Comprehensive two-dimensional gas chromatography-mass spectrometry of complex mixtures of anaerobic bacterial metabolites of petroleum hydrocarbons.

Anaerobic biotransformation of petroleum hydrocarbons is an important alteration mechanism, both subsurface in geological reservoirs, in aquifers and in anoxic deep sea environments. Here we report the resolution and identification, by comprehensive two-dimensional gas chromatography-mass spectrometry (GC×GC-MS), of complex mixtures of aromatic acid and diacid metabolites of the anaerobic biodegradation of many crude oil hydrocarbons. An extended range of metabolites, including alkylbenzyl, alkylindanyl, alkyltetralinyl, alkylnaphthyl succinic acids and alkyltetralin, alkylnaphthoic and phenanthrene carboxylic acids, is reported in samples from experiments conducted under sulfate-reducing conditions in a microcosm over two years. The range of metabolites identified shows that the fumarate addition mechanism applies to the alteration of hydrocarbons with up to C8 alkylation in monoaromatics and that functionalisation of up to three ring aromatic hydrocarbons with at least C1 alkylation occurs. The GC×GC-MS method might now be applied to the identification of complex mixtures of metabolites in samples from real environmental oil spills.

Analysis of sentinel node positivity in primary cutaneous melanoma: an 8-year single institution experience.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a standard method for determining the pathologic status of the regional lymph nodes. AIMS: The aim of our study was to determine the incidence and clinicopathologic factors predictive of SLN positivity, and to evaluate the prognostic importance of SLNB in patients with cutaneous melanoma. METHODS: We performed a retrospective analysis of a prospectively maintained database of all patients who underwent SLNB for primary melanoma at our institution from 2005 to 2012. Statistical analysis was performed using χ 2 and Fischer exact test. RESULTS: In total, 318 patients underwent SLNB, of which 65 were for thin melanoma (≤1 mm). There were 36 positive SLNB, 278 negative SLNB and in four cases the SLN was not located. The incidence rate for SLNB was 11.3% overall and 1.5% in thin melanomas alone. Statistical analysis identified Breslow thickness >1 mm (P = 0.006), Clark level ≥ IV (P = 0.004) and age <75 years (P = 0.035) as the strongest predictors of SLN positivity. Our overall false negativity rate was 20% (9/45) with one case of false-negative SLNB in thin melanomas. CONCLUSION: Breslow thickness of the primary tumour remains the strongest predictor of SLN positivity. Our findings point to a possible limited role for SLNB in thin melanoma due to its low positivity rate, associated false-negative rate and related morbidity.

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample.

Assessment of major adverse cardiovascular events (MACE) after liver transplantation (LT) has been limited by the lack of a multicenter study with detailed clinical information. An integrated database linking information from the University HealthSystem Consortium and the Organ Procurement and Transplant Network was analyzed using multivariate Poisson regression to assess factors associated with 30- and 90-day MACE after LT (February 2002 to December 2012). MACE was defined as myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), cardiac arrest, pulmonary embolism, and/or stroke. Of 32 810 recipients, MACE hospitalizations occurred in 8% and 11% of patients at 30 and 90 days, respectively. Recipients with MACE were older and more likely to have a history of nonalcoholic steatohepatitis (NASH), alcoholic cirrhosis, MI, HF, stroke, AF and pulmonary and chronic renal disease than those without MACE. In multivariable analysis, age >65 years (incidence rate ratio [IRR] 2.8, 95% confidence interval [95% CI] 1.8-4.4), alcoholic cirrhosis (IRR 1.6, 95% CI 1.2-2.2), NASH (IRR 1.6, 95% CI 1.1-2.4), pre-LT creatinine (IRR 1.1, 95% CI 1.04-1.2), baseline AF (IRR 6.9, 95% CI 5.0-9.6) and stroke (IRR 6.3, 95% CI 1.6-25.4) were independently associated with MACE. MACE was associated with lower 1-year survival after LT (79% vs. 88%, p < 0.0001). In a national database, MACE occurred in 11% of LT recipients and had a negative impact on survival. Pre-LT AF and stroke substantially increase the risk of MACE, highlighting potentially high-risk LT candidates.

Medical use of cannabis: an addiction medicine perspective.

The use of cannabis for medical purposes, evident throughout history, has become a topic of increasing interest. Yet on the present medical evidence, cannabis-based treatments will only be appropriate for a small number of people in specific circumstances. Experience with cannabis as a recreational drug, and with use of psychoactive drugs that are prescribed and abused, should inform harm reduction in the context of medical cannabis.

Imaging of cardiovascular complications in patients with systemic lupus erythematosus.

In the long-term survival of patients with systemic lupus erythematosus (SLE), cardiovascular disease (CVD) is a leading cause of death. Recently, multimodality cardiovascular imaging methods have been adopted for the evaluation of cardiovascular risk, which has shown to be associated with both traditional cardiovascular risk factors and SLE-specific conditions. Quantitative imaging biomarkers, which can describe both morphological and functional abnormalities in the heart, are expected to provide new insights to stratify cardiovascular risks and to guide SLE management by assessing individual responses to therapies either protecting the cardiovascular system or suppressing the autoimmune reactions. In this review, we will discuss cutting-edge cardiovascular imaging techniques and potential clinical applications and limitations of those techniques for the evaluation of major SLE-related heart disorders.

The Irish contribution to the plastic surgery literature: 21 years of publications.

INTRODUCTION: The Republic of Ireland has always had an influence on medicine and has produced many renowned doctors who have helped shape its history. Furthermore, many clinical articles that have originated from Ireland have changed clinical practice throughout the world. The Irish have also had an impact on the plastic surgery literature yet it has never specifically been analyzed before. The purpose of this study was to identify and analyze all papers that have originated from the plastic surgery units in the Republic of Ireland in the medical literature over the past 21 years. METHODOLOGY: Twenty-four well-known plastic surgery, hand surgery and burns journals were selected for this study. By utilizing Scopus, the largest abstract and citation database of peer-reviewed literature, we analyzed each of our chosen 24 journals looking for Irish publications. Each paper was examined for article type, authorship, year of publication, institution of origin and level of evidence. RESULTS: Papers from the Republic of Ireland were published in 20 of the 24 journals over the past 21 years. A total of 245 articles from Ireland were published in the plastic surgery, hand surgery and burns literature over the 21-year period. Of these, 111 were original articles and 73 were case reports. The institution that published the most papers over the past 21 years was University Hospital Galway (66 publications) followed by Cork University Hospital with 54 papers. The journal with the most Irish articles was the Journal of Plastic, Reconstructive and Aesthetic Surgery with 56 papers. 2014 was the year with the most publications (28 papers). Authorship numbers also increased over time as the average number of authors in 1994 was 3.5, whereas it was 5.54 in 2014. DISCUSSION: The number of publications per year continues to increase along with authorship numbers. This mirrors the trend in other specialties. Publications are now no longer required for selection on to a higher surgical training scheme. There is now a fear that the academic output of trainees will decrease as a consequence. To prevent this, each unit must actively support and encourage research activity with their trainees.

A review of sentinel lymph node biopsy for thin melanoma.

INTRODUCTION: Although there is a lack of established survival benefit of sentinel lymph node biopsy (SLNB), this technique has been increasingly applied in the staging of patients with thin (≤1.00 mm) melanoma (T1Nx), without clear supportive evidence. METHODS: We review the guidelines and available literature on the indications and rationale for performing SLNB in thin melanoma. RESULTS: As a consequence of the paucity of evidence of SLNB in thin melanoma, there is considerable variability in the guidelines. It is difficult to define clinicopathologic factors that reliably predict the presence of nodal metastasis. SLNB does not yet inform management in thin melanoma to improve survival outcome. CONCLUSION: Based on available evidence, high risk patients with melanomas between 0.75 and 1.00 mm may be appropriate candidates to be considered for SLN biopsy after discussing the likelihood of finding evidence of nodal progression, the risks of sentinel node biopsy, and the lack of proven survival benefit from any form of surgical nodal staging.

The quantitative significance of Syntrophaceae and syntrophic partnerships in methanogenic degradation of crude oil alkanes.

Libraries of 16S rRNA genes cloned from methanogenic oil degrading microcosms amended with North Sea crude oil and inoculated with estuarine sediment indicated that bacteria from the genera Smithella (Deltaproteobacteria, Syntrophaceace) and Marinobacter sp. (Gammaproteobacteria) were enriched during degradation. Growth yields and doubling times (36 days for both Smithella and Marinobacter) were determined using qPCR and quantitative data on alkanes, which were the predominant hydrocarbons degraded. The growth yield of the Smithella sp. [0.020 g(cell-C)/g(alkane-C)], assuming it utilized all alkanes removed was consistent with yields of bacteria that degrade hydrocarbons and other organic compounds in methanogenic consortia. Over 450 days of incubation predominance and exponential growth of Smithella was coincident with alkane removal and exponential accumulation of methane. This growth is consistent with Smithella's occurrence in near surface anoxic hydrocarbon degrading systems and their complete oxidation of crude oil alkanes to acetate and/or hydrogen in syntrophic partnership with methanogens in such systems. The calculated growth yield of the Marinobacter sp., assuming it grew on alkanes, was [0.0005 g(cell-C)/g(alkane-C)] suggesting that it played a minor role in alkane degradation. The dominant methanogens were hydrogenotrophs (Methanocalculus spp. from the Methanomicrobiales). Enrichment of hydrogen-oxidizing methanogens relative to acetoclastic methanogens was consistent with syntrophic acetate oxidation measured in methanogenic crude oil degrading enrichment cultures. qPCR of the Methanomicrobiales indicated growth characteristics consistent with measured rates of methane production and growth in partnership with Smithella.

Therapeutic whole lung lavage for inhaled plutonium oxide revisited.

Two reviews in the last 12 years have differed widely in their indications for the use of whole lung lavage (WLL) to remove plutonium from the lung, one recommending its use at relatively low radiation doses to prevent stochastic effects and the other recommending restricting its use to high doses to prevent deterministic effects only. Since the publication of these reviews significant data have accumulated demonstrating the increased safety of WLL, and there are additional data on stochastic and deterministic effects. We discuss deterministic and stochastic risks and the practical aspects of undertaking WLL. We recommend that each case be assessed individually.

The effect of retinoic acid on mouse mandibular molar development in vitro, using alkaline phosphatase as a molecular indicator of differentiation.

INTRODUCTION: An excellent model system that links evolutionary biology and developmental biology in seeking to understand evolutionary diversity is the study of tooth development in mammals. These studies reflect the diversity of mammalian radiations which bear on the interpretation of South African fossil hominids. Tooth development occurs via epithelio-mesenchymal interactions and involves the production of many substances, including alkaline phosphatase, which is necessary for dentine and enamel formation. Retinoic acid is a known morphogen and is important in tooth development. In excess, retinoic acid has been found to alter the formation of teeth. OBJECTIVES: In order to determine whether retinoic acid has any effect on tooth morphology, exogenous retinoic acid was administered to developing mouse molar teeth in vitro, and alkaline phosphatase was utilized as an indicator of differentiation. METHODS: Molars were microdissected from 15.5 day mouse embryo mandibles and cultured at the air: medium interface with or without retinoic acid for seven days. Following fixation and embedding, the explants were sectioned for morphological analysis. Alkaline phosphatase activity was detected using a modified Gomori's histochemical method. RESULTS AND CONCLUSION: Retinoic acid appeared to retard the growth and differentiation of the molar explants. This was coincident with reduced alkaline phosphatase.

A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: derivation, validation and incorporation into a bedside programme.

BACKGROUND: Risk stratification for patients with acute dyspnoea is a challenging task. No quantitative tool for mortality prediction among patients with acute dyspnoea is available. METHODS: 595 dyspnoeic subjects were enrolled in an emergency department. Clinical and biochemical factors independently predictive of death by 1 year were used to develop a mortality risk prediction tool. RESULTS: Seven factors comprised the final tool: age (x0.3), heart rate (x0.2), blood urea nitrogen (x0.3), New York Heart Association class (x5), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) >or=986 pg/ml (18 points), systolic blood pressure <100 mm Hg (11 points) and presence of a murmur (11 points). A continuous rise in mortality was seen from 1.7% in the lowest score quintile (n = 118; score or=85.5; p<0.001 for trend). Receiver operating characteristic curve analysis of the score's accuracy produced an area under the curve (AUC) of 0.82 (95% CI 0.78 to 0.85) with similar AUCs in subjects with acutely destabilised heart failure (AUC = 0.73, 95% CI 0.67 to 0.79) and those without (AUC = 0.83, 95% CI 0.77 to 0.85, p for the comparison = NS). The score was validated in a separate population of dyspnoeic patients (AUC = 0.73, 95% CI 0.64 to 0.82; p<0.001) and was incorporated into a computer program suitable for near-patient calculation. CONCLUSION: A new risk stratification tool for acutely dyspnoeic patients has been derived and validated.

Crude-oil biodegradation via methanogenesis in subsurface petroleum reservoirs.

Biodegradation of crude oil in subsurface petroleum reservoirs has adversely affected the majority of the world's oil, making recovery and refining of that oil more costly. The prevalent occurrence of biodegradation in shallow subsurface petroleum reservoirs has been attributed to aerobic bacterial hydrocarbon degradation stimulated by surface recharge of oxygen-bearing meteoric waters. This hypothesis is empirically supported by the likelihood of encountering biodegraded oils at higher levels of degradation in reservoirs near the surface. More recent findings, however, suggest that anaerobic degradation processes dominate subsurface sedimentary environments, despite slow reaction kinetics and uncertainty as to the actual degradation pathways occurring in oil reservoirs. Here we use laboratory experiments in microcosms monitoring the hydrocarbon composition of degraded oils and generated gases, together with the carbon isotopic compositions of gas and oil samples taken at wellheads and a Rayleigh isotope fractionation box model, to elucidate the probable mechanisms of hydrocarbon degradation in reservoirs. We find that crude-oil hydrocarbon degradation under methanogenic conditions in the laboratory mimics the characteristic sequential removal of compound classes seen in reservoir-degraded petroleum. The initial preferential removal of n-alkanes generates close to stoichiometric amounts of methane, principally by hydrogenotrophic methanogenesis. Our data imply a common methanogenic biodegradation mechanism in subsurface degraded oil reservoirs, resulting in consistent patterns of hydrocarbon alteration, and the common association of dry gas with severely degraded oils observed worldwide. Energy recovery from oilfields in the form of methane, based on accelerating natural methanogenic biodegradation, may offer a route to economic production of difficult-to-recover energy from oilfields.

Unusual presentations for pharmacotherapy-poppy seed dependence.

Two cases of patients presenting with opioid dependence who maintained their dependence with poppy tea are described. There appears to have been an increase in this practice in some groups, although dependent use is uncommon. These cases illustrate significant levels of dependence on a licit, and readily available, source of opiates requiring high doses of pharmacotherapy that match those typically required by individuals who are treated for heroin dependence.

Anaerobic hydrocarbon biodegradation in deep subsurface oil reservoirs.

Biodegradation of crude oil in subsurface petroleum reservoirs is an important alteration process with major economic consequences. Aerobic degradation of petroleum hydrocarbons at the surface is well documented and it has long been thought that the flow of oxygen- and nutrient-bearing meteoric waters into reservoirs was necessary for in-reservoir petroleum biodegradation. The occurrence of biodegraded oils in reservoirs where aerobic conditions are unlikely, together with the identification of several anaerobic microorganisms in oil fields and the discovery of anaerobic hydrocarbon biodegradation mechanisms, suggests that anaerobic degradation processes could also be responsible. The extent of anaerobic hydrocarbon degradation processes in the world's deep petroleum reservoirs, however, remains strongly contested. Moreover, no organism has yet been isolated that has been shown to degrade hydrocarbons under the conditions found in deep petroleum reservoirs. Here we report the isolation of metabolites indicative of anaerobic hydrocarbon degradation from a large fraction of 77 degraded oil samples from both marine and lacustrine sources from around the world, including the volumetrically important Canadian tar sands. Our results therefore suggest that anaerobic hydrocarbon degradation is a common process in biodegraded subsurface oil reservoirs.

Modelling of epithelial tissue impedance measured using three different designs of probe.

Impedance measurement is a promising technique for detecting pre-malignant changes in epithelial tissue. This paper considers how the design of the impedance probe affects the ability to discriminate between tissue types. To do this, finite element models of the electrical properties of squamous and glandular columnar epithelia have been used. The glandular tissue model is described here for the first time. Glandular mucosa is found in many regions of the gastrointestinal tract, such as the stomach and intestine, and has a large effective surface area. Firstly, the electrical properties of a small section of gland, with epithelial cells and supportive tissue, are determined. These properties are then used to build up a three-dimensional model of a whole section of mucosa containing many thousands of glands. Measurements using different types of impedance probe were simulated by applying different boundary conditions to the models. Transepithelial impedance, and tetrapolar measurement with a probe placed on the tissue surface have been modelled. In the latter case, the impedance can be affected by conductive fluid, such as mucus, on the tissue surface. This effect has been investigated, and a new design of probe, which uses a guard electrode to counteract this potential source of variability, is proposed.

Indispensable benefits and unavoidable costs of unattended sound for cognitive functioning.

Critical to survival, and also to the organism's efficient management of the flow of information in the brain, is attentional selectivity; the ability to select one source of information to guide action whilst ignoring others that are irrelevant to the current behavioural goal. But such selectivity is not merely the inclusion of the relevant information and the complete neglect of irrelevant information. We discuss in this paper the way that all sound is processed in an obligatory fashion--whether relevant or irrelevant--and discuss the fate of sound in the case when it is irrelevant to the immediate mental task. Using the so-called irrelevant sound paradigm we show that unattended information is both registered and organised. This obligatory process of organisation compromises the efficiency of particular types of mental activity. We discuss how such interference comes about but the key emphasis is upon the possible beneficial effects of such processing-of-the-irrelevant, in allowing the switching of attention to be more facile and intelligent and in allowing the accumulation of evidence about statistical regularities in the auditory world (such as those helpful to the efficient perception, acquisition and use of language). In sum, we describe how purposeful processing based on directed attention is in a state of tension with the obligatory, automatic processing of the unattended. One of the consequences of this tension is typically manifested in auditory distraction, but the benefits of processing of the attended may considerably outweigh this disadvantage.

Modelled current distribution in cervical squamous tissue.

The electrical properties of cervical squamous epithelium have been modelled in the frequency range 100 Hz to 10 MHz. The hierarchical modelling process comprises a cellular level stage, which includes detailed models of cells typical of different depths within the epithelium and a tissue model, which utilizes electrical properties obtained from the cellular models. The fit between the modelled and measured impedance spectra and the distribution of current with depth depends on the macroscopic model structure. Both the properties of the basement membrane and the presence of a surface mucus layer are shown to have a significant effect. The best fit with measured data is obtained when a 10 microm thick, high-conductivity surface layer is included in the tissue model.

Risk of laboratory-acquired meningococcal disease.

Five probable secondary cases of meningococcal disease were identified in microbiology laboratory workers in England and Wales during a 15-year period. All cases had prepared suspensions of Neisseria meningitidis outside a safety cabinet upto seven days before onset of illness. Relative risk in laboratory workers compared with the background adult population was 184 (95% CI 60-431). In view of the potentially serious outcome from this infection, a safety cabinet should always be used when preparing or working with suspensions of meningococci. Vaccination policy for microbiology laboratory workers should be reviewed.

The impact of broadband noise on serial memory: changes in band-pass frequency increase disruption.

Irrelevant sound consisting of bursts of broadband noise, in which centre frequency changes with each burst, markedly impaired short-term memory for order. In contrast, a sequence of irrelevant sound in which the same band-pass noise burst was repeated did not produce significant disruption. Serial recall for both visual-verbal (Experiment 1) and visual-spatial items (Experiment 2) was sensitive to the increased disruption produced by changing irrelevant noise. The results provide evidence that sounds that are largely aperiodic can produce marked disruption of serial recall in a similar manner to periodic sounds (e.g., speech, musical streams, and tones), and thus show a changing-state effect.

Bioremediation of coal tar PAH in soils using biodiesel.

The addition of biodiesel together with nitrate and phosphate to soil containing coal tar, in laboratory and field experiments, resulted in degradation of coal tar polycyclic aromatic hydrocarbons (PAH) that was not apparent when the nutrients alone were added. The addition of motor diesel fuel instead of biodiesel was also tested. Over the 55 days of the field and laboratory experiments, the biodiesel resulted in an increased degradation of naphthalene in the coal tar by 52% and 85%, respectively, and motor diesel resulted in increased depletions of 85% and 96%, respectively. Other PAH containing up to four rings were depleted to lesser extents. The increases in PAH biodegradation by the diesel treatments were ascribed to tar solubilisation and dispersion thereby increasing the PAH bioavailability. The ready biodegradability and low phytotoxicity of biodiesel suggest that it may be suitable as a novel treatment for the bioremediation of coal tar contaminated soils.