Collective movement of schooling fish reduces the costs of locomotion in turbulent conditions.

The ecological and evolutionary benefits of energy-saving in collective behaviors are rooted in the physical principles and physiological mechanisms underpinning animal locomotion. We propose a turbulence sheltering hypothesis that collective movements of fish schools in turbulent flow can reduce the total energetic cost of locomotion by shielding individuals from the perturbation of chaotic turbulent eddies. We test this hypothesis by quantifying energetics and kinematics in schools of giant danio (Devario aequipinnatus) and compared that to solitary individuals swimming under laminar and turbulent conditions over a wide speed range. We discovered that, when swimming at high speeds and high turbulence levels, fish schools reduced their total energy expenditure (TEE, both aerobic and anaerobic energy) by 63% to 79% compared to solitary fish (e.g., 228 versus 48 kj kg-1). Solitary individuals spend approximately 22% more kinematic effort (tail beat amplitude•frequency: 1.7 versus 1.4 BL s-1) to swim in turbulence at higher speeds than in laminar conditions. Fish schools swimming in turbulence reduced their three-dimensional group volume by 41% to 68% (at higher speeds, approximately 103 versus 33 cm3) and did not alter their kinematic effort compared to laminar conditions. This substantial energy saving highlights that schooling behaviors can mitigate turbulent disturbances by sheltering fish (within schools) from the eddies of sufficient kinetic energy that can disrupt locomotor gaits. Therefore, providing a more desirable internal hydrodynamic environment could be one of the ecological drivers underlying collective behaviors in a dense fluid environment.

Limited Sustained Remission After Nucleos(t)ide Analog Withdrawal: Results From a Large, Global, Multiethnic Cohort of Patients With Chronic Hepatitis B (RETRACT-B Study).

INTRODUCTION: Complete viral suppression with nucleos(t)ide analogs (NAs) has led to a profound reduction in hepatocellular carcinoma and mortality among patients with chronic hepatitis B. Finite therapy yields higher rates of functional cure; however, initial hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) elevations are almost certain after treatment interruption. We aimed to analyze off-treatment outcomes beyond 12 months after NA cessation. METHODS: Patients with well-suppressed chronic hepatitis B who were hepatitis B e antigen-negative at NA cessation and remained off treatment without hepatitis B surface antigen (HBsAg) loss at 12 months were included (n = 945). HBV DNA and ALT fluctuations were allowed within the first 12 months. We used Kaplan-Meier methods to analyze outcomes beyond 12 months. Sustained remission was defined as HBV DNA <2,000 IU/mL and ALT <2× upper limit of normal (ULN) and an ALT flare as ALT ≥5× ULN. RESULTS: Cumulative probability of sustained remission was 29.7%, virological relapse was 65.2% with a mean peak HBV DNA of 5.0 ± 1.5 log 10 IU/mL, an ALT flare was 15.6% with a median peak ALT × ULN of 8.3 (5.7-11.3), HBsAg loss was 9.9% and retreatment was 34.9% at 48 months after NA cessation. A single occurrence of virological relapse or an ALT flare within the first 12 months off-treatment were associated with significantly lower rates of sustained remission beyond 12 months. DISCUSSION: Despite allowing for HBV DNA and ALT fluctuations within the first 12 months off-treatment, most patients without HBsAg loss did not maintain a sustained response thereafter. The best candidates for NA withdrawal are patients with low HBsAg levels at NA cessation, and those without profound or recurrent virological and biochemical relapses in the first off-treatment year.

Immunosuppression-Free Life after Pediatric Liver Transplant: A Case-Control Study from the Society of Pediatric Liver Transplant (SPLIT) Registry.

OBJECTIVE: To compare long-term outcomes of pediatric liver transplant (LT) recipients off immunosuppression (IS) with matched controls on IS using data from the Society of Pediatric Liver Transplant (SPLIT) registry. STUDY DESIGN: This was a retrospective case-control study. SPLIT participants <18 years of age, ≥4 years after isolated LT, and off IS for ≥1 year (cases) were age- and sex-matched 1:2 to patients with the same primary diagnosis and post-LT follow-up duration (controls). Primary outcomes included retransplantation, allograft rejection, IS comorbidities, and prevalence of SPLIT-derived composite ideal outcome (c-IO) achieved at the end of the follow-up period. Differences were compared using multiple linear regression for continuous outcomes and logistic regression for dichotomous data. RESULTS: The study cohort was composed of 33 cases (42.4% male, 60.6% biliary atresia, median age at LT of 0.7 [P25, P75, 0.5, 1.6] years, median IS withdrawal time of 9 [P25, P75, 6, 12] years after LT) and 66 age- and sex-matched controls. No cases required retransplantation. Cases and controls had similar growth parameters, laboratory values, calculated glomerular filtration rates, rates of post-transplant lymphoproliferative disease, graft rejection, and attainment of c-IO. CONCLUSIONS: No differences in allograft rejection rates, IS complications, or c-IO prevalence were seen between SPLIT patients off IS and age- and sex-matched controls remaining on IS. Discontinuation of IS most commonly occurred in the context of rigorously designed IS withdrawal trials. The available sample size was small, affecting generalizability to the broader pediatric LT population.

Impact of early immunosuppression on pediatric liver transplant outcomes within 1 year.

OBJECTIVES: The Starzl Network for Excellence in Pediatric Transplantation identified optimizing immunosuppression (IS) as a priority practice improvement area for patients, families, and providers. We aimed to evaluate associations between clinical characteristics, early IS, and outcomes. METHODS: We analyzed pediatric liver transplant (LT) data from 2013 to 2018 in the United Network for Organ Sharing (UNOS) and the Society of Pediatric Liver Transplantation (SPLIT) registries. RESULTS: We included 2542 LT recipients in UNOS and 1590 in SPLIT. IS choice varied between centers with steroid induction and mycophenolate mofetil (MMF) use each ranging from 0% to 100% across centers. Clinical characteristics associated with early IS choice were inconsistent between the two data sets. T-cell depleting antibody use was associated with improved 1-year graft (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.34-0.76) and patient (HR 0.40, 95% CI 0.20-0.79) survival in UNOS but decreased 1-year patient survival (HR 4.12, 95% CI 1.31-12.93) and increased acute rejection (HR 1.58, 95% CI 1.07-2.34) in SPLIT. Non-T-cell depleting antibody use was not associated with differential risk of survival nor rejection. MMF use was associated with improved 1-year graft survival (HR 0.73, 95% CI 0.54-0.99) in UNOS only. CONCLUSIONS: Variation exists in center choice of early IS regimen. UNOS and SPLIT data provide conflicting associations between IS and outcomes in multivariable analysis. These results highlight the need for future multicenter collaborative work to identify evidence-based IS best practices.

Epstein-Barr virus-associated post-transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States.

BACKGROUND: Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorders (PTLD) is the most common malignancy in children after transplant; however, difficulties for early detection may worsen the prognosis. METHODS: The prospective, multicenter, study enrolled 944 children (≤21 years of age). Of these, 872 received liver, heart, kidney, intestinal, or multivisceral transplants in seven US centers between 2014 and 2019 (NCT02182986). In total, 34 pediatric EBV+ PTLD (3.9%) were identified by biopsy. Variables included sex, age, race, ethnicity, transplanted organ, EBV viral load, pre-transplant EBV serology, immunosuppression, response to chemotherapy and rituximab, and histopathological diagnosis. RESULTS: The uni-/multivariable competing risk analyses revealed the combination of EBV-seropositive donor and EBV-naïve recipient (D+R-) was a significant risk factor for PTLD development (sub-hazard ratio: 2.79 [1.34-5.78], p = .006) and EBV DNAemia (2.65 [1.72-4.09], p < .001). Patients with D+R- were significantly more associated with monomorphic/polymorphic PTLD than those with the other combinations (p = .02). Patients with monomorphic/polymorphic PTLD (n = 21) had significantly more EBV DNAemia than non-PTLD patients (p < .001) and an earlier clinical presentation of PTLD than patients with hyperplasias (p < .001), within 6-month post-transplant. Among non-liver transplant recipients, monomorphic/polymorphic PTLD were significantly more frequent than hyperplasias in patients ≥5 years of age at transplant (p = .01). CONCLUSIONS: D+R- is a risk factor for PTLD and EBV DNAemia and associated with the incidence of monomorphic/polymorphic PTLD. Intensive follow-up of EBV viral load within 6-month post-transplant, especially for patients with D+R- and/or non-liver transplant recipients ≥5 years of age at transplant, may help detect monomorphic/polymorphic PTLD early in pediatric transplant.

Circulating miR-16 and miR-21 Levels in Multiple Myeloma: Prognostic Significance of Survival and Response to Lenalidomide Treatment.

MicroRNAs (miRNAs), particularly miR-16 and miR-21, play a crucial role in multiple myeloma (MM) pathogenesis by regulating gene expression. This study evaluated the prognostic significance of circulating miR-16 and miR-21 expression levels in 48 patients with MM at diagnosis treated with lenalidomide-dexamethasone (LD) compared with 15 healthy individuals (HI). All patients were treated with LD, 13 at first line and 35 at relapse, of whom 21 were tested twice at diagnosis and before LD initiation. The results revealed significantly lower levels of miR-16 and miR-21 in patients than in HIs, both at diagnosis and relapse, with decreased miR-16 levels at diagnosis, indicating improved overall survival (OS) (p value 0.024). Furthermore, miR-16 and miR-21 levels were associated with disease markers, while both correlated with the depth of response and mir-16 with sustained response to LD treatment. Ratios of both miR-16 and miR-21 expression levels (prior to LD treatment/diagnosis) below two predicted a shorter time to response (p = 0.027) and a longer time to next treatment (p = 0.042), respectively. These findings suggested a prognostic value for serum miR-16 and miR-21 levels in MM, as their expression levels correlated with disease variables and treatment outcomes.

The CorInnova Implantable Cardiac Assist System for Direct Cardiac Compression.

The CorInnova cardiac compression device (CorInnova, Inc., Houston, TX, USA) is designed to provide direct biventricular support, increase cardiac output, and improve ventricular unloading in patients with heart failure. Placed within the pericardium and surrounding both ventricles, the device has two concentric sets of thin-film polyurethane chambers: (1) inner (epicardial) saline-filled chambers that conform intimately to the epicardial surface, eradicating any gaps in the interface between the device and the heart; and (2) outer air-filled chambers cycled to provide epicardial compression during systole and negative epicardial pressure during diastole, consistent with physiological cardiac contraction and relaxation. A superelastic, collapsible Nitinol frame gives the device structure, enables minimally invasive self-deployment, and enhances diastolic filling. Preclinical testing has been extremely promising, with improvements in cardiac output and other cardiac parameters in animal heart failure models. This potentially transformative technology is moving rapidly toward first-in-human use. The CorInnova device may provide an effective device-based solution for patients with heart failure who currently have few or limited mechanical cardiac support options, including patients with biventricular cardiac failure, those with right heart failure, those who are older, and those who are of smaller size. It can be removed easily and requires minimal maintenance. An important, unique feature of this technology is that it provides mechanical cardiac assistance without blood contact or need for anticoagulation. The CorInnova device may be particularly important for those patients who have contraindications to anticoagulation due to allergy, neurological bleeds, or preexisting hemorrhage. No other mechanical circulatory support device addresses these underserved heart-failure populations.

Energy conservation by collective movement in schooling fish.

Many animals moving through fluids exhibit highly coordinated group movement that is thought to reduce the cost of locomotion. However, direct energetic measurements demonstrating the energy-saving benefits of fluid-mediated collective movements remain elusive. By characterizing both aerobic and anaerobic metabolic energy contributions in schools of giant danio (Devario aequipinnatus), we discovered that fish schools have a concave upward shaped metabolism-speed curve, with a minimum metabolic cost at ~1 body length s-1. We demonstrate that fish schools reduce total energy expenditure (TEE) per tail beat by up to 56% compared to solitary fish. When reaching their maximum sustained swimming speed, fish swimming in schools had a 44% higher maximum aerobic performance and used 65% less non-aerobic energy compared to solitary individuals, which lowered the TEE and total cost of transport by up to 53%, near the lowest recorded for any aquatic organism. Fish in schools also recovered from exercise 43% faster than solitary fish. The non-aerobic energetic savings that occur when fish in schools actively swim at high speed can considerably improve both peak and repeated performance which is likely to be beneficial for evading predators. These energetic savings may underlie the prevalence of coordinated group locomotion in fishes.

Schools of fish, flocks of birds flying in a V-formation and other collective movements of animals are common and mesmerizing behaviours. Moving as a group can have many benefits including helping the animals to find food and reproduce and protecting them from predators. Collective movements may also help animals to save energy as they travel by altering the flow of air or water around individuals. Computational models based on the flow of water suggest several possible mechanisms for how fish swimming in schools may use less energy compared to fish swimming on their own. However, few studies have directly measured how much energy fish schools actually use while they swim compared to a solitary individual. Zhang and Lauder used a device called a respirometer to directly measure the energy used by small tropical fish, known as giant danio, swimming in schools and on their own in an aquatic treadmill. The experiments found that the fish swimming in schools used 53% less energy compared with fish swimming on their own, and that fish in schools recovered from a period of high-speed swimming 43% quicker than solitary fish. By adjusting the flow of the water in the tanks, the team were able to study the fish schools swimming at different speeds. This revealed that the fish used more energy when they hovered slowly, or swam fast, than when they swam at a more moderate speed. Previous studies have found that many fish tend to swim at a moderate speed of around one body length per second while they travel long distances. Zhang and Lauder found that the giant danio used the least energy when they swam at this 'migratory' speed. These findings show that swimming in schools can help fish save energy compared with swimming alone. Along with furthering our understanding of how collective movement benefits fish and other animals, this work may help engineers to design robots that can team up with other robots to move more efficiently through the water.

Combining Computational Fluid Dynamics and Experimental Data to Understand Fish Schooling Behavior.

Understanding the flow physics behind fish schooling poses significant challenges due to the difficulties in directly measuring hydrodynamic performance and the three-dimensional, chaotic, and complex flow structures generated by collective moving organisms. Numerous previous simulations and experiments have utilized computational, mechanical, or robotic models to represent live fish. And existing studies of live fish schools have contributed significantly to dissecting the complexities of fish schooling. But the scarcity of combined approaches that include both computational and experimental studies, ideally of the same fish schools, has limited our ability to understand the physical factors that are involved in fish collective behavior. This underscores the necessity of developing new approaches to working directly with live fish schools. An integrated method that combines experiments on live fish schools with computational fluid dynamic (CFD) simulations represents an innovative method of studying the hydrodynamics of fish schooling. CFD techniques can deliver accurate performance measurements and high-fidelity flow characteristics for comprehensive analysis. Concurrently, experimental approaches can capture the precise locomotor kinematics of fish and offer additional flow information through particle image velocimetry (PIV) measurements, potentially enhancing the accuracy and efficiency of CFD studies via advanced data assimilation techniques. The flow patterns observed in PIV experiments with fish schools and the complex hydrodynamic interactions revealed by integrated analyses highlight the complexity of fish schooling, prompting a reevaluation of the classic Weihs model of school dynamics. The synergy between CFD models and experimental data grants us comprehensive insights into the flow dynamics of fish schools, facilitating the evaluation of their functional significance and enabling comparative studies of schooling behavior. In addition, we consider the challenges in developing integrated analytical methods and suggest promising directions for future research.

Septic Arthritis of the Sternoclavicular Joint.

Introduction: Sternoclavicular joint (SCJ) septic arthritis is a rare but rapidly fatal joint infection. Without proper medical or surgical management, it can progress to osteomyelitis, chest wall abscess, mediastinitis, or myositis. Case Report: A 57-year-old male with a past history of intravenous drug use presented to the emergency department (ED) with chest tenderness of one week duration. Vital signs were unremarkable, and exam was notable for tender, raised right SCJ without any fluctuance. On point-of-care ultrasound we noted fluid collection and capsular distention along the SCJ, which aided in rapidly diagnosing septic arthritis. The patient was immediately started on antibiotics and taken to the operating room for excision and debridement. Conclusion: While computed tomography is routinely used in the emergency department for diagnosing septic arthritis, ultrasound offers a rapid and safe alternative for diagnosis.

Hydrodynamic function of the slimy and scaly surfaces of teleost fishes.

The scales and skin mucus of bony fishes are both proposed to have a role in beneficially modifying the hydrodynamics of water flow over the body surface. However, it has been challenging to provide direct experimental evidence that tests how mucus and fish scales change the boundary layer in part due to the difficulties in working with live animal tissue and difficulty directly imaging the boundary layer. In this manuscript we use direct imaging and flow tracking within the boundary layer to compare boundary layer dynamics over surfaces of fish skin with mucus, without mucus, and a flat control surface. Our direct measurements of boundary layer flows for these three different conditions are repeated for two different species, bluegill sunfish (Lepomis macrochirus) and blue tilapia (Oreochromis aureus). Our goals are to understand if mucus and scales reduce drag, shed light on mechanisms underlying drag reduction, compare these results between species, and evaluate the relative contributions to hydrodynamic function for both mucus and scales. We use our measurements of boundary layer flow to calculate shear stress (proportional to friction drag), and we find that mucus reduces drag overall by reducing the velocity gradient near the skin surface. Both bluegill and tilapia showed similar patterns of surface velocity reduction. We also note that scales alone do not appear to reduce drag, but that mucus may reduce friction drag up to 50% compared to scaled surfaces without mucus or flat controls.

Management of an Iatrogenic Pulmonary Artery Rupture via Balloon Tamponade.

Pulmonary artery rupture is a rare complication of right heart catheterization characterized by a rapid clinical deterioration and high mortality rate. We present the case of an 89-year-old woman with severe symptomatic aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement. The patient had acute cardiopulmonary deterioration due to pulmonary artery rupture at the time of right heart catheterization, that was successfully sealed by balloon tamponade.

The Interplay between Endocrine-Disrupting Chemicals and the Epigenome towards Metabolic Dysfunction-Associated Steatotic Liver Disease: A Comprehensive Review.

Metabolic dysfunction-associated steatotic liver disease (MASLD), described as the most prominent cause of chronic liver disease worldwide, has emerged as a significant public health issue, posing a considerable challenge for most countries. Endocrine-disrupting chemicals (EDCs), commonly found in daily use items and foods, are able to interfere with nuclear receptors (NRs) and disturb hormonal signaling and mitochondrial function, leading, among other metabolic disorders, to MASLD. EDCs have also been proposed to cause transgenerationally inherited alterations leading to increased disease susceptibility. In this review, we are focusing on the most prominent linking pathways between EDCs and MASLD, their role in the induction of epigenetic transgenerational inheritance of the disease as well as up-to-date practices aimed at reducing their impact.

Aggregation and breakage dynamics of alumina particles under shear by coupled Computational Fluid Dynamics - Discrete Element Method.

HYPOTHESIS: Shear affects simultaneous aggregation and fragmentation of fine particles. Understanding the effect of shear on the dynamics of particle aggregation and break-up is important to predict aggregate size and structure. It is hypothesized that there is a transition from pure breakage of large aggregates to regimes where restructuring and aggregation also play a role as aggregates become smaller. SIMULATIONS: Here, aggregation and fragmentation dynamics of alumina particles are investigated under laminar shear flow using Discrete Element Method (DEM) coupled with Computational Fluid Dynamics (CFD). The effect of the shear rate on the aggregation and breakage rates is quantified accounting for particle-particle and particle-fluid interactions. FINDINGS: High shear rates promote the formation of small, compact aggregates. The collision efficiency decreases with increasing shear rate following a power law for shear rates higher than 1250 s-1. The transition from the pure breakage limit to the region dominated by breakage and restructuring has been observed for the first time. The breakage rate decreases significantly as the transition occurs upon decreasing aggregate size. CFD-DEM-derived collision efficiency and breakage rate equations are proposed that can be readily employed in detailed population balance equation models for industrial particle process design.

Incidence and risk factors of acute kidney injury in cirrhosis: a systematic review and meta-analysis of 5,202,232 outpatients, inpatients, and ICU-admitted patients.

INTRODUCTION: Acute kidney injury (AKI) is a commonly seen condition in the natural course of cirrhosis. The aim of this study was to evaluate the pooled incidence and risk factors of AKI in different clinical stages and situations in patients with cirrhosis. METHODS: Search was conducted on 13 December 2023 across MEDLINE (PubMed), Embase, and Cochrane databases. Meta-analysis was performed using a generalized linear mixed model. RESULTS: In total, 73 studies with 5,202,232 patients were finally enrolled in the meta-analysis. AKI commonly occurs among hospitalized cirrhotics experiencing any decompensation event (29%) as well as among stable outpatients (28%) throughout a 1-year follow-up period. On admission, patients with infection or sepsis/septic shock had the highest AKI rate (47%), followed by those with hepatic encephalopathy (41%). Furthermore, the severity of liver disease proved to be a substantial driver for AKI development, while patients at intensive care unit had the greatest AKI incidence (61%). CONCLUSIONS: Both hospitalized patients and stable outpatients with cirrhosis exhibited an elevated susceptibility to AKI. Patients at intensive care unit and those with severe liver disease, infection, sepsis/septic shock, hepatic encephalopathy, or acute on chronic liver failure upon admission are at higher risk for AKI. TRIAL REGISTRATION: PROSPERO, registered 09/12/23, CRD42023487736.

Current approaches for risk assessment of intestinal transplant patients: A view from the histocompatibility laboratory.

Despite its recent decline in volumes, intestinal transplantation remains an important option for patients with irreversible intestinal failures. The long-term outcome of an intestinal transplant has stagnated. The major cause of graft loss is rejection, resulting from mismatches in human leukocyte antigens (HLA) and the presence of antibodies to mismatched donor-specific HLA antigens (DSA). Literature has reported that DSAs, either preformed before transplantation or developed de novo after transplantation, are harmful to intestinal grafts, especially for those without combined liver grafts. A comprehensive assessment of DSA by the histocompatibility laboratory is critical for successful intestinal transplantation and its long-term survival. This paper briefly reviews the history and current status of different methods for detecting DSA and their clinical applications in intestinal transplantation. The focus is on applying different antibody assays to manage immunologically challenging intestinal transplant patients before and after transplantation. A clinical case is presented to illustrate the complexity of HLA tests and the necessity of multiple assays. The review of risk assessment by the histocompatibility laboratory also highlights the need for close interaction between the laboratory and the intestinal transplant program.

Formation of Polyimide Membranes via Non-Solvent Induced Phase Separation: Insight from Molecular Dynamics Simulations.

Molecular dynamics simulations were applied to investigate the formation of P84 polyimide membranes through the non-solvent induced phase separation (NIPS) process, considering two scenarios: one using a conventional organic solvent like n-methyl-2-pyrrolidone (NMP) and the other a greener alternative, γ-butyrolactone (GBL), with water serving as the non-solvent. Different compositions of polymer solutions were established along the binodal boundaries of the respective systems, derived from experimental cloud point data on the ternary phase diagram. The resulting polymer membranes were analyzed and compared in terms of their morphology. The wettability of their surfaces was notably affected by the polymer content in the initial casting solution and demonstrated a correlation with the Brunauer-Emmet-Teller (BET) specific surface area of the associated polymer nanostructures. The GBL solvent systems produced porous polymers qualitatively similar to those obtained with NMP, albeit with slightly narrower pore size distributions.

Rapid hollow fiber-coating device for thin film composite membrane preparation.

Aligned with the recent trend and imperative to reduce separation layer thickness in gas separation membranes to the nanometer scale in order to raise permeance to levels that can render them competitive with respect to other gas separation technologies, a novel approach and device for fabricating defect-free composite hollow fiber (HF) membranes by dip-coating is described. The presented method avoids the fundamental drawbacks of state-of-the-art techniques for applying a thin gas separation layer onto a porous HF substrate, providing a safe but, at the same time, easily up-scalable way of producing HF membranes at a relatively high production rate. As a basic concept, hanging HF substrates are coated by allowing the coating solution to flow and drip along their external surface. The adaptability of this method, stemming from the array of available coating solutions (a plethora of dispersed nanofillers) and the multitude of substrate options, holds great promise for the fabrication of highly selective and defect-free composite HF membranes.