Validation of the society of thoracic surgeons predicted risk of mortality score for long-term survival after cardiac surgery in Israel.

BACKGROUND: Long-term survival is an important metric in assessing procedural value. We previously confirmed that the Society of Thoracic Surgeons predicted risk of mortality score (PROM) accurately predicts 30-day mortality in Israeli patients. The present study investigated the ability of the PROM to reliably predict long-term survival. METHODS: Data on 1279 patients undergoing cardiac surgery were prospectively entered into our database and used to calculate PROM. Long-term mortality was obtained from the Israeli Social Security Database. Patients were stratified into five cohorts according to PROM (A: 0-0.99%, B: 1.0-1.99%, C: 2.0-2.99%, D: 3.0-4.99% and E: ≥ 5.0%). Kaplan-Meier estimates of survival were calculated for each cohort and compared by Wilcoxon signed-rank test. We used C-statistics to assess model discrimination. Cox regression analysis was performed to identify predictors of long-term survival. RESULTS: Follow-up was achieved for 1256 (98%) patients over a mean period of 62 ± 28 months (median 64, range 0-107). Mean survival of the entire cohort was 95 ± 1 (95% CI 93-96) months. Higher PROM was associated with reduced survival: A-104 ± 1 (103-105) months, B-96 ± 2 (93-99) months, C-93 ± 3 (88-98) months, D-89 ± 3 (84-94) months, E-74 ± 3 (68-80) months (p < 0.0001). The Area Under the Curve was 0.76 ± 0.02 indicating excellent model discrimination. Independent predictors of long-term mortality included advanced age, lower ejection fraction, reoperation, diabetes mellitus, dialysis and PROM. CONCLUSIONS: The PROM was a reliable predictor of long-term survival in Israeli patients undergoing cardiac surgery. The PROM might be a useful metric for assessing procedural value and surgical decision-making.

Ogre-Faced, Net-Casting Spiders Use Auditory Cues to Detect Airborne Prey.

Prey capture behavior among spiders varies greatly from passive entrapment in webs to running down prey items on foot. Somewhere in the middle are the ogre-faced, net-casting spiders [1] (Deinopidae: Deinopis) that actively capture prey while being suspended within a frame web [2-5]. Using a net held between their front four legs, these spiders lunge downward to ensnare prey from off the ground beneath them. This "forward strike" is sensorially mediated by a massive pair of hypersensitive, night-vision eyes [5-7]. Deinopids can also intercept flying insects with a "backward strike," a ballistically rapid, overhead back-twist, that seems not to rely on visual cues [4, 5, 8]. Past reports have hypothesized a role of acoustic detection in backward strike behavior [4, 5, 8]. Here, we report that the net-casting spider, Deinopis spinosa, can detect auditory stimuli from at least 2 m from the sound source, at or above 60 dB SPL, and that this acoustic sensitivity is sufficient to trigger backward strike behavior. We present neurophysiological recordings in response to acoustic stimulation, both from sound-sensitive areas in the brain and isolated forelegs, which demonstrate a broad range of auditory sensitivity (100-10,000 Hz). Moreover, we conducted behavioral assays of acoustic stimulation that confirm acoustic triggering of backward net-casting by frequencies in harmony with flight tones of known prey. However, acoustic stimulation using higher frequency sounds did not elicit predatory responses in D. spinosa. We hypothesize higher frequencies are emitted by avian predators and that detecting these auditory cues may aid in anti-predator behavior. VIDEO ABSTRACT.

The Long and Short of Hearing in the Mosquito Aedes aegypti.

Mating behavior in Aedes aegypti mosquitoes occurs mid-air and involves the exchange of auditory signals at close range (millimeters to centimeters) [1-6]. It is widely assumed that this intimate signaling distance reflects short-range auditory sensitivity of their antennal hearing organs to faint flight tones [7, 8]. To the contrary, we show here that male mosquitoes can hear the female's flight tone at surprisingly long distances-from several meters to up to 10 m-and that unrestrained, resting Ae. aegypti males leap off their perches and take flight when they hear female flight tones. Moreover, auditory sensitivity tests of Ae. aegypti's hearing organ, made from neurophysiological recordings of the auditory nerve in response to pure-tone stimuli played from a loudspeaker, support the behavioral experiments. This demonstration of long-range hearing in mosquitoes overturns the common assumption that the thread-like antennal hearing organs of tiny insects are strictly close-range ears. The effective range of a hearing organ depends ultimately on its sensitivity [9-13]. Here, a mosquito's antennal ear is shown to be sensitive to sound levels down to 31 dB sound pressure level (SPL), translating to air particle velocity at nanometer dimensions. We note that the peak of energy of the first formant of the vowels of the human speech spectrum range from about 200-1,000 Hz and is typically spoken at 45-70 dB SPL; together, they lie in the sweet spot of mosquito hearing. VIDEO ABSTRACT.

Perceptual interaction of local motion signals.

Motion signals are a rich source of information used in many everyday tasks, such as segregation of objects from background and navigation. Motion analysis by biological systems is generally considered to consist of two stages: extraction of local motion signals followed by spatial integration. Studies using synthetic stimuli show that there are many kinds and subtypes of local motion signals. When presented in isolation, these stimuli elicit behavioral and neurophysiological responses in a wide range of species, from insects to mammals. However, these mathematically-distinct varieties of local motion signals typically co-exist in natural scenes. This study focuses on interactions between two kinds of local motion signals: Fourier and glider. Fourier signals are typically associated with translation, while glider signals occur when an object approaches or recedes. Here, using a novel class of synthetic stimuli, we ask how distinct kinds of local motion signals interact and whether context influences sensitivity to Fourier motion. We report that local motion signals of different types interact at the perceptual level, and that this interaction can include subthreshold summation and, in some subjects, subtle context-dependent changes in sensitivity. We discuss the implications of these observations, and the factors that may underlie them.

Airborne Acoustic Perception by a Jumping Spider.

Jumping spiders (Salticidae) are famous for their visually driven behaviors [1]. Here, however, we present behavioral and neurophysiological evidence that these animals also perceive and respond to airborne acoustic stimuli, even when the distance between the animal and the sound source is relatively large (∼3 m) and with stimulus amplitudes at the position of the spider of ∼65 dB sound pressure level (SPL). Behavioral experiments with the jumping spider Phidippus audax reveal that these animals respond to low-frequency sounds (80 Hz; 65 dB SPL) by freezing-a common anti-predatory behavior characteristic of an acoustic startle response. Neurophysiological recordings from auditory-sensitive neural units in the brains of these jumping spiders showed responses to low-frequency tones (80 Hz at ∼65 dB SPL)-recordings that also represent the first record of acoustically responsive neural units in the jumping spider brain. Responses persisted even when the distances between spider and stimulus source exceeded 3 m and under anechoic conditions. Thus, these spiders appear able to detect airborne sound at distances in the acoustic far-field region, beyond the near-field range often thought to bound acoustic perception in arthropods that lack tympanic ears (e.g., spiders) [2]. Furthermore, direct mechanical stimulation of hairs on the patella of the foreleg was sufficient to generate responses in neural units that also responded to airborne acoustic stimuli-evidence that these hairs likely play a role in the detection of acoustic cues. We suggest that these auditory responses enable the detection of predators and facilitate an acoustic startle response. VIDEO ABSTRACT.

Supplementation of krill oil with high phospholipid content increases sum of EPA and DHA in erythrocytes compared with low phospholipid krill oil.

BACKGROUND: Bioavailability of krill oil has been suggested to be higher than fish oil as much of the EPA and DHA in krill oil are bound to phospholipids (PL). Hence, PL content in krill oil might play an important role in incorporation of n-3 PUFA into the RBC, conferring properties that render it effective in reducing cardiovascular disease (CVD) risk. The objective of the present trial was to test the effect of different amounts of PL in krill oil on the bioavailability of EPA and DHA, assessed as the rate of increase of n-3 PUFA in plasma and RBC, in healthy volunteers. METHODS AND DESIGN: In a semi randomized crossover single blind design study, 20 healthy participants consumed various oils consisting of 1.5 g/day of low PL krill oil (LPL), 3 g/day of high PL krill oil (HPL) or 3 g/day of a placebo, corn oil, for 4 weeks each separated by 8 week washout periods. Both LPL and HPL delivered 600 mg of total n-3 PUFA/day along with 600 and 1200 mg/day of PL, respectively. RESULTS: Changes in plasma EPA, DPA, DHA, total n-3 PUFA, n-6:n-3 ratio and EPA + DHA concentrations between LPL and HPL krill oil supplementations were observed to be similar. Intake of both forms of krill oils increased the RBC level of EPA (p < 0.001) along with reduced n-6 PUFA (LPL: p < 0.001: HPL: p = 0.007) compared to control. HPL consumption increased (p < 0.001) RBC concentrations of EPA, DPA, total and n-3 PUFA compared with LPL. Furthermore, although LPL did not alter RBC n-6:n-3 ratio or the sum of EPA and DHA compared to control, HPL intake decreased (p < 0.001) n-6:n-3 ratio relative to control with elevated (p < 0.001) sum of EPA and DHA compared to control as well as to LPL krill oil consumption. HPL krill oil intake elevated (p < 0.005) plasma total and LDL cholesterol concentrations compared to control, while LPL krill oil did not alter total and LDL cholesterol, relative to control. CONCLUSIONS: The results indicate that krill oil with higher PL levels could lead to enhanced bioavailability of n-3 PUFA compared to krill oil with lower PL levels. TRIAL REGISTRATION: Clinicaltrials.gov# NCT01323036.

Sub-chronic (13-week) oral toxicity study, preceded by an in utero exposure phase and genotoxicity studies with fish source phosphatidylserine in rats.

The safety of fish phosphatidylserine (PS) conjugated to DHA (InCog™) was examined in a series of toxicology studies as first step to support future use in infants and general population using in vitro genotoxicity tests and in a sub-chronic toxicity study with an in-utero exposure phase. PS is a major lipid in the cell membrane, active in various membrane-mediated processes. PS-DHA, present in human milk, has been suggested to be important for early brain development. Rats were exposed to diets containing 1.5%, 3% or 4.5% InCog or two control diets. Parental (F0) animals were fed throughout mating, gestation and lactation. Subsequently, a subchronic, 13-week study was conducted on the F1 animals followed by 4 weeks of recovery. The genotoxicity tests showed no mutagenicity potential. No significant toxicological findings were found in the F0 rats or the F1 pups. In the 13-weeks study, an increase in the presence of renal minimal-mild multifocal corticomedullary mineralization was noted in nine females of the high-dose group. This change was not associated with any inflammatory or degenerative changes in the kidneys. The no-observed-adverse-effect level (NOAEL) in the present study was placed at 3% in the diet (mid-dose group), equivalent to an overall intake of at least 2.1 g InCog/kg bw/day in the F1 generation.

Visual perception in the brain of a jumping spider.

Jumping spiders (Salticidae) are renowned for a behavioral repertoire that can seem more vertebrate, or even mammalian, than spider-like in character. This is made possible by a unique visual system that supports their stalking hunting style and elaborate mating rituals in which the bizarrely marked and colored appendages of males highlight their song-and-dance displays. Salticids perform these tasks with information from four pairs of functionally specialized eyes, providing a near 360° field of view and forward-looking spatial resolution surpassing that of all insects and even some mammals, processed by a brain roughly the size of a poppy seed. Salticid behavior, evolution, and ecology are well documented, but attempts to study the neurophysiological basis of their behavior had been thwarted by the pressurized nature of their internal body fluids, making typical physiological techniques infeasible and restricting all previous neural work in salticids to a few recordings from the eyes. We report the first survey of neurophysiological recordings from the brain of a jumping spider, Phidippus audax (Salticidae). The data include single-unit recordings in response to artificial and naturalistic visual stimuli. The salticid visual system is unique in that high-acuity and motion vision are processed by different pairs of eyes. We found nonlinear interactions between the principal and secondary eyes, which can be inferred from the emergence of spatiotemporal receptive fields. Ecologically relevant images, including prey-like objects such as flies, elicited bursts of excitation from single units.

The statistics of local motion signals in naturalistic movies.

Extraction of motion from visual input plays an important role in many visual tasks, such as separation of figure from ground and navigation through space. Several kinds of local motion signals have been distinguished based on mathematical and computational considerations (e.g., motion based on spatiotemporal correlation of luminance, and motion based on spatiotemporal correlation of flicker), but little is known about the prevalence of these different kinds of signals in the real world. To address this question, we first note that different kinds of local motion signals (e.g., Fourier, non-Fourier, and glider) are characterized by second- and higher-order correlations in slanted spatiotemporal regions. The prevalence of local motion signals in natural scenes can thus be estimated by measuring the extent to which each of these correlations are present in space-time patches and whether they are coherent across spatiotemporal scales. We apply this technique to several popular movies. The results show that all three kinds of local motion signals are present in natural movies. While the balance of the different kinds of motion signals varies from segment to segment during the course of each movie, the overall pattern of prevalence of the different kinds of motion and their subtypes, and the correlations between them, is strikingly similar across movies (but is absent from white noise movies). In sum, naturalistic movies contain a diversity of local motion signals that occur with a consistent prevalence and pattern of covariation, indicating a substantial regularity of their high-order spatiotemporal image statistics.

Anaphylactic shock due to rupture of a hepatic hydatid cyst into a pericystic blood vessel following blunt abdominal trauma.

Partial drainage of a hepatic hydatid cyst into a pericystic blood vessel caused anaphylactic shock following minimal blunt abdominal trauma in a child. A case report including diagnostic procedures and treatment is presented.

Foreign body removal through an appendicostomy.

The removal of button cell batteries or small coins impacted in the terminal ileum or right colon through an appendicostomy is described. This technique was used effectively in three patients.

[Spermatic cord hematoma simulating torsion of testis in Henoch-Schönlein syndrome].

Henoch-Schönlein syndrome (HSS) is a systemic disease of young children characterized by colicky pain, with melena, vomiting and damage to the joints, kidneys and other organs. Surgical problems involving the gastrointestinal tract include bleeding, intussusception and perforation. Uncommon complications, caused by bleeding into brain tissue and into the scalp, muscles, chest and scrotum, are real challenges for the physician. Spermatic cord hematoma is a rare complication of HSS. Other complications of HSS mentioned in the literature which affect the male genital system include edema of the spermatic cord or testis, epididymitis, orchitis, bleeding, Morgagni cyst, or hematoma surrounding the testis. Considering the low incidence of testicular torsion in HSS, we believe that when a patient with HSS develops acute testicular pain, noninvasive diagnostic procedures such as Doppler, ultrasound and radioisotope scans should be performed in the hope of avoiding unnecessary surgical interventions. A 2-year-old boy with HSS in whom torsion of the testis developed is reported.