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We aimed to identify a simple metric accounting for peri-procedural hemoglobin changes, independent of blood product transfusion strategies, and assess its correlation with outcomes in patients undergoing left ventricular assist device (LVAD) implantation We included consecutive patients undergoing LVAD implantation at a single center between 10/1/2008 and 6/1/2014. The anemia stress index (ASI), defined as the sum of number of packed red blood cells transfused and the hemoglobin changes after LVAD implantation, was calculated for each patient at 24 h, discharge, and 3 months after LVAD implantation. Our cohort included 166 patients (80.1% males, mean age 56.3 ± 15.6 years) followed up for a median of 12.3 months. Increases in ASI per unit were associated with a higher hazard for all-cause mortality and early RV failure. The associations between the ASI and all-cause mortality persisted after multivariable adjustment, irrespective of when it was calculated (adjusted HR of 1.11, 95% CI 1.03–1.20 per unit increase in ASI). Similarly, ASI at 24 h after implant was associated with early RV failure despite multivariable adjustment (OR 1.09, 95% CI 1.05–1.14). We present a novel metric, the ASI, that is correlated with an increased risk for all-cause mortality and early RV failure in LVAD recipients.

The origins and dispersal of the chicken across the ancient world remains one of the most enigmatic questions regarding Eurasian domesticated animals1,2. The lack of agreement regarding the timing and center of origin is due, in large part, to issues with morphological identifications, a lack of direct dating, and poor preservation of thin bird bones. Historical sources attest to the prominence of chickens in southern Europe and southwest Asia by the last centuries BC3. Likewise, art historical depictions of chickens and anthropomorphic rooster-human chimeras are reoccurring motifs in Central Asian prehistoric and historic traditions4-6. However, when this ritually and economically significant bird spread along the trans-Eurasian exchange routes has remained a mystery. Here we show that chickens were widely raised by people at villages across southern Central Asia from the third century BC through medieval periods for their eggs and likely also meat. In this study, we present archaeological and molecular evidence for the cultivation of chickens for egg production from 12 different Central Asian archaeological sites spanning a millennium and a half. These eggshells were recovered in high abundance at all of these sites, suggesting that chickens were widely raised by people at villages across southern Central Asia from the third century BC through medieval periods and that they were an important part of the overall diet. Contrary to views that ancient peoples of Central Asia were primarily herding sheep, goat, and cattle, these data show that chicken was also important in the subsistence economy and that it was widely spread along the ancient Silk Road. Introduction - Rapid Dissemination across the Ancient World Results - Archaeological Eggshells - Peptide Mass Fingerprinting Discussion - Evidence for Non-Seasonal Egg Laying - The Rise in Symbolic and Economic Prominence of the Chicken in Central Asia Conclusions

The study of faunal remains from archaeological sites is often complicated by the presence of large numbers of highly fragmented, morphologically unidentifiable bones. In Australia, this is the combined result of harsh preservation conditions and frequent scavenging by marsupial carnivores. The collagen fingerprinting method known as zooarchaeology by mass spectrometry (ZooMS) offers a means to address these challenges and improve identification rates of fragmented bones. Here, we present novel ZooMS peptide markers for 24 extant marsupial and monotreme species that allow for genus-level distinctions between these species. We demonstrate the utility of these new peptide markers by using them to taxonomically identify bone fragments from a nineteenth-century colonial-era pearlshell fishery at Bandicoot Bay, Barrow Island. The suite of peptide biomarkers presented in this study, which focus on a range of ecologically and culturally important species, have the potential to significantly amplify the zooarchaeological and paleontological record of Australia. 1. Introduction 2. Material and methods 2.1. Materials 2.1.1. Modern reference specimens 2.1.2. Archaeological specimens 2.2. Collagen extraction 2.3. Matrix-assisted laser desorption/ionization–tandem time of flight mass spectrometry 2.4. Liquid chromatography with tandem mass spectrometry 2.5. Identification and confirmation of biomarkers 3. Results 3.1. Novel ZooMS peptide markers 3.2. Marsupial versus monotreme ZooMS markers 3.3. Marsupial ZooMS markers 3.4. Using ZooMS to identify macropods 3.5. Collagen fingerprinting of archaeological specimens 4. Discussion 4.1. ZooMS insights at Bandicoot Bay 4.2. Comparison to published markers 4.3. Challenges and future prospects

The Lower Palaeolithic, Middle Pleistocene locality Schoningen has been a focus of archaeological research for over two decades. The locality is best-known for the discovery of wooden spears in close association with numerous butchered remains of horses and other large mammals in the Spear Horizon (Scho 13II-4), with an age of ca. 300 kyr. Several site formation models have been proposed to explain the faunal accumulation at the site: 1) single hunting event on a dried lake shore; 2) multiple hunting events in the soft mud of a lake shore; 3) deposition on an exposed delta plain; 4) geogenic displacement by hydrological processes; 5) hominin waste disposal and storage behaviour; and 6) hominin butchering activities on a frozen lake surface. Visual spatial analyses allow for the (subjective) incorporation of archaeological knowledge in the interpretation of spatial data, while spatial statistics allow for more objective and reproducible inferences about spatial patterns. The combination of the two could thus provide a vital tool in disentangling complex site formation processes. This study uses a combination of visual spatial analyses, spatial statistics and orientation analyses in order to further disentangle the site formation history of Scho 13II-4 and to assess the impact of post-depositional processes on the faunal assemblage. This study revealed the existence of intra-site and inter-species differences in spatial distribution and orientation. The results of this study are compared to the suggested site formation models for Scho 13II-4 to test which of these models is most parsimonious with the spatial distribution and orientation of the faunal assemblage. It is concluded that the previously proposed site formation models are overly simplified and cannot be used to explain the site formation history of Scho 13II-4.

Objective Congenital ventricular wall defects are very rare and include congenital ventricular aneurysms (CVAs) and diverticula (CVDs). Method We report a series of five fetuses: three with CVAs and two with CVDs referred due to fetal arrhythmia. In addition to routine fetal echocardiography, fetal magnetocardiography (fMCG) was used. The literature in CVA and CVD is reviewed. Results Incessant premature ventricular contractions (PVC), mainly bigeminy and trigeminy were found in three fetuses with CVAs and in one with CVD, who also had ventricular couplets. The other fetus with CVD, referred because of PVCs, had only sinus tachycardia. ST elevation was noted in two. Fetal movement had a variable impact on PVCs. Postnatal evaluation demonstrated two persistent left ventricular aneurysms and one persistent right CVD; one CVD resolved at 35-week gestation. Two neonates had incessant PVCs. Both arrhythmias resolved spontaneously while being treated with propranolol. Conclusion FMCG is complementary to echocardiographic imaging. In fetuses with left ventricular wall defects, additional electrophysiological diagnosis can be made by fMCG, including the complexity of ventricular ectopy, arrhythmic response to fetal movement, presence of ST-T wave abnormalities, and atrial amplitude increases. Prenatal risk factor assessment using fMCG can additionally support post-natal treatment and follow-up. © 2014 John Wiley & Sons, Ltd.

PURPOSE: Epileptic seizure is a common presentation for patients with malignant glioma. Although the biological mechanisms which produce tumor-associated seizures are unclear, seizures are more prevalent in grade II gliomas. We hypothesized that an invasive growth kinetic would be associated with seizure incidence at presentation, and this association may explain why non-grade IV gliomas are more likely to present with seizures. METHODS: A total of 354 patients with contrast enhancing gliomas WHO grade II (N = 13), III (N = 28), and IV (N = 313) were studied. We incorporated diagnostic T1 + contrast and T2/FLAIR MRIs into a mathematical growth model to calculate a ratio of migration (D, mm2/yr) and proliferation (P, 1/yr) rates of tumor growth. We examined the association between the relative invasiveness ratio (D/P, mm2) and seizure presentation. RESULTS: When stratifying patients by histologic grade, grade III seizure presenting (SP) patients exhibited higher average D/P (p = 0.012, t-test) than non-seizure presenting (NSP) patients. Within grade III patients, SP patients with little to no mass effect similarly exhibited higher average D/P than NSP patients (p = 0.035 t-test). Broadening our scope, we observed that among all grade II-IV contrast enhancing gliomas, SP patients had higher D/P (p = 0.025, Mann-Whitney) than NSP patients. CONCLUSIONS: The association of high D/P with SP suggests that patients with an invasive growth pattern (high D/P) may be more likely to present with seizures than nodular tumors (low D/P). We interpret this association to imply that more infiltrative tumor growth is more likely to produce a seizure due to tumor cell invasion along white matter tracts, disrupting functional connectivity. In contrast, nodular growth may predominately push against, rather than invade along white matter tracts, leading to less disruption of functional connectivity and decreased seizure incidence.

BACKGROUND: The Days Gained (DG) response metric, which incorporates knowledge of the tumor growth rate, has been shown to correlate with progression-free (PFS) and overall survival (OS) following concurrent chemoradiotherapy for newly diagnosed glioblastoma (Neal et al., 2013 PLOS One; Neal et al., 2013 Cancer Research). We describe the first use of this metric to analyze radiographic response of recurrent malignant gliomas to large-volume re-irradiation using proton beam therapy (PBT). METHODS: The equation described in Neal, et al., 2013 was utilized to derive the DG score for 8 patients with histologically confirmed, contrast-enhancing recurrent gliomas. For each patient, the DG response metric was calculated from the enhancing T1 + Gad sequences of 2 MRIs immediately prior to PBT and the first MRI following completion of PBT. OS time from PT start was estimated with Kaplan-Meier analysis; comparisons used log-rank statistic. RESULTS: Median age was 43, median KPS score was 90, and median number of salvage treatments was 2. The mean DG score was 78.8 (range: -32.3-276.8). Concomitant use of temozolomide and bevacizumab during PBT was associated with a higher mean DG score (191.2 vs. 11.4; p = 0.03). In addition, association between higher DG score and superior OS trended to statistical significance (HR = 0.986, p = 0.08). CONCLUSIONS: First analysis of radiographic response of recurrent malignant gliomas to re-irradiation using PBT supports a possible association between DG and OS and the prolongation of DG with the concomitant use of temozolomide and bevacizumab during re-irradiation. Further analysis with larger sample size remains ongoing.