A remnant kidney surgery model in cats induces acute and chronic outcomes that mimic spontaneous chronic kidney disease.

OBJECTIVE: To report acute and chronic outcomes of cats with chronic kidney disease (CKD) induced by a remnant kidney model. ANIMALS: 32 purpose-bred cats (n = 15 female, n = 17 male). PROCEDURES: Cats underwent a 2-stage reduction in renal mass through partial arterial ligation of 1 kidney (day 28) and delayed contralateral nephrectomy (day 0), targeting an 11/12th functional nephrectomy. Acute (days -28 - 29) survival and renal function parameters were compared over time, and the latter were evaluated as predictors for acute mortality. Chronic (days 30 to >1,100) survival, renal function, and morphology were described. RESULTS: Acutely, renal function deteriorated in all cats (mean ± SD baseline and day 28 serum creatinine mean concentration, 1.13 ± 0.23 mg/dL and 3.03 ± 1.20 mg/dL, respectively; P < .001; and GFR, 3.22 mL/min/kg ± 0.12 and 1.21 mL/min/kg ± 0.08, respectively; P < .001). Seven (22%) cats were euthanized after because of clinical signs of uremia after contralateral nephrectomy. Prenephrectomy renal function tests were not significant indicators for survival during this acute phase. Twenty-five cats entered the chronic phase. Ten cats were euthanized at a median of 163 days from nephrectomy because of progressive renal dysfunction. Median survival times were significantly different when stratified by acute kidney injury grade at day 29. Cats in the chronic phase had clinical courses similar to cats with naturally occurring CKD, and most (13/15) were in CKD stage 2. CLINICAL RELEVANCE: The remnant kidney model is effective at reducing kidney function to an extent that mimics important characteristics of spontaneous CKD in cats.

Prognostic Awareness, Disease and Palliative Understanding Among Caregivers of Patients With Dementia.

BACKGROUND: Persons with dementia (PwD) often have significant cognitive deficits and functional limitations, requiring substantial caregiver assistance. Given the high symptom burden and terminal nature of dementia, good prognostic awareness and integration of palliative care (PC) is needed. OBJECTIVE: To evaluate prognostic awareness, disease, and PC understanding among caregivers of PwD and to assess for improvements in routine care. DESIGN: A cross-sectional study of 2 cohorts at a single-academic medical center. Surveys were mailed to 200 caregivers of PwD in 2012 (cohort 1). Surveys were sent to new subset of caregivers of PwD (n = 80) in 2018 (cohort 2) to assess trends over time. RESULTS: A total of 154 of caregivers completed the survey (response rate 55%). Compared to 2012, a higher proportion of caregivers in 2018 reported having conversations about prognosis with PwD's physicians (25% in 2012 vs 45% in 2018; P = .027). However, a large percentage (43% in 2012 and 40% in 2018) of caregivers reported no understanding of the PwD's prognosis. Despite most stating dementia was not curable, only 39% in 2012 and 52% in 2018 (P = .015) understood that dementia was a terminal disease. In addition, only 32% in 2012 and 40% in 2018 (P = .39) felt that they were knowledgeable about PC. CONCLUSIONS: Prognostic discussions between caregivers of PwD and the PwD's physicians may be occurring more often; however, a high percentage of caregivers report a poor understanding about the terminal nature of dementia and the role of PC.

Phenotypic and mtDNA variation in Philippine Kappaphycus cottonii (Gigartinales, Rhodophyta).

Members of the carrageenan-producing seaweeds of the genus Kappapphycus have a complicated taxonomic history particularly with regard to species identification. Many taxonomic challenges in this group have been currently addressed with the use of mtDNA sequences. The phylogenetic status and genetic diversity of one of the lesser known species, Kappaphycus cottonii, have repeatedly come into question. This study explored the genetic variation in Philippine K. cottonii using the mtDNA COI-5P gene and cox2-3 spacer sequences. The six phenotypic forms in K. cottonii did not correspond to the observed genetic variability; hinting at the greater involvement of environmental factors in determining changes to the morphology of this alga. Our results revealed that the Philippine K. cottonii has the richest number of haplotypes that have been detected, so far, for any Kappaphycus species. Our inferred phylogenetic trees suggested two lineages: a lineage, which exclusively includes K. cottonii and another lineage comprising the four known Kappaphycus species: K. alvarezii, K. inermis, K. malesianus, and K. striatus. The dichotomy supports the apparent synamorphy for each of these lineages (the strictly terete thalli, lack of protuberances, and the presence of a hyphal central core in the latter group, while the opposite of these morphologies in K. cottonii). These findings shed new light on understanding the evolutionary history of the genus. Assessing the breadth of the phenotypic and genetic variation in K. cottonii has implications for the conservation and management of the overall Kappaphycus genetic resources, especially in the Philippines.

Linear infrastructure impacts on landscape hydrology.

The extent of roads and other forms of linear infrastructure is burgeoning worldwide, but their impacts are inadequately understood and thus poorly mitigated. Previous studies have identified many potential impacts, including alterations to the hydrological functions and soil processes upon which ecosystems depend. However, these impacts have seldom been quantified at a regional level, particularly in arid and semi-arid systems where the gap in knowledge is the greatest, and impacts potentially the most severe. To explore the effects of extensive track, road, and rail networks on surface hydrology at a regional level we assessed over 1000 km of linear infrastructure, including approx. 300 locations where ephemeral streams crossed linear infrastructure, in the largely intact landscapes of Australia's Great Western Woodlands. We found a high level of association between linear infrastructure and altered surface hydrology, with erosion and pooling 5 and 6 times as likely to occur on-road than off-road on average (1.06 erosional and 0.69 pooling features km-1 on vehicle tracks, compared with 0.22 and 0.12 km-1, off-road, respectively). Erosion severity was greater in the presence of tracks, and 98% of crossings of ephemeral streamlines showed some evidence of impact on water movement (flow impedance (62%); diversion of flows (73%); flow concentration (76%); and/or channel initiation (31%)). Infrastructure type, pastoral land use, culvert presence, soil clay content and erodibility, mean annual rainfall, rainfall erosivity, topography and bare soil cover influenced the frequency and severity of these impacts. We conclude that linear infrastructure frequently affects ephemeral stream flows and intercepts natural overland and near-surface flows, artificially changing site-scale moisture regimes, with some parts of the landscape becoming abnormally wet and other parts becoming water-starved. In addition, linear infrastructure frequently triggers or exacerbates erosion, leading to soil loss and degradation. Where linear infrastructure densities are high, their impacts on ecological processes are likely to be considerable. Linear infrastructure is widespread across much of this relatively intact region, but there remain areas with very low infrastructure densities that need to be protected from further impacts. There is substantial scope for mitigating the impacts of existing and planned infrastructure developments.

Prevalence of blood type A and risk of vascular complications following transcatheter aortic valve implantation.

OBJECTIVES: To assess the prevalence of blood type A among patients referred for transcatheter aortic valve implantation (TAVI) and whether it is related to vascular complications. BACKGROUNDS: Vascular complications following TAVI are associated with adverse outcomes. Various blood types, particularly type A, have been shown to be more prevalent in cardiovascular diseases and to be related to prognosis. METHODS: The prevalence of various blood types in a cohort of 491 consecutive patients who underwent TAVI was compared with a control group of 6500 consecutive hospitalised patients. The prevalence and predictors of vascular complications and bleeding events were evaluated in the blood type A group and were compared with non-type A patients. RESULTS: The mean age of TAVI patients was 83 ± 6 years, and 40 % were males. Patients were divided into two groups: blood type A (n = 220) and non-type A (n = 271). Type A was significantly more prevalent in the TAVI group than in the control group (45 vs. 38 %, p = 0.023). Compared with the non-type A group, patients with blood type A had more major and fatal bleeding (14.5 vs. 8.1 %, p = 0.027) and more vascular complications (any vascular complication: 24.5 vs. 15.9 % p = 0.016; major vascular complications: 12.3 vs. 7 % p = 0.047). In a multivariable analysis, blood type A emerged as a significant and independent predictor for vascular complications and bleeding events. CONCLUSIONS: Blood type A is significantly more prevalent in TAVI patients than in the general population and is related to higher rates of vascular and bleeding complications.

Under the radar: mitigating enigmatic ecological impacts.

Identifying the deleterious ecological effects of developments, such as roads, mining, and urban expansion, is essential for informing development decisions and identifying appropriate mitigation actions. However, there are many types of ecological impacts that slip 'under the radar' of conventional impact evaluations and undermine the potential for successful impact mitigation (including offsets). These 'enigmatic' impacts include those that are small but act cumulatively; those outside of the area directly considered in the evaluation; those not detectable with the methods, paradigms, or spatiotemporal scales used to detect them; those facilitated, but not directly caused, by development; and synergistic impact interactions. Here, we propose a framework for conceptualising enigmatic impacts and discuss ways to address them.

The association between the embolic load and atrial size in acute pulmonary embolism.

BACKGROUND: Early identification by computed tomography pulmonary angiography (CTPA) of patients with acute pulmonary embolism (PE) who have signs associated with a high embolic burden would be highly desirable. OBJECTIVES: To investigate whether an increased obstruction of the pulmonary vasculature is associated with reduced left atrial (LA) and increased right atrial (RA) areas. METHODS: We retrospectively analyzed a consecutive series of CTPA studies of 137 patients with acute PE and 38 controls without PE between October 2004 and March 2006. Left and right atrial areas and longitudinal and short axis diameters were measured and correlated with the pulmonary arterial obstruction index (PAOI) divided into tertiles (obstruction of < 12.5%, 12.5%-42.5% and ≥ 42.5%). RESULTS: There was a significant negative age- and gender-adjusted correlation between the PAOI and LA measurements, particularly the LA area (r = -0.259) and the LA short axis diameter (r = -0.331). All RA measurements had positive correlations (RA area, r = 0.279; RA short axis diameter, r = 0.313). The LA/RA area ratio correlated negatively with the PAOI (r = -0.447). All above-mentioned correlations had P < 0.002. All the LA measurements were the largest in the controls and gradually decreased with higher PAOIs. A receiver operating characteristic curve analysis demonstrated that the RV/LV diameter, LA/RA area and LA/RA short axis diameter ratios had comparable discriminative ability for higher PAOI tertiles. CONCLUSIONS: The higher the clot load in the pulmonary arteries, the smaller the LA area and the larger the RA area. Atrial area measurements by CTPA may serve as a real-time parameter in assessing the severity of PE upon diagnosis.

Pulmonary dysfunction in systemic lupus erythematosus and anti-phospholipid syndrome patients.

OBJECTIVE: To assess and compare parameters of pulmonary function in systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APS) patients. METHODS: Consecutive patients (n = 74) who were free of respiratory symptoms were divided into four groups: 1) SLE (n = 23); 2) SLE with anti-phospholipid antibodies (aPL) (n = 18); 3) SLE with APS (n = 20); and 4) primary APS (PAPS) (n = 13). Pulmonary function testing, single breath diffusion capacity of carbon monoxide (DLCO/SB) and echocardiography studies were performed. Induced sputum cytology was analysed. RESULTS: Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and DLCO were significantly reduced in SLE compared to PAPS patients (p = 0.039; p = 0.017; p = 0.029, respectively). Elevated pulmonary arterial pressure was observed in two patients with SLE and aPL and in two with SLE and APS. Lymphocyte and eosinophil counts in induced sputum showed no significant differences; however, a trend towards lower CD4 counts in SLE vs. PAPS was noted (p = 0.086), while in patients with both SLE and APS, a low CD4/CD8 ratio was seen. Patients with APS were older than patients without APS (47.12+/-14.86 vs. 34.29+/-12.6, p = 0.0001), while SLE patients were younger than PAPS patients (38.19+/-14.68 vs. 48.53+/-13.97, p = 0.023). CONCLUSION: Abnormal pulmonary functions tests were detected frequently in asymptomatic patients with SLE or PAPS. Although SLE patients were younger, pulmonary function was significantly more impaired in SLE as compared to PAPS patients.

Circulating adiponectin concentrations in patients with congestive heart failure.

OBJECTIVES: To determine concentrations of adiponectin and its predictive value on outcome in a cohort of patients with congestive heart failure (CHF). METHODS: Serum and clinical data were obtained for outpatients with clinically controlled CHF (n = 175). Serum concentrations of adiponectin, C reactive protein, N-terminal pro-brain natriuretic peptide (NT-proBNP), interleukin (IL) -1beta, IL-6, IL-8, IL-10, IL-12, tumour necrosis factor alpha and CD-40 ligand were determined. The association of adiponectin with the clinical severity of CHF was sought as well as the predictive value of this adipokine on mortality, CHF hospitalisations or the occurrence of each of these end points. RESULTS: Concentrations of adiponectin were significantly increased in patients with CHF. Patients with higher New York Heart Association class had significantly higher serum concentrations of adiponectin. Adiponectin serum concentrations were lower in patients with diabetes and CHF as well as in patients with ischaemic cardiomyopathy. Serum adiponectin concentration was positively associated with age and NT-proBNP but was negatively correlated with C reactive protein concentrations. Serum adiponectin above the 75th centile was found to be an independent predictor of total mortality, CHF hospitalisations or a composite of these end points over a two-year prospective follow up. CONCLUSION: Adiponectin is increased in CHF patients and predicts mortality and morbidity.

Overexpression of 15-lipoxygenase in the vascular endothelium is associated with increased thymic apoptosis in LDL receptor-deficient mice.

BACKGROUND: 15-Lipoxygenase (15-LO) is a nonheme iron-containing enzyme that catalyzes the peroxidation of fatty acids. Herein, we studied the effect of 15-LO overexpression in the vascular endothelium on thymocyte apoptosis by evaluating thymuses from low-density lipoprotein receptor-deficient (LDL-RD) mice and LDL-RD/15-LO mice. Thymuses were evaluated by immunohistochemistry and by TUNEL whereas in vitro studies were carried out by employing freshly isolated thymocytes from the respective mice and evaluation of apoptosis by propidium iodide and annexin V cytometry. METHODS AND RESULTS: The apoptotic index in LDL-RD/15-LO mice was significantly higher than in the LDL-RD mice. In the thymic medulla the difference was smaller, although still significant. Freshly isolated thymus cells from LDL-RD/15-LO mice exhibited a higher rate of spontaneous cell death than controls. Incubation of thymus cells in the presence of the cell-permeable caspase-3 inhibitor DEVD-CMK resulted in a decrease in the frequency of apoptotic cells in LDL-RD/15-LO thymocytes, whereas no effect was evident in control thymocytes. The antioxidant N-acetylcysteine causes the increase in apoptosis in both groups. CONCLUSION: LDL-RD/15-LO mice exhibit increased thymocyte apoptosis both in vivo and in vitro. These findings may suggest a role for 15-LO in the natural selection of thymocytes.

[The effect of spouse participation in cardiac rehabilitation program on patients' compliance and exercise level].

BACKGROUND: Exercise-based cardiac rehabilitation programs have proven to be associated with decreased morbidity and mortality after cardiac events. Unfortunately, attendance is often poor, and long term compliance is low. This study examined the effect of the active participation of spouses in the exercise program on the compliance and physical fitness level of their partners. METHODS: During the years 1998-2001, 24 couples joined our cardiac rehabilitation program. The couples were divided into 2 groups on the basis of their medical status. In Group 1--Rehabilitation program (n = 14); one of the couple had suffered a myocardial infraction or underwent a coronary bypass surgery at least 3 weeks before starting the program. In Group 2--secondary prevention (n = 10); one of the couple had a medical history of cardiac disease. The third Group included the spouse. Each group was compared with a matched control group based on their medical condition. The parameters that were measured were: the number of sessions attended, basic and final physical training level. RESULTS: In the rehabilitation groups, the participants attended a larger number of sessions (87.3 + 17) compared to control (47.7 + 6) (p < 0.05). There was no difference in the basic training level between the groups (3.5 + 0.2 METS; compared with 3.4 + 0.2 METS) (P = 0.5) and both groups had similarly improved their training level by 0.79 + 0.1 METS compared with 0.6 + 0.1 METS in the control group (p = 0.2). In the secondary preventive groups, the control group attended a larger number of sessions (51 + 13 compared with 31.2 + 6 sessions) (p < 0.02). There was no difference in the basic training level between groups 3.7 + 0.3 METS compared with 4.2 + 0.2 in the control group (p = 0.2). However, at the end of the training period, the control group showed greater improvement in their training level by 0.7 + 0.2 METS compared to 0.3 + 0.1 METS (p < 0.05). The spouses themselves had attended a greater number of sessions (45 + 10 compared with 37 + 6 in the control group) (p = 0.2). There was no difference between those groups in the training level at baseline and at the end of training period. CONCLUSION: Active support during the rehabilitation program may improve the rates of participation but in the secondary prevention program active spouse support may encourage early dropout.

Correction of anemia in patients with congestive heart failure increases resting energy expenditure.

BACKGROUND & AIM: Congestive heart failure (CHF) and anemia were reported to affect resting energy expenditure (REE). The aim of this study was to evaluate the effect of the correction of anemia on REE in subjects with CHF. PATIENTS AND METHODS: Nine anemic patients with compensated CHF and CRF were studied before and after correction of anemia. REE was studied by an open circuit indirect calorimeter, body composition by dual-energy-X-ray absorption and total body and extracellular water by multi-frequency bioelectrical impedence. Four anemic and 5 non-anemic CHF patients who did not receive any new treatment served as controls. RESULTS: After the correction of their anemia patients tended to increase weight (P<0.06), but no significant changes were observed in body composition. Daily caloric intake increased significantly (P<0.02). Ejection fraction increased (P<0.05) and pulse rate decreased significantly (P<0.001). REE and REEPP were in the normal range before correction but increased significantly afterwards (1402+/-256 vs. 1496+/-206 kcal/d, and 101+/-9 vs. 109+/-8, P<0.023 and P<0.006, respectively). CONCLUSION: Correction of anemia in patients with CHF increases their REE. This can be related either to improved tissue oxygenation and/or to increased caloric intake.