Anterior superior iliac spine avulsion in a young soccer player

Avulsion fractures of the anterior superior iliac spine are rare. They usually occur in teenagers during sport activities. Cases concerning adults are very uncommon. We report here the case of a 23-year-old man who was admitted for recent pain of the left hip that worsened while kicking a ball in a soccer match eight days earlier. The examination found pain when moving the left hip in extension. Radiographs showed an avulsion fracture of the left anterior superior iliac spine, which was confirmed by computer tomography. The treatment was conservative consisting in rest and non-weight bearing with releasing of pain a few weeks later.     

Association between inflammatory mediators and response to inhaled nitric oxide in a model of endotoxin-induced lung injury

Introduction  

Inhaled nitric oxide (INO) allows selective pulmonary vasodilation in acute respiratory distress syndrome and improves PaO₂ by redistribution of pulmonary blood flow towards better ventilated parenchyma. One-third of patients are nonresponders to INO, however, and it is difficult to predict who will respond. The aim of the present study was to identify, within a panel of inflammatory mediators released during endotoxin-induced lung injury, specific mediators that are associated with a PaO₂ response to INO.     

Intensive care unit acquired infection and organ failure

Objective To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). Design and setting Observational, single center study in a mixed intensive care unit of a university hospital. Patients We analyzed 1,191 patients hospitalized for more than 2 days during a 2-year observation period: 845 did not acquire IAI, 306 of whom had infection on admission (IOA); 346 did acquire IAI, 125 of whom had IOA. Measurements and results The SOFA score was calculated daily, both SOFAmax, the sum of the worst OD/F during the ICU stay, and SOFApreinf, the sum of the worst OD/F existing before the occurrence of the first IAI. The SAPS II and SOFA score of the first 24 h were significantly higher in patients with than in those without IAI. SOFApreinf of IAI patients was also higher than the SOFAmax of patients without IAI both in patients with (12.1 ± 4.6 vs. 8.9 ± 4.7) and those without IOA (9.2 ± 4.0 vs. 6.7 ± 3.5). SOFApreinf represented 85.7% of the value of SOFAmax in patients with IAI. SOFApreinf increased significantly with the occurrence of sepsis, severe sepsis, or septic shock during ICU stay. Severe sepsis and septic shock during ICU stay as well as SOFApreinf were part of the factors associated with hospital mortality. Conclusions IAI is significantly associated with hospital mortality; however, its contribution to OD/F is minor. Moreover, severity of IAI seems to be related to previous health status. This article is discussed in the editorial available at: .     

Limits to gene flow in a cosmopolitan marine planktonic diatom

The role of geographic isolation in marine microbial speciation is hotly debated because of the high dispersal potential and large population sizes of planktonic microorganisms and the apparent lack of strong dispersal barriers in the open sea. Here, we show that gene flow between distant populations of the globally distributed, bloom-forming diatom species Pseudo-nitzschia pungens (clade I) is limited and follows a strong isolation by distance pattern. Furthermore, phylogenetic analysis implies that under appropriate geographic and environmental circumstances, like the pronounced climatic changes in the Pleistocene, population structuring may lead to speciation and hence may play an important role in diversification of marine planktonic microorganisms. A better understanding of the factors that control population structuring is thus essential to reveal the role of allopatric speciation in marine microorganisms.     

Symmetric Dimethylarginine as a Proinflammatory Agent in Chronic Kidney Disease

Summary

Background & objectives

Chronic kidney disease (CKD) is characterized by chronic inflammation, considered a nontraditional risk factor for cardiovascular disease, the major cause of death in CKD. Symmetric dimethylarginine (SDMA) was recently demonstrated to induce reactive oxygen species in monocytes. The present study further investigates the inflammatory character of SDMA compared with its structural counterpart asymmetric dimethylarginine (ADMA).

Design, setting, participants, & measurements

In vitro, the effect of SDMA on intracellular monocytic expression of IL-6 and TNF-α was studied followed by an evaluation of nuclear factor (NF)–κB activation. Additionally, an association of SDMA with inflammatory parameters in consecutive stages of CKD was evaluated in vivo.

Results

Monocytes incubated with SDMA showed increased IL-6 and TNF-α expression and a rise in active NF-κB. N-acetylcysteine abrogated both these effects. No significant effects were observed with ADMA. In vivo, 142 patients (67 ± 12 years) at different stages of CKD showed an inverse association between serum SDMA and ADMA and renal function. Correlations between SDMA and IL-6, TNF-α, and albumin were more significant than for ADMA, while multiple regression analysis only retained TNF-α at a high significance for SDMA (P < 0.0001). In receiver operating characteristic analysis for inflammation, defined as an IL-6 level above 2.97 pg/ml (median), the discriminative power of SDMA (area under the curve [AUC]: 0.69 ± 0.05) directly followed that of C-reactive protein (AUC: 0.82 ± 0.04) and albumin (AUC: 0.72 ± 0.05; for all, P < 0.0001) and preceded that of ADMA (P = 0.002).

Conclusions

The present study shows that SDMA is involved in the inflammatory process of CKD, activating NF-κB and resulting in enhanced expression of IL-6 and TNF-α, which is corroborated by the clinical data pointing to an in vivo association of SDMA with inflammatory markers in CKD at different stages.     

Comparison of relative and actual chest compression depths during cardiac arrest in children, adolescents, and young adults

Aim

Cardiopulmonary resuscitation (CPR) guidelines recommend specific chest compression (CC) target depths for children. We quantitatively describe relative anterior–posterior diameter (APD) depth, actual depth, and force of CCs during real CPR events in children.

Methods

CC depth and force were recorded during real CPR events in children ≥8 years using FDA-approved CC sensor. Patient chest APD was measured at conclusion of each CPR event. CC data was stratified and analyzed according to age (pre-puberty, 8–14 years; post-puberty, 15+ years). Relative (% APD) and actual CC depth, corrected for mattress deflection, were assessed and compared with American Heart Association (AHA) 2005 and 2010 pediatric CPR guidelines.

Results

35 events in 32 subjects included 16,158 CCs for data analysis: 16 pre-puberty (CCs = 7484, age 11.9 ± 2 years, APD 164.6 ± 25.1 mm); 19 post-puberty (CCs = 8674, age 18.0 ± 2.7 years, APD 196.5 ± 30.4 mm). After correction for mattress deflection, 92% of CC delivered to pre-puberty were <1/3 relative APD and 60% of CC were <38 mm actual depth. Mean actual CC depth (36.2 ± 9.6 mm vs. 36.8 ± 9.9 mm, p = 0.64), mean relative APD (22.5% ± 7.0% vs. 19.5 ± 6.7%, p = 0.13), and mean CC force (30.7 ± 7.6 kg vs. 33.6 ± 9.4 kg, p = 0.07) were not significantly less in pre-puberty vs. post-puberty.

Conclusions

During in-hospital cardiac arrest of children ≥8 years, CCs delivered by resuscitation teams were frequently <1/3 relative APD and <38 mm actual depth after mattress deflection correction, below pediatric and adult target guidelines. Mean CC actual depth and force were not significantly different in pre-puberty and post-puberty. Additional investigation to determine depth of CCs to optimize hemodynamics and outcomes is needed to inform future CPR guidelines.     

Unbiased plasma proteomics for novel diagnostic biomarkers in cardiovascular disease: identification of quiescin Q6 as a candidate biomarker of acutely decompensated heart failure

Aims Biochemical marker testing has improved the evaluation and management of patients with cardiovascular diseases over the past decade. Natriuretic peptides (NPs), used in clinical practice to assess cardiac dysfunction, exhibit many limitations, however. We used an unbiased proteomics approach for the discovery of novel diagnostic plasma biomarkers of heart failure (HF). Methods and results A proteomics pipeline adapted for very low-abundant plasma proteins was applied to clinical samples from patients admitted with acute decompensated HF (ADHF). Quiescin Q6 (QSOX1), a protein involved in the formation of disulfide bridges, emerged as the best performing marker for ADHF (with an area under the receiver operator characteristic curve of 0.86, 95% confidence interval: 0.79-0.92), and novel isoforms of NPs were also identified. Diagnostic performance of QSOX1 for ADHF was confirmed in 267 prospectively collected subjects of whom 76 had ADHF. Combining QSOX1 to B-type NP (BNP) significantly improved diagnostic accuracy for ADHF by particularly improving specificity. Using thoracic aortic constriction in rats, QSOX1 was specifically induced within both left atria and ventricles at the time of HF onset. Conclusion The novel biomarker QSOX1 accurately identifies ADHF, particularly when combined with BNP. Through both clinical and experimental studies we provide lines of evidence for a link between ADHF and cardiovascular production of QSOX1.     

Effect of rearing water temperature on protandrous sex inversion in cultured Asian Seabass (Lates calcarifer)

Asian Seabass, Lates calcarifer (Bloch, 1790), is a protandrous species cultured for Aquaculture. The cultured Asian Seabass in Australia exhibits precocious sex inversion before 2years of age. This phenomenon highly affects on maintaining a proper broodstock in a hatchery. The effect of temperature on sex inversion inducement in Asian Seabass was thus investigated at five different temperature regimes experienced in Australia. Asian Seabass (14months) grown in fresh water under natural temperature in a commercial farm in Queensland were transported to the research facility at James Cook University, Australia and held in fresh water at 28°C until acclimatized to the experimental conditions. Fish were acclimated to the experimental conditions (30ppt salinity) over the first and final week (22°C, 25°C, 28°C, 31°C and 34°C) of one month acclimatizing period. Fish were fed daily with a commercial pellet (50% protein, 18MJkg(-1)) to satiety. Blood, brain and gonad collected before transfer to the experimental temperature regime in the final week of acclimatization and at the end of the experiment were analysed. Plasma sex steroids level and aromatase activity of brain and gonad were also measured. There was an increase in plasma estradiol levels with increasing temperature from 25°C while no significant difference was observed among all treatment temperatures except at 25°C. However, fish held at 22°C showed higher estradiol level than at 25°C and 28°C. Significantly higher (p<0.05) plasma testosterone levels were detected in fish held at 31°C and 34°C while a reducing trend was observed towards lower temperature regimes. Fish held at 22°C had significantly lower plasma testosterone than all others as well those sampled at the beginning. The plasma 11-ketoTestosterone was at non-detectable levels in all experimental temperatures as shown at the beginning. The average aromatase activity in brain was highest at 28°C among all temperatures, but no significant differences (p>0.05) observed. The Average aromatase activity in gonad was highest at 31°C followed by at 34°C and 28°C. No or very low level of gonad aromatase activity recorded in fish sacrificed prior to treatment. The aromatase activity was greater in brain than in gonad suggesting that the aromatase produced in the brain yet to transfer to the gonad or brain is the first place to response for culture environmental temperature. It is concluded that plasma sex steroids levels and aromatase activity in Asian Seabass have positive response to increasing temperature in culture facilities.     

ROTUNDA3 function in plant development by phosphatase 2A-mediated regulation of auxin transporter recycling

The shaping of organs in plants depends on the intercellular flow of the phytohormone auxin, of which the directional signaling is determined by the polar subcellular localization of PIN-FORMED (PIN) auxin transport proteins. Phosphorylation dynamics of PIN proteins are affected by the protein phosphatase 2A (PP2A) and the PINOID kinase, which act antagonistically to mediate their apical–basal polar delivery. Here, we identified the ROTUNDA3 (RON3) protein as a regulator of the PP2A phosphatase activity in Arabidopsis thaliana. The RON3 gene was map-based cloned starting from the ron3-1 leaf mutant and found to be a unique, plant-specific gene coding for a protein with high and dispersed proline content. The ron3-1 and ron3-2 mutant phenotypes [i.e., reduced apical dominance, primary root length, lateral root emergence, and growth; increased ectopic stages II, IV, and V lateral root primordia; decreased auxin maxima in indole-3-acetic acid (IAA)-treated root apical meristems; hypergravitropic root growth and response; increased IAA levels in shoot apices; and reduced auxin accumulation in root meristems] support a role for RON3 in auxin biology. The affinity-purified PP2A complex with RON3 as bait suggested that RON3 might act in PIN transporter trafficking. Indeed, pharmacological interference with vesicle trafficking processes revealed that single ron3-2 and double ron3-2 rcn1 mutants have altered PIN polarity and endocytosis in specific cells. Our data indicate that RON3 contributes to auxin-mediated development by playing a role in PIN recycling and polarity establishment through regulation of the PP2A complex activity.Organ growth is determined by cell numbers produced by meristems and by cell expansion to reach final volume. Plant hormones steer the extent and timing of growth and mediate signals of various types that are transmitted within the cell, between cells, or at a long distance within the plant. The phytohormone auxin is a major regulator of cell division and expansion during plant growth and development. The molecular mechanisms by which auxin controls these essential cellular responses are roughly understood thanks to the recent progress in the identification of auxin receptors and components of auxin signaling, transport, and metabolism (1). Auxin gradients between the cells are generated and maintained by intercellular auxin transport mediated by efflux carriers from the PIN-FORMED (PIN) family (2). PIN proteins contain transmembrane domains and continuously cycle between the basal (rootward) and apical (shootward) plasma membranes and endosomes, allowing rapid and dynamic changes in the PIN localization (3). The sorting of PIN proteins into the apical or basal trafficking pathway depends on the PIN phosphorylation status, which is controlled by the PINOID (PID) protein kinase and phosphatase 2A (PP2A) (4, 5), a heterotrimeric complex consisting of a C-catalytic subunit together with A- and B-regulatory subunits. One of the A-subunit isoforms, ROOTS CURL IN NAPHTHYLPHTHALAMIC ACID1 (RCN1), acts as a key positive regulator of the PP2A activity in seedlings. The rcn1 mutant that lost part of the PP2A activity displays abnormalities related to defective auxin transport, such as altered gravity response and lateral root growth (6, 7).In an ethyl methanesulfonate-induced collection of Arabidopsis thaliana leaf mutants (8), we identified ROTUNDA3 (RON3) as a proline-rich, plant-specific single-copy gene with a function in auxin-related processes in all organs throughout the plant’s lifecycle. Affinity purification of the PP2A complex with RON3 as bait, and genetic and cell biology analyses support the hypothesis that RON3 affects the cellular dynamics of PIN proteins through interference with the PP2A activity.