Treating hemodialysis access thrombosis with the InThrill Thrombectomy System: Technique and case report.

The purpose of this report is to describe via a case example an efficient mechanical thrombectomy technique for hemodialysis access thrombosis using the InThrill Thrombectomy System (Inari Medical, Irvine, CA). A man in his late 60s with end-stage renal disease and a thrombosed femoral arteriovenous graft (AVG) underwent a thrombectomy procedure to remove all thrombotic material including the arterial plug and restore use of the graft for hemodialysis. The InThrill Thrombectomy System used in this procedure consists of a mechanical thrombectomy catheter with a wall-apposing coring element and a sheath with a retractable funnel and aspiration port. The technique starts with gaining wire and sheath access towards the venous outflow. The InThrill Thrombectomy catheter is deployed proximal to the sheath to sequentially remove small segments of thrombus thus avoiding sheath obstruction. A locking syringe is used for rapid aspiration, reducing or eliminating the need to remove the InThrill sheath with every mechanical thrombectomy pass. Finally, the arterial plug is pulled using a Fogarty balloon sheath (Edwards Lifesciences, Irvine, CA) and extracted using the InThrill catheter, removing what may be the nidus for recurrent AV access thrombosis. The technique described here provided a means to remove all thrombotic material including the arterial plug in a planned, sequential manner, without the need for thrombolytics. Patency was restored to the patient's femoral AVG within 60 minutes, and hemodialysis resumed shortly thereafter. Further studies are needed to support long-term efficacy of this thrombolytic-free treatment option.

Nocardia australiensis sp. nov. and Nocardia spumae sp. nov., isolated from sea foam in Queensland, Australia.

Strains USC-21046T and USC-21048T were isolated from foaming coastal marine waters on the Sunshine Coast, Queensland, Australia. Both strains displayed growth and morphological characteristics typical for members belonging to the genus Nocardia. The major polar lipids were diphosphatidylglycerol and phosphatidylethanolamine, and the major fatty acids were C16 : 0, C18 : 1 ω9c, C18 : 0 and C18 : 0 10-methyl. The mycolic acids of strains USC-21046T and USC-21048T consisted of chain lengths between 50-64 and 56-68, respectively. Moreover, both of those strains contained meso-diaminopimelic acid and ribose, arabinose, glucose and galactose as whole cell sugars. Based on the phylogenomic results, both strains belonged to the genus Nocardia with strain USC-21046T showing an 80.4 % genome similarity to N. vinacea NBRC 16497T and N. pseudovaccinii NBRC 100343T, whereas USC-21048T strain showed an 83.6 % genome similarity to N. aobensis NBRC 100429T. Both strains were delineated from their closely related relatives based on physiological (e.g. growth on sole carbon source) and chemotaxonomic (e.g. cellular fatty composition) differences. The digital DNA-DNA hybridization (dDDH) values between USC-21046T and USC-21048T and their closely related relatives were below the dDDH threshold value of ≤70 % used for the taxonomic classification of novel species status. The genome length of strains USC-21046T and USC-21048T were 6 878 863 and 7 066 978 bp, with G+C contents of 65.2 and 67.8 mol%, respectively. For the novel isolates, we propose the names Nocardia australiensis sp. nov. with the type strain USC-21046T (=DSM 111727T=NCCB 100867T) and Nocardia spumae sp. nov. with the type strain USC-21048T (=DSM 111726T=NCCB 100868T).

Isolation and Characterization of Nocardiae Associated with Foaming Coastal Marine Waters.

Nocardiosis is an infectious disease caused by Nocardia species that occurs worldwide, albeit more prevalently in tropical/subtropical regions. It can appear as either acute, subacute or as a chronic infection mostly with those with a compromised/weakened immune system. Inhalation of spores and or mycelium fragments is the main transmission route for developing pulmonary nocardiosis. In contrast, cutaneous nocardiosis usually occurs via direct contact. In the subtropical region of the Sunshine Coast in Australia foaming events with thick and persistent and orange-brown color foam have been observed during summer seasons in the near shore marine environments. This study reports the existence of nocardiae in these near shore marine environments by the use of a novel isolation method which used the gas requirements of nocardiae as a selective battery. A total of 32 nocardiae were isolated with the use of this novel method and subsequently conducted molecular identification methods confirmed that the isolates belonged to the genus Nocardia. Twenty-one isolates out of the 32 were closely related to N. nova strains MGA115 and one was related to CBU 09/875, in addition when compared with human pathogenic nocardiae twenty of the isolates were found to be related to N. nova strain JCM 6044. Isolates displayed varied resistance against some of the antibiotics tested when interpretation threshold recommended the Comite de L'Antibiogramme de la Societe Francaise de Microbiologie were used. The highest level of resistance against cefotaxime (n = 27) and ceftriaxone (n = 24). Some of the isolates (n = 6) that displayed resistance to selected antibiotics also possessed potential human pathogenic characteristics such as adherence and translocation through human long epithelial cells as well as displaying phage resistance (n = 26). They might thus present a potential public health risk if frequently encountered through exposure to aerosols generated by the foam as well as direct contact through a wound. Preventative measures to control the growth of nocardiae in such environments such as the control of pollutants, might prevent potential infections that might be caused by these bacteria in humans as well as in marine animals.

All tears are crocodile tears: Impaired perception of emotion authenticity in psychopathic traits.

In everyday life, other peoples' distress is sometimes genuine (e.g., real sadness) and sometimes pretended (e.g., feigned sadness aimed at manipulating others). Here, we present the first study of how psychopathic traits affect responses to genuine versus posed distress. Using facial expression stimuli and testing individual differences across the general population (N = 140), we focus on the affective features of psychopathy (e.g., callousness, poor empathy, shallow affect). Results show that although individuals low on affective psychopathy report greater arousal and intent to help toward faces displaying genuine relative to posed distress, these differences weakened or disappeared with higher levels of affective psychopathy. Strikingly, a key theoretical prediction-that arousal should mediate the association between affective psychopathy and intent to help-was supported only for genuine distress and not for posed distress. A further novel finding was of reduced ability to discriminate the authenticity of distress expressions with higher affective psychopathy, which, in addition to and independently of arousal, also mediated the association between affective psychopathy and reduced prosociality. All effects were specific to distress emotions (did not extend to happiness, anger, or disgust), and to affective psychopathy (did not extend to Factor 2 psychopathy, disinhibition, or boldness). Overall, our findings are highly consistent with Blair's theorizing that atypical processing of distress emotions plays a key etiological role in the affective aspects of psychopathy. We go beyond these ideas to add novel evidence that unwillingness to help others is also associated with a failure to fully appreciate the authenticity of their distress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reduced willingness to approach genuine smilers in social anxiety explained by potential for social evaluation, not misperception of smile authenticity.

We investigate perception of, and responses to, facial expression authenticity for the first time in social anxiety, testing genuine and polite smiles. Experiment 1 (N = 141) found perception of smile authenticity was unaffected, but that approach ratings, which are known to be reduced in social anxiety for happy faces, are more strongly reduced for genuine than polite smiles. Moreover, we found an independent contribution of social anxiety to approach ratings, over and above general negative affect (state/trait anxiety, depression), only for genuine smiles, and not for polite ones. We argue this pattern of results can be explained by genuine smilers signalling greater potential for interaction - and thus greater potential for the scrutiny that is feared in social anxiety - than polite smiles. Experiment 2 established that, relative to polite smilers, genuine smilers are indeed perceived as friendlier and likely to want to talk for longer if approached. Critically, the degree to which individual face items were perceived as wanting to interact correlated strongly with the amount that social anxiety reduced willingness to approach in Experiment 1. We conclude it is the potential for social evaluation and scrutiny signalled by happy expressions, rather than their positive valence, that is important in social anxiety.

Screening for Transplant Renal Artery Stenosis: Ultrasound-Based Stenosis Probability Stratification.

OBJECTIVE: The objective of our study was to evaluate which spectral Doppler ultrasound parameters are useful in patients with clinical concern for transplant renal artery stenosis (TRAS) and create mathematically derived prediction models that are based on these parameters. MATERIALS AND METHODS: The study subjects included 120 patients with clinical signs of renal dysfunction who had undergone ultrasound followed by angiography (either digital subtraction angiography or MR angiography) between January 2005 and December 2015. Five ultrasound variables were evaluated: ratio of highest renal artery velocity to iliac artery velocity, highest renal artery velocity, spectral broadening, resistive indexes, and acceleration time. Angiographic studies were categorized as either showing no stenosis or showing stenosis. Reviewers assessed the ultrasound examinations for TRAS using all five variables, which we refer to as the full model, and using a reduced number of variables, which we refer to as the reduced-variable model; sensitivities and specificities were generated. RESULTS: Ninety-seven patients had stenosis and 23 had no stenosis. The full model had a sensitivity and specificity of 97% and 91%, respectively. The reduced-variable model excluded the ratio and resistive index variables without affecting sensitivity and specificity. We applied cutoff values to the variables in the reduced-variable model, which we refer to as the simple model. Using these cutoff values, the simple model showed a sensitivity and specificity of 96% and 83%. The simple model was able to categorize patients into four risk categories for TRAS: low, intermediate, high, and very high risk. CONCLUSION: We propose a simple model that is based on highest renal artery velocity, distal spectral broadening, and acceleration time to classify patients into risk categories for TRAS.

Perceived emotion genuineness: normative ratings for popular facial expression stimuli and the development of perceived-as-genuine and perceived-as-fake sets.

In everyday social interactions, people's facial expressions sometimes reflect genuine emotion (e.g., anger in response to a misbehaving child) and sometimes do not (e.g., smiling for a school photo). There is increasing theoretical interest in this distinction, but little is known about perceived emotion genuineness for existing facial expression databases. We present a new method for rating perceived genuineness using a neutral-midpoint scale (-7 = completely fake; 0 = don't know; +7 = completely genuine) that, unlike previous methods, provides data on both relative and absolute perceptions. Normative ratings from typically developing adults for five emotions (anger, disgust, fear, sadness, and happiness) provide three key contributions. First, the widely used Pictures of Facial Affect (PoFA; i.e., "the Ekman faces") and the Radboud Faces Database (RaFD) are typically perceived as not showing genuine emotion. Also, in the only published set for which the actual emotional states of the displayers are known (via self-report; the McLellan faces), percepts of emotion genuineness often do not match actual emotion genuineness. Second, we provide genuine/fake norms for 558 faces from several sources (PoFA, RaFD, KDEF, Gur, FacePlace, McLellan, News media), including a list of 143 stimuli that are event-elicited (rather than posed) and, congruently, perceived as reflecting genuine emotion. Third, using the norms we develop sets of perceived-as-genuine (from event-elicited sources) and perceived-as-fake (from posed sources) stimuli, matched on sex, viewpoint, eye-gaze direction, and rated intensity. We also outline the many types of research questions that these norms and stimulus sets could be used to answer.

Diagnosis and Management of Transplanted Kidney Extrarenal Pseudoaneurysms: A Series of Four Cases and a Review of the Literature.

Extrarenal pseudoaneurysms of transplanted kidneys are very rare but can have devastating consequences. In the past, these extrarenal pseudoaneurysms have often led to graft loss as well as significant morbidity and mortality. The role of advanced diagnostic imaging studies and of modern radiologic interventional management has not been studied. In this case series, we present four cases of extrarenal pseudoaneurysms of transplanted kidneys, describe the clinical scenarios and imaging that led to the angiographic diagnosis, and discuss the various endovascular and surgical approaches to management.

Occurrence and value of the color Doppler "line sign" after radiofrequency ablation of solid abdominal organs.

OBJECTIVES: The purposes of this study were to identify the frequency of the color "line sign" after track coagulation during electrode removal and to evaluate the usefulness of color Doppler sonography in predicting complications after radiofrequency ablation. METHODS: A total of 104 consecution radiofrequency ablations of either the liver (n = 68) or the kidney (n = 36) were evaluated for hemorrhagic complications by color Doppler sonography. All radiofrequency ablations were performed in a similar fashion, including track coagulation during electrode removal. Follow-up computed tomography of the organ of interest was performed within 24-hours after the procedure. RESULTS: The study included 32 patients with 36 renal radiofrequency ablations and 43 patients with 68 hepatic ablations. There were 1 arterial and 0 venous Doppler signals in the renal ablations and 2 arterial and 2 venous Doppler signals in the hepatic ablations. No major complications were observed, but a moderate hematoma occurred in 1 renal ablation. A statistically significant correlation was noted between the computed tomographic findings of hematomas and the presence of a color line sign (P = .048). We found a lower percentage of the color line sign compared to prior reports that identified this sign after biopsy of the liver or kidney. CONCLUSIONS: There is a decreased frequency of the color line sign and hemorrhagic complications after radiofrequency ablation compared to their rates of occurrence with core biopsy. Identification of the color line sign may be useful for predicting hemorrhagic complications.