Cytophysiological correlations between prothoracic gland activity and hemolymph ecdysteroid concentrations in Rhodnius prolixus during the fifth larval instar: further studies in normal and decapitated larvae

Hemolymph ecdysteroid titers in fifth instar larvae of Rhodnius prolixus were determined by radioimmunoassay, and their prothoracic glands were excised and examined by electron microscopy. During the last larval instar, the titer of ecdysteroid increased between the head-critical period until Day 13, at which time the peak titer was 3100 pg 20-hydroxyecdysone equivalents/microliter. The activation of secretory cells at the time of the second period of prothoracicotropic hormone release was correlated with the development of major cellular organelles. The smooth endoplasmic reticulum first appeared at the head-critical period and then proliferated in close relation to the increase in ecdysteroid titer until Day 13, after which time it disappeared. Mitochondria expand and develop tubular cristae. They are closely associated with the smooth endoplasmic reticulum. When insects were decapitated, hemolymph ecdysteroid titer remained below 10 pg/microliter and the prothoracic gland cells failed to develop smooth endoplasmic reticulum. We conclude that in the prothoracic gland cells as well as other steroidogenic tissues the smooth endoplasmic reticulum in association with mitochondria is involved in ecdysone biosynthesis.     

The Impact of Weather on Mobility and Participation in Older US Adults

Objectives. We examined the impact of weather on the daily lives of US adults to understand which populations are most vulnerable to various weather conditions.Methods. Data came from a 2013 supplement to the University of Michigan–Thomson Reuters Surveys of Consumers, a nationally representative telephone survey of 502 adults in the contiguous United States. We used logistic regressions to assess the odds of mobility difficulty and participation restriction during different weather conditions, as well as age group differences.Results. Ice was most likely to change the way respondents got around (reported by 47%). In icy conditions, participants had difficulty leaving home (40%) and driving (35%). Facing ice, older adults (≥ 65 years) had twice the odds of having great difficulty leaving home (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.12, 4.42) and curtailing work or volunteer activities (OR = 2.01; 95% CI = 1.01, 4.06), and 3 times the odds of difficulty driving (OR = 3.33; 95% CI = 1.62, 6.86) as younger respondents. We also found significant differences in mobility and participation by gender and region of residence.Conclusions. Weather can affect social isolation, health, well-being, and mortality among older US adults.Increasing attention is being paid to the impact of extreme weather (e.g., heat waves, hurricanes) on population health.1–7 However, the challenges of day-to-day weather have not received as much attention, particularly for older adults, who are more vulnerable to weather-related factors because of their limited mobility and social isolation.2,8 As a result, we have little knowledge of how weather-related factors (e.g., reduced daylight hours during winter, slippery surfaces caused by rain or snow) affect mobility and independence in day-to-day life and how these effects vary across persons, regions, and seasons.Mobility, defined as the ability to move about effectively in our surroundings,9,10 is important for independence, quality of life, and mortality.11–13 Independent mobility is also important for participation in day-to-day activities, such as work or volunteer activities, grocery shopping, and engaging in physical activity. The International Classification of Functioning, Disability, and Health conceptualizes mobility and participation as part of a complex biopsychosocial model of health and function that includes interactions with environmental factors, such as climate and weather, which can act as either barriers or facilitators to activities and participation.14Studies examining the health impact of weather-related factors have tended to focus almost exclusively on mortality or morbidity as an outcome.3,15–21 But the ability to move and travel and to participate in daily activities is important for health and is also likely to depend on weather-related factors. Some of America’s major cities receive an average of more than 2 meters of snow every year and have snow on the ground for more than 3 months each year. Previous studies showed that icy and slushy surfaces and snow banks are the most frequently named barriers to mobility among pedestrians during winter, particularly for people with underlying limitations in physical functioning.22,23 Li et al. found that 37% of older adults in Toronto, Canada, reduced their outdoor walking during the winter when expecting slippery road conditions.24 Similarly, qualitative work with older adults in Detroit, Michigan, found that a fear of falling on ice, sidewalks not cleared of snow and ice, and cold and rainy weather discouraged walking outdoors.25 Car use may increase in winter for adults fearful of falling on the way to the bus stop, but can also decrease because of fear of driving on icy roads or in the dark.26However, a lack of data from a representative sample of adults across the United States limits our understanding of the weather-related factors that are important for mobility and participation across a range of activities and risk groups (e.g., by age, gender, or geographic region). We used nationally representative data to examine the impact of weather-related factors on the daily lives of US adults to understand which populations are most vulnerable to weather conditions and exactly what those conditions are.     

In vivo measurement of dose distribution in patients' lymphocytes: helical tomotherapy versus step-and-shoot IMRT in prostate cancer

In radiotherapy, in vivo measurement of dose distribution within patients'' lymphocytes can be performed by detecting gamma-H2AX foci in lymphocyte nuclei. This method can help in determining the whole-body dose. Options for risk estimations for toxicities in normal tissue and for the incidence of secondary malignancy are still under debate. In this investigation, helical tomotherapy (TOMO) is compared with step-and-shoot IMRT (SSIMRT) of the prostate gland by measuring the dose distribution within patients'' lymphocytes. In this prospective study, blood was taken from 20 patients before and 10 min after their first irradiation fraction for each technique. The isolated leukocytes were fixed 2 h after radiation. DNA double-stranded breaks in lymphocyte nuclei were stained immunocytochemically using anti-gamma-H2AX antibodies. Gamma-H2AX foci distribution in lymphocytes was determined for each patient. Using a calibration line, dose distributions in patients'' lymphocytes were determined by studying the gamma-H2AX foci distribution, and these data were used to generate a cumulative dose–lymphocyte histogram (DLH). Measured in vivo (DLH), significantly fewer lymphocytes indicated low-dose exposure (<40% of the applied dose) during TOMO compared with SSIMRT. The dose exposure range, between 45 and 100%, was equal with both radiation techniques. The mean number of gamma-H2AX foci per lymphocyte was significantly lower in the TOMO group compared with the SSIMRT group. In radiotherapy of the prostate gland, TOMO generates a smaller fraction of patients'' lymphocytes with low-dose exposure relative to the whole body compared with SSIMRT. Differences in the constructional buildup of the different linear accelerator systems, e.g. the flattening filter, may be the cause thereof. The influence of these methods on the incidence of secondary malignancy should be investigated in further studies.     

Plasma sRAGE is independently associated with increased mortality in ARDS: a meta-analysis of individual patient data

Purpose

The soluble receptor for advanced glycation end-products (sRAGE) is a marker of lung epithelial injury and alveolar fluid clearance (AFC), with promising values for assessing prognosis and lung injury severity in acute respiratory distress syndrome (ARDS). Because AFC is impaired in most patients with ARDS and is associated with higher mortality, we hypothesized that baseline plasma sRAGE would predict mortality, independently of two key mediators of ventilator-induced lung injury.

Methods

We conducted a meta-analysis of individual data from 746 patients enrolled in eight prospective randomized and observational studies in which plasma sRAGE was measured in ARDS articles published through March 2016. The primary outcome was 90-day mortality. Using multivariate and mediation analyses, we tested the association between baseline plasma sRAGE and mortality, independently of driving pressure and tidal volume.

Results

Higher baseline plasma sRAGE [odds ratio (OR) for each one-log increment, 1.18; 95% confidence interval (CI) 1.01–1.38; P?=?0.04], driving pressure (OR for each one-point increment, 1.04; 95% CI 1.02–1.07; P?=?0.002), and tidal volume (OR for each one-log increment, 1.98; 95% CI 1.07–3.64; P?=?0.03) were independently associated with higher 90-day mortality in multivariate analysis. Baseline plasma sRAGE mediated a small fraction of the effect of higher ΔP on mortality but not that of higher V_T.

Conclusions

Higher baseline plasma sRAGE was associated with higher 90-day mortality in patients with ARDS, independently of driving pressure and tidal volume, thus reinforcing the likely contribution of alveolar epithelial injury as an important prognostic factor in ARDS. Registration: PROSPERO (ID: CRD42018100241).

     

Left-Atrial Appendage Thrombosis in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

BackgroundData about the impact of left-atrial appendage thrombosis (LAAT) on early safety and mortality in patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) are scarce. We aimed to investigate the prevalence and predictors of LAAT and the outcome associated with this condition in patients treated by TF-TAVI.MethodsRetrospective data analysis was derived from a prospective single-centre registry comparing patients with and without LAAT regarding early safety at 30 days, according to Valve Academic Research Consortium-2 (VARC-2) and 2-year mortality.ResultsLAAT was found in 7.6% of the whole cohort (n = 2527) and in 16.6% in those patients with known pre-existing atrial fibrillation (AF cohort, n = 1099). Compared with controls, patients with LAAT were sicker, indicated by a higher Society of Thoracic Surgeons (STS) score and burden of comorbidities. Neither VARC-2–defined early safety at 30 days nor the rate of stroke was different between LAAT and controls in both the whole (early safety: 29.2% vs 24.2%, P = 0.123; stroke: 5.9% vs 4.7%, P = 0.495) and AF cohort (early safety: 29.1% vs 22.9%, P = 0.072; stroke: 5.6% vs 3.3%, P = 0.142). Evaluating the whole cohort in a univariate analysis, the 2-year mortality was significantly higher in LAAT compared with controls (hazard ratio, 1.41; 95% confidence interval, 1.07-1.86; P = 0.014). However, multivariate analysis of the whole cohort and the AF cohort revealed no association between LAAT and 2-year mortality.ConclusionsLAAT was frequent in patients undergoing TF-TAVI— in particular, in patients with histories of AF—but it was not associated with an increase in periprocedural complications and did not predict 2-year mortality.     

Sports-Related Sudden Cardiac Arrest in Germany

BackgroundKnowledge about causes of sports-related sudden cardiac arrest (SrSCA) may influence national strategies to prevent such events. Therefore, we established a prospective registry on SrSCA to estimate the incidence and in particular describe the etiologies of SrSCA in the general population in Germany.MethodsThe registration of SrSCA based upon 4 pillars: a web-based platform to record SrSCA cases in competitive and recreational athletes, media-monitoring, cooperation with the German Resuscitation Registry, and 15 institutes of forensic medicine.ResultsAfter an observation period of 6 years, a total of 349 cases was recorded (mean age 48.0 ± 12.7 years); 109 subjects survived. Most of the cases occurred during nonelite competitive or recreational sports. Bystander cardiopulmonary resuscitation (CPR) was initiated in 262 cases (75%); however, rhythm analysis and defibrillation (if indicated) was mainly performed by medical services. In patients ≤ 35 years of age, premature coronary artery disease (CAD) and sudden arrhythmic death syndrome (SADS) prevailed, followed by myocarditis. In athletes ≥ 35 years of age, CAD predominated.ConclusionsCountry-specific registries are necessary to define the national screening and prevention strategy optimally. In Germany, premature CAD, SADS, and myocarditis are the leading causes of SrSCA in young athletes, reinforcing the great disparity of the prevalence of cardiac diseases among different countries. Extension of on-site SCD-prevention campaigns, with training of CPR and explanation of the efficient use of automated external defibrillators (AEDs), may decrease the burden of SrSCD.     

Role of prothrombin 19911 A>G polymorphism,blood group and male gender in patients with venous thromboembolism: Results of a German cohort study

Journal of Thrombosis and Thrombolysis - The role of the A&gt;G polymorphism at position 19911 in the prothrombin gene (factor [F] 2 at rs3136516) as a risk factor for venous thromboembolism...     

The effect of hydroxychloroquine on platelet activation in model experiments

Journal of Thrombosis and Thrombolysis - Hydroxychloroquine (HCQ) is an antimalarial agent with pleiotropic effects and now represents a cornerstone in the management of patients with autoimmune...