angiography methods and their relative advantages and disadvantages. The paper also guides the reader on which technique to consider when determining the optimal imaging modality for each individual patient.

Microbial resistance to currently available antibiotics poses a great threat in the global fight against infections. An important step in determining bacterial antibiotic resistance can be selective DNA sequence capture and fluorescence labeling. In this paper, we demonstrate the fabrication of simple, robust, inexpensive microfluidic devices for DNA capture and fluorescence detection of a model antibiotic resistance gene sequence. We laser micromachined polymethyl methacrylate microchannels and enclosed them using pressure-sensitive adhesive tapes. We then formed porous polymer monoliths with DNA capture probes in these microchannels and used them for sequence-specific capture, fluorescent labeling, and laser-induced fluorescence detection of picomolar (pM) concentrations of synthetic and plasmid antibiotic resistance gene targets. The relative fluorescence for the elution peaks increased with loaded target DNA concentration. We observed higher fluorescence signal and percent recovery for synthetic target DNA compared to plasmid DNA at the same loaded target concentration. A non-target gene was used for control experiments and produced 3% capture relative to the same concentration of target. The full analysis process including device fabrication was completed in less than 90 min with a limit of detection of 30 pM. The simplicity of device fabrication and good DNA capture selectivity demonstrated herein have potential for application with processes for bacterial plasmid DNA extraction and single-particle counting to facilitate determination of antibiotic susceptibility. Graphical abstract.

Three-dimensional (3D) nipple–areolar tattoo is a novel approach to nipple–areolar complex reconstruction for which little data exist. Our aim was to evaluate 3D nipple–areolar tattoo outcomes and investigate if patient factors, payer status, surgeries, or therapies affect tattoo utilization. Patients pursuing skin-sparing (SSM) or attempted nipple-sparing mastectomy (NSM) with breast reconstruction from 2008 to 2019 were reviewed. Outcomes included frequency of 3D tattoo, post-procedure complications (infections, or other local adverse sequelae), and rates, indications, and timing of revisions. Patient factors, payer status, surgeries, and adjuvant therapies underwent univariate analysis comparing rates of 3D tattoo and revisions. A total of 191 patients were identified; median follow-up was 4 years. The majority of patients were white (165, 86%), married (146, 76%), and post-menopausal (97, 51%), with private insurance (156, 81%). Surgeries included SSM (172, 90%) or attempted NSM (19, 10%) with implant (154, 81%) or autologous reconstruction (37, 19%). Sixty-two patients (32%) underwent 3D nipple–areolar tattooing. No post-procedure complications occurred. After tattooing, 20 patients (32%) pursued revisions, the majority due to color fading (12, 60%). Average time from tattoo to completion of revisions was 5.6 months. Patients undergoing autologous reconstruction had a higher rate of 3D tattooing (p

Parvalbumin-expressing interneurons (PV-INs) are highly vulnerable to stressors and have been implicated in many neuro-psychiatric diseases such as schizophrenia, Alzheimer’s disease, autism spectrum disorder, and bipolar disorder. We examined the literature about the current knowledge of the physiological properties of PV-INs and gathered results from diverse research areas to provide insight into their vulnerability to stressors. Among the factors that confer heightened vulnerability are the substantial energy requirements, a strong excitatory drive, and a unique developmental trajectory. Understanding these stressors and elaborating on their impact on PV-IN health is a step toward developing therapies to protect these neurons in various disease states and to retain critical brain functions.

Up-conversion photoluminescence (UCPL) refers to the elementary process where low-energy photons are converted into high-energy ones via consecutive interactions inside a medium. When additional energy is provided by internal thermal energy in the form of lattice vibrations (phonons), the process is called phonon-assisted UCPL. Here, we report the exceptionally large phonon-assisted energy gain of up to ~ 8kBT (kB is Boltzmann constant, T is temperature) on all-inorganic lead halide perovskite semiconductor colloidal nanocrystals that goes beyond the maximum capability of only harvesting optical phonon modes. By systematic optical study in combination with a statistical probability model, we explained the nontrivial phonon-assisted UCPL process in perovskites nanocrystals, where in addition to the strong electron-phonon (light-matter) coupling, other nonlinear processes such as phonon-phonon (matter-matter) interaction also effectively boost the up-conversion efficiency. Ministry of Education (MOE) National Research Foundation (NRF) Accepted version Q. X. gratefully acknowledges financial support from the Singapore National Research Foundation through the NRF Investigatorship Award (No. NRF-NRFI2015-03) and the Singapore Ministry of Education via AcRF Tier 3 Programme (No. MOE2018-T3-1-002), Tier 2 grant (No. MOE2018-T2-2-068)and Tier 1 grants (Nos. RG103/15 and RG113/16). A. G. D. A. gratefully acknowledges the financial support of the Presidential Postdoctoral Fellowship program of the Nanyang Technological University. We acknowledge Dr. Lulu Zhang for his help on the TEM characterization.

The present research examines the combined role of the message and source of a news article in persuading political partisans about an environmental policy. In a series of three experiments, we presented participants (total N = 3457) with a realistic news article summarizing scientific evidence concerning the environmental and economic costs and benefits of hydraulic fracturing (fracking). The article’s message was manipulated to support either a conservative (pro-fracking) or liberal (anti-fracking) policy and was attributed to either a conservative news source (Fox News) or a liberal one (MSNBC). Participants who read pro-fracking articles were generally more supportive of fracking than those who read anti-fracking articles, regardless of whether articles were from an ideologically friendly or unfriendly source. Consistent with previous research, however, participants perceived articles with ideologically unfriendly messages to have worse methods than articles with ideologically friendly messages. Finally, liberal participants showed some reduction in resistance to ideologically unfriendly messages coming from an ideologically friendly source, but conservative participants did not. Implications for politicization of environmental policy and future research are discussed.