Ultrasound evaluation of prognosis in fetuses with posterior urethral valves

Purpose

The aim of this study was to evaluate the ability of prenatal ultrasound markers to predict postnatal renal prognosis in fetuses with posterior urethral valves.

Methods

Medical files on fetuses with prenatal diagnosis of posterior urethral valves from 2000 to 2006 were reviewed retrospectively. Data from prenatal follow-up included gestational age at diagnosis, ultrasound renal parenchyma evaluation, and presence and time of oligohydramnios onset. Prenatal parameters studied were correlated to postnatal renal function.

Results

Thirty-one male fetuses were included. Six pregnancies were terminated. Of the remaining 25 pregnancies that were continued, 4 children had abnormal creatine and 21 normal creatinine levels at follow-up. Presence and time of oligohydramnios onset did not differ between groups (P = .43). Ultrasound detected bilateral renal abnormalities in 3 fetuses (75%) with altered renal function, and 10 fetuses (55%) with normal creatinine, at follow-up.

Conclusions

None of the ultrasound parameters evaluated were able to reliably predict postnatal renal function.     

Modelling human pathology of traumatic brain injury in animal models

Traumatic brain injury (TBI) is caused by a head impact with a force exceeding regular exposure from normal body movement which the brain normally can accommodate. People affected include, but are not restricted to, sport athletes in American football, ice hockey, boxing as well as military personnel. Both single and repetitive exposures may affect the brain acutely and can lead to chronic neurodegenerative changes including chronic traumatic encephalopathy associated with the development of dementia. The changes in the brain following TBI include neuroinflammation, white matter lesions, and axonal damage as well as hyperphosphorylation and aggregation of tau protein. Even though the human brain gross anatomy is different from rodents implicating different energy transfer upon impact, especially rotational forces, animal models of TBI are important tools to investigate the changes that occur upon TBI at molecular and cellular levels. Importantly, such models may help to increase the knowledge of how the pathologies develop, including the spreading of tau pathologies, and how to diagnose the severity of the TBI in the clinic. In addition, animal models are helpful in the development of novel biomarkers and can also be used to test potential disease‐modifying compounds in a preclinical setting.     

Rapid reductions and millennial-scale variability in Nordic Seas sea ice cover during abrupt glacial climate changes

Constraining the past sea ice variability in the Nordic Seas is critical for a comprehensive understanding of the abrupt Dansgaard-Oeschger (D-O) climate changes during the last glacial. Here we present unprecedentedly detailed sea ice proxy evidence from two Norwegian Sea sediment cores and an East Greenland ice core to resolve and constrain sea ice variations during four D-O events between 32 and 41 ka. Our independent sea ice records consistently reveal a millennial-scale variability and threshold response between an extensive seasonal sea ice cover in the Nordic Seas during cold stadials and reduced seasonal sea ice conditions during warmer interstadials. They document substantial and rapid sea ice reductions that may have happened within 250 y or less, concomitant with reinvigoration of deep convection in the Nordic Seas and the abrupt warming transitions in Greenland. Our empirical evidence thus underpins the cardinal role of rapid sea ice decline and related feedbacks to trigger abrupt and large-amplitude climate change of the glacial D-O events.

Sea ice is a critical component of the global climate system as it affects Earth’s albedo, phytoplankton productivity, ocean-atmosphere heat and gas exchange, and ocean circulation (1). Rapid sea ice retreat, as observed in the modern Arctic Ocean, exerts important climate feedbacks that may lead to an accelerated climate warming at northern high latitudes (2). While many climate models have difficulties in reproducing the currently observed Arctic sea ice decline (3), the rates of ongoing atmospheric warming in some Arctic regions are already comparable with those of prominent abrupt climate changes that occurred during the last glacial period (4). The latter are referred to as Dansgaard–Oeschger (D-O) climate events and known from Greenland ice core records as abrupt shifts between cold Greenland stadials (GS) and warmer Greenland interstadials (GI) occurring repeatedly ∼10–110 ka (5, 6). The millennial-scale glacial climate variability was a global phenomenon with different characteristics in the northern and southern hemispheres, but the most striking feature of the D-O events is an extremely abrupt climate transition that includes an atmospheric warming of 5–16.5 °C over the Greenland ice sheet happening in just a few decades (7). Analogous to the modern and future sea ice retreat and resulting warming in the Arctic, the abrupt D-O climate transitions are widely believed to have been amplified by rapid sea ice retreat in the Nordic Seas (8–15).Today, the Nordic Seas are largely ice-free, and warm Atlantic surface waters flow into the Norwegian Sea as far north as Svalbard at ∼80°N (Fig. 1), where the Arctic sea ice cover is being eroded, in particular in the Barents Sea. The warm Atlantic surface waters release heat to the atmosphere as it flows northward, which is accompanied by convective intermediate and deep-water formation between Norway and Greenland, feeding the lower limb of the Atlantic Meridional Overturning Circulation (AMOC) (16). A portion of the Atlantic waters continues flowing into the stratified Arctic Ocean as subsurface waters (17). While the pattern of ocean circulation during GI was fairly comparable to that today, proxy data indicate that the glacial Nordic Seas exhibited a stable surface stratification during GS, similar to the modern Arctic Ocean (13, 18). The AMOC and associated northward surface heat transport into the Nordic Seas were weakened during GS, with most extreme weakening related to Heinrich events signified by massive iceberg discharges to the North Atlantic (19, 20). Intermediate and deep waters in the stadial Nordic Seas were 2–4 °C warmer as compared with GI or modern conditions, resulting from a stable halocline and reduced open-ocean convection (21, 22). Contemporaneously, an extended sea ice cover reaching at least as far south as the Greenland–Scotland Ridge at ∼60°N insulated the high-latitude atmosphere from the deep oceanic heat reservoir (23, 24). Model simulations support a subsurface warming scenario under extended sea ice during GS (22, 25, 26) and suggest that a rapid removal of the sea ice cover might have caused the abrupt and high-amplitude D-O climate warming (11, 12, 14, 15).Open in a separate windowFig. 1.Core sites and regional context of the study area. Yellow diamonds mark the core sites investigated in this study. The map shows the core-top P_BIP₂₅ distribution (42, 43, 63), illustrating the great potential of the biomarker approach for sea ice reconstruction. Orange, yellow, and green dots mark core-top sites north, east, and south of Greenland, respectively, data of which are investigated in this study. Small black dots indicate locations of published core-top data. Purple lines mark the modern sea ice extent during September (dashed) and March (solid), averaged between A.D. 1981 and 2010 (https://nsidc.org/; ref. 64). The thin blue line shows the P_BIP₂₅ = 0.2 isoline, representing best the modern winter/spring sea ice extent. Red arrows illustrate the warm and saline North Atlantic Current (NAC). The map was produced with Ocean Data View software (65).Although there is some evidence of millennial-scale sea ice fluctuations during the last glacial, the few available sea ice proxy records (23, 24, 27–31) are mostly restricted to the southern Norwegian Sea and the Arctic Ocean, often have a limited temporal resolution, and partly reflect opposing trends regarding stadial–interstadial sea ice changes depending on the proxies used. Here we present high-resolution sea ice biomarker records from two key sites that form a North–South transect within the Atlantic inflow region in the Norwegian Sea and are thus ideally suited to record spatiotemporal shifts in sea ice cover in both the entrance and the interior of the ocean basin, oceanic fronts, and Atlantic water inflow during the last glacial (Fig. 1). Furthermore, we combine these marine sea ice proxy records with an independent sea ice record based on bromine-enrichment (Br_enr) values from an East Greenland ice core, which significantly enhances the spatial coverage, the robustness of results, and temporal constraint of the sea ice reconstruction. We focus on five representative glacial D-O cycles between 32 and 41 ka, which comprise long- and short-lasting GI as well as several GS, one of which includes Heinrich Event 4. The application of the cryptotephra-based chronological constraints provides a level of robustness as to the timing, duration, and nature of the events unfolding during abrupt climate changes. Our study provides robust empirical evidence that resolves rapid and widespread sea ice retreat in the Nordic Seas and its role in initiating and amplifying the abrupt climate change of the glacial D-O events.     

Carrots and sticks: impact of an incentive/disincentive employee flexible credit benefit plan on health status and medical costs.

PURPOSE: Employee wellness programs aim to assist in controlling employer costs by improving the health status and fitness of employees, potentially increasing productivity, decreasing absenteeism, and reducing medical claims. Most such programs offer no disincentive for nonparticipation. We evaluated an incentive/disincentive program initiated by a large teaching hospital in western Michigan. METHODS: The HealthPlus Health Quotient program is an incentive/disincentive approach to health promotion. The employer's contribution to the cafeteria plan benefit package is adjusted based on results of an annual appraisal of serum cholesterol, blood pressure, tobacco use, body fat, physical fitness, motor vehicle safety, nutrition, and alcohol consumption. The adjustment (health quotient [HQ]) can range from -$25 to +$25 per pay period. We examined whether appraised health improved between 1993 and 1996 and whether the HQ predicted medical claims. RESULTS: Mean HQ increased slightly (+$0.47 per pay period in 1993 to +$0.89 per pay period in 1996). Individuals with HQs of less than -$10 per pay period incurred approximately twice the medical claims of the other groups (test for linear trend, p = .003). After adjustment, medical claims of employees in the worst category (HQ < -$10 per pay period) were $1078 (95% confidence interval $429-$1728) greater than those for the neutral (HQ between -$2 and +$2 per pay period) category. A decrease in HQ of at least $6 per pay period from 1993 to 1995 was associated with $956 (95% confidence interval $264-$1647) greater costs in 1996 than was a stable HQ. CONCLUSIONS: The HealthPlus Health Quotient program is starting to yield benefits. Most employees are impacted minimally, but savings are accruing to the employer from reductions in medical claims paid and in days lost to illness and disability.     

Pulmonary lymphangitic spread of carcinoma: appearance on CT scans

Chest computed tomography (CT), including high-resolution CT with thin (1.5-mm) sections was used to evaluate proved (pathologically or clinically) lymphangitic spread (LS) of tumor in 12 patients. These appearances were compared with thin-section scans obtained in 11 healthy subjects. Thin-section CT demonstrated findings consistent with thickening of the normal lung interstitium. In all patients, thin sections showed an increase in the number of peripheral lines (1-2 cm in length) that were diffuse in generalized disease and localized in focal disease. Normal peripheral arcades were not increased in number, but the limbs forming the arcades were thickened in all patients. A diffuse increase in linear and curvilinear structures (reticular pattern) was seen toward the center of the lung. Polygonal structures 1-2 cm in diameter were seen in seven patients with LS but not in healthy subjects. Fissures were thickened in nine patients. Selected 1.5-mm-thick CT sections are recommended through abnormal areas (seen at CT or on chest radiographs) or if these are normal at three levels (midapex, hilus, and 3 cm above the diaphragm) when scanning patients with tumors known to cause LS.