The purpose of this study was to compare optical coherence tomography (OCT) angiography to standard fluorescein angiography (FA) in the grading of diabetic macular ischemia.
In our study, OCT ...angiography and traditional FA images were acquired from 24 diabetic patients. The level of diabetic macular ischemia in the superficial capillary plexus was graded with standard Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and a comparison between conventional FA and OCT angiography was performed. The deep vascular plexus and choriocapillaris were also graded for macular ischemia. Additionally, flow indices were analyzed for all OCT angiography images.
We identified moderate agreement between diabetic macular ischemia grades for conventional FA and OCT angiography (weighted κ of 0.53 and 0.41). In addition, the intergrader agreement for the superficial, deep, and choriocapillaris scores was substantial (weighted κ of 0.65, 0.61, and 0.65, respectively). Finally, the parafoveal flow indices were shown to have a statistically significant relationship with diabetic macular ischemia grades for the superficial capillary plexus (P = 0.04) and choriocapillaris (P = 0.036), with a trend toward significance for the deep capillary plexus (P = 0.13).
We demonstrated moderate agreement between diabetic macular ischemia grading results for OCT angiography and conventional FA using standard ETDRS protocols. We also showed that OCT angiography images could be graded for diabetic macular ischemia with substantial intergrader agreement.
A theory is developed that explains the genesis of the strikingly regular hexagonal arrays of nanoscale mounds that can form when a flat surface of a binary compound is subjected to normal-incidence ...ion bombardment. We find that the species with the higher sputter yield is concentrated at the peaks of the nanodots and that hysteretic switching between the flat and the hexagonally ordered state can occur as the sample temperature is varied. Surface ripples are predicted to emerge for a certain range of the parameters.
► Hexagonal arrays of nanodots can form when a binary compound is ion bombarded. ► We develop a theory that explains the genesis of these arrays. ► The species with the higher sputter yield is ...concentrated at the peaks of the nanodots. ► For a range of the parameters, the nanodot arrays coarsen as time passes.
We review and augment our recent work which demonstrates that a surface layer of altered composition can have a crucial effect on pattern formation induced by ion bombardment of a solid surface. First, we discuss a theory that explains the genesis of the strikingly regular hexagonal arrays of nanodots that can form when the binary material GaSb is bombarded at normal incidence. In the theory, the coupling between a surface layer of altered stoichiometry and the topography of the surface is the key to the observed pattern formation. For a certain range of the parameters, we find that nanodot arrays with strong short-range hexagonal order emerge spontaneously. Well-ordered arrays of nanoholes develop in another range of the parameters. A closely related theory governs the dynamics of the surface of an elemental material that is seeded with impurities during ion bombardment. If the incident impurity flux exceeds a critical value, the surface layer in which impurities are present destabilizes the surface, leading to the formation of a disordered array of nanodots.
Cerebral protection techniques during aortic arch surgery include deep hypothermic circulatory arrest, retrograde cerebral perfusion, and (or) antegrade cerebral perfusion. It is unclear whether ...unilateral selective antegrade cerebral perfusion (uSACP) in the setting of moderate hypothermic circulatory arrest (MHCA) constitutes an effective cerebral protective strategy during aortic arch reconstruction.
A retrospective review was performed for all aortic arch cases involving uSACP between January 2004 and December 2009. Of these 412 patients, 97 (24%) were treated emergently. Adverse outcomes included operative mortality, permanent neurologic dysfunction, temporary neurologic dysfunction, and renal failure requiring dialysis. Potential selection bias was controlled by the inclusion of 11 covariates. Multivariable logistic regression analysis was used to model adverse outcome as a function of MHCA and the covariates. Adjusted odds ratios were formulated along with 95% confidence intervals.
Three hundred forty-four patients underwent hemiarch reconstruction and 68 patients underwent total arch replacement. The mean core body temperature at the initiation of uSACP was 25.7 degrees C + or - 2.8 degrees C with a uSACP time of 30 + or - 15 minutes. Overall operative mortality occurred in 29 (7.0%) patients. The incidence of permanent neurologic dysfunction and temporary neurologic dysfunction were 3.6% and 5.1%, respectively. Nineteen (4.6%) patients suffered postoperative renal failure requiring dialysis. In the adjusted analysis, MHCA was not found to be an independent predictor of mortality, permanent neurologic dysfunction, temporary neurologic dysfunction, or renal failure requiring dialysis.
The MHCA with adjunctive uSACP is not an independent risk factor for adverse outcomes after aortic arch surgery. These data suggest that MHCA combined with uSACP represents an effective cerebral protective strategy in patients undergoing arch reconstruction in both the elective and emergent settings.
Objective To examine the clinical outcomes and impact of using moderate hypothermic circulatory arrest (MHCA) and unilateral selective antegrade cerebral perfusion (uSACP) in the setting of total ...aortic arch replacement (TOTAL). Methods From 2004 to 2012, 733 patients underwent open arch reconstruction with MHCA and SACP. Of these, 145 (20%) underwent TOTAL. Measured outcomes included death, stroke, temporary neurologic dysfunction (TND), and renal failure. Mean follow-up time was 33 months and ranged from 0 to 95 months. Results Core temperature at the onset of MHCA was 25.8°C. Cardiopulmonary bypass and myocardial ischemic times were 236 minutes and 181 minutes, respectively. Twenty-three patients (16%) underwent emergency repair of acute type A dissection. Fifty-four cases (37%) were reoperative and 52 (34%) were stage I elephant trunk procedures. Concomitant root replacement was performed in 50 (35%) patients, including 20 David V valve-sparing procedures. Mean duration of circulatory arrest was 55 minutes. Operative mortality was 9.7%. Overall incidence of stroke and TND was 2.8% and 5.6%, respectively. Four patients (2.8%) required postoperative dialysis. Seven-year survival was significantly reduced ( P = .04) after repair of type A dissection (83.8%) compared with elective surgery (89.5%). Higher temperature during TOTAL was not found to be a significant risk factor for adverse events. Conclusions TOTAL using MHCA and uSACP can be accomplished with excellent early and late results. MHCA was not associated with adverse neurologic outcomes or higher operative risk, despite prolonged periods of circulatory arrest.
The optimal method of arterial cannulation and circulation management for acute type A aortic dissection (type A) remains debated. Moderate hypothermic circulatory arrest (MHCA) and unilateral ...selective antegrade cerebral perfusion (uSACP) is effective in the elective setting. In this study, the impact of MHCA and uSACP on outcomes for type A repair was evaluated.
A retrospective review identified 346 patients who underwent type A repair under circulatory arrest, including 193 patients who had MHCA/uSACP. Measured outcomes included operative mortality, permanent neurologic deficit (PND) and temporary neurologic deficit, renal failure, and tracheostomy. Propensity-adjusted, multivariable logistic regression analysis was used to model adverse outcomes.
The mean age of MHCA/uSACP patients was 56 years. The mean temperature during MHCA was 26.9 ± 2.0°C. Operative mortality for MHCA/SACP patients was 9.8% compared with 20.3% for the non-MHCA/SACP group (p < 0.01). Propensity score analysis found that MHCA/uSACP did not represent an adverse risk factor for mortality, temporary neurologic deficit, PND, renal failure, or the need for tracheostomy compared with non-MHCA/uSACP techniques. There was a 2.32-fold higher incidence of PND among patients who underwent cross-clamping of the dissected aorta during cooling before circulatory arrest (p < 0.05).
Emergent type A repair can be accomplished with respectable operative risk using MHCA/uSACP. Cross-clamping the dissected aorta before MHCA increases the incidence of PND. These data suggest that MHCA/uSACP represents an effective circulation management strategy for patients undergoing repair of type A and obviates the need for deep hypothermic circulatory arrest.
The
Arabidopsis
nucleotide-binding leucine-rich repeat protein ZAR1 can recognize at least six distinct families of pathogenic effector proteins to mount an effector-triggered immune response. This ...remarkable immunodiversity appears to be conveyed by receptor-like cytoplasmic kinase (RLCK) complexes, which associate with ZAR1 to sense several effector-induced kinase perturbations. Here we show that the recently identified ZAR1-mediated immune responses against the HopX1, HopO1, and HopBA1 effector families of
Pseudomonas syringae
rely on an expanded diversity of RLCK sensors. We show that individual sensors can recognize distinct effector families, thereby contributing to the expanded surveillance potential of ZAR1 and supporting its role as a guardian of the plant kinome.
We have observed that the vapor-phase deposition of polymers onto liquid substrates can result in the formation of polymer films or particles at the liquid–vapor interface. In this study, we ...demonstrate the relationship between the polymer morphology at the liquid–vapor interface and the surface tension interaction between the liquid and polymer, the liquid viscosity, the deposition rate, and the deposition time. We show that the thermodynamically stable morphology is determined by the surface tension interaction between the liquid and the polymer. Stable polymer films form when it is energetically favorable for the polymer to spread over the surface of the liquid, whereas polymer particles form when it is energetically favorable for the polymer to aggregate. For systems that do not strongly favor spreading or aggregation, we observe that the initial morphology depends on the deposition rate. Particles form at low deposition rates, whereas unstable films form at high deposition rates. We also observe a transition from particle formation to unstable film formation when we increase the viscosity of the liquid or increase the deposition time. Our results provide a fundamental understanding about polymer growth at the liquid–vapor interface and can offer insight into the growth of other materials on liquid surfaces. The ability to systematically tune morphology can enable the production of particles for applications in photonics, electronics, and drug delivery and films for applications in sensing and separations.
Nephrotoxic medication (NTMx) exposure is a common cause of acute kidney injury (AKI) in hospitalized children. The Nephrotoxic Injury Negated by Just-in time Action (NINJA) program decreased NTMx ...associated AKI (NTMx-AKI) by 62% at one center. To further test the program, we incorporated NINJA across nine centers with the goal of reducing NTMx exposure and, consequently, AKI rates across these centers. NINJA screens all non-critically ill hospitalized patients for high NTMx exposure (over three medications on the same day or an intravenous aminoglycoside over three consecutive days), and then recommends obtaining a daily serum creatinine level in exposed patients for the duration of, and two days after, exposure ending. Additionally, substitution of equally efficacious but less nephrotoxic medications for exposed patients starting the day of exposure was recommended when possible. The main outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria (increase of 50% or 0.3 mg/dl over baseline). The primary outcome measure was AKI episodes per 1000 patient-days. Improvement was defined by statistical process control methodology and confirmed by Autoregressive Integrated Moving Average (ARIMA) modeling. Eight consecutive bi-weekly measure rates in the same direction from the established baseline qualified as special cause change for special process control. We observed a significant and sustained 23.8% decrease in NTMx-AKI rates by statistical process control analysis and by ARIMA modeling; similar to those of the pilot single center. Thus, we have successfully applied the NINJA program to multiple pediatric institutions yielding decreased AKI rates.
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Sallow and/or dull skin appearance is greatly attributable to the yellow components of skin tone. Bilirubin is a yellow chromophore known to be made in the liver and/or spleen and is transported ...throughout the body via the blood stream. Recent publications suggest bilirubin may be synthesized in other cells/organs, including the skin. We found human keratinocytes express the transcripts involved in bilirubin biosynthesis. In parallel, we also found human keratinocytes could indeed synthesize bilirubin in monolayer keratinocytes and in a 3D human skin-equivalent model. The synthesized amount was substantial enough to contribute to skin yellowness. In addition, oxidative stress enhanced bilirubin production. Using UnaG, a protein that forms a fluorescent species upon binding to bilirubin, we also visualized the intracellular expression of bilirubin in keratinocytes. Finally, we screened a compound library and discovered that the sucrose laurate/dilaurate (SDL) combination significantly reduced bilirubin levels, as well as bilirubin-mediated yellowness. In conclusion, bilirubin is indeed synthesized in epidermal keratinocytes and can be upregulated by oxidative stress, which could contribute to chronic or transient yellow skin tone appearance. Application of SDL diminishes bilirubin generation and may be a potential solution to mitigate yellowish and/or dull skin appearance.
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