Introduction
This narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the ...10 years after its official recognition and definition.
Results
In the last 10 years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients.
Conclusion
CCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Fouling remains a long-standing unsolved problem that hinders the widespread use of membrane applications in industry. This article reports the use of numerical simulations coupled with extensive ...material synthesis and characterization to fabricate fouling-resistant 3D printed composite membranes. The membranes consist of a thin polyethersulfone selective layer deposited onto a 3D printed flat and double sinusoidal (wavy) support. Fouling and cleaning of the composite membranes were tested by using bovine serum albumin solution in a cross-flow ultrafiltration setup. The transmembrane pressure was regulated at 1 bar and the cross-flow Reynolds number (Re) varied between 400 and 1000. In comparison to the flat membrane, the wavy membrane showed superior performance in terms of pure water permeance (PWP) (10% higher) and permeance recovery ratio (87% vs 53%) after the first filtration cycle at Re = 1000. Prolong testing showed that the wavy membrane could retain approximately 87% of its initial PWP after 10 complete filtration cycles. This impressive fouling-resistant behavior is attributed to the localized fluid turbulence induced by the 3D printed wavy structure. These results show that not only the lifetime of membrane operations could be favorably extended but also the operational costs and environmental damage of membrane-based processes could also be significantly reduced.
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IJS, KILJ, NUK, PNG, UL, UM
•Novel and efficient zeta-based approach to LA-ICP-MS U determinations for apatite fission track dating.•Precise zeta factor determined in just one large LA-ICP-MS primary session using ...Durango.•Primary zeta factor reused in all other sessions by employing a sessionspecific zeta fractionation factor.•Approach is easily modifiable for fission track dating of zircon or titanite if suitable age standards are employed.
The LA-ICP-MS method is becoming increasingly popular for uranium determinations in fission track dating of apatite, zircon or titanite. This is because the approach has several advantages over the classical external detector method (EDM), including faster sample throughput, simultaneous acquisition of additional data (such as U-Pb age information and trace element abundances), while removing the need for neutron irradiation. Two different approaches are used to determine U contents in LA-ICP-MS fission track dating: an absolute dating approach, or a zeta-based determination analogous to the classical EDM. Absolute age dating by LA-ICP-MS potentially suffers from small but systematic deviations in apatite U contents, which in turn propagate through to minor systematic deviations in the accuracy of absolute fission track age determinations. A zeta-based approach typically requires time-consuming counting of large numbers of zeta-standard grains (usually Durango apatite) so as to yield a precise zeta factor for every LA-ICP-MS session containing unknowns. The modification of the zeta-based approach proposed here has two major advantages. Firstly, it employs just one large primary LA-ICP-MS session to determine a precise primary zeta factor on a large number of counted Durango primary zeta grains. During subsequent secondary LA-ICP-MS sessions with unknowns, no further fission track counting of the primary zeta standard is required. This is because we reanalyse a subset of the primary zeta grains to calculate a session-specific zeta fractionation factor, which is related to variations in the instrumental operating conditions (primarily plasma tuning) between primary and secondary LA-ICP-MS sessions. This enables us to ‘reuse’ the primary zeta factor, and thus avail of its precision derived from the large spontaneous track count. The second advantage is that reusing the primary zeta grains by applying a session-specific zeta fractionation factor allows us to verify that background and drift corrections applied during the secondary LA-ICP-MS session were fully appropriate. This method has been successfully tested by dating samples of known apatite fission track age, by comparing EDM and LA-ICP-MS data from the same sample and by participating in a round robin test between international fission track laboratories where ‘blind’ fission track dating of two unknown samples was undertaken. Our LA-ICP-MS apatite fission track dating approach is also easily modifiable for fission track dating of zircon or titanite if suitable age standards are employed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the ...scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique.
Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed.
A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively.
Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Survivors of preterm birth have a high incidence of neurodevelopmental impairment which is not explained by currently understood brain abnormalities. The aim of this study was to test the hypothesis ...that the neurodevelopmental abilities of 2-year-old children who were born preterm and who had no evidence of focal abnormality on conventional MR imaging were consistently linearly related to specific local changes in white matter microstructure. We studied 33 children, born at a median (range) gestational age of 28+5 (24+4–32+1) weeks. The children were recruited as infants from the Neonatal Intensive Care Unit at Queen Charlotte's and Hammersmith Hospital in the early neonatal period and imaged at a median corrected age of 25.5 (24–27) months. The children underwent diffusion tensor imaging to measure fractional anisotropy (FA) as a measure of tissue microstructure, and neurodevelopmental assessment using the Griffiths Mental Development Scales giving an overall developmental quotient (DQ) and sub-quotients scores for motor, personal–social, hearing–language, eye–hand coordination and performance scales at 2 years corrected age. Tract-based spatial statistics with linear regression analysis of voxel-wise cross-subject statistics were used to assess the relationship between FA and DQ/sub-quotient scores and results confirmed by reduced major axis regression of regions with significant correlations. We found that DQ was linearly related to FA values in parts of the corpus callosum; performance sub-scores to FA values in the corpus callosum and right cingulum; and eye–hand coordination sub-scores to FA values in the cingulum, fornix, anterior commissure, corpus callosum and right uncinate fasciculus. This study shows that specific neurodevelopmental impairments in infants born preterm are precisely related to microstructural abnormalities in particular regions of cerebral white matter which are consistent between individuals. FA may aid prognostication and provide a biomarker for therapeutic or mechanistic studies of preterm brain injury.
It is widely accepted that the familial Parkinson's disease (PD)-linked gene product, parkin, functions as a ubiquitin ligase involved in protein turnover via the ubiquitin-proteasome system. ...Substrates ubiquitinated by parkin are hence thought to be destined for proteasomal degradation. Because we demonstrated previously that parkin interacts with and ubiquitinates synphilin-1, we initially expected synphilin-1 degradation to be enhanced in the presence of parkin. Contrary to our expectation, we found that synphilin-1 is normally ubiquitinated by parkin in a nonclassical, proteasomal-independent manner that involves lysine 63 (K63)-linked polyubiquitin chain formation. Parkin-mediated degradation of synphilin-1 occurs appreciably only at an unusually high parkin to synphilin-1 expression ratio or when primed for lysine 48 (K48)-linked ubiquitination. In addition we found that parkin-mediated ubiquitination of proteins within Lewy-body-like inclusions formed by the coexpression of synphilin-1, alpha-synuclein, and parkin occurs predominantly via K63 linkages and that the formation of these inclusions is enhanced by K63-linked ubiquitination. Our results suggest that parkin is a dual-function ubiquitin ligase and that K63-linked ubiquitination of synphilin-1 by parkin may be involved in the formation of Lewy body inclusions associated with PD.
Apatite is an important common U- and Th-bearing accessory mineral in igneous, metamorphic and clastic sedimentary rocks. The advent of in situ U–Th–Pb apatite geochronology by the SIMS and ...LA-(MC)-ICP-MS methods has demonstrated the importance of having uniform and homogeneous reference materials. Recently, it has been shown that Sr and Nd isotopic data combined with U–Pb age and trace element concentration data can provide important constraints on apatite paragenesis because this phase usually exhibits high Sr and REE concentrations but has low Rb/Sr ratios which result in negligible corrections for the ingrowth of radiogenic Sr. However, as apatite can potentially have complex internal structures resulting from multiple thermal events, such as inherited cores and metamorphic overgrowths, requires that the Sr and Nd isotopic data should be measured with high spatial resolution. However isobaric interferences hamper the precise determination of Sr or Nd isotopic compositions in LA-MC-ICP-MS analysis. In this work we undertook in situ measurements of Sr and Nd isotopic compositions of eleven apatite reference materials (AP1, AP2, Durango, MAD, Otter Lake, NW-1, Slyudyanka, UWA-1, Mud Tank, McClure Mountain and SDG) commonly used in U–Th–Pb geochronology. Our obtained Sr and Sm–Nd isotopic compositions for these apatite samples are consistent with those values obtained by solution-based methods (isotope dilution and ion chromatography) using MC-ICP-MS or TIMS, which demonstrates the reliability and robustness of our analytical protocol.
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•Sr and Nd isotopes by laser and solution analysis are reported for eleven apatites.•AP1, AP2, MAD, Otter Lake, NW-1 and SDG are potential reference materials.•Durango, UWA-1, Mud Tank and McClure are not promising reference materials.•Matrix effects during laser ablation are investigated for different materials.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Identifying host immune determinants governing HIV transcription, latency and infectivity in vivo is critical to developing an HIV cure. Based on our recent finding that the host factor p21 regulates ...HIV transcription during antiretroviral therapy (ART), and published data demonstrating that the human carbohydrate-binding immunomodulatory protein galectin-9 regulates p21, we hypothesized that galectin-9 modulates HIV transcription. We report that the administration of a recombinant, stable form of galectin-9 (rGal-9) potently reverses HIV latency in vitro in the J-Lat HIV latency model. Furthermore, rGal-9 reverses HIV latency ex vivo in primary CD4+ T cells from HIV-infected, ART-suppressed individuals (p = 0.002), more potently than vorinostat (p = 0.02). rGal-9 co-administration with the latency reversal agent "JQ1", a bromodomain inhibitor, exhibits synergistic activity (p<0.05). rGal-9 signals through N-linked oligosaccharides and O-linked hexasaccharides on the T cell surface, modulating the gene expression levels of key transcription initiation, promoter proximal-pausing, and chromatin remodeling factors that regulate HIV latency. Beyond latent viral reactivation, rGal-9 induces robust expression of the host antiviral deaminase APOBEC3G in vitro and ex vivo (FDR<0.006) and significantly reduces infectivity of progeny virus, decreasing the probability that the HIV reservoir will be replenished when latency is reversed therapeutically. Lastly, endogenous levels of soluble galectin-9 in the plasma of 72 HIV-infected ART-suppressed individuals were associated with levels of HIV RNA in CD4+ T cells (p<0.02) and with the quantity and binding avidity of circulating anti-HIV antibodies (p<0.009), suggesting a role of galectin-9 in regulating HIV transcription and viral production in vivo during therapy. Our data suggest that galectin-9 and the host glycosylation machinery should be explored as foundations for novel HIV cure strategies.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Quality of recovery (QoR) after surgery is often focused on morbidity, mortality and physiological changes, while well‐being and emotional state are other important aspects that are often ...ignored. QoR is poorly investigated in clinical settings and a psychometrically tested questionnaire, QoR‐15, has recently been developed. QoR‐15 has not been validated for Swedish conditions. The aim of this study was to translate, adapt and validate QoR‐15 to Swedish conditions (QoR‐15swe).
Methods
A translation and cultural adaption was performed resulting in a Swedish version of the instrument, QoR‐15swe. Patients answered the QoR‐15swe before surgery, 24 and 48 h after surgery. Feasibility, validity, reliability and responsiveness of the QoR‐15swe were evaluated.
Results
The QoR‐15swe was feasible in 85.5% of the eligible patients. Construct validity was good, with significant correlations between QoR‐15swe score and, ASA‐PS class, grade of surgery, length of surgery and time in the post‐anaesthesia care unit. The instrument demonstrated good internal consistency with an inter‐item Cronbach's α of 0.83–0.87, and inter‐dimension Cronbach's α was acceptable 0.71–0.76. Test‐retest repeatability was also good with Cronbach′s alpha > 0.99 and an interclass correlation coefficient of 0.992 (CI: 0.981–0.997). There were no floor and ceiling effects. Responsiveness assessed by Cliff's effect size was −0.23 indicating a moderate ability to detect change at 24 h postoperatively.
Conclusion
We have translated and culturally adapted the QoR‐15 into Swedish. The score demonstrated acceptable validity, reliability and responsiveness. The QoR‐15swe is a clinically acceptable and feasible outcome measure after surgery in a Swedish population.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
The temperature sensitivity of the U-Pb apatite system (350–570 °C) makes it a powerful tool to study thermal histories in the deeper crust. Recent studies have exploited diffusive Pb loss from ...apatite crystals to generate t-T paths between ~350–570 °C, by comparing apatite U-Pb ID-TIMS (isotope dilution-thermal ionisation mass spectrometry) dates with grain size or by LA-MC-ICP-MS (laser ablation-multicollector-inductively coupled plasma-mass spectrometry) age depth profiling/traverses of apatite crystals, and assuming the effective diffusion domain is the entire crystal. The key assumptions of apatite U-Pb thermochronology are discussed including (i) that Pb has been lost by Fickian diffusion, (ii) can experimental apatite Pb diffusion parameters be extrapolated down temperature to geological settings and (iii) are apatite grain boundaries open (i.e., is Pb lost to an infinite reservoir). Particular emphasis is placed on detecting fluid-mediated remobilisation of Pb, which invalidates assumption (i). The highly diverse and rock-type specific nature of apatite trace-element chemistry is very useful in this regard—metasomatic and low-grade metamorphic apatite can be easily distinguished from sub-categories of igneous rocks and high-grade metamorphic apatite. This enables reprecipitated domains to be identified geochemically and linked with petrographic observations. Other challenges in apatite U-Pb thermochronology are also discussed. An appropriate choice of initial Pb composition is critical, while U zoning remains an issue for inverse modelling of single crystal ID-TIMS dates, and LA-ICP-MS age traverses need to be integrated with U zoning information. A recommended apatite U-Pb thermochronology protocol for LA-MC-ICP-MS age depth profiling/traverses of apatite crystals and linked to petrographic and trace element information is presented.
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CEKLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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