Low, rather than high, body mass index confers increased risk for post-liver transplant death and graft loss: Risk modulated by model for end-stage liver disease.

With increasing attention being paid to optimizing patient outcomes, it has been proposed that liver transplantation (LT) for individuals with elevated body mass index (BMI) values and high Model for End-Stage Liver Disease (MELD) scores may adversely affect post-LT outcomes. We investigated the impact of BMI on post-LT outcomes in the context of MELD at LT. Using United Network for Organ Sharing data, we identified all adult (≥ 18 years) primary LT recipients from March 1, 2002 to September 30, 2011. BMI categories included the following: underweight, normal, overweight, class I obese, class II obese, and class III obese (<18.5; 18.5-24.9; 25-29.9; 30-34.9; 35-39.9; ≥ 40 kg/m(2), respectively). One-year post-LT death and graft loss were modeled using Cox regression, including interactions between BMI and MELD. A total of 45,551 adult recipients were identified: 68% male; median (interquartile range [IQR]) age 55 years (IQR, 49-60 years); MELD, 19 (IQR, 13-26); and donor risk index, 1.39 (IQR, 1.12-1.69). Representations in the BMI categories were underweight (n = 863, 2%), normal (n = 13,262, 29%), overweight (n = 16,329, 36%), class I obese (n = 9639, 21%), class II obese (n = 4062, 9%), and class III obese (n = 1396, 3%). In adjusted analyses, elevated BMI was not associated with increased risk for death or graft loss. Among the underweight, there were significant interactions between BMI and MELD with respect to death (P = 0.02) and graft loss (P = 0.01), with significantly increased risks for death (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.38-2.09; P = 0.006) and graft loss (HR, 1.45; 95% CI, 1.21-1.74; P = 0.02) among those with low MELD (≤ 26), compared to normal BMI recipients with low MELD. In conclusion, overweight and obese LT recipients do not have increased risk of death or graft loss regardless of MELD. Underweight patients are at increased risk for poor outcomes post-LT, specifically underweight recipients with low MELD have increased risk for death and graft loss. Mechanisms underlying this phenomenon warrant further investigation.

Activity and social factors affect cohesion among individuals in female Japanese macaques: A simultaneous focal-follow study.

Understanding cohesion among individuals within a group is necessary to reveal the social system of group-living primates. Japanese macaques (Macaca fuscata) are female-philopatric primates that reside in social groups. We investigated whether individual activity and social factors can affect spatio-temporal cohesion in wild female Japanese macaques. We conducted behavioral observation on a group, which contained 38 individuals and ranged over ca. 60 ha during the study period. Two observers carried out simultaneous focal-animal sampling of adult female pairs during full-day follows using global positioning system which enabled us to quantify interindividual distances (IIDs), group members within visual range (i.e., visual unit), and separation duration beyond visual range as indicators of cohesion among individuals. We found considerable variation in spatio-temporal group cohesion. The overall mean IID was 99.9 m (range = 0-618.2 m). The percentage of IIDs within visual range was 23.1%, within auditory range was 59.8%, and beyond auditory range was 17.1%. IIDs varied with activity; they were shorter during grooming and resting, and longer during foraging and traveling. Low-ranking females showed less cohesion than high-ranking ones. Kin females stayed nearly always within audible range. The macaques were weakly cohesive with small mean visual unit size (3.15 counting only adults, 5.99 counting all individuals). Both-sex units were the most frequently observed visual unit type when they were grooming/resting. Conversely, female units were the most frequently observed visual unit type when they were foraging. The overall mean visual separation duration was 25.7 min (range = 3-513 min). Separation duration was associated with dominance rank. These results suggest that Japanese macaques regulate cohesion among individuals depending on their activity and on social relationships; they were separated to adapt food distribution and aggregated to maintain social interactions.

Drug-induced liver injury due to varenicline: a case report.

BACKGROUND: Liver injury due to prescription and nonprescription medications is an expanding public health concern in the United States, with drug-induced liver injury (DILI) being the single most common reason for regulatory actions instituted by the Food and Drug Administration against certain medications and supplements. CASE PRESENTATION: A 69-year-old Latino man was referred to Hepatology Clinic for urgent evaluation of new onset jaundice, nausea and fatigue associated with a >40-fold increase in his transaminase levels and elevated INR and alkaline phosphatase. The patient had received a new prescription for varenicline to aid with smoking cessation approximately 3 weeks prior to his evaluation in Hepatology Clinic. Within 5 days of starting the varenicline, the patient developed new onset of nausea, vomiting, malaise and deep jaundice. The varenicline was discontinued on day 5 by the patient. Hepatologic evaluation revealed no evidence of acute viral hepatitis, autoimmune, metabolic or alcohol-related liver disorders. The patient's past medical history was notable, however, for chronic hepatitis C. His liver enzymes and synthetic function completely normalized 9 weeks after discontinuation of the varenicline. CONCLUSION: This report represents the second documented cases of drug-induced liver injury related to varenicline therapy, highlighting the need for clinician awareness regarding potential hepatotoxicity of varenicline, particularly among patients with pre-existing liver disease.

Activity synchrony and travel direction synchrony in wild female Japanese macaques.

The degree of behavioural synchrony of animals within a group can be considered a reflection of how individuals adjust their behaviours to manage the costs/benefits accompanying group-living. In this study, we focused on activity synchrony and travel direction synchrony as behavioural synchrony. We aimed to quantify the degree of behavioural synchrony and identify which factors can affect the synchrony in wild females of Japanese macaques. Japanese macaques live in female philopatric multi-female and multi-male groups and have a linear dominance hierarchy. The groups are characterized by changing spatio-temporal cohesiveness among group members. Two observers conducted simultaneous focal animal sampling on adult females using global positioning system devices to record locations. The overall degree of activity synchrony was positive compared with random, and the degree was highest when macaques were located within visual range of each other. Both activity synchrony and travel direction synchrony were influenced by spatial cohesion, i.e. interindividual distance, which shows that the probabilities of synchrony were higher with individuals located closer. Activity synchrony was also influenced by activity type, showing that the probabilities of synchrony were higher when individuals engaged in foraging. These results suggest that synchronized foraging may be caused by enhanced feeding with other group members when they are closer to each other. Our approach to quantitatively measure spatial dispersal while observing group members simultaneously revealed the roles of spatial cohesion and activity types for determining the degree of behavioural synchrony.

Correction to: Review of GPS collar deployments and performance on nonhuman primates.

In the original publication of the article, figure 1 was wrongly published as a duplication.

Review of GPS collar deployments and performance on nonhuman primates.

Over the past 20 years, GPS collars have emerged as powerful tools for the study of nonhuman primate (hereafter, "primate") movement ecology. As the size and cost of GPS collars have decreased and performance has improved, it is timely to review the use and success of GPS collar deployments on primates to date. Here we compile data on deployments and performance of GPS collars by brand and examine how these relate to characteristics of the primate species and field contexts in which they were deployed. The compiled results of 179 GPS collar deployments across 17 species by 16 research teams show these technologies can provide advantages, particularly in adding to the quality, quantity, and temporal span of data collection. However, aspects of this technology still require substantial improvement in order to make deployment on many primate species pragmatic economically. In particular, current limitations regarding battery lifespan relative to collar weight, the efficacy of remote drop-off mechanisms, and the ability to remotely retrieve data need to be addressed before the technology is likely to be widely adopted. Moreover, despite the increasing utility of GPS collars in the field, they remain substantially more expensive than VHF collars and tracking via handheld GPS units, and cost considerations of GPS collars may limit sample sizes and thereby the strength of inferences. Still, the overall high quality and quantity of data obtained, combined with the reduced need for on-the-ground tracking by field personnel, may help defray the high equipment cost. We argue that primatologists armed with the information in this review have much to gain from the recent, substantial improvements in GPS collar technology.

Future Trends in Demand for Liver Transplant: Birth Cohort Effects Among Patients With NASH and HCC.

BACKGROUND: With increasing US adiposity, nonalcoholic steatohepatitis (NASH) is now a leading liver transplant (LT) indication. Given its association with hepatocellular carcinoma (HCC), the burden of NASH is substantial. We analyzed birth cohort effects among NASH LT registrants, with and without HCC. METHODS: All new LT registrants in United Network for Organ Sharing (1995-2015) were identified. Birth cohorts were defined as: 1936-1940, 1941-1945, 1946-1950, 1951-1955, 1956-1960, 1961-1965, 1966-1970, 1971-2015. Poisson regression examined trends in LT registration, by disease etiology (NASH, hepatitis C virus [HCV], other liver disease etiologies [OTHER]), and HCC. RESULTS: We identified 182 368 LT registrants with median age of 52 years (range, 0-86 years). Nine percent (n = 16 160) had NASH, 38% (n= 69 004) HCV, 53% (n = 97 204) OTHER. HCC was present in: 13% (n = 2181), 27% (n = 18 295), and 11% (n = 10 902), of NASH, HCV, and OTHER, respectively. Liver transplant registration for HCC increased significantly from 2002 to 2015 across all etiologies (NASH, 6%-18%; HCV, 19%-51%; OTHER, 9%-16%; P < 0.0001 for all). NASH LT registrations, with and without HCC, increased sharply in patients born from 1945 to 2015. This upward NASH trend is in stark contrast to HCV LT registrations, which showed a general decline. Notably, a sharp rise in LT registrations is occurring among younger NASH patients (35-55 years), mirroring the increasing adiposity across all age groups in the US population. CONCLUSIONS: NASH LT registrants, with and without HCC, have increased over time, and are projected to increase unabated in the future, notably among younger birth cohorts ("Adipose Wave Effect"). HCC LT registration patterns demonstrate that, compared with HCV, NASH patients encompass younger birth cohorts. These data illustrate that the full impact of NASH on demand for LT is yet to be realized.

Whole-body biodistribution and radiation dosimetry in monkeys and humans of the phosphodiesterase 4 radioligand [(11)C](R)-rolipram: comparison of two-dimensional planar, bisected and quadrisected image analyses.

INTRODUCTION: [(11)C](R)-Rolipram is a selective radioligand for positron emission tomography (PET) imaging of phosphodiesterase 4, an enzyme that metabolizes 3',5'-cyclic adenosine monophosphate. The aim of this study was to estimate the human radiation absorbed dose of the radioligand based on its biodistribution in both monkeys and humans. METHODS: Whole-body PET images were acquired for 2 h after injecting [(11)C](R)-rolipram in eight healthy humans and three monkeys. The simple method of using a single two-dimensional (2D) planar image was compared to more time-consuming methods that used two (bisected) or four (quadrisected) tomographic images in the anteroposterior direction. RESULTS: Effective dose was 4.8 microGy/MBq based on 2D planar images. The effective dose was only slightly lower by 1% and 5% using the bisected and quadrisected images, respectively. Nevertheless, the two tomographic methods may have more accurately estimated the exposure of some organs (e.g., kidneys) that are asymmetrically located in the body or have radioactivity that appears to overlap on 2D planar images. Monkeys had a different biodistribution pattern compared to humans (e.g., greater urinary excretion) such that their data overestimated the effective dose in humans by 40%. CONCLUSIONS: The effective dose of [(11)C](R)-rolipram was modest and comparable to that of other (11)C-labeled radioligands. The simple and far less time-consuming 2D planar method provided accurate and somewhat more conservative estimates of effective dose than the two tomographic methods. Although monkeys are commonly used to estimate human radiation exposures, their data gave a considerable overestimation for this radioligand.

Human biodistribution and radiation dosimetry of the tachykinin NK1 antagonist radioligand [18F]SPA-RQ: comparison of thin-slice, bisected, and 2-dimensional planar image analysis.

UNLABELLED: (18)F-Labeled substance P antagonist-receptor quantifier ([(18)F]SPA-RQ) [2-fluoromethoxy-5-(5-trifluoromethyl-tetrazol-1-yl)-benzyl]-[(2S,3S)-2-phenyl-piperidin-3-yl)amine] is a selective radioligand for in vivo quantification of tachykinin NK(1) receptors with PET. The aims of this study were to estimate the radiation safety profile and relative risks of [(18)F]SPA-RQ with 3 different methods of image analysis. METHODS: Whole-body PET images were acquired in 7 healthy subjects after injection of 192 +/- 7 MBq (5.2 +/- 0.2 mCi) [(18)F]SPA-RQ. Emission images were serially acquired at multiple time-points from 0 to 120 min and approximately 180-240 min after injection. Urine samples were collected after each imaging session and for 24 h after the last scan to measure excreted radioactivity. Horizontal tomographic images were compressed to varying degrees in the anteroposterior direction to create 3 datasets: thin-slice, bisected, and 2-dimensional (2D) planar images. Regions of interest were drawn around visually identifiable source organs to generate time-activity curves for each dataset. Residence times were determined from these curves, and doses to individual organs and the body as a whole were calculated using OLINDA/EXM 1.0. RESULTS: The lungs, upper large intestine wall, small intestine, urinary bladder wall, kidneys, and thyroid had the highest radiation-absorbed doses. Biexponential fitting of mean bladder and urine activity showed that about 41% of injected activity was excreted via urine. Assuming a 2.4-h urine voiding interval, the calculated effective doses from thin-slice, bisected, and 2D planar images were 29.5, 29.3, and 32.3 microSv/MBq (109, 108, and 120 mrem/mCi), respectively. CONCLUSION: Insofar as effective dose is an accurate measure of radiation risk, all 3 methods of analysis provided quite similar estimates of risk to human subjects. The radiation dose was moderate and would potentially allow subjects to receive multiple PET scans in a single year. Individual organ exposures varied among the 3 methods, especially for structures asymmetrically located in an anterior or posterior position. Bisected and 2D planar images almost always provided higher organ dose estimates than thin-slice images. Thus, either the bisected or 2D planar method of analysis appears acceptable for quantifying human radiation burden, at least for radioligands with a relatively broad distribution in the body and not concentrated in a small number of radiation sensitive organs.

Spatialization design: comparing points and landscapes.

Spatializations represent non-spatial data using a spatial layout similar to a map. We present an experiment comparing different visual representations of spatialized data, to determine which representations are best for a non-trivial search and point estimation task. Primarily, we compare point-based displays to 2D and 3D information landscapes. We also compare a colour (hue) scale to a grey (lightness) scale. For the task we studied, point-based spatializations were far superior to landscapes, and 2D landscapes were superior to 3D landscapes. Little or no benefit was found for redundantly encoding data using colour or greyscale combined with landscape height. 3D landscapes with no colour scale (height-only) were particularly slow and inaccurate. A colour scale was found to be better than a greyscale for all display types, but a greyscale was helpful compared to height-only. These results suggest that point-based spatializations should be chosen over landscape representations, at least for tasks involving only point data itself rather than derived information about the data space.

Suppression of aldosterone and progesterone in preeclampsia.

OBJECTIVE: Preeclampsia (preE) is a hypertensive disorder seen in 3-10% of human pregnancies and is diagnosed by de novo onset of hypertension and proteinuria. Several research groups provided evidence for reduced aldosterone (Aldo) and progesterone (Prog) availability in preE. The aim of this study was to determine the levels of Aldo and Prog in preE. METHODS: Normal pregnant (NP; n = 39) and preE (n = 30) patients were recruited to have their blood drawn between 21 and 40 weeks of pregnancy. Two groups of rats were used in this study: NP rats (n = 10) and preE rats (n = 10), which were given weekly injections of desoxycorticosterone acetate and 0.9% saline to drink. Aldo and Prog levels were assayed in plasma and urine samples by ELISA kits. RESULTS: In preE patients, the mean Aldo and Prog levels were suppressed (p < 0.05) compared to NP patients. NP patients exhibited a trend of increased levels of Aldo with an increase in gestational age; however, preE patients had the opposite trend. Both normal and preE patients exhibited a trend of increased levels of Prog with an increase in gestational age. The plasma and urinary Aldo and Prog levels were lower (p < 0.05) in preE rats compared to NP rats. CONCLUSIONS: We have demonstrated using a rat model and patients that both Aldo and Prog are suppressed in preE and thus may be used as biomarkers for preE.

Field testing a global positioning system (GPS) collar on a Japanese monkey: reliability of automatic GPS positioning in a Japanese forest.

A global positioning system (GPS) collar recorded the locations of an adult female Japanese macaque over a 9-day period in a habitat with mixed suburban and rural land-uses in Chiba Prefecture, Japan. The GPS device acquired positions even in forested areas. The GPS data located the female mostly in forested areas, although the female had ranged through a habitat with inter-mingled fields, orchards, quarries, and residential areas. However, the GPS position acquisition rate was low compared to studies carried out on North American mammals. The GPS fixed a position in 20% of positioning attempts. When the collared female was tracked by radio-telemetry, almost all failures of the GPS to fix a position occurred in forest.