Correlation between thromboelastography and rotational thromboelastometry values in adult liver transplant recipients.

BACKGROUND AND AIMS: Viscoelastic haemostatic assays (VHA) namely Thromboelastogram (TEG) and Rotational thromboelastometry (ROTEM) are used for global assessment of coagulopathy and guiding transfusion during living donor liver transplant (LDLT).We conducted a study to compare the interchangeability of the values obtained from these devices in patients with End stage liver disease (ESLD) undergoing LDLT. METHODS: In 76 patients undergoing LDLT, ROTEM and TEG were performed and assessed for interchangeability using Spearman Correlation. The direction and strength of correlation between equivalent parameters was calculated using Inter Class Correlation (ICC) and Bland Altman analysis. RESULTS: The correlation ρ between CT (clotting time) of ROTEM and R of TEG was 0.16 (P = 0.19).The ICC was 0.15, with 95% confidence interval (CI) of -0.38-0.48 (P = 0.25).The ρ of CFT (ROTEM) with K (TEG) was 0.425 (P=<0.001). The ICC was0.49 with 95% CI of 0.17-0.69, P = 0.003.Alpha of ROTEM correlated with Angle of TEG with ρ of 0.475 (P=<0.001). The ICC was 0.61, with 95% CI of 0.36-0.76, P=<0.001.Maximum Clot firmness (MCF) correlated with maximum amplitude (MA) with ρ=0.76 (P=<0.001).The ICC was 0.86, with 95% CI of 0.77-0.92, P=<0.001. Lysis index (L30) of ROTEM correlated clot lysis (CL30) of TEG with ρ of 0.16 (P = 0.18).However, the ICC was 0.45, with 95% CI of 0.11-0.66, P = 0.08. The correlation between CT of ROTEM and R of TEG as well as L30 of ROTEM and CL30 of TEG was not significant.The strongest correlation was found between MCF and MA (P < 0.001). However the MCF/MA showed an agreement of only 86% (ICC = 0.86). CONCLUSION: Values from ROTEM and TEG were not found to be interchangeable.

Highly Thermotolerant Metal Halide Perovskite Solids.

By virtue of their narrow emission bands, near-unity quantum yield, and low fabrication cost, metal halide perovskites hold great promise in numerous aspects of optoelectronic applications, including solid-state lighting, lasing, and displays. Despite such promise, the poor temperature tolerance and suboptimal quantum yield of the existing metal halide perovskites in their solid state have severely limited their practical applications. Here, a straightforward heterogeneous interfacial method to develop superior thermotolerant and highly emissive solid-state metal halide perovskites is reported and their use as long-lasting high-temperature and high-input-power durable solid-state light-emitting diodes is illustrated. It is found that the resultant materials can well maintain their superior quantum efficiency after heating at a temperature over 150 °C for up to 22 h. A white light-emitting diode (w-LED) constructed from the metal halide perovskite solid exhibits superior temperature sustainable lifetime over 1100 h. The w-LED also displays a highly durable high-power-driving capability, and its working current can go up to 300 mA. It is believed that such highly thermotolerant metal halide perovskites will unleash the possibility of a wide variety of high-power and high-temperature solid-state lighting, lasing, and display devices that have been limited by existing methods.

Vapour confinement as a strategy to fabricate metal and bimetallic nanostructures.

Metal nanostructures have attracted much attention in biomedical, plasmonic, hydrogen storage, and high-energy battery applications. However, the synthesis of various nanostructures of highly reactive elements (e.g. Mg) is still a difficult task and no single-approach has been reported for synthesizing such nanostructures. In this work, we produced magnesium nanoparticles (NPs), nanowires (NWs) and nanoneedles (NNs) in a single-approach, based on thermal evaporation without any carrier gas. Importantly, we employed rapid heating and cooling via a rapid thermal processing (RTP) furnace to control the nucleation and growth of nanostructures. The testing of Zn and Mg-Zn nanostructures was done to validate our approach and design for other metals and bimetallics. Interestingly, Cu and Ag nanoparticles were produced from metal salts (metal acetates and nitrates) with a reasonable control. The tuning of various nanostructures was possible by interplaying (i) with the curvature/outer diameter of the quartz bottle used for evaporation and (ii) by varying the position of the substrates. More specifically, the curvature of the quartz bottle increased the vapour collisions and effectively reduced the thermal energy of the vapour. Altogether, this favoured the control and confinement of vapour onto substrates and achieved supersaturation. Simultaneously, it led to the formation of various nanostructures without any carrier gas. The presented experimental set up is a versatile, simple, single-step and cost-effective solution for producing high-quality nanostructures.

Molecular characterization of Enterococcus faecalis isolates from urinary tract infection and interaction between Enterococcus faecalis encountered Dendritic and Natural Killer cells.

PURPOSE: Enterococcus faecalis is an emerging nosocomial pathogen. The study investigates the E. faecalis specific innate immune cells interplay between Natural Killer cells (NK) and Dendritic cells (DCs) in vitro. The present study also determines the prevalence, phenotype, and genotype of Enterococcus faecalis isolated from paediatric patients with urinary tract infection. MATERIALS AND METHODS: A total of 14 clinical isolates of Enterococcus spp were characterized using standard phenotypic tests and virulence factors were determined by polymerase chain reaction (PCR). Immature monocyte-derived DCs were cultured in the presence of six pathogenic E. faecalis isolates infected DCs were co-cultured with NK cells. Bacteria induced matured DCs and activated NK cells were evaluated by polychromatic flow cytometry. RESULTS: Out of 14 isolates, 13 were identified as E. faecalis. E. faecalis infected DCs differentiated into inflammatory and CD141 + DCs that promote NK cell activation. Activated NK cells significantly elevated the secretion of cytokines and chemokines in infected DCs during E. faecalis. This suggests that DC induced NK cell activation is effectively enhanced by the presence of E. faecalis. CONCLUSIONS: Studies on virulence determinants are necessary to understand the pathogenesis of E. faecalis. DC/NK cross-talk is of particular importance at mucosal surfaces such as the intestine, urinary tract where the immune system exists in intimate association with commensal bacteria. We found E. faecalis specific NK cells activation by infected DC-derived effector signals may involve in the killing of transformed or infected cells, thus coordinating innate and adaptive immune responses. E. faecalis specific DC/NK interaction is necessary for DC maturation and modulation of innate effector functions. Similarly, activated NK cells that induce- maturation of DC by pattern recognition receptors are also required for the generation of bacterial specific adaptive immunity.

Pseudomonas aeruginosa infection stimulates mitogen-activated protein kinases signaling pathway in human megakaryocytes.

Pseudomonas aeruginosa is a major cause of nosocomial infections and contributes to higher mortality in hospitalized individuals. Infection by P. aeruginosa triggers host immune response through activation of pathogen recognition receptors, which are present in innate cells. Several studies have reported the mechanism of P. aeruginosa induced innate immunity in multiple cell types. But so far there is no reports on response of megakaryocytes to P. aeruginosa infection. Hence, our aim was to investigate the precise role and signaling mechanism of megakaryocytes during P. aeruginosa infection. In this study, we used Mo7e cells as representatives of human megakaryocyte and found that P. aeruginosa infection induces cytotoxicity in these cells. We further demonstrated that P. aeruginosa infection modulates p38 and extracellular signal regulated kinase pathways in Mo7e cells. Protein expression profiling in P. aeruginosa lipopolysaccharide-treated Mo7e cells revealed upregulation of importin subunit ß and downregulation of metabolic enzymes. Our results suggest that P. aeruginosa infection regulates mitogen-activated protein kinases signaling pathway and importin in Mo7e cells and that this is a potential mechanism for nuclear translocation of nuclear factor binding near the κ light-chain gene in B cells and c-Jun N-terminal kinases to induce cell cytotoxicity.

Correlation of early ROTEM parameters with conventional coagulation tests in patients with chronic liver disease undergoing liver transplant.

BACKGROUND AND AIMS: Viscoelastic tests such as rotational thromboelastometry (ROTEM) provide a quick and holistic assessment of coagulation status to guide transfusion during liver transplant (LT). Conventional coagulation tests (CCTs) measure single parameters in isolation, and also the results are delayed hampering management of patients during surgery. We evaluated the correlation of early ROTEM-derived parameters with CCTs and also assessed the ability of ROTEM-derived parameters to predict thrombocytopaenia and hypofibrinogenaemia during LT in patients with end-stage liver disease (ESLD). METHODS: This retrospective study was carried out in 100 patients with decompensated ESLD undergoing LT. Correlation between CCTs and ROTEM parameters was analyzed. Receiver operating characteristic curves with area under the curve were used to determine the cut-off values of A5 andA10 on EXTEM and FIBTEM. RESULTS: The values of A5EXTEM and A10EXTEM highly correlated with fibrinogen levels and platelet count, whereas A5FIBTEM and A10FIBTEM correlated well with fibrinogen levels. A5EXTEM<21 mm and A10EXTEM<28 mm correlated with a platelet count <75,000 mm-3, whereas A5EXTEM<18 mm and A10EXTEM<25 mm correlated with a platelet count <50,000 mm-3. Fibrinogen levels <100 mg/dL better correlated with A5FIBTEM<5 mm, A10FIBTEM<6 mm, A5EXTEM<21 mm and A10EXTEM<30 mm. CONCLUSION: Early ROTEM parameters A5 and A10 of both EXTEM and FIBTEM had an excellent correlation with thrombocytopaenia and hypofibrinogenaemia and may potentially guide early transfusion of relevant blood products during LT.

Substrate-independent and catalyst-free synthesis of magnesium nanowires.

We report a catalyst free and substrate independent synthesis of magnesium nanowires using a simple thermal evaporation method. The produced Mg nanowires have a size of 8-60 nm with a crystalline MgO shell of ∼2-5 nm thickness. The synthesized nanowires grow along the [001] direction and horizontal to the substrate. Moreover, from ex situ TEM investigation the various sequential stages involved in the nanowire formation process were identified. The experimental outcome indicates the sequential stages including (i) formation of Mg nanoparticles, (ii) coarsening of Mg nanoparticles to microparticles via deposition diffusion aggregation (DDA) and the orientation attachment (OA) process, and (iii) nucleation and growth of Mg nanowires. In depth analysis confirms two types of nanowires, straight and serpentine-like, where the latter dominates as the holding duration/temperature of the synthesis increases. The straight nanowires are formed by the direct attachment of nanodroplets from the core to the surface and serpentine-like wires are formed on the surface of a microparticle which is in a quasi-melted state. Moreover, nanowires were produced by confining the Mg vapour to the substrate using a curved quartz bottle, thereby controlling the supersaturation in the absence of any inert/reactive gas during the synthesis. Our synthesis method is cost effective and can be applied to other low melting point elements for producing various nanostructures. Finally based on the experimental results a possible growth mechanism is proposed.

Shape and structural motifs control of MgTi bimetallic nanoparticles using hydrogen and methane as trace impurities.

In this work we report the influence of methane/hydrogen on the nucleation and formation of MgTi bimetallic nanoparticles (NPs) prepared by gas phase synthesis. We show that a diverse variety of structural motifs can be obtained from MgTi alloy, TiCx/Mg/MgO, TiCx/MgO and TiHx/MgO core/shell NPs via synthesis using CH4/H2 as a trace gas, and with good control of the final NP morphology and size distribution. Moreover, depending on the concentration of Ti and type of employed trace gas, the as prepared MgTi NPs can be tuned from truncated hexagonal pyramid to triangular and hexagonal platelet shapes. The shape of MgTi NPs is identified using detailed analysis from selected area electron diffraction (SAED) patterns and tomography (3D reconstruction based on a tilt series of Bright-Field transmission electron microscopy (TEM) micrographs). We observe the truncated hexagonal pyramid as a shape of MgTi alloy NPs in contrast to Mg NPs that show a hexagonal prismatic shape. Moreover, based on our experimental observations and generic geometrical model analysis, we also prove that the formation of the various structural motifs is based on a sequential growth mechanism instead of phase separation. One of the prime reasons for such mechanism is based on the inadequacy of Mg to nucleate without template in the synthesis condition. In addition, the shape of the TiCx/TiHx core, and the concentration of Mg have strong influence on the shape evolution of TiCx/MgO and TiHx/MgO NPs compared to TiCx/Mg/MgO NPs, where the thermodynamics and growth rates of the Mg crystal planes dominate the final shape. Finally, it is demonstrated that the core shape of TiCx and TiHx is affected by the Mg/Ti target ratio (affecting the composition in the plasma), and the type of the trace gas employed. In the case of CH4 the TiCx core forms a triangular platelet, while in the case of H2 the TiHx core transforms into a hexagonal platelet. We elucidate the reason for the TiCx/TiHx core shape based on the presence of (i) defects, and (ii) hydrogen and carbon adsorption on {111} planes that alter the growth rates and surface facet stabilization.

Elastic versus Alloying Effects in Mg-Based Hydride Films.

Magnesium thin films covered with a layer of Pd absorb hydrogen at much higher pressures than bulk Mg. Such an effect was originally explained as a consequence of elastic clamping on Mg by the capping Pd layer. An alternative interpretation later suggested that the pressure increase could originate from simple alloying between Mg and Pd. Here we resolve this controversy by measuring the hydrogenation and dehydrogenation isotherms of Mg-Pd thin film alloys over a wide range of compositions. Our results disentangle the effects of elastic clamping and alloying and highlight the role of plastic deformations.

Strategies to initiate and control the nucleation behavior of bimetallic nanoparticles.

In this work we report strategies to nucleate bimetallic nanoparticles (NPs) made by gas phase synthesis of elements showing difficulty in homogeneous nucleation. It is shown that the nucleation assisted problem of bimetallic NP synthesis can be solved via the following pathways: (i) selecting an element which can itself nucleate and act as a nucleation center for the synthesis of bimetallic NPs; (ii) introducing H2 or CH4 as an impurity/trace gas to initiate nucleation during the synthesis of bimetallic NPs. The latter can solve the problem if none of the elements in a bimetallic NP can initiate nucleation. We illustrate the abovementioned strategies for the case of Mg based bimetallic NPs, which are interesting as hydrogen storage materials and exhibit both nucleation and oxidation issues even under ultra-high vacuum conditions. In particular, it is shown that adding H2 in small proportions favors the formation of a solid solution/alloy structure even in the case of immiscible Mg and Ti, where normally phase separation occurs during synthesis. In addition, we illustrate the possibility of improving the nucleation rate, and controlling the structure and size distribution of bimetallic NPs using H2/CH4 as a reactive/nucleating gas. This is shown to be associated with the dimer bond energies of the various formed species and the vapor pressures of the metals, which are key factors for NP nucleation.

Anesthetic management of emergent laparoscopic bilateral adrenalectomy in a patient with a life-threatening cortisol crisis.

Cushing syndrome may rarely present with life-threatening hypercortisolism, manifested by hypertension, hypokalemia, hyperglycemia, and edema. If medical treatment proves ineffective in ameliorating the symptoms, emergent rescue adrenalectomy may be the only way to relieve the crisis. We describe the anesthetic management of a patient with an ectopic adrenocorticotropic hormone-secreting tumor, whose condition was rapidly deteriorating due to severe cortisol excess, and emergent adrenalectomy was the only available therapeutic modality. Despite severe metabolic derangement, edema, and incipient respiratory failure, emergent bilateral laparoscopic adrenalectomy was performed and the patient improved sufficiently to undergo surgery for the ectopic lesion without incident.

Synthesis and exceptional thermal stability of Mg-based bimetallic nanoparticles during hydrogenation.

Here we report the extraordinary thermal stability of Mg rich bimetallic nanoparticles (NPs), which is important for hydrogen storage technology. The enhanced NP stability is accomplished because of two critical improvements: (i) no void development within NPs (nanoscale Kirkendall effect) during their formation and (ii) suppressed Mg evaporation and NP hollowing during Mg hydrogenation at elevated temperature. The mechanism leading to the improved thermal stability of Mg-based bimetallic NPs is shown to be due to MgH2 hydride formation before evaporation can take place. These findings were tested for various compositions of Mg with Ni, Cu, and Ti, which are interesting combinations of materials for hydrogen storage systems. To achieve this we first demonstrate the synthesis mechanism of Mg-Ni and Mg-Cu NPs, which is well controlled at the single particle level, in order to accomplish multi-shell, alloy and intermetallic structures of interest for hydrogen storage tests. Aberration corrected transmission electron microscopy was carried out to unravel the detailed atomic structure and composition of the bimetallic NPs after production, processing, and hydrogenation. Finally, a simple and effective methodology is proposed for tuning the composition of the Mg-based bimetallic NPs based on the temperature-dependent nucleation behavior of NPs in the gas-phase.

Determination of the electronic energy levels of colloidal nanocrystals using field-effect transistors and Ab-initio calculations.

Colloidal nanocrystals electronic energy levels are determined by strong size-dependent quantum confinement. Understanding the configuration of the energy levels of nanocrystal superlattices is vital in order to use them in heterostructures with other materials. A powerful method is reported to determine the energy levels of PbS nanocrystal assemblies by combining the utilization of electric-double-layer-gated transistors and advanced ab-initio theory.

Tuning structural motifs and alloying of bulk immiscible Mo-Cu bimetallic nanoparticles by gas-phase synthesis.

Nowadays bimetallic nanoparticles (NPs) have emerged as key materials for important modern applications in nanoplasmonics, catalysis, biodiagnostics, and nanomagnetics. Consequently the control of bimetallic structural motifs with specific shapes provides increasing functionality and selectivity for related applications. However, producing bimetallic NPs with well controlled structural motifs still remains a formidable challenge. Hence, we present here a general methodology for gas phase synthesis of bimetallic NPs with distinctively different structural motifs ranging at a single particle level from a fully mixed alloy to core-shell, to onion (multi-shell), and finally to a Janus/dumbbell, with the same overall particle composition. These concepts are illustrated for Mo-Cu NPs, where the precise control of the bimetallic NPs with various degrees of chemical ordering, including different shapes from spherical to cube, is achieved by tailoring the energy and thermal environment that the NPs experience during their production. The initial state of NP growth, either in the liquid or in the solid state phase, has important implications for the different structural motifs and shapes of synthesized NPs. Finally we demonstrate that we are able to tune the alloying regime, for the otherwise bulk immiscible Mo-Cu, by achieving an increase of the critical size, below which alloying occurs, closely up to an order of magnitude. It is discovered that the critical size of the NP alloy is not only affected by controlled tuning of the alloying temperature but also by the particle shape.

The baby, the bathwater and the bath itself: a response to Tyrer et al.'s review of the successes and failures of dangerous and severe personality disorder.

A recent paper by Tyrer et al. in this journal has reviewed the dangerous and severe personality disorder (DSPD) initiative in the assessment and management of severe personality disorder associated with high risk. This previous paper summarized the authors' perceptions of the successes and failures of the DSPD pilot. In the present paper we identify some inaccuracies in the previous review and provide a critique of the conclusions reached.

Formation and stability of hollow MgO nanoshells.

High temperature annealing of gas phase synthesized Mg nanoparticles surrounded by an MgO shell leads to formation of hollow MgO nanoshells due to the evaporation assisted Kirkendall effect. Under electron beam exposure in TEM, the (220) MgO facets reduce their high surface energy by forming cube facets, which is followed by nanoshell size reduction and collapse within a few minutes. However, in ambient conditions the nanoshells remain stable for significant periods of time and further degrade by becoming filled with carbon while lossing any MgO identity. Finally, in moderate low vacuum they remained stable for months indicating promise for applications.

Motivating factors for male forensic patients with personality disorder.

INTRODUCTION: Treatability is currently a crucial component for detention under the Mental Health Act (England and Wales) for the Psychopathic Disorder (personality disorder) classification and there is continuing debate about the nature and assessment of treatability of individuals with personality disorder. Previous research has identified motivation to engage in treatment as a significant factor in the assessment of treatability; however, motivation is not a static predictor but a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. While previous studies have explored factors within the individual that are used to assess treatability, this study aims to explore what, if any, aspects of an inpatient forensic setting influence patients' motivation to engage in treatment. METHOD: The study examines patients' experiences of engaging in treatment in an inpatient forensic Personality Disorder Directorate using a qualitative approach to identify possible service-, ward- and therapist-level influences on patients' motivation to engage. RESULTS: Preliminary categories were identified across the data, including: support, treatment, safety, external belief, belonging, internal motivation and therapeutic relationship. CONCLUSIONS: Implications for the service are identified and areas for further qualitative exploration are highlighted.

Syphilitic abdominal aortic aneurysm.

A case report of a syphilitic aortic aneurysm in a 37-year-old male, presenting as upper abdominal pain accompanied by a pulsatile abdominal mass, is discussed.