Vessel diameter and close surveillance helps predict early patency in native arteriovenous fistulas.

INTRODUCTION: Arteriovenous fistulas are the preferred method of vascular access for haemodialysis. Data suggests patency rates can be low and may be related to vessel diameters prior to creation. We use specific size criteria for fistula selection. We aimed to establish patency rates in relation to vessel size and whether other factors affect fistula patency. METHODS: Consecutive patients undergoing radiocephalic (RCF) or brachiocephalic (BCF) creation between 2016 and 2018 were analysed. Preoperative arterial and venous diameters were collected. Six-week and six-month primary and secondary patency rates were analysed to establish any impact of vessel size on patency and re-intervention rates between groups. A univariate analysis was performed. RESULTS: Ninety four RCFs and 101 BCFs were created. Median artery and vein size for RCF were 2.7 and 3.0 mm respectively. For BCF, they were 4.6 and 4.3 mm respectively. At 6-weeks, overall satisfactory patency for RCF and BCF combined was 91.8%. 89.7% demonstrated primary patency; 2.1% secondary patency. At 6-months, overall patency was 78.7%; 58.5% demonstrated primary patency, 20.2% secondary patency. A univariate analysis, for both groups, revealed vein size was a significant predictor of overall satisfactory patency at 6-weeks, with larger veins more likely to remain patent (p = 0.025 RCF, p = 0.007 BCF). However, artery size was not predictive (p = 0.1 RCF, p = 0.5 BCF). At 6-months, neither artery nor vein diameter were predictive in either group. When comparing size of vessel based on fistula type, vessels used to create RCFs were smaller than those for BCFs (p < 0.001). RCFs were more likely to receive endovascular intervention or occlude when compared to BCFs (p = 0.014). DISCUSSION: Excellent patency and maturation rates can be achieved using fairly strict vessel size criteria. Vein size might be the more important predictor of early success. RCFs can be challenging due to smaller vessels, but maturation rates can be optimised by close surveillance and aggressive re-intervention.

Safety and Validity of the Proposed European Society for Vascular Surgery Infrarenal Endovascular Aneurysm Repair Surveillance Protocol: A Single Centre Evaluation.

OBJECTIVE: Long term surveillance after endovascular aneurysm repair (EVAR) is essential to detect late complications, but there is variation in practice. The European Society for Vascular Surgery (ESVS) made a recommendation for a new surveillance protocol; one element involves risk stratifying patients depending on sac size reduction and presence of endoleak at their 30 day computed tomography angiogram into low risk groups (delayed imaging to five years) or higher risk groups (continue with the current protocol). The aim was to test this suggested protocol retrospectively within an EVAR patient cohort. METHODS: Data on EVARs performed from October 2009 to October 2019 were collected. Information gathered from an existing surveillance programme was used to assess the proposed ESVS protocol. All patients who underwent re-intervention were reviewed to see whether adopting the proposed ESVS protocol would have detected these events. RESULTS: In total, 309 procedures were included. Altogether, 219 of these patients had no endoleak (70.9%) and 86 had a type II (27.8%) endoleak. Only four developed a type I or III endoleak. No patient in the low risk cohort (no initial endoleak or sac shrinkage > 1 cm) required secondary intervention. Five year follow up data were available for 103 patients. In the type II endoleak group, there were 28 secondary interventions in 22 patients. No patient experienced a ruptured aneurysm within five years post-operatively. Had the proposed ESVS protocol been followed, all patients requiring a secondary intervention or with increasing sac size would have been detected/captured. Further, adherence to the ESVS guidelines would have resulted in 103 patients with a five year follow up history qualifying for reduced surveillance. A further 120 patients who had reached the three and four year follow up timepoints could have qualified for a reduced surveillance, reducing imaging cost further. CONCLUSION: Adopting the proposed ESVS EVAR surveillance protocol safely identified "low risk" patients who did not go on to require a secondary intervention. These patients could benefit from reduced surveillance scanning.

Possible Role for Allelic Variation in Yeast MED15 in Ecological Adaptation.

The propensity for Saccharomyces cerevisiae yeast to ferment sugars into ethanol and CO2 has long been useful in the production of a wide range of food and drink. In the production of alcoholic beverages, the yeast strain selected for fermentation is crucial because not all strains are equally proficient in tolerating fermentation stresses. One potential mechanism by which domesticated yeast may have adapted to fermentation stresses is through changes in the expression of stress response genes. MED15 is a general transcriptional regulator and RNA Pol II Mediator complex subunit which modulates the expression of many metabolic and stress response genes. In this study, we explore the role of MED15 in alcoholic fermentation. In addition, we ask whether MED15 alleles from wine, sake or palm wine yeast improve fermentation activity and grape juice fermentation stress responses. And last, we investigate to what extent any differences in activity are due to allelic differences in the lengths of three polyglutamine tracts in MED15. We find that strains lacking MED15 are deficient in fermentation and fermentation stress responses and that MED15 alleles from alcoholic beverage yeast strains can improve both the fermentation capacity and the response to ethanol stresses when transplanted into a standard laboratory strain. Finally, we find that polyglutamine tract length in the Med15 protein is one determinant in the efficiency of the alcoholic fermentation process. These data lead to a working model in which polyglutamine tract length and other types of variability within transcriptional hubs like the Mediator subunit, Med15, may contribute to a reservoir of transcriptional profiles that may provide a fitness benefit in the face of environmental fluctuations.

Med15: Glutamine-Rich Mediator Subunit with Potential for Plasticity.

The Mediator complex is required for basal activity of the RNA polymerase (Pol) II transcriptional apparatus and for responsiveness to some activator proteins. Med15, situated in the Mediator tail, plays a role in transmitting regulatory information from distant DNA-bound transcription factors to the transcriptional apparatus poised at promoters. Yeast Med15 and its orthologs share an unusual, glutamine-rich amino acid composition. Here, we discuss this sequence feature and the tendency of polyglutamine tracts to vary in length among strains of Saccharomyces cerevisiae, and we propose that different polyglutamine tract lengths may be adaptive within certain domestication habitats.

Designing greener plasticizers: Effects of alkyl chain length and branching on the biodegradation of maleate based plasticizers.

The ubiquitous presence of the plasticizer di (2-ethylhexyl) phthalate (DEHP) in the environment is of concern due to negative biological effects associated with it and its metabolites. In particular, the metabolite mono (2-ethylhexyl) phthalate (MEHP) is a potential endocrine disruptor. Earlier work had identified the diester di (2-ethylhexyl) maleate (DEHM) as a potential greener candidate plasticizer to replace DEHP, yet its biodegradation rate was reported to be slow. In this study, we modified the side chains of maleate diesters to be linear (i.e., unbranched) alkyl chains that varied in length from ethyl to n-octyl. The plasticization efficiency of these compounds blended into PVC at 29 wt.% increased with the overall length of the molecule, but all compounds performed as well as or better than comparable samples with DEHP. Tests conducted with the equally long DEHM and dihexyl maleate (DHM) showed that branching has no effect on glass transition temperature (Tg) reduction efficiency. Biodegradation experiments with the common soil bacterium Rhodococcus rhodocrous in the presence of the plasticizer showed acceptable hydrolysis rates of maleates with unbranched side chains, while the branched DEHM showed almost no degradation. The addition of hexadecane as auxiliary carbon source improved hydrolysis rates. Temporary buildup of the respective monoester of the compounds were observed, but only in the case of the longest molecule, dioctyl maleate (DOM), did this buildup lead to growth inhibition of the bacteria. Maleates with linear side chains, if designed and tested properly, show promise as potential candidate plasticizers as replacements for DEHP.

Impact of the cell life-cycle on bacteriophage T4 infection.

Synchronized Escherichia coli cultures were infected with bacteriophage T4 at discrete points in the cell growth cycle. The cell cycle had a significant impact on the outcome of infection. Cell burst size was smallest for newly formed cells and increased dramatically as these progressed in the cell cycle. The largest burst sizes were achieved when infecting cells immediately prior to cell division. When cells were infected during cell division, the burst size was reduced back to its initial value. Interestingly, lysis time was longest for young cells, reached a minimum at the same point that burst size reached its maximum value, and then increased at the commencement of cell division. Consequently, phage productivity in cells about to undergo cell division was almost three times greater than the productivity of young, newly formed cells. The availability of intracellular resources is believed to be the major driving force behind phage productivity during infection. Indeed, intracellular RNA contents at the time of infection were found to correlate strongly with phage productivity. There was no significant relationship between cell DNA levels and phage productivity. Finally, burst size experiments suggested that the cell cycle also influenced the likelihood of a phage to undergo productive infection.

CREMA-D: Crowd-sourced Emotional Multimodal Actors Dataset.

People convey their emotional state in their face and voice. We present an audio-visual data set uniquely suited for the study of multi-modal emotion expression and perception. The data set consists of facial and vocal emotional expressions in sentences spoken in a range of basic emotional states (happy, sad, anger, fear, disgust, and neutral). 7,442 clips of 91 actors with diverse ethnic backgrounds were rated by multiple raters in three modalities: audio, visual, and audio-visual. Categorical emotion labels and real-value intensity values for the perceived emotion were collected using crowd-sourcing from 2,443 raters. The human recognition of intended emotion for the audio-only, visual-only, and audio-visual data are 40.9%, 58.2% and 63.6% respectively. Recognition rates are highest for neutral, followed by happy, anger, disgust, fear, and sad. Average intensity levels of emotion are rated highest for visual-only perception. The accurate recognition of disgust and fear requires simultaneous audio-visual cues, while anger and happiness can be well recognized based on evidence from a single modality. The large dataset we introduce can be used to probe other questions concerning the audio-visual perception of emotion.

Designing green plasticizers: influence of alkyl chain length on biodegradation and plasticization properties of succinate based plasticizers.

Phthalate diesters such as di (2-ethylhexyl) phthalate (DEHP) are considered ubiquitous contaminants and are poorly biodegraded in the environment. Moreover, both the parent compound and stable metabolites such as mono (2-ethylhexyl) phthalate (MEHP) are linked to several negative impacts on the environment and human health. Earlier work established that saturated diester compounds, such as succinates, showed better biodegradation characteristics and comparable plasticizer properties compared to DEHP. In this work we examine the effect of alkyl chain length of succinate molecules on plasticizer and biodegradation properties. This included both the side chains (n-ethyl to n-octyl) as well as substituents on the middle part of the succinate molecule. We showed that the common soil bacterium Rhodococcus rhodocrous could rapidly break down all unsubstituted succinates, without the appearance of stable metabolites. Furthermore, the organisms used the plasticizer metabolites as carbon source. The introduction of a large cyclohexyl substituent on the succinate resulted in a poorer degradation rate. Glass Transition Temperature (Tg) measurements were performed to evaluate plasticizer properties and showed that longer side chains reduced the Tg more efficiently, while large cyclohexyl substituents on the succinate decreased this effect. However, all compounds performed better or equal to DEHP at reducing the Tg.

Action Unit Models of Facial Expression of Emotion in the Presence of Speech.

Automatic recognition of emotion using facial expressions in the presence of speech poses a unique challenge because talking reveals clues for the affective state of the speaker but distorts the canonical expression of emotion on the face. We introduce a corpus of acted emotion expression where speech is either present (talking) or absent (silent). The corpus is uniquely suited for analysis of the interplay between the two conditions. We use a multimodal decision level fusion classifier to combine models of emotion from talking and silent faces as well as from audio to recognize five basic emotions: anger, disgust, fear, happy and sad. Our results strongly indicate that emotion prediction in the presence of speech from action unit facial features is less accurate when the person is talking. Modeling talking and silent expressions separately and fusing the two models greatly improves accuracy of prediction in the talking setting. The advantages are most pronounced when silent and talking face models are fused with predictions from audio features. In this multi-modal prediction both the combination of modalities and the separate models of talking and silent facial expression of emotion contribute to the improvement.

Aqueous leaching of di-2-ethylhexyl phthalate and "green" plasticizers from poly(vinyl chloride).

A method was developed to assess leaching of several poly(vinyl chloride) (PVC) plasticizers in aqueous media using gas chromatography (GC), and compared to a gravimetric standard test method (ASTM Method D1239). The GC method was a more direct measurement of plasticizer concentration in the aqueous phase. The leaching of commercial plasticizers, as well as several series of "green" candidate plasticizers, were assessed as a function of their molecular characteristics and compared to the industry standard PVC plasticizer, di-2-ethylhexyl phthalate (DEHP). It was found that plasticizers containing longer alkyl chains or non-polar branching emanating from polar structural units, increased the hydrophobicity of the molecule and reduced its aqueous leaching rate. Several "green" plasticizer candidates were found to minimize aqueous leaching to rates ten times below that of DEHP; notably dioctyl succinate (DOS), dihexyl maleate (DHM), methyl cyclohexyl diester (MCDE), diethylhexyl succinate (DEHS), hexanediol dibenzoate (C6), and the commercially available Hexamoll® DINCH.

Self-cycling operation increases productivity of recombinant protein in Escherichia coli.

Self-cycling fermentation (SCF), a cyclical, semi-continuous process that induces cell synchrony, was incorporated into a recombinant protein production scheme. Escherichia coli CY15050, a lac(-) mutant lysogenized with temperature-sensitive phage λ modified to over-express ß-galactosidase, was used as a model system. The production scheme was divided into two de-coupled stages. The host cells were cultured under SCF operation in the first stage before being brought to a second stage where protein production was induced. In the first stage, the host strain demonstrated a stable cycling pattern immediately following the first cycle. This reproducible pattern was maintained over the course of the experiments and a significant degree of cell synchrony was obtained. By growing cells using SCF, productivity increased 50% and production time decreased by 40% compared to a batch culture under similar conditions. In addition, synchronized cultures induced from the end of a SCF cycle displayed shorter lysis times and a more complete culture-wide lysis than unsynchronized cultures. Finally, protein synthesis was influenced by the time at which the lytic phase was induced in the cell life cycle. For example, induction of a synchronized culture immediately prior to cell division resulted in the maximum protein productivity, suggesting protein production can be optimized with respect to the cell life cycle using SCF.

Designing green plasticizers: influence of molecular geometry on biodegradation and plasticization properties.

The plasticizer di (2-ethylhexyl) phthalate (DEHP) and its metabolites are considered ubiquitous contaminants, which have a range of implications on the environment and human health. This work considered several alternative compounds with structural features similar to DEHP. This added to the understanding of why DEHP is so poorly biodegraded once it enters the environment. These alternative compounds were based on 2-ethylhexyl diesters of maleic acid (cis-isomer), fumaric acid (trans-isomer) and succinic acid (saturated analogue). The rates of biodegradation by the common soil bacterium Rhodococcus rhodocrous were shown to be dependent on the structure of the central unit derived from the diacid used to make the ester. The diacid components of DEHP and the maleate both had a cis orientation and they were the two that were slow to biodegrade. Plasticizing properties were also compared and, because the ester of the saturated succinic acid was degraded quickly and also had good plasticizing properties, it was concluded that the succinic esters of straight chain alcohols would make the best green plasticizers. The maleate ester had excellent plasticizing properties but this is mitigated by a significant resistance to biodegradation.

First-bite syndrome complicating carotid endarterectomy: a case report and literature review.

First-bite syndrome (FBS) is an infrequently encountered complication of parapharyngeal space surgery. Patients experience excruciating pain in the ipsiltateral parotid gland region at the first bite of each meal, which improves with subsequent mastication. This is thought to be due to parotid gland sympathetic denervation from surgery with resultant hypersensitivity to parasympathetic impulses. There is no consensus on best treatment for FBS although symptoms tend to improve with time. There are only 2 case reports linking carotid endarterectomy and FBS so far. We report the third case of FBS after carotid endarterectomy to raise awareness among vascular surgeons of the possibility of this complication.

Two-stage, self-cycling process for the production of bacteriophages.

BACKGROUND: A two-stage, self-cycling process for the production of bacteriophages was developed. The first stage, containing only the uninfected host bacterium, was operated under self-cycling fermentation (SCF) conditions. This automated method, using the derivative of the carbon dioxide evolution rate (CER) as the control parameter, led to the synchronization of the host bacterium. The second stage, containing both the host and the phage, was operated using self-cycling infection (SCI) with CER and CER-derived data as the control parameters. When each infection cycle was terminated, phages were harvested and a new infection cycle was initiated by adding host cells from the SCF (first stage). This was augmented with fresh medium and the small amount of phages left from the previous cycle initiated the next infection cycle. Both stages were operated independently, except for this short period of time when the SCF harvest was added to the SCI to initiate the next cycle. RESULTS: It was demonstrated that this mode of operation resulted in stable infection cycles if the growth of the host cells in the SCF was synchronized. The final phage titers obtained were reproducible among cycles and were as good as those obtained in batch productions performed under the same conditions (medium, temperature, initial multiplicity of infection, etc.). Moreover, phages obtained in different cycles showed no important difference in infectivity. Finally, it was shown that cell synchronization of the host cells in the first stage (SCF) not only maintained the volumetric productivity (phages per volume) but also led to higher specific productivity (phage per cell per hour) in the second stage (SCI). CONCLUSIONS: Production of bacteriophage T4 in the semi-continuous, automated SCF/SCI system was efficient and reproducible from cycle to cycle. Synchronization of the host in the first stage prior to infection led to improvements in the specific productivity of phages in the second stage while maintaining the volumetric productivity. These results demonstrate the significant potential of this approach for both upstream and downstream process optimization.

Synchronized populations of Escherichia coli using simplified self-cycling fermentation.

Self-cycling fermentation (SCF) was developed as a method to continuously produce synchronized microbial populations at high cell densities. The present study demonstrates the application of this process to populations of Escherichia coli, making use of a simpler and non-intrusive approach to the control strategy. The carbon dioxide evolution rate (CER) could be easily monitored during growth in batch experiments and its first derivative was found to be a good indicator of the transition from exponential growth to stationary phase. This, in turn, was shown to be a suitable control parameter for stable SCF operation. Earlier approaches to the volume changes during the harvest and refilling steps of SCF using load cells and intermediate vessels have been cumbersome and subject to errors in these crucial measurements. In the improved set up, these were replaced with electro-optic level sensors, which resulted in <2% error in volume. This helped to generate stable synchrony with a high degree of inter-cycle reproducibility. The new system was more robust, reliable, cheaper, not subject to probe fouling and easier to scale up. The cultures of E. coli demonstrated significant synchrony as early as the third cycle and, in every experiment, stable synchrony was observed by the sixth cycle. The stable pattern had a synchrony index between 0.68 and 0.74 and the cycle time was 2.47h+/-0.08. Unexpectedly, the cells doubled in the middle of each synchronized cycle and the length of these cycles was noticeably longer than the doubling time calculated from a batch culture. Neither of these led to a significant loss of cell productivity.

Remote ischemic preconditioning will reduce graft-related events after surgical infrainguinal revascularization: evidence-based surgery hypothesis.

Surgical lower extremity revascularization obligates ischemia-reperfusion, and local ischemia-reperfusion provokes systemic inflammation; perhaps counterintuitively, remote ischemic preconditioning elicits a constructive anti-inflammatory response. So, remote ischemic preconditioning will decrease graft-related complications after surgical infrainguinal revascularization.

Endovascular occlusion of a ruptured popliteal artery aneurysm.

Popliteal artery aneurysms are the most common of the peripheral aneurysms. Rupture is a rare complication of these aneurysms. Here we present a case of a ruptured popliteal aneurysm in a patient with severe joint disease and immobility due to rheumatoid arthritis. The condition was treated endovascularly with an Amplatzer arterial occlusion device. The aneurysm was successfully thrombosed without inducing critical limb ischemia, as the distal popliteal was chronically occluded. Ligation of peripheral aneurysms is an infrequent treatment without simultaneous bypass graft placement. Endovascular occlusion of ruptured popliteal aneurysms should be considered a valid therapeutic strategy where exclusion bypass is not required due to distal arterial occlusion.

Biodegradation of pharmaceuticals by Rhodococcus rhodochrous and Aspergillus niger by co-metabolism.

This work investigated the possible fate of pharmaceuticals in the environment that are known to be resistant to biodegradation. A co-metabolism approach, adding a readily degradable carbon source, was used to study the biodegradation of some pharmaceuticals. The pharmaceuticals selected were all known to be micro pollutants and frequently used by humans. The microorganisms used primarily were Rhodococcus rhodochrous, known to co-metabolize difficult to degrade hydrocarbons and Aspergillus niger. Because of the long periods of time required for the degradation experiments after growth had reached the stationary phase, it was found to be necessary to correct for water loss from the media. Co-metabolism of carbamazepine, sulfamethizole and sulfamethoxazole was observed and as much as 20% of these compounds could be removed. Small amounts of stable metabolites were observed during the degradation of some of these drugs and these were different from the metabolites obtained from abiotic degradation. A metabolite arising from the biodegradation of sulfamethoxazole by R.rhodochrous was identified.

Bacteriophage adsorption efficiency and its effect on amplification.

Existing models for bacteriophage adsorption are modified with the addition of a new term, adsorption efficiency, and applied to a T4-Escherichia coli system. The adsorption efficiency is the fraction of phage that adsorbs irreversibly to the host. Adsorption kinetics were modeled using the adsorption rate constant(k) and the adsorption efficiency(epsilon). Experimental data demonstrated that the adsorption rate constant depends strongly on the condition of the host while the adsorption efficiency is a property of the bacteriophage population. The adsorption efficiency exhibited a marked dependence on the concentration of L-tryptophan. The system was used to study the effect of adsorption kinetics on bacteriophage amplification. Increasing adsorption efficiency had an effect similar to increasing the initial multiplicity of infection; the number of phages produced during amplification decreased. Optimizing the adsorption efficiency by manipulating the L-tryptophan concentration yielded a 14-fold increase in the number of phages produced.

Using the rate of respiration to monitor events in the infection of Escherichia coli cultures by bacteriophage T4.

The growing interest in applications of bacteriophages creates a need for improvements in the production processes. Continuous monitoring of the phage production is an essential aspect of any control strategy and, at present, there is no completely satisfactory option. The approach presented here uses IR-spectrometry to continuously measure the rate of respiration (CO(2) released) of Escherichia coli infected by phage T4 at various multiplicities of infection (MOI). Within the trends in these data, or in other aspects of the rate of respiration, it was possible to reliably and reproducibly identify five features that reflected specific events in the infection process. These included two events in the host cell apparent growth rate and events in the magnitude of the host cell density, in the measurement of OD(600) or in the specific rate of respiration. All of these correlations were within 95% confidence showing that they are suitable for the monitoring and control of E. coli populations infected by phage T4. This method is reliable, cheap, and can be operated in-line and in real time.