摘要： A pain medicine physician’s unique skill set in interventional techniques may lead to requests to perform a stellate ganglion blockade for ventricular tachyarrhythmias (VT). Although stellate ganglion blocks are a typical block performed in the chronic pain setting, its utilization for cardiac causes is less likely to be a component of formal pain medicine training. VT are often lethal clinical events that can be challenging to treat and may be refractory to traditional beta blockade therapy and other antiarrhythmic therapies. Furthermore, in the setting of sustained VT, or electrical storm (ES), patients are frequently too unstable for ablative procedures or surgical sympathetic denervation. In such scenarios, the need for urgent sympathetic denervation or blockade can be met through utilization of an alternative bedside procedural modality: ultrasound-guided percutaneous stellate ganglion blockade (SGB).

关键词： microsampling   TDM   DBS  

摘要： Dried blood spots (DBS) have been used in newborn screening programs for several years. More recently, there has been growing interest in using DBS as a home sampling tool for the quantitative determination of analytes. However, this presents challenges, mainly because of the well-known hematocrit effect and other DBS-specific parameters, including spotted volume and punch site, which could add to the method uncertainty. Therefore, new microsampling devices that quantitatively collect capillary dried blood are continuously being developed. In this review, we provided an overview of devices that are commercially available or under development that allow the quantitative (volumetric) collection of dried blood (-based) microsamples and are meant to be used for home or remote sampling. Considering the field of therapeutic drug monitoring (TDM), we examined different aspects that are important for a device to be implemented in clinical practice, including ease of patient use, technical performance, and ease of integration in the workflow of a clinical laboratory. Costs related to microsampling devices are briefly discussed, because this additionally plays an important role in the decision-making process. Although the added value of home sampling for TDM and the willingness of patients to perform home sampling have been demonstrated in some studies, real clinical implementation is progressing at a slower pace. More extensive evaluation of these newly developed devices, not only analytically but also clinically, is needed to demonstrate their real-life applicability, which is a prerequisite for their use in the field of TDM.

关键词： Lupus nephritis   Thrombotic microangiopathy   Complement pathway   Urine biomarkers   Systemic lupus erythematosus  

摘要： Introduction/objective Thrombotic microangiopathy (TMA) in systemic lupus erythematosus is a rare manifestation associated with activation of the complement system. This study aimed to compare plasma and urine complement activation products between patients with active lupus nephritis (aLN) and those with acute TMA plus concomitant active LN (aTMA+aLN). Methods Plasma and urine samples were obtained from 20 patients with aTMA+aLN, 20 patients with aLN matched by the histological activity index, 5 patients with chronic TMA, 20 patients with inactive LN, and 10 kidney donors. Complement fragments C3a, C4a, C4d, Ba, C5a, C5bC9, and factor H were determined by ELISA;and kidney C4d deposition was detected by immunohistochemistry. Patients were followed for > 12 months and complement activation products re-measured after treatment in 10 aTMA+aLN patients. Results Both aTMA+aLN and aLN groups had increased circulating C3a, Ba, and C5bC9;and decreased circulating C3, C4, C4a, C4d, and factor H. Urinary C3a, C5a, Ba, and C5bC9 were higher in patients with aTMA+aLN than in aLN. After treatment, levels of circulating C3, C4, and factor H increased;while levels of urinary C3a, C5a, Ba, and C5bC9 decreased in patients with aTMA+aLN. These changes were observed at each aTMA episode in two patients studied during repeated TMA episodes. There was no difference in C4d deposition in glomerular capillaries, tubular basement membrane, peritubular capillaries, and arterioles between patients with aLN and those aTMA+aLN. Conclusions Circulating and urine complement activation products suggest that thrombotic microangiopathy associated with LN is mediated through activation of the alternative complement pathway. Key Points Immune-complex kidney disease in systemic lupus erythematosus (SLE) is associated with activation of the classical, lectin, and alternative complement pathways Indirect evidence from measurement of circulating and urinary complement pathway activation products suggests

摘要： BACKGROUND Acute kidney injury (AKI) is associated with poor outcomes after noncardiac surgery. Whether pre-operative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after noncardiac surgery is unclear. OBJECTIVE To investigate the predictive role of pre-operative NT-proBNP on postoperative AKI. DESIGN Retrospective cohort study. SETTING Nanfang Hospital, Southern Medical University, China. PATIENTS Adult patients who had a serum creatinine and NT-proBNP measurement within 30 pre-operative days and at least one serum creatinine measurement within 7 days after noncardiac surgery between February 2008 and May 2018 were identified. MAIN OUTCOME MEASURES The primary outcome was postoperative AKI, defined by the kidney disease: improving global outcomes creatinine criteria. RESULTS In all, 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Pre-operative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (OR comparing top to bottom quintiles 2.29, 95% CI, 1.47 to 3.65, P < 0.001 for trend;OR per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI, 1.16 to 1.39). Compared with clinical variables alone, the addition of NT-proBNP improved model fit, modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, P = 0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI, 0.111 to 0.308, improved integrated discrimination 0.0044, 95% CI, 0.0016 to 0.0072) of AKI and non-AKI cases, and achieved higher net benefit in decision curve analysis. CONCLUSIONS Pre-operative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing noncardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.

关键词： Gas exchange   Mentha arvensis   Mentha viridis   Micropropagation   Secondary metabolism  

摘要： The aims of the present study were to evaluate the effects of different ventilation systems and sucrose concentrations on the growth, photosynthetic pigment content, and chemical composition of Mentha arvensis L. and M. viridis L. Photon flux (PPF) and growth were also evaluated based on M. arvensis heterotrophic, photomixotrophic, and photoautotrophic culture systems. Nodal segment explants were cultured on medium with 0, 15, and 30 g L-1 sucrose and four alternative membrane systems (AMS) in culture medium, namely no membrane (NMS), one (AMS1), two (AMS2), and four (AMS4) membranes. Mentha arvensis cultivation on medium containing 15 g L-1 of sucrose and four membrane (AMS4) led to the highest dry weight accumulation. Mentha viridis reached the same result with medium containing 30 g L-1 sucrose and AMS2 and AMS4. Mentha arvensis produced higher chlorophyll a, b and total chlorophyll, as well as carotenoids when cultured on medium with 30 g L-1 of sucrose and AMS4 and M. viridis when cultured on medium with 15 g L-1 of sucrose and AMS4. The NMS without sucrose favored higher pulegone and AMS4 induced higher menthol, menthone, and limonene from M. arvensis cultured in vitro. Furthermore, AMS2 induced menthol production and AMS1 increased trans-sabinene, linalol, and limonene content in M. viridis. Mentha arvensis plantlets cultivated under photoautotrophic system with 130 mu mol m(-2) s(-1) showed improved growth and the highest leaf area. Thus, the recommendation to increase upper biomass and plantlet quality in mint species lies on employing an alternative membrane system under higher PPF.

关键词： Cholesterol   Mitochondria   Bile acids   Hepatocellular carcinoma   Oxysterols   STARD1  

摘要： Background & Aims: Besides their physiological role in bile formation and fat digestion, bile acids (BAs) synthesised from cholesterol in hepatocytes act as signalling molecules that modulate hepatocellular carcinoma (HCC). Trafficking of cholesterol to mitochondria through steroidogenic acute regulatory protein 1 (STARD1) is the rate-limiting step in the alternative pathway of BA generation, the physiological relevance of which is not well understood. Moreover, the specific contribution of the STARD1-dependent BA synthesis pathway to HCC has not been previously explored. Methods: STARD1 expression was analyzed in a cohort of human non-alcoholic steatohepatitis (NASH)-derived HCC specimens. Experimental NASH-driven HCC models included MUP-uPA mice fed a high-fat high-cholesterol (HFHC) diet and diethylnitrosamine (DEN) treatment in wild-type (WT) mice fed a HFHC diet. Molecular species of BAs and oxysterols were analyzed by mass spectrometry. Effects of NASH-derived BA profiles were investigated in tumour-initiated stem-like cells (TICs) and primary mouse hepatocytes (PMHs). Results: Patients with NASH-associated HCC exhibited increased hepatic expression of STARD1 and an enhanced BA pool. Using NASH-driven HCC models, STARD1 overexpression in WT mice increased liver tumour multiplicity, whereas hepatocyte-specific STARD1 deletion (Stard1(Delta Hep)) in WT or MUP-uPA mice reduced tumour burden. These findings mirrored the levels of unconjugated primary BAs, beta-muricholic acid and cholic acid, and their tauroconjugates in STARD1-overexpressing and Stard1(Delta Hep) mice. Incubation of TICs or PMHs with a mix of BAs mimicking this profile stimulated expression of genes involved in pluripotency, stemness and inflammation. Conclusions: The study reveals a previously unrecognised role of STARD1 in HCC pathogenesis, wherein it promotes the synthesis of primary BAs through the mitochondrial pathway, the products of which act in TICs to stimulate self-renewal, stemness an

摘要： BACKGROUND Pre-operative anaemia is associated with adverse outcomes of noncardiac surgery, but its association with myocardial injury after noncardiac surgery (MINS) has not been fully investigated. OBJECTIVE The association between pre-operative anaemia and MINS. DESIGN A single-centre retrospective cohort study. SETTING Tertiary care referral centre. PATIENTS Patients with measured cardiac troponin (cTn) I levels after noncardiac surgery. INTERVENTIONS Patients were separated according to pre-operative anaemia (haemoglobin <13 g dl(-1) in men and <12 g dl(-1) in women). Anaemia was further stratified into mild and moderate-to-severe at a haemoglobin level threshold of 11 g dl(-1). MAIN OUTCOME MEASURES The primary outcome was MINS, defined as a peak cTn I level more than 99th percentile of the upper reference limit within 30 postoperative days. RESULTS Data from a total of 35 170 patients were collected, including 22 062 (62.7%) patients in the normal group and 13 108 (37.3%) in the anaemia group. After propensity score matching, 11919 sets of patients were generated, and the incidence of MINS was significantly associated with anaemia [14.5 vs. 21.0%, odds ratio (OR) 1.57, 95% confidence interval (CI) 1.47 to 1.68, P < 0.001]. For the entire population, multivariable analysis showed a graded association between anaemia severity and MINS (OR 1.32, 95% CI 1.22 to 1.43, P < 0.001 for mild anaemia and OR 1.80, 95% CI 1.66 to 1.94, P < 0.001 for moderate-to-severe anaemia compared with the normal group) and a significantly higher incidence of MINS for moderate-to-severe anaemia than mild anaemia (18.6 vs. 28.6%, OR 1.37, 95% CI 1.25 to 1.50, P < 0.001). The estimated threshold for pre-operative haemoglobin associated with MINS was 12.2 g dl(-1), with an area under the curve of 0.622. CONCLUSIONS Pre-operative anaemia was independently associated with MINS, suggesting that MINS may be related to the association between anaemia and postoperative mortality.

关键词： Inland desalination wastewater   Algal cultivation   Biomass   Phycocyanin   Protein   Feed application  

摘要： The chemical composition of inland desalination concentrate (DC) contains several microelements necessary for metabolism in microalgae. This study investigated the biomass concentration and biochemical composition of Spirulina platensis cultivated in DC under indoor (laboratory) and outdoor (raceway ponds) units. Initially, S. platensis was cultivated indoor testing different concentrations 0-, 20-, 40-, 60-, 80-, 100-% of DC, and results showed that mixing 60% DC with 40% Paoletti Synthetic Medium (PSM) is a suitable medium for S. platensis. After that, the optimum 60% DC to cultivateS. platensisunder outdoor raceway pond was utilized. In parallel, a control assay using 100% PSM constituents was performed.S. platensiscultured in optimum DC, under outdoor conditions, exhibited biomass productivity (similar to 10 g m(-2) day(-1)) and protein content (45.0%) comparable to literature data. In addition,S. platensiscultivated in optimum DC was also able to synthesize carbohydrates, amino acids, fatty acids, and phycocyanin, which could be potentially used as biofertilizer and supplement in animal and aquaculture feed. Our results demonstrated the valorization of brine management throughS. platensiscultivation, which can be considered as a step forward of reducing freshwater and conventional nutrients for algal mass cultivation. [GRAPHICS]

关键词： Kobe Bryant   Fatherhood   Girl dad   NBA   Phenomenology   Qualitative   Social father  

摘要： Over 40 years ago, Cazenave (1979) provided one of the first scholarly examinations of how middle-income Black fathers defined the provider role. Since that time, scholars have studied the realities of biological and social fathers (Coles et al., 2010;Connor & White, 2006;Hamer, 2001, 1997;McDougal III & George III, 2016;Ransaw, 2017), as well as the relationship between fathering and sport (Fletcher, 2020). This qualitative work examined the words the late Kobe Bryant (January 23, 1978-January 26, 2020) used to describe his role as father to four daughters. To determine the underlying messages behind Bryant's words, I used Phenomenology as the theoretical framework. Qualitative analysis of the words featured in the Insider article, "Kobe Bryant's 10 Most Touching Quotes on Fatherhood and Raising Daughters" By Emily Cavanaugh (February 25, 2020) revealed three themes: (1) Bryant made being a present father a priority;(2) Bryant publicly praised his late daughter Gianna and her sisters;and ( 3) Bryant saw himself as a role model to children. Most important, Bryant's fame and status in professional basketball along with his narratives regarding being a father to daughters is a strong, enduring counter narrative to the " absent Black father" trope that is common in society. The work also discussed the reasons why in light of the rape scandal Kobe Bryant is a good role model. Implications for how fatherhood will shape the Bryant legacy will be discussed.