Little is known about mixed cellular and antibody-mediated rejection (MR) in heart transplantation. It remains unclear whether cardiac MR has distinctive pathologic and clinical features beyond those ...of simultaneous cellular rejection (CR) and antibody-mediated rejection (AMR). In this study we systematically explore the pathologic and clinical characteristics of MR in heart transplantation.
The UTAH Cardiac Transplant Program database was queried for transplant recipients who survived long enough to have at least one endomyocardial biopsy (EMB) between 1985 and 2014. Only EMBs with both CR and AMR scores documented were included. In addition to detailed pathologic analyses, we also examined the incidence and prevalence of MR, the likelihood to transition from and to MR, and mortality associated with MR.
Patients (n = 1,207) with a total of 28,484 EMBs met the study inclusion criteria. The overall prevalence of MR was 7.8% and it was nearly twice as frequent within the first year post-transplant. Mild MR was by far the most common occurrence and was typically preceded by an immune active state. When CR increased in severity, AMR tended to follow, but the reverse was not true. On pathology, individual features of CR and AMR were more easily separated in cases of mild MR, whereas they substantially overlapped in more severe cases. MR was associated with a significant cardiovascular death risk that was incremental with severity.
MR is not common, usually occurs early after transplant, and is associated with worse outcomes. MR reflects a complex interplay between cellular and humoral processes, which varies with rejection severity.
Growing evidence suggests worse cardiac allograft vasculopathy and mortality in patients with asymptomatic antibody-mediated rejection (AMR). Debate continues about whether therapeutic intervention ...is warranted to avoid adverse outcomes. In this study we examine the course of individual episodes of untreated asymptomatic AMR on follow-up endomyocardial biopsy (EMB).
The U.T.A.H. Cardiac Transplant Program database was queried for transplant recipients between 1985 and 2009 who survived beyond 1 year and had at least 1 episode of lone AMR with a follow-up EMB. All EMBs were screened for AMR by immunofluorescence and graded for severity. Data were analyzed based on time from transplant (early, ≤12 months; late, >12 months).
Nine hundred fifty-eight patients with a total of 15,448 biopsies qualified for the study. Average age at transplant was 46.7 years; 13% of the patients were female. Within the first year post-transplant, asymptomatic AMR was diagnosed in 13.6% of biopsies compared with 5.2% beyond 1 year. AMR resolved in 65% (early) vs 75% (late) on follow-up EMB. More severe AMR was less likely to improve regardless of time from transplant. Furthermore, after an episode of AMR had resolved, the recurrence rate at 3, 6 and 12 months was 44%, 50.1% and 56.2%, respectively.
The incidence of AMR is higher in the first year post-transplant and the likelihood of resolution is less on follow-up EMB, especially when more severe. A small but significant number of cases became worse or did not change. These new findings may be helpful in planning future studies that test whether therapeutic interventions on asymptomatic AMR favorably impact outcomes.
Through traditional epidemiologic techniques and molecular typing, multiple state health departments and the CDC identified a large nationwide outbreak of gastrointestinal illness caused by ...salmonella Saintpaul that was most closely associated with jalapeño and serrano peppers.
Salmonella is a leading bacterial cause of gastroenteritis in the United States, and the incidence has changed little in the past decade.
1
Produce that is eaten raw is an increasingly recognized vehicle for transmission of pathogens, including salmonella species.
2
,
3
On May 22, 2008, the New Mexico Department of Health notified the Centers for Disease Control and Prevention (CDC) about 19 cases of salmonella infection in May. All seven isolates with completed serotyping were
Salmonella enterica
serotype Saintpaul.
4
Four of the tested isolates had indistinguishable patterns on pulsed-field gel electrophoresis (PFGE). On May 23, the CDC's staff at PulseNet (a . . .
Switchgrass (Panicum virgatum L.) is a dominant, perennial C₄ grass of North American tallgrass prairies with cultivars that are widely used in grassland restoration, pastures, and landscaping. ...However, these cultivars may be genetically dissimilar to small, remnant populations, raising concerns about altered genetic composition of native populations through gene flow. To address this issue on a local scale in Ohio and Illinois, we used microsatellite markers to characterize genetic diversity and differentiation of 10 remnant prairie populations (5 in each state) and 8 common cultivars. The bulk of genetic variation was found to reside within rather than among wild populations, consistent with the outcrossing breeding system of switchgrass. Genetic diversity was similar among the remnant populations despite large differences in area (approximately 2–2,590 ha), highlighting the importance of small native populations as reservoirs of variation and potential seed sources for prairie restoration. Cultivars generally had similar levels of variation to the wild populations, but we found clear genetic dissimilarity between wild and cultivated gene pools (especially for Kanlow, but also Trailblazer, Blackwell, Dacotah, Summer, and Sunburst cultivars). This suggests that using cultivars in local prairie restoration efforts may alter the genetic composition of wild populations. Whether such changes are deemed as negative depends on the cultivar under consideration and specific conservation goals for preserving native switchgrass populations. Patterns of genetic variation in remnant prairie populations and potential cultivar sources can be used to develop guidelines for restoration as well as future planting of cultivars for biofuels.
Background
Parents’ personal psychotherapy experiences can shape their expectancies of mental health treatment for themselves and offspring. For instance, parents with negative psychotherapy ...experiences may view mental health treatment as less likely to be helpful—and seek treatment at lower rates—for themselves and their children. However, these associations are not absolute. One potential moderator may be parents’
beliefs about failure
as debilitating versus enhancing.
Objective
We tested whether beliefs about failure moderated links between parents’ own past psychotherapy experiences and their expectancies for future psychotherapy, both for themselves and offspring.
Method
One-hundred and forty-three parents with a history of receiving psychotherapy reported on beliefs about failure, past psychotherapy experiences, and future psychotherapy expectancies and preferences, for themselves and their offspring. All measures were completed through mTurk, an online method of collecting survey data.
Results
Parents perceiving their own past psychotherapy as ineffective held significantly lower expectancies that psychotherapy would benefit their offspring and were more likely to decline hypothetical treatment for offspring. These relations were significantly stronger among parents holding “failure-is-debilitating” beliefs, versus those with “failure-is-enhancing” beliefs. Parents’ reporting negative past therapy experiences had lower expectancies for their own future therapy regardless of failure beliefs.
Conclusions
“Failure-is-enhancing” beliefs may strengthen parents’ confidence that psychotherapy can benefit their children, especially in parents with negative treatment experiences themselves.
Colonizing weed populations face novel selective environments, which may drive rapid shifts in life history. These shifts may be amplified when colonists are hybrids of species with divergent life ...histories. Selection on such phenotypically diverse hybrids may create highly fecund weeds. We measured the phenotypic variation, strength of natural selection and evolutionary response of hybrid and nonhybrid weeds. We created F₁ hybrids of wild radish, an early flowering, small-stemmed weed, and its late-flowering, large-stemmed, crop relative (Raphanus spp.). Replicate wild and hybrid populations were established in an agricultural landscape in Michigan, USA. The consequences of three generations of natural selection were measured in a common garden experiment. Hybrid populations experienced strong selection for larger, earlier flowering plants whereas selection was relatively weak on wild populations. Large plant size evolved two to three times faster in the hybrid populations than in wild populations, yet hybrid populations did not evolve earlier flowering. Strong selection on size and phenotypic correlations between age at reproduction and size may have limited the response of flowering phenology. Our findings demonstrate hybridization between species with divergent life histories may catalyse the rapid evolution of certain adaptive, weedy traits while tradeoffs limit the evolution of others.
PREMISE: Studies of hybridizing species are facilitated by the availability of species-specific molecular markers for identifying early- and later-generation hybrids. Cattails are a dominant feature ...of wetland communities, and a better understanding of the prevalence of hybrids is needed to assess the ecological and evolutionary effects of hybridization. Hybridization between Typha angustifolia and T. latifolia produce long-lived clones, known as Typha xglauca, which are considered to be invasive. Although morphological variation in cattails makes it difficult to recognize early- and later-generation hybrids, several dominant, species-specific RAPD markers are available. Our goal was to find codominant, species-specific markers with greater polymorphism than RAPDs, to identify later-generation hybrids more efficiently. METHODS: We screened nine SSR (simple sequence repeat) loci that were described from populations in Ukraine, and we surveyed 31 cattail populations from the upper Midwest and eastern USA. Key results: Seven SSR loci distinguished the parent taxa and were consistent with known species-specific RAPD markers, allowing easier detection of backcrossing. We used linear discriminant analysis to show that F₁ hybrid phenotypes were intermediate between the parent taxa, while those of backcrossed plants overlapped with the hybrids and their parents. Log(leaf length/leaf width), spike gap length, spike length, and stem diameter explained much of the variation among groups. CONCLUSIONS: We provide the first documentation of backcrossed plants in hybridizing cattail populations in Michigan. The diagnostic SSR loci we identified should be extremely useful for examining the evolutionary and ecology interactions of hybridizing cattails in North America.
When species hybridize, offspring typically exhibit reduced fitness and maladapted phenotypes. This situation has biosafety implications regarding the unintended spread of novel transgenes, and risk ...assessments of crop‐wild hybrids often assume that poorly adapted hybrid progeny will not evolve adaptive phenotypes. We explored the evolutionary potential of early generation hybrids using nontransgenic wild and cultivated radish (Raphanus raphanistrum, Raphanus sativus) as a model system. We imposed four generations of selection for two weedy traits – early flowering or large size – and measured responses in a common garden in Michigan, USA. Under selection for early flowering, hybrids evolved to flower as early as wild lineages, which changed little. These early‐flowering hybrids also recovered wild‐type pollen fertility, suggesting a genetic correlation that could accelerate the loss of crop traits when a short life cycle is advantageous. Under selection for large size at reproduction, hybrids evolved longer leaves faster than wild lineages, a potentially advantageous phenotype under longer growing seasons. Although early generation hybrid offspring have reduced fitness, our findings provide novel support for rapid adaptation in crop‐wild hybrid populations. Biosafety risk assessment programs should consider the possibility of rapid evolution of weedy traits from early generations of seemingly unfit crop‐wild hybrids.
Endovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which ...used CT-perfusion imaging selection.
Large vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS). Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY) up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$ reference year 2014).
There were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12-19). The median (IQR) disability-weighted utility score at 90 days was 0.65 (0.00-0.91) in the alteplase-only versus 0.91 (0.65-1.00) in the endovascular group (
= 0.005). Modeled life expectancy was greater in the endovascular versus alteplase-only group (median 15.6 versus 11.2 years,
= 0.02). The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years median (IQR) 5.5 (3.2-8.7) versus 8.9 (4.7-13.8),
= 0.02 and more QALY gained median (IQR) 9.3 (4.2-13.1) versus 4.9 (0.3-8.5),
= 0.03. Endovascular patients spent less time in hospital median (IQR) 5 (3-11) days versus 8 (5-14) days,
= 0.04 and rehabilitation median (IQR) 0 (0-28) versus 27 (0-65) days,
= 0.03. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569,
= 0.008) offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515). The average saving per patient treated with thrombectomy was US$4,365.
Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had reduced length of stay and overall costs to 90 days. There was evidence of clinically relevant improvement in long-term survival and quality of life.
http://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011).
Seed predation has the potential to strongly reduce seed production and thereby act as a selective force on the evolution of flowering traits and other defenses against herbivory. We characterized ...levels of predispersal seed predation on Hibiscus moscheutos (Malvaceae) during 2001 and 2002 at four sites in Ohio and Maryland, USA. The seed predators were a weevil, Conotrachelus fissinguis (Coleoptera, Curculionidae) and a bruchid beetle, Althaeus hibisci (Coleoptera, Bruchidae). The weevil occurred at three of the four sites and damaged 24% to 94% of fruits in these populations. The bruchid occurred at all four sites, where it destroyed 4% to 27% of the seeds. Seed predation varied between years and among sites for both predators and year-by-site interactions were common. Variation in predation levels indicates that seed predators did not influence this species uniformly, but they were often abundant and sometimes destroyed nearly all of the seeds produced. At one of the Ohio sites, we assessed levels of seed predation at 5-d intervals during the 2001 flowering season. At this population, bruchid damage was greatest for seeds produced by flowers that opened in late July, when flowers were scarce, whereas weevil damage was greatest in mid-August and coincided with peak flowering. The timing and greater extent of weevil damage suggest that they may have a greater effect on plant fitness than bruchids.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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