An adaptive teosinte mexicana introgression modulates phosphatidylcholine levels and is associated with maize flowering time.

Native Americans domesticated maize (Zea mays ssp. mays) from lowland teosinte parviglumis (Zea mays ssp. parviglumis) in the warm Mexican southwest and brought it to the highlands of Mexico and South America where it was exposed to lower temperatures that imposed strong selection on flowering time. Phospholipids are important metabolites in plant responses to low-temperature and phosphorus availability and have been suggested to influence flowering time. Here, we combined linkage mapping with genome scans to identify High PhosphatidylCholine 1 (HPC1), a gene that encodes a phospholipase A1 enzyme, as a major driver of phospholipid variation in highland maize. Common garden experiments demonstrated strong genotype-by-environment interactions associated with variation at HPC1, with the highland HPC1 allele leading to higher fitness in highlands, possibly by hastening flowering. The highland maize HPC1 variant resulted in impaired function of the encoded protein due to a polymorphism in a highly conserved sequence. A meta-analysis across HPC1 orthologs indicated a strong association between the identity of the amino acid at this position and optimal growth in prokaryotes. Mutagenesis of HPC1 via genome editing validated its role in regulating phospholipid metabolism. Finally, we showed that the highland HPC1 allele entered cultivated maize by introgression from the wild highland teosinte Zea mays ssp. mexicana and has been maintained in maize breeding lines from the Northern United States, Canada, and Europe. Thus, HPC1 introgressed from teosinte mexicana underlies a large metabolic QTL that modulates phosphatidylcholine levels and has an adaptive effect at least in part via induction of early flowering time.

Prognostic implications of troponin I elevation in emergency department patients with tachyarrhythmia.

BACKGROUND: Tachyarrhythmias are very common in emergency medicine, and little is known about the long-term prognostic implications of troponin I levels in these patients. HYPOTHESIS: This study aimed to investigate the correlation of cardiac troponin I (cTnI) levels and long-term prognosis in patients admitted to the emergency department (ED) with a primary diagnosis of tachyarrhythmia. METHODS: A retrospective cohort study was conducted between January 2012 and December 2013, enrolling patients admitted to the ED with a primary diagnosis of tachyarrhythmia and having documented cTnI measurements. Clinical characteristics and 5-year all-cause mortality were analyzed. RESULTS: Of a total of 222 subjects with a primary diagnosis of tachyarrhythmia, 73 patients had elevated levels of cTnI (32.9%). Patients with elevated cTnI levels were older and presented significantly more cardiovascular risk factors. At the 5-year follow-up, mortality was higher among patients with elevated cTnI levels (log-rank test P < 0.001). In the multivariable Cox regression analysis, elevated cTnI was an independent predictor of all-cause death (hazard ratio, 1.95, 95% confidence interval: 1.08-3.50, P = 0.026), in addition to age and prior heart failure. CONCLUSION: Patients admitted to the ED with a primary diagnosis of tachyarrhythmia and high cTnI levels have higher long-term mortality rates than patients with low cTnI levels. cTnI is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of this population.

Clinical Features and Prognosis of Patients with Acute and Chronic Myocardial Injury Admitted to the Emergency Department.

BACKGROUND: This study aimed to investigate the clinical features and prognosis of acute and chronic myocardial injury without clinical evidence of myocardial infarction in patients admitted to the emergency department. METHODS: We analyzed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 who had at least 2 determinations of troponin I (TnI Ultra Siemens, Advia Centaur) and without a diagnosis of myocardial infarction. Clinical events were evaluated in a 3-year follow-up. RESULTS: A total of 1201 patients met the study's inclusion criteria and were included in the analysis (833 with cTnI below the 99th percentile, 261 with acute myocardial injury, and 107 with chronic myocardial injury). During a median follow-up of more than 36 months, mortality and rehospitalization for heart failure were significantly higher in patients with acute or chronic myocardial injury compared with patients without myocardial injury. No differences were observed in overall mortality between patients with acute and chronic myocardial injury, or in the rate of readmission due to acute coronary syndrome. However, the risk of readmission due to heart failure (adjusted HR 2.17; 95% confidence interval, 1.26-3.75; P = .005) was higher in patients with chronic myocardial injury. CONCLUSIONS: Mortality in long-term follow-up is high and similar in acute and chronic myocardial injury; however, the risk of readmission due to heart failure is higher in patients with chronic myocardial injury compared with patients with acute myocardial injury.

Cooking breakfast after a brain injury.

Acquired brain injury (ABI) often compromises the ability to carry out instrumental activities of daily living such as cooking. ABI patients' difficulties with executive functions and memory result in less independent and efficient meal preparation. Accurately assessing safety and proficiency in cooking is essential for successful community reintegration following ABI, but in vivo assessment of cooking by clinicians is time-consuming, costly, and difficult to standardize. Accordingly, we examined the usefulness of a computerized meal preparation task (the Breakfast Task; Craik and Bialystok, 2006) as an indicator of real life meal preparation skills. Twenty-two ABI patients and 22 age-matched controls completed the Breakfast Task. Patients also completed the Rehabilitation Activities of Daily Living Survey (RADLS; Salmon, 2003) and prepared actual meals that were rated by members of the clinical team. As expected, the ABI patients had significant difficulty on all aspects of the Breakfast Task (failing to have all their foods ready at the same time, over- and under-cooking foods, setting fewer places at the table, and so on) relative to controls. Surprisingly, however, patients' Breakfast Task performance was not correlated with their in vivo meal preparation. These results indicate caution when endeavoring to replace traditional evaluation methods with computerized tasks for the sake of expediency.

Ventilatory support in critically ill hematology patients with respiratory failure.

INTRODUCTION: Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Noninvasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks. METHODS: To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicenter, observational study were analyzed. All hematology patients admitted to one of the 34 participating ICUs in a 17-month period were followed up. Data on demographics, diagnosis, severity, organ failure, and supportive therapies were recorded. A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure. RESULTS: Of 450 patients, 300 required ventilatory support. A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival, whereas APACHE II score, allogeneic transplantation, and NIMV failure increased the risk of death. The risk factors associated with NIMV success were age, congestive heart failure, and bacteremia. Patients with NIMV failure experienced a more severe respiratory impairment than did those electively intubated. CONCLUSIONS: NIMV improves the outcome of hematology patients with respiratory insufficiency, but NIMV failure may have the opposite effect. A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success.

Características epidemiológicas, clínicas y supervivencia de pacientes con diagnóstico de pénfigo atendidos en el Hospital Regional Docente de Trujillo. Período 1994-2006 / Clinical and pathological characteristic and survival of patients with diagnosis of pemphigus attended at Hospital Regional Docente de Trujillo 1994-2006

Objetivo. Determinar las características epidemiológicas, clínicas y supervivencia de los pacientes con diagnóstico de pénfigo atendidos en el Hospital Regional Docente de Trujillo (HRDT) durante el período 1994-2006. Material y métodos. Estudio longitudinal. La población estuvo constituida por pacientes con diagnóstico clínico y/o histopatológico de pénfigo atendidos en el HRDT durante el período 1994-2006. Los pacientes fueron entrevistados a través de una visita domiciliaria o mediante vía telefónica obteniéndose su edad, sexo, procedencia, ocupación, tipo de pénfigo, recaídas, tratamiento farmacológico, inicio y tiempo tratamiento. La supervivencia fue estimada utilizando el método Kaplan-Meier; mientras que para comparar las curvas de supervivencia se empleó la prueba de log-rank. Resultados. Se entrevistó en total a 33pacientes. La supervivencia global estimada a intervalos de 2, 4, 6, 8, 10 y más de 10 años tras el diagnóstico de pénfigo fué de 100,0%, 93,9%, 80,6%, 76,0%, 68,4% y 61,5%, respectivamente. La prueba de log-rank mostró que la supervivencia fue significativamente mayor en los grupos de edad de 30 a 49 años y de 50 a 69 años (p < 0,001) así como en los pacientes que iniciaron tratamiento antes de los 6 meses de enfermedad (p < 0,001). No se observó diferencias significativas entre géneros, procedencia, tipo de pénfigo, tratamiento y tiempo de tratamiento. Conclusiones. La supervivencia de los pacientescon pénfigo del HRDT a los 10 años de enfermedad fue del 68.4% siendo significativamente mayor en los grupos de edad de30 a 49 años y de 50 a 69 años como en los que iniciaron tratamiento antes de los seis meses de enfermedad.

Objective. Determine the clinical and pathological characteristic of patients with diagnosis of pemphigus attended at Hospital Regional Docente de Trujillo (HRDT) during the period 1994-2006. Material and Methods. Longitudinal study. Population was patients with clinical and/or histopathological diagnosis of pemphigus attended in the HRDT. Patients were interviewed in a home visit or by telephone, obtaining dates as age, gender, origin, occupation, type of pemphigus, relapse, pharmacological treatment, beginning and time of treatment. Survival was estimated using the Kaplan-Meier method; while the log-rank test was used for compraing the survival curves. Results. 33 patients were interviewed. The total survival estimated in intervals of 2, 4, 6, 8,10 and more than 10 years after the diagnosis of pemphigus was 100,0%, 93,9%, 80,6%, 76,0%, 68,4% and 61,5% , respectively. The log-rank test showed that the survival was significantly more in the groups aged between 30- 49 year old and in 50-69 year old(p < 0,001) as well as in patients that began their treatment beforethe 6 months of disease (p > 0,001). Significantly differences between gender, origin, type of pemphigus, treatment and time of treatment there were no found. Conclusions. Survival of patients with pemphigus at HRDT at 10 years of disease was 68,4%, being significantly more in the groups of ages between 30-49 years and 50-69 years; as well as in patients that began their treatment before the 6 months of disease.

Comportamiento clínico y radiológico en un brote de histoplasmosis en soldados del ejército de Nicaragua, R.A.A.N. atendidos en el Hospital Militar Escuela Alejandro Dávila Bolaños (H.M.E.AD.B) febrero del 2003 / Clinical and radiological behavior in an outbreak of histoplasmosis in soldiers of the army of Nicaragua, R.A.A.N. attended in the Military Hospital School Alejandro Dávila Bolaños (H.M.E.AD.B) February of the 2003

Se realizó un estudio de tipo descriptivo tranversal, en el H.M.A.D.B. durante febrero del 2003 con el objetivo de determinar el comportamiento de un brote histoplasmosis