Analysis of diurnal variation in serum testosterone levels in men with symptoms of testosterone deficiency.

BACKGROUND: Testosterone (T) plays a crucial role in various physiological functions in men, and understanding the variations in T levels during the day is essential for diagnosing and treating testosterone deficiency (TD). AIM: We sought to evaluate the reduction in serum total T (TT) levels throughout the day in men with symptoms of testosterone deficiency and to determine the variables having an impact on the extent of this decline. METHODS: The study population consisted of a group of men who within 3 months of each other had all undergone both early morning and afternoon TT level measurements. We did not include patients with a history of a prior orchiectomy, testosterone levels below 100 ng/dL or above 1000 ng/dL, a history of androgen deprivation therapy, or patients on T therapy. Statistical analyses were conducted using descriptive statistics, t-tests, chi-square tests, and correlation calculations. Liquid chromatography-tandem mass spectrometry was used to measure TT, and a change in TT levels greater than 100 ng/dL was considered significant. Using multivariable and univariable analysis, we attempted to define predictors of a decrease in afternoon TT levels. OUTCOMES: The majority of men showed no significant difference in T levels between morning and afternoon. RESULTS: In total, 506 men with a median age of 65 years were analyzed. The most common comorbidities were hypertension and hyperlipidemia. Levels of TT were measured in the morning and afternoon, and no significant differences in mean T levels based on the time of the test were found. Age was not significantly associated with T levels. CLINICAL IMPLICATIONS: There was a weak negative correlation between age and the difference between morning and afternoon T levels, with younger men showing more significant variations in T levels. The most considerable differences in T levels were observed in men younger than 30 years. There were no predictors of the magnitude of the T decrease in the afternoon. STRENGTHS AND LIMITATIONS: Strengths of the study include the number of subjects and the use of liquid chromatography-tandem mass spectrometry for T measurement. Limitations include failure to measure morning and afternoon T levels on the same day, the retrospective nature of the study, and a smaller sample size of patients younger than 30 years. CONCLUSION: In this study we found no strong link between age and daily T fluctuation, but we observed a decrease in the magnitude of variation with aging. The group experiencing the most significant decline in daily T had higher morning and consistently normal afternoon T levels.

Stigma-related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement.

Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm-reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm-reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi-discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm-reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real-world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm-reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm-reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services.

The secreted protein Cowpox Virus 14 contributes to viral virulence and immune evasion by engaging Fc-gamma-receptors.

The genome of cowpoxvirus (CPXV) could be considered prototypical for orthopoxviridae (OXPV) since it contains many open reading frames (ORFs) absent or lost in other OPXV, including vaccinia virus (VACV). These additional ORFs are non-essential for growth in vitro but are expected to contribute to the broad host range, virulence and immune evasion characteristics of CPXV. For instance, unlike VACV, CPXV encodes proteins that interfere with T cell stimulation, either directly or by preventing antigen presentation or co-stimulation. When studying the priming of naïve T cells, we discovered that CPXV, but not VACV, encodes a secreted factor that interferes with activation and proliferation of naïve CD8+ and CD4+ T cells, respectively, in response to anti-CD3 antibodies, but not to other stimuli. Deletion mapping revealed that the inhibitory protein is encoded by CPXV14, a small secreted glycoprotein belonging to the poxvirus immune evasion (PIE) family and containing a smallpoxvirus encoded chemokine receptor (SECRET) domain that mediates binding to chemokines. We demonstrate that CPXV14 inhibition of antibody-mediated T cell activation depends on the presence of Fc-gamma receptors (FcγRs) on bystander cells. In vitro, CPXV14 inhibits FcγR-activation by antigen/antibody complexes by binding to FcγRs with high affinity and immobilized CPXV14 can trigger signaling through FcγRs, particularly the inhibitory FcγRIIB. In vivo, CPXV14-deleted virus showed reduced viremia and virulence resulting in reduced weight loss and death compared to wildtype virus whereas both antibody and CD8+ T cell responses were increased in the absence of CPXV14. Furthermore, no impact of CPXV14-deletion on virulence was observed in mice lacking the inhibitory FcγRIIB. Taken together our results suggest that CPXV14 contributes to virulence and immune evasion by binding to host FcγRs.

Climbing since the early Miocene: The fossil record of Paullinieae (Sapindaceae).

Paullinieae are a diverse group of tropical and subtropical climbing plants that belong to the soapberry family (Sapindaceae). The six genera in this tribe make up approximately one-quarter of the species in the family, but a sparse fossil record limits our understanding of their diversification. Here, we provide the first description of anatomically preserved fossils of Paullinieae and we re-evaluate other macrofossils that have been attributed to the tribe. We identified permineralized fossil roots in collections from the lower Miocene Cucaracha Formation where it was exposed along the Culebra Cut of the Panama Canal. We prepared the fossils using the cellulose acetate peel technique and compared the anatomy with that of extant Paullinieae. The fossil roots preserve a combination of characters found only in Paullinieae, including peripheral secondary vascular strands, vessel dimorphism, alternate intervessel pitting with coalescent apertures, heterocellular rays, and axial parenchyma strands of 2-4 cells, often with prismatic crystals. We also searched the paleontological literature for other occurrences of the tribe. We re-evaluated leaf fossils from western North America that have been assigned to extant genera in the tribe by comparing their morphology to herbarium specimens and cleared leaves. The fossil leaves that were assigned to Cardiospermum and Serjania from the Paleogene of western North America are likely Sapindaceae; however, they lack diagnostic characters necessary for inclusion in Paullinieae and should be excluded from those genera. Therefore, the fossils described here as Ampelorhiza heteroxylon gen. et sp. nov. are the oldest macrofossil evidence of Paullinieae. They provide direct evidence of the development of a vascular cambial variant associated with the climbing habit in Sapindaceae and provide strong evidence of the diversification of crown-group Paullinieae in the tropics by 18.5-19 million years ago.

Evidence of ubiquitous Alfvén pulses transporting energy from the photosphere to the upper chromosphere.

The multi-million degree temperature increase from the middle to the upper solar atmosphere is one of the most fascinating puzzles in plasma-astrophysics. Although magnetic waves might transport enough energy from the photosphere to heat up the local chromosphere and corona, observationally validating their ubiquity has proved challenging. Here, we show observational evidence that ubiquitous Alfvén pulses are excited by prevalent intensity swirls in the solar photosphere. Correlation analysis between swirls detected at different heights in the solar atmosphere, together with realistic numerical simulations, show that these Alfvén pulses propagate upwards and reach chromospheric layers. We found that Alfvén pulses carry sufficient energy flux (1.9 to 7.7 kW m-2) to balance the local upper chromospheric energy losses (~0.1 kW m-2) in quiet regions. Whether this wave energy flux is actually dissipated in the chromosphere and can lead to heating that balances the losses is still an open question.

Antibody-Drug Conjugates Derived from Cytotoxic seco-CBI-Dimer Payloads Are Highly Efficacious in Xenograft Models and Form Protein Adducts In Vivo.

This work discloses the first examples of antibody-drug conjugates (ADCs) that are constructed from linker-drugs bearing dimeric seco-CBI payloads (duocarmycin analogs). Several homogeneous, CD22-targeting THIOMAB antibody-drug conjugates (TDCs) containing the dimeric seco-CBI entities are shown to be highly efficacious in the WSU-DLCL2 and BJAB mouse xenograft models. Surprisingly, the seco-CBI-containing conjugates are also observed to undergo significant biotransformation in vivo in mice, rats, and monkeys and thereby form 1:1 adducts with the Alpha-1-Microglobulin (A1M) plasma protein from these species. Variation of both the payload mAb attachment site and length of the linker-drug is shown to alter the rates of adduct formation. Subsequent experiments demonstrated that adduct formation attenuates the in vitro antiproliferation activity of the affected seco-CBI-dimer TDCs, but does not significantly impact the in vivo efficacy of the conjugates. In vitro assays employing phosphatase-treated whole blood suggest that A1M adduct formation is likely to occur if the seco-CBI-dimer TDCs are administered to humans. Importantly, protein adduct formation leads to the underestimation of total antibody (Tab) concentrations using an ELISA assay but does not affect Tab values determined via an orthogonal LC-MS/MS method. Several recommendations regarding bioanalysis of future in vivo studies involving related seco-CBI-containing ADCs are provided based on these collective findings.

Retrospective Validation and Clinical Implementation of Automated Contouring of Organs at Risk in the Head and Neck: A Step Toward Automated Radiation Treatment Planning for Low- and Middle-Income Countries.

Purpose We assessed automated contouring of normal structures for patients with head-and-neck cancer (HNC) using a multiatlas deformable-image-registration algorithm to better provide a fully automated radiation treatment planning solution for low- and middle-income countries, provide quantitative analysis, and determine acceptability worldwide. Methods Autocontours of eight normal structures (brain, brainstem, cochleae, eyes, lungs, mandible, parotid glands, and spinal cord) from 128 patients with HNC were retrospectively scored by a dedicated HNC radiation oncologist. Contours from a 10-patient subset were evaluated by five additional radiation oncologists from international partner institutions, and interphysician variability was assessed. Quantitative agreement of autocontours with independently physician-drawn structures was assessed using the Dice similarity coefficient and mean surface and Hausdorff distances. Automated contouring was then implemented clinically and has been used for 166 patients, and contours were quantitatively compared with the physician-edited autocontours using the same metrics. Results Retrospectively, 87% of normal structure contours were rated as acceptable for use in dose-volume-histogram-based planning without edit. Upon clinical implementation, 50% of contours were not edited for use in treatment planning. The mean (± standard deviation) Dice similarity coefficient of autocontours compared with physician-edited autocontours for parotid glands (0.92 ± 0.10), brainstem (0.95 ± 0.09), and spinal cord (0.92 ± 0.12) indicate that only minor edits were performed. The average mean surface and Hausdorff distances for all structures were less than 0.15 mm and 1.8 mm, respectively. Conclusion Automated contouring of normal structures generates reliable contours that require only minimal editing, as judged by retrospective ratings from multiple international centers and clinical integration. Autocontours are acceptable for treatment planning with no or, at most, minor edits, suggesting that automated contouring is feasible for clinical use and in the ongoing development of automated radiation treatment planning algorithms.

A liana from the lower Miocene of Panama and the fossil record of Connaraceae.

PREMISE OF THE STUDY: Permineralized wood is common in the Miocene beds exposed during the expansion of the Panama Canal. We describe a stem with the distinctive anatomy of a liana and evaluate the evolutionary, biogeographic, and ecological significance of this discovery. METHODS: The object of the study was obtained from a collection of fossil woods and fruits from a locality in the lower Miocene Cucaracha Formation, where the formation is exposed by the Culebra Cut of the Panama Canal. Thin sections were prepared using the cellulose acetate peel technique and examined using transmitted light microscopy. We described the anatomy and compared it with that of extant and fossil species. We also reviewed and evaluated published reports of fossils attributed to Connaraceae. KEY RESULTS: The anatomy of this fossil wood matches the genus Rourea (Connaraceae). The stem is only 1 cm in diameter, but vessels >200 µm in diameter also occur, indicating the perennial climbing habit. We evaluated 12 other pre-Quaternary occurrences attributed to Connaraceae. Four are accepted, three are rejected, and we consider five unknown or uncertain. CONCLUSIONS: The discovery of this Rourea stem confirms the presence of Connaraceae in the Neotropics by the early Miocene, provides the oldest evidence of the climbing habit in the family, and contributes to our understanding of the flora of Panama 19 mya. Although the fossil record of Connaraceae is sparse, reliable occurrences span three continents and indicate that the family originated as early as the Late Cretaceous-Paleocene and was widespread by the early Miocene.

Paternal Genome Elimination in Liposcelis Booklice (Insecta: Psocodea).

How sex is determined in insects is diverse and dynamic, and includes male heterogamety, female heterogamety, and haplodiploidy. In many insect lineages, sex determination is either completely unknown or poorly studied. We studied sex determination in Psocodea-a species-rich order of insects that includes parasitic lice, barklice, and booklice. We focus on a recently discovered species of Liposcelis booklice (Psocodea: Troctomorpha), which are among the closest free-living relatives of parasitic lice. Using genetic, genomic, and immunohistochemical approaches, we show that this group exhibits paternal genome elimination (PGE), an unusual mode of sex determination that involves genomic imprinting. Controlled crosses, following a genetic marker over multiple generations, demonstrated that males only transmit to offspring genes they inherited from their mother. Immunofluorescence microscopy revealed densely packed chromocenters associated with H3K9me3-a conserved marker for heterochromatin-in males, but not in females, suggesting silencing of chromosomes in males. Genome assembly and comparison of read coverage in male and female libraries showed no evidence for differentiated sex chromosomes. We also found that females produce more sons early in life, consistent with facultative sex allocation. It is likely that PGE is widespread in Psocodea, including human lice. This order represents a promising model for studying this enigmatic mode of sex determination.

Fruits and wood of Parinari from the early Miocene of Panama and the fossil record of Chrysobalanaceae.

PREMISE OF THE STUDY: Chrysobalanaceae are woody plants with over 500 species in 20 genera. They are among the most common trees in tropical forests, but a sparse fossil record has limited our ability to test evolutionary and biogeographic hypotheses, and several previous reports of Chrysobalanaceae megafossils are doubtful. METHODS: We prepared fossil endocarps and wood collected from the lower Miocene beds along the Panama Canal using the cellulose acetate peel technique and examined them using light microscopy. We compared the fossil endocarps with previously published fossils and with fruits from herbarium specimens. We compared the fossil wood with photographs and descriptions of extant species. KEY RESULTS: Parinari endocarps can be distinguished from other genera within Chrysobalanaceae by a suite of features, i.e., thick wall, a secondary septum, seminal cavities lined with dense, woolly trichomes, and two ovate to lingulate basal germination plugs. Fossil endocarps from the Cucaracha, Culebra, and La Boca Formations confirm that Parinari was present in the neotropics by the early Miocene. CONCLUSIONS: The earliest unequivocal evidence of crown-group Chrysobalanaceae is late Oligocene-early Miocene, and the genus Parinari was distinct by at least 19 million years ago. Parinari and other Chrysobalanaceae likely reached the neotropics via long-distance dispersal rather than vicariance. The presence of Parinari in the Cucaracha flora supports the interpretation of a riparian, moist tropical forest environment. Parinari was probably a canopy-dominant tree in the Cucaracha forest and took advantage of the local megafauna for seed dispersal.

Correcting nonlinear drift distortion of scanning probe and scanning transmission electron microscopies from image pairs with orthogonal scan directions.

Unwanted motion of the probe with respect to the sample is a ubiquitous problem in scanning probe and scanning transmission electron microscopies, causing both linear and nonlinear artifacts in experimental images. We have designed a procedure to correct these artifacts by using orthogonal scan pairs to align each measurement line-by-line along the slow scan direction, by fitting contrast variation along the lines. We demonstrate the accuracy of our algorithm on both synthetic and experimental data and provide an implementation of our method.

Room-temperature negative capacitance in a ferroelectric-dielectric superlattice heterostructure.

We demonstrate room-temperature negative capacitance in a ferroelectric-dielectric superlattice heterostructure. In epitaxially grown superlattice of ferroelectric BSTO (Ba0.8Sr0.2TiO3) and dielectric LAO (LaAlO3), capacitance was found to be larger compared to the constituent LAO (dielectric) capacitance. This enhancement of capacitance in a series combination of two capacitors indicates that the ferroelectric was stabilized in a state of negative capacitance. Negative capacitance was observed for superlattices grown on three different substrates (SrTiO3 (001), DyScO3 (110), and GdScO3 (110)) covering a large range of substrate strain. This demonstrates the robustness of the effect as well as potential for controlling the negative capacitance effect using epitaxial strain. Room-temperature demonstration of negative capacitance is an important step toward lowering the subthreshold swing in a transistor below the intrinsic thermodynamic limit of 60 mV/decade and thereby improving energy efficiency.

Acute care surgery practice model: Targeted growth for fiscal success.

PURPOSE: Acute care surgery (ACS) remains in its infancy as a defined surgical specialty within hospital systems. Little has been published regarding the financial impact of this method of care delivery to hospital systems and departments when combining trauma, surgical critical care, emergent, and elective general surgery into a single practice model. We sought to compare hospital net income and divisional clinical productivity measures of a newly formed, university division of ACS based on patient type-trauma, emergency general surgery, and elective surgery-to determine the best avenues by which to focus on programmatic growth. METHODS: Single calendar year, retrospective review of hospital system income and divisional fiscal productivity of specific patient visits by patient type (trauma, emergent, or elective) admitted to or discharged by the acute care surgeons. Demographic data, payor mix, patient volumes, and operative rates were determined for each patient type. Fiscal contribution by patient type to both hospital and clinical productivity were measured by hospital net income and divisional work relative value units (wRVU) production respectively. The Chi-square test for independence compared payor mix and analysis of variance was used for comparison of fiscal performance between patient types. RESULTS: We included 1,492 patients in the analysis of calendar year 2010; 1,056 trauma (67% male; mean age, 41.9; range, 0-102), 346 emergent (53% male; mean age, 44.6; range, 15-91), and 90 elective (51% male; mean age, 46; range, 16-87) patient encounters met criteria for analysis. There were no differences in payor mix between patient types. Significant differences were seen in average per patient encounter hospital net income, divisional wRVU production and duration of stay. The ACS team (n = 3) operated on 12% of trauma patients compared with 52% of emergent and 100% of elective surgery encounters. Hospital net income per patient was greatest for trauma encounters, whereas divisional clinical productivity per patient encounter was greatest for emergent patients. Elective encounters contributed negatively to hospital margins. CONCLUSION: Per-patient hospital system income and a majority of clinical wRVU productivity remains greatest for the care of injured patients in our ACS practice model; emergent general surgical encounters demonstrate the greatest per-patient rates of divisional clinical productivity.

The polar bear in the room: diseases of poverty in the Arctic.

In the face of global warming, budgetary austerity and impoverished Arctic residents, the nations of the circumpolar region are presented with a number of difficult choices regarding the provision of health care to the far-flung and isolated regions of their northernmost provinces. Complicating that picture is the reality of neglected tropical diseases in areas far from their perceived normal equatorial range as well as endemic food-borne diseases, including protozoan and helminth parasites, respiratory and gastrointestinal diseases and vaccine-preventable illnesses. This paper discusses the problems of caring for the health and well-being of indigenous populations suffering from extreme poverty, isolation and discrimination in the circumpolar region. After presenting difficulties as supported by the extant literature, the paper continues by suggesting solutions that include novel telenursing applications, targeted distance-educational programs and local community-based health care assistant (HCA) vocational training. These programs will provide cost-effective care that increases life-spans, improves quality of life and provides opportunities to distressed populations in isolated rural communities of the Far North. The toolkit presented in the paper is intended to spur discussion on community health programs that could be adopted to provide proper and humane care for marginalized Arctic populations in an extreme and rapidly changing environment.

BiFeO3 domain wall energies and structures: a combined experimental and density functional theory+U study.

We determined the atomic structures and energies of 109°, 180°, and 71° domain walls in BiFeO3, combining density functional theory+U calculations and aberration-corrected transmission electron microscopy images. We find a substantial Bi sublattice shift and a rather uniform Fe sublattice across the walls. The calculated wall energies (γ) follow the sequence γ109<γ180<γ71 for the 109°, 180°, and 71° walls. We attribute the high 71° wall energy to an opposite tilting rotation of the oxygen octahedra and the low 109° wall energy to the opposite twisting rotation of the oxygen octahedra across the domain walls.

Preliminary study of transplanting as a process for reducing levels of Vibrio vulnificus and Vibrio parahaemolyticus in shellstock oysters.

Increasingly strict standards for harvest of oysters for the raw, half-shell market (designated as "white tag") should increase the proportion of oysters not meeting these standards (designated as "green tag"). Transplanting of green tag oysters into highsalinity waters (>20 practical salinity units) was explored as a means of returning Vibrio vulnificus and Vibrio parahaemolyticus levels to levels present on initial harvest. In summer 2011, oysters originally harvested in Louisiana were transplanted on two separate occasions (n = 2) to two sites in Mississippi Sound, AL: Sandy Bay and Dauphin Island. Oysters were tested for V. vulnificus and V. parahaemolyticus densities (by using the U.S. Food and Drug Administration enrichment method) after 2, 7, and 14 days deployed, with baseline samples taken (i) at the time of original harvest and iced, (ii) from oysters refrigerated within 1 h of harvest at <45°F ([7.2°C] white tag) and, (iii) from oysters not refrigerated during the harvest trip (green tag) but refrigerated after an 8-h trip. White and green tag oysters were sampled ∼24 h on arrival in Bon Secour, AL, put on ice, and shipped for analysis. Among baseline samples, there were no significant differences in V. vulnificus and V. parahaemolyticus densities, although the densities in the green tag oysters tended to be highest. After transplanting, V. vulnificus densities were significantly highest on day 2, with no significant differences among any of the other days within a site. On day 2, Sandy Bay had significantly greater densities of V. vulnificus than the Dauphin Island site, but no other days differed from time zero. For Vibrio parahaemolyticus, densities were greatest on day 2 and lowest at time zero, but this did not differ significantly from abundance on day 14. Average survival was 83.4% (± 3.13 SD), with no differences between sites. These preliminary results indicate that high-salinity transplanting could be an effective method of converting green tag oysters to oysters suitable for "reharvest" as white tag oysters.

Crystal structure of the cowpox virus-encoded NKG2D ligand OMCP.

The NKG2D receptor is expressed on the surface of NK, T, and macrophage lineage cells and plays an important role in antiviral and antitumor immunity. To evade NKG2D recognition, herpesviruses block the expression of NKG2D ligands on the surface of infected cells using a diverse repertoire of sabotage methods. Cowpox and monkeypox viruses have taken an alternate approach by encoding a soluble NKG2D ligand, the orthopoxvirus major histocompatibility complex (MHC) class I-like protein (OMCP), which can block NKG2D-mediated cytotoxicity. This approach has the advantage of targeting a single conserved receptor instead of numerous host ligands that exhibit significant sequence diversity. Here, we show that OMCP binds the NKG2D homodimer as a monomer and competitively blocks host ligand engagement. We have also determined the 2.25-Å-resolution crystal structure of OMCP from the cowpox virus Brighton Red strain, revealing a truncated MHC class I-like platform domain consisting of a beta sheet flanked with two antiparallel alpha helices. OMCP is generally similar in structure to known host NKG2D ligands but has notable variations in regions typically used to engage NKG2D. Additionally, the determinants responsible for the 14-fold-higher affinity of OMCP for human than for murine NKG2D were mapped to a single loop in the NKG2D ligand-binding pocket.

Subcutaneous heparin does not increase postoperative complications in neurosurgical patients: An institutional experience.

INTRODUCTION: Prophylaxis for venous thromboembolic disease continues to pose a challenging management problem in postoperative neurosurgical patients, particularly those in the intensive care unit (ICU). This study evaluates neurosurgical patients admitted to the surgical ICU (SICU) at a tertiary hospital and compared those who had received subcutaneous unfractionated heparin (SQUFH) to those who did not. This study was conducted to better evaluate if the administration of SQUFH to neurosurgical patients is safe and whether the administration of SQUFH is an independent risk factor for bleeding in this patient population. METHODS: Retrospective analysis was performed on prospectively collected data on all postoperative neurosurgical patients admitted over the course of 11 years to the SICU at Long Island Jewish Medical Center. This study included neurosurgical patients who received SQUFH and those who did not. Data acquired included demographic information, hemodynamic monitoring, pharmacologic interventions, laboratory results, and survival outcomes as well as occurrences of heparin-induced thrombocytopenia and pulmonary embolism. Subcutaneous unfractionated heparin for venous thromboembolic prophylaxis were dosed according to previously established literature based hospital protocols. Data were analyzed by χ(2), Fisher exact test, Mann-Whitney U test, or the product limit method, where appropriate. RESULTS: Five hundred twenty-two neurosurgical patients were included in the study. Two hundred thirteen patients (40.8%) with mean age of 58 years received SQUFH (133 patients received SQUFH within 24 hours of surgery and 80 patients received SQUFH 24 hours postoperatively). Once SQUFH was initiated, it was continued until discharge from the hospital. Three hundred nine patients (59.2%) with mean age 57.8 years received no anticoagulation. In the SQUFH patient population, 72 patients (33.8%) had a diagnosis of subarachnoid hemorrhage compared with 125 patients (40.5%) from the group who had not received anticoagulation. There was no significant difference in ICU length of stay between the groups, 5.8 ± 5.4 (no deep vein thrombosis prophylaxis), and those receiving SQUFH, 6.7 ± 6.1 (over 24 hours) and 5.9 ± 4.8 (over 24 hours). No postoperative hemorrhages were observed (confirmed by computed tomography of the brain) in any of the neurosurgical patients with subarachnoid hemorrhage, intracerebral hemorrhage, or subdural or epidural hemorrhage. No instances of heparin-induced thrombocytopenia (HIT) or pulmonary embolism (PE) were observed. CONCLUSIONS: Administration of SQUFH dosed according to the risk for thromboembolism does not appear to contribute to postoperative hemorrhage in neurosurgical patients. This study supports the concept that the administration of SQUFH is safe in postoperative neurosurgical population.

Characterization and validation of a streptozotocin-induced diabetes model in the vervet monkey.

INTRODUCTION: Streptozotocin (STZ), preferentially toxic to pancreatic beta cells, is commonly used to model Type 1 diabetes mellitus (DM) in numerous species, including nonhuman primates. METHODS: We induced DM in twenty vervet monkeys (Chlorocebus aethiops) by intravenous administration of either 45 (n=8, STZ-45) or 55 mg/kg STZ (n=12, STZ-55); ten control (CTL) monkeys received saline. RESULTS: Overall there was 15% mortality, likely secondary to renal toxicity. Twice-daily insulin therapy was initiated to maintain comparable glycemic control, confirmed by comparable glycated hemoglobin levels. Exogenous insulin requirements increased rapidly for 4weeks; STZ-45 insulin doses stabilized thereafter while STZ-55 doses continued to increase through 16weeks. Glucose tolerance testing and arginine-stimulated insulin secretion confirmed 80-90% reduction in pancreatic beta cell function in both groups. Body weight was reduced in all STZ monkeys, with return to baseline only in STZ-45 at 16 wks. Elevated blood urea nitrogen (BUN) and creatinine were noted in the STZ-55 group. Alkaline phosphatase (ALKP) was also increased with STZ-55 (p < 0.05 vs. CTL) whereas STZ-45 ALKP elevation resolved by study end. Red cell parameters were reduced in all STZ monkeys, but more severely in the STZ-55 group. DISCUSSION: We have demonstrated that a model of DM can be induced and maintained in vervets with a single dose of STZ. The lower dose of STZ (45 mg/kg) significantly improved the toxicity profile without altering efficacy in inducing DM. Finally, sufficient time following induction is recommended to allow transient renal, hepatic and hematologic parameters to resolve.