Filter placement for duplicated cava

Anatomic variations of the inferior vena cava (IVC) are found in 3-5% of the population. IVC duplication is a well-known anatomic variation that is important when relevant procedures are being planed. Therefore, the identification of IVC anomalies should be checked prior to pertinent interventions. We report two cases of dual IVC filter placement for duplicated cava including a missing left inferior vena cava and subsequent pulmonary embolism. The rationale of one versus two filters and the current literature are discussed.     

Enhancement of transfection activity in HEK293 cells by lipoplexes containing cholesteryl nitrogen-pivoted aza-crown ethers

Two nitrogen-pivoted aza-crown ethers (aza-CEs) linked to the cholesteryl-fused ring system N-(cholesteryloxycarbonyl)aza-15-crown-5 and N-(cholesteryloxycarbonyl)aza-18-crown-6 have been incorporated into cationic liposomes containing the cytofectin 3β[N-(N′,N′-dimethylaminopropane) carbamoyl] cholesterol (Chol-T) and the neutral co-lipid dioleoylphosphatidylethanolamine. These novel liposomes form stable complexes with plasmid DNA and afford it good protection from serum nuclease digestion. Ethidium displacement studies suggest that the DNA is more loosely packed in aza-CE containing lipoplexes, a finding which is supported by band shift assays that reveal N/P end point ratios of 2:1, 3:1 and 3.5:1 for Chol-T control liposomes, aza-15-crown-5 and aza-18-crown-6 containing liposomes, respectively. The transfection activities of crown ether-containing lipoplex formulations in the human embryonic kidney cell line HEK293 are twofold greater than those achieved by Chol-T lipoplexes not containing the aza-CEs. This observation may be attributable to the more loosely packed DNA, which facilitates disassembly, and to endosomal perturbations caused by macrocycle entrapped cations.     

Accelerated sequence divergence of conserved genomic elements in Drosophila melanogaster

Recent genomic sequencing of 10 additional Drosophila genomes provides a rich resource for comparative genomics analyses aimed at understanding the similarities and differences between species and between Drosophila and mammals. Using a phylogenetic approach, we identified 64 genomic elements that have been highly conserved over most of the Drosophila tree, but that have experienced a recent burst of evolution along the Drosophila melanogaster lineage. Compared to similarly defined elements in humans, these regions of rapid lineage-specific evolution in Drosophila differ dramatically in location, mechanism of evolution, and functional properties of associated genes. Notably, the majority reside in protein-coding regions and primarily result from rapid adaptive synonymous site evolution. In fact, adaptive evolution appears to be driving substitutions to unpreferred codons. Our analysis also highlights interesting noncoding genomic regions, such as regulatory regions in the gene gooseberry-neuro and a putative novel miRNA.     

Loss of the signaling adaptor TRAF1 causes CD8+ T cell dysregulation during human and murine chronic infection

The signaling adaptor TNFR-associated factor 1 (TRAF1) is specifically lost from virus-specific CD8 T cells during the chronic phase of infection with HIV in humans or lymphocytic choriomeningitis virus (LCMV) clone 13 in mice. In contrast, TRAF1 is maintained at higher levels in virus-specific T cells of HIV controllers or after acute LCMV infection. TRAF1 expression negatively correlates with programmed death 1 expression and HIV load and knockdown of TRAF1 in CD8 T cells from viral controllers results in decreased HIV suppression ex vivo. Consistent with the desensitization of the TRAF1-binding co-stimulatory receptor 4-1BB, 4-1BBL-deficient mice have defects in viral control early, but not late, in chronic infection. TGFβ induces the posttranslational loss of TRAF1, whereas IL-7 restores TRAF1 levels. A combination treatment with IL-7 and agonist anti-4-1BB antibody at 3 wk after LCMV clone 13 infection expands T cells and reduces viral load in a TRAF1-dependent manner. Moreover, transfer of TRAF1(+) but not TRAF1(-) memory T cells at the chronic stage of infection reduces viral load. These findings identify TRAF1 as a potential biomarker of HIV-specific CD8 T cell fitness during the chronic phase of disease and a target for therapy.     

Patient and family education in the emergency department: how nurses can help

Non-emergent use of the emergency department has grown over the past decade. Lack of resources, access to care, medical insurance, and knowledge can all contribute to the inappropriate use of the emergency department. In return, the increase in the number of patients will then add to the wait time for those who need emergent treatment. The role of the emergency nurse can be enhanced by providing discharge teaching to patients and families about the proper use of the emergency department or where to seek treatment if needed. This education has the potential to significantly reduce the number of repeat visits, as well as misuse of the emergency department. The purpose of this article is to discuss the importance of discharge teaching for the patient and family in the ED setting.     

Recent Findings in the Genetics of Blood Pressure: How to Apply in Practice or Is a Moonshot Required?

Purpose of Review

Hypertension is recognised as the biggest contributor to the global burden of disease, but it is controlled in less than a fifth of patients worldwide, despite being relatively easy to detect and the availability of inexpensive safe generic drugs. Blood pressure is regulated by a complex network of physiologic pathways with currently available drugs targeting key receptors or enzymes in the top pathways. Major advances in the dissection of both monogenic and polygenic determinants of blood pressure regulation and variation have not resulted in rapid translation of these discoveries into clinical applications or precision medicine.

Recent Findings

Uromodulin is an example of a novel gene for hypertension identified from genome-wide association studies, currently the basis of a clinical trial to reposition loop diuretics in hypertension management. Gene-editing studies have established a genome-wide association studies (GWAS) SNP in chromosome 6p24, implicated in six conditions including hypertension, as a distal regulator of the endothelin-1 gene around 3000 base pairs away. Genomics of aldosterone-producing adenomas bring to focus the paradox in genomic medicine where availability of cheap generic drugs may render precision medicine uneconomical.

Summary

The speed of technology-driven genomic discoveries and the sluggish traditional pathways of drug development and translation need harmonisation to make a timely and early impact on global public health. This requires a directed collaborative effort for which we propose a hypertension moonshot to make a quantum leap in hypertension management and cardiovascular risk reduction by bringing together traditional bioscience, omics, engineering, digital technology and data science.