Elasticity of Nuclear Pasta.

The elastic properties of neutron star crusts are relevant for a variety of currently observable or near-future electromagnetic and gravitational wave phenomena. These phenomena may depend on the elastic properties of nuclear pasta found in the inner crust. We present large-scale classical molecular dynamics simulations where we deform nuclear pasta. We simulate idealized samples of nuclear pasta and describe their breaking mechanism. We also deform nuclear pasta that is arranged into many domains, similar to what is known for the ions in neutron star crusts. Our results show that nuclear pasta may be the strongest known material, perhaps with a shear modulus of 10^{30} ergs/cm^{3} and a breaking strain greater than 0.1.

Prolonged Mechanical Ventilation After Lung Transplantation-A Single-Center Study.

This single-center study examines the incidence, etiology, and outcomes associated with prolonged mechanical ventilation (PMV), defined as time to definite spontaneous ventilation >21 days after double lung transplantation (LTx). A total of 690 LTx recipients between January 2005 and December 2012 were analyzed. PMV was necessary in 95 (13.8%) patients with decreasing incidence during the observation period (p < 0.001). Independent predictors of PMV were renal replacement therapy (odds ratio [OR] 11.13 [95% CI, 5.82-21.29], p < 0.001), anastomotic dehiscence (OR 8.74 [95% CI 2.42-31.58], p = 0.001), autoimmune comorbidity (OR 5.52 [95% CI 1.86-16.41], p = 0.002), and postoperative neurologic complications (OR 5.03 [95% CI 1.98-12.81], p = 0.001), among others. Overall 1-year survival was 86.0% (90.4% for LTx between 2010 and 2012); it was 60.7% after PMV and 90.0% in controls (p < 0.001). Conditional long-term outcome among hospital survivors, however, did not differ between the groups (p = 0.78). Multivariate analysis identified renal replacement therapy (hazard ratio [HR] 3.55 [95% CI 2.40-5.25], p < 0.001), post-LTx extracorporeal membrane oxygenation (HR 3.47 [95% CI 2.06-5.83], p < 0.001), and prolonged inotropic support (HR 1.95 [95% CI 1.39-2.75], p < 0.001), among others, as independent predictors of mortality. In conclusion, PMV complicated 14% of LTx procedures and, although associated with increased in-hospital mortality, outcomes among patients surviving to hospital discharge were unaffected.

Disordered nuclear pasta, magnetic field decay, and crust cooling in neutron stars.

Nuclear pasta, with nonspherical shapes, is expected near the base of the crust in neutron stars. Large-scale molecular dynamics simulations of pasta show long lived topological defects that could increase electron scattering and reduce both the thermal and electrical conductivities. We model a possible low-conductivity pasta layer by increasing an impurity parameter Q_{imp}. Predictions of light curves for the low-mass x-ray binary MXB 1659-29, assuming a large Q_{imp}, find continued late time cooling that is consistent with Chandra observations. The electrical and thermal conductivities are likely related. Therefore, observations of late time crust cooling can provide insight on the electrical conductivity and the possible decay of neutron star magnetic fields (assuming these are supported by currents in the crust).

Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis.

BACKGROUND AND STUDY AIM: Placement of covered self-expanding metal or plastic stents (SEMS or SEPS) is an established method for managing intrathoracic leaks. Recently, endoscopic vacuum-assisted closure (EVAC) has been described as a new effective treatment option. Our aim was to compare stent placement with EVAC for nonsurgical closure of intrathoracic anastomotic leaks. PATIENTS AND METHODS: In a retrospective analysis we were able to identify 39 patients who were treated with SEMS or SEPS and 32 patients who were treated with EVAC for intrathoracic leakage. In addition to successful fistula closure, we analyzed hospital mortality, number of endoscopic interventions, incidence of stenoses, and duration of hospitalization. RESULTS: In a multivariate analysis, successful wound closure was independently associated with EVAC therapy (hazard ratio 2.997, 95 % confidence interval [95 %CI] 1.568 - 5.729; P = 0.001). The overall closure rate was significantly higher in the EVAC group (84.4 %) compared with the SEMS/SEPS group (53.8 %). No difference was found for hospitalization and hospital mortality. We found significantly more strictures in the stent group (28.2 % vs. 9.4 % with EVAC, P < 0,05). CONCLUSIONS: EVAC is an effective endoscopic treatment option for intrathoracic leaks and showed higher effectiveness than stent placement in our cohort.

Secondary sclerosing cholangitis in critically ill patients: model of end-stage liver disease score and renal function predict outcome.

Secondary sclerosing cholangitis in critically ill patients (SSC - CIP) is an underdiagnosed emerging disease. The aim of this study was to characterize clinical features and prognostic factors for mortality in SSC - CIP. This retrospective study included 54 patients who were diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) after cardiothoracic surgery (n = 21), sepsis (n = 13), polytrauma (n = 11), and others (n = 9). In total, 33 patients who either died (n = 27) or needed liver transplantation (n = 6) were compared with surviving patients (n = 21). The model for end-stage liver disease (MELD) score and need for renal replacement therapy were independent risk factors for mortality. Compared with ERCP, accuracy was 30% for ultrasound and 36 % for liver biopsies. As a result of microbiological bile analysis, 28 % of patients required a change in antibiotic treatment. SSC - CIP is frequently a fatal disease. ERCP should be considered in selected patients to establish the diagnosis and hence provide useful clinical information.

[Acute liver failure. How much diagnostic work-up and therapy does my patient need?]. / Akutes Leberversagen. Wie viel Diagnostik und Therapie braucht mein Patient?

Acute liver failure is a multisystem disease with predominantly sudden and severe hepatic injury and hepatic encephalopathy caused by apoptotic or necrotic hepatocyte damage. The clinical challenge in patients with acute liver failure is to promptly identify those with poor prognosis and refer them for emergency liver transplantation. This review article highlights the main aspects of decision making in the setting of acute liver failure, summarizes new aspects of its critical care management and gives an overview of sclerosing cholangitis in the critically ill patient, an under-recognized disease entity that can progress to acute liver failure.

Crystallization of carbon-oxygen mixtures in white dwarf stars.

We determine the phase diagram for dense carbon-oxygen mixtures in white dwarf (WD) star interiors using molecular dynamics simulations involving liquid and solid phases. Our phase diagram agrees well with predictions from Ogata et al. and from Medin and Cumming and gives lower melting temperatures than Segretain et al. Observations of WD crystallization in the globular cluster NGC 6397 by Winget et al. suggest that the melting temperature of WD cores is close to that for pure carbon. If this is true, our phase diagram implies that the central oxygen abundance in these stars is less than about 60%. This constraint, along with assumptions about convection in stellar evolution models, limits the effective S factor for the 12C(α,γ)16O reaction to S(300)≤170 keV b.

Mobility of water bound to biological membranes. A proton NMR relaxation study.

Water proton nuclear magnetic resonance relaxation measurements have been obtained for aqueous suspensions of red cell membranes. These data support a model in which water molecules are exchanging rapidly between a bound phase with restricted motions and a free phase with dynamic properties similar to liquid water. From this model and these data, estimates are obtained for the relaxation time for bound phase water. Possible relaxation mechanisms for bound phase water are discussed and some support is found for an intermolecular interaction modulated by translational motions characterized by a diffusion constant of 10(-9) cm2/s.

Cholinergic stimulants and excess potassium ion increase the fluidity of plasma membranes isolated from adrenal chromaffin cells.

Chromaffin cell membranes from the bovine adrenal medulla were labelled with the hydrophobic fluorescent probe 1,6-diphenyl-1,3,5-hexatriene, and the fluorescence polarization (P) of the membrane suspensions was measured as a function of temperature. The P versus t profiles, between 20 and 37 degrees C, showed two linear regions separated by a break in the vicinity of 30 degrees C, reflecting a change in the phase behaviour of the constitutent lipids. Decreases in P values at higher temperature indicated progressive fluidization of the lipid bilayer. Previous incubation with either acetylcholine (0.5 mM) or nicotine (50 microM) produced further fluidization, the extent of which depended on the presence of added Ca2+ (2.2 mM). Thus, the flow activation energy, delta E, between approx. 30 and 37 degrees C was 9.1 kcal/mol for acetylcholine and 8.8 kcal/mol for acetylcholine plus Ca2+, as compared to 7.9 kcal/mol in the absence of acetylcholine and Ca2+. In the presence of nicotine, delta E was 11.4 kcal/mol when Ca2+ was absent and 9.5 kcal/mol when it was present. The cholinergic blocker, hexamethonium (0.5 mM), abolished the acetylcholine- or nicotine-induced changes. 65 mM K+ produced a similar fluidization, which was reversed by addition of Ca2+. An additive effect was observed when the membranes were incubated with both nicotine and K+, with delta E = 16.6 kcal/mol in the presence of Cas2+. These results indicate a receptor-mediated modulation of the lipid distribution between rigid and fluid regions in the membrane, which could be of importance for stimulated catecholamine secretion in the intact cell.

The effect of dodecyl sulfate on immunoglobulin hapten binding.

The instantaneous effect of dodecyl sulfate (DDS), in the mM concn range, on the binding of monovalent hapten by immunoglobulin was examined. Fluorescence measurements were utilized to study the effect of the detergent on sheep antiserum generated against thyroxin (T4) and against methamphetamine. Haptens were conjugated with the thiocyanate derivative of fluorescein in order to determine hapten binding on the basis of increased fluorescence polarization for the fluorescein-thiocarbamyl-hapten adducts (FT4 or FA) bound to immunoglobulin. Incubation of anti-T4-serum with DDS for 1 hr before the addition of FT4 resulted in diminished binding. The effect occurred at DDS concns greater than 0.1 mM and was essentially complete at a DDS conc of 1 mM. A kinetic study demonstrated a two stage process. An initial, rapid stage, with a half time less than 30 sec accounted for a reduction of immunoglobulin binding by 75%. The remaining 25% binding capacity was lost during a second, much slower phase with a half-time of about 11/2 hr. Prior hapten binding inhibited the effect of DDS. The degree of protection from combining site denaturation afforded by prior hapten binding was limited by the dissociation rate of bound hapten. The major, rapid phase was completely and immediately reversible by dilution. Prolonged incubation in DDS resulted in irreversible denaturation. The overall rate of DDS denaturation of the entire immunoglobulin molecule, as revealed by changes in the circular dichroism spectrum of a sheep gamma globulin fraction, was considerably slower than the denaturation rate of the combining site.

New case of Cole-Carpenter syndrome.

We describe a girl with a severe progressive type of osteogenesis imperfecta, in association with multisutural craniosynostosis, growth failure, and craniofacial findings including ocular proptosis, marked frontal bossing, midface hypoplasia, and micrognathia. Collagen analysis was normal. These features are consistent with the diagnosis of Cole-Carpenter syndrome. This report provides further evidence for the existence of this rare genetic entity.

Comprehensive 4-year follow-up on a case of maternal heterodisomy for chromosome 16.

Uniparental disomy for chromosome 16 has been previously identified in fetal deaths and newborn infants with limited follow-up. Thus there is a lack of information about the long-term effects of maternal uniparental disomy 16 on growth and development. We present a case of maternal heterodisomy for chromosome 16 and a comprehensive 4-year physical and cognitive evaluation. Cytogenetic analysis of chorionic villus obtained at 10 weeks gestation for advanced maternal age showed trisomy 16. At 15 weeks, amniocentesis demonstrated low level mosaicism 47,XY,+16[1]/46,XY[25]. Decreased fetal growth was noted in the last 2 months of pregnancy and the infant was small for gestational age at birth. Molecular studies revealed only maternal alleles for chromosome 16 in a peripheral blood sample from the child, consistent with maternal uniparental heterodisomy 16. Although short stature remains a concern, there appears to be no major cognitive effects of maternal disomy 16. Clinical evaluation and follow-up on additional cases should further clarify the role of placental mosaicism and maternal disomy 16 in intrauterine growth retardation and its effects on long-term growth in childhood.

Calcium transport proteins in active secretory zones: Na-Ca exchange isoforms and exchanger kinetic properties in chromaffin granules and plasma membranes.

We have found that Na-Ca exchange influences Ca(2+) efflux, signal decay, and the rate of secretion in chromaffin cells. We now report the presence of two distinct splicing variant isoforms of Na-Ca exchange proteins in bovine chromaffin cells and their transport properties in chromaffin granules and plasma membrane vesicles.

Functional nicotinic acetylcholine receptor expression on stem and progenitor cells of the early embryonic nervous system.

Although the adult brain contains nicotinic acetylcholine (ACh) receptors vital to cortical function, little is known about the assembly of embryonic receptor subunits into functional receptors or their role in fetal brain development. We now report the first evidence of functional nicotinic ACh receptors on stem and progenitor cells of fetal mouse cerebral cortex as early as embryonic day 10.

Calcium dependence of the thrombin-induced increase in endothelial albumin permeability.

We examined whether the increase in endothelial albumin permeability induced by alpha-thrombin is dependent on extracellular Ca2+ influx. Permeability of 125I-albumin across confluent monolayers of cultured bovine pulmonary artery endothelial cells was measured before and after the addition of 0.1 microM alpha-thrombin. In the presence of normal extracellular Ca2+ concentration ([Ca2+]o, 1000 microM), alpha-thrombin produced a 175 +/- 10% increase in 125I-albumin permeability. At lower [Ca2+]o (100, 10, 1, or less than 1 microM), alpha-thrombin caused a 140% increase in permeability (P less than 0.005). LaCl3 (1 mM), which competes for Ca2+ entry, blunted 38% of the increase in permeability. Preloading endothelial monolayers with quin2 to buffer cytosolic Ca2+ (Cai2+) produced a dose-dependent inhibition of the increase in 125I-albumin permeability. Preincubation with nifedipine or verapamil was ineffective in reducing the thrombin-induced permeability increase. A 60 mM K+ isosmotic solution did not alter base-line endothelial permeability. alpha-Thrombin increased [Ca2+]i in a dose-dependent manner and the 45Ca2+ influx rate. Extracellular medium containing 60 mM K+ did not increase 45Ca2+ influx, and nifedipine did not block the rise in 45Ca2+ influx caused by alpha-thrombin. Ca2+ flux into endothelial cells induced by alpha-thrombin does not occur through voltage-sensitive channels but may involve receptor-operated channels. In conclusion, the increase in endothelial albumin permeability caused by alpha-thrombin is dependent on Ca2+ influx and intracellular Ca2+ mobilization.

Effect of striatal implantation of bovine adrenal chromaffin cells on turning behavior in a rat model of Parkinson's disease.

Rats lesioned unilaterally with 6-hydroxydopamine, as an animal model of Parkinson's disease, were tested for D-amphetamine-induced rotation. Buffer or isolated bovine adrenal chromaffin cells were implanted into the lesioned striatum. Rats were retested for rotation 1 and 4 weeks postimplantation. Those with surviving implants rotated significantly less than controls. HPLC assay of striata showed that implants contained elevated norepinephrine and epinephrine, but not dopamine. The results show that the bovine chromaffin cell implants can function as a restorative treatment for nigrostriatal damage, that neonatal implants work better than adult implants, and that such restoration occurs independent of dopamine levels.

Ibogaine acts at the nicotinic acetylcholine receptor to inhibit catecholamine release.

In an effort to determine mechanisms of action of the putative anti-addictive agent ibogaine, we have measured its effects on catecholamine release in a model neuronal system, cultured bovine chromaffin cells. Various modes of stimulating catecholamine release were used including nicotinic ACh receptor activation, membrane depolarization with elevated K+ and Na+ channel activation with veratridine. In addition, because ibogaine has been reported to interact with kappa opioid receptors, we tested whether kappa receptor antagonists could reverse ibogaine's effects on catecholamine release. Ibogaine, at low concentration (<10 microM) was found to selectively inhibit nicotinic receptor-mediated catecholamine release, while having no significant effect on release evoked by either veratridine or membrane depolarization with elevated K+. The inhibitory actions of ibogaine and the kappa agonists were not reversed by preincubation with the opioid antagonists nor-binaltorphimine or naltrexone, suggesting that these inhibitory effects are not mediated by the kappa opioid receptor. The effects of low dose (10 microM) ibogaine were rapidly reversible, while the inhibitory effects of higher ibogaine doses persisted for at least 19 h following ibogaine washout. The results provide evidence for a mechanism of action ibogaine at the nicotinic ACh receptor. The results are consistent with a model in which the initial high transient brain concentrations (100 microM) of ibogaine act at multiple cellular sites and then have a selective action at the nicotinic ACh receptor cation channel following its metabolism to lower brain concentrations. The present findings are relevant to potential anti-addictive actions of ibogaine and to the development of drugs to combat nicotine addiction.

Ibogaine selectively inhibits nicotinic receptor-mediated catecholamine release.

The effects of ibogaine, a putative anti-addictive drug, on stimulated catecholamine release were examined in cultured chromaffin cells to clarify its mechanism(s) of action. Low concentrations of ibogaine (1-10 microM) had a selective inhibitory action on nicotinic receptor-mediated catecholamine release, while higher concentrations (100 microM) inhibited additional modes of stimulated catecholamine release. These results suggest a selective inhibitory action of ibogaine at the nicotinic acetylcholine receptor, possibly at the receptor ion channel site.

Muscarinic receptor-mediated inositol tetrakisphosphate response in bovine adrenal chromaffin cells.

Inositol trisphosphate (IP3), a product of the phosphoinositide cycle, mobilizes intracellular Ca2+ in many cell types. New evidence suggests that inositol tetrakisphosphate (IP4), an IP3 derivative, may act as another second messenger to further alter calcium homeostasis. However, the function and mechanism of action of IP4 are presently unresolved. We now report evidence of muscarinic receptor-mediated accumulation of IP4 in bovine adrenal chromaffin cells, a classic neurosecretory system in which calcium movements have been well studied. Muscarine (0.4 mM) stimulated an increase in [3H]IP4 and [3H]IP3 accumulation in chromaffin cells and this effect was completely blocked by atropine (0.5 mM). [3H]IP4 accumulation was detectable within 15 sec, increased to a maximum by 30 sec and thereafter declined. 2,3-diphosphoglycerate, an inhibitor of IP3 and IP4 hydrolysis, enhanced accumulation of these inositol polyphosphates. The results provide the first evidence of a rapid inositol tetrakisphosphate response in adrenal chromaffin cells, which should facilitate the future resolution of the relationship between IP4 and calcium homeostasis.

Task specific grip force control in writer's cramp.

OBJECTIVE: Writer's cramp is defined as a task specific focal dystonia generating hypertonic muscle co-contractions during handwriting resulting in impaired writing performance and exaggerated finger force. However, little is known about the generalisation of grip force across tasks others than writing. The aim of the study was to directly compare regulation of grip forces during handwriting with force regulation in other fine-motor tasks in patients and control subjects. METHODS: Handwriting, lifting and cyclic movements of a grasped object were investigated in 21 patients and 14 controls. The applied forces were registered in all three tasks and compared between groups and tasks. In addition, task-specific measures of fine-motor skill were assessed. RESULTS: As expected, patients generated exaggerated forces during handwriting compared to control subjects. However there were no statistically significant group differences during lifting and cyclic movements. The control group revealed a generalisation of grip forces across manual tasks whereas in patients there was no such correlation. CONCLUSION: We conclude that increased finger forces during handwriting are a task-specific phenomenon that does not necessarily generalise to other fine-motor tasks. SIGNIFICANCE: Force control of patients with writer's cramp in handwriting and other fine-motor tasks is characterised by individualised control strategies.