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"Flood, James"
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Warriors. SkyClan & the stranger
Leafstar is proud to see the Skyclan thrive under her leadership, but things go awry when she is captured by a Twoleg as she is about to give birth to her kits.
Book
Urinary NGAL as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Cirrhosis: A Prospective Study
Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.
Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI). NGAL was assessed for its ability to discriminate ATN from non-ATN AKI and to predict 90-day outcomes.
Among patients with AKI, 57 (35%) had prerenal AKI, 55 (34%) had HRS, and 49 (30%) had ATN, with a median serum creatinine of 2.0 (interquartile range 1.5, 3.0) mg/dL at enrollment. At an optimal cutpoint of 244 μg/g creatinine, NGAL distinguished ATN (344 [132, 1,429] μg/g creatinine) from prerenal AKI (45 [0, 154] μg/g) or HRS (110 [50, 393] μg/g; P < 0.001), with a C statistic of 0.762 (95% confidence interval 0.682, 0.842). By 90 days, 71 of 213 patients (33%) died. Higher median NGAL was associated with death (159 [50, 865] vs 58 [0, 191] μg/g; P < 0.001). In adjusted and unadjusted analysis, NGAL significantly predicted 90-day transplant-free survival (P < 0.05 for all Cox models) and outperformed Model for End-Stage Liver Disease score by C statistic (0.697 vs 0.686; P = 0.04), net reclassification index (37%; P = 0.008), and integrated discrimination increment (2.7%; P = 0.02).
NGAL differentiates the type of AKI in cirrhosis and may improve prediction of mortality; therefore, it holds potential to affect management of AKI in cirrhosis.
Journal Article
The New Substance Abuse and Mental Health Services Administration Oral Fluid Cutoffs for Cocaine and Heroin-Related Analytes Applied to an Addiction Medicine Setting: Important, Unanticipated Findings with LC-MS/MS
We implemented oral fluid (OF) as an alternative specimen type to urine for detection of cocaine (COC) and opiate abuse in outpatient addiction medicine clinics.
We implemented a 2-μg/L limit of quantification OF LC-MS/MS assay and compiled and reviewed all findings from a 22-month collection period for COC, benzoylecgonine (BZE), codeine (COD), 6-acetylmorphine (MAM), and morphine (MOR). We also compared the results of our clinical samples at different OF cutoffs and analytes specified in the new 2015 SAMHSA OF guidelines.
Of 3608 OF samples, COC and BZE were positive in 593 and 508, respectively. COC or BZE was positive in 662 samples. Importantly and unexpectedly, 154 samples were COC positive and BZE negative, with 125 having COC 2.0-7.9 μg/L. A simulation with the new guideline cutoffs confirmed 65% (430 of 662) of all COC- or BZE-positive data set samples. Similarly, the new guidelines confirmed 44% (263 of 603) of data set samples positive for MOR or COD. Simulation found that the new, lower MAM guideline cutoffs detected 89% of the 382 MAM-positive samples in the data set, 104 of which the new guidelines had identified as negative for MOR and COD.
COC (not BZE) is the dominant low-concentration OF analyte in an addiction medicine setting. This information will aid OF test interpretation. It also illustrates the importance of the 2015 guideline's new immunoassay cross-reactivity requirements and the likely improvement in detection of heroin use stemming from the new, lower MAM cutoffs.
Journal Article
Quality Control Practices for Chemistry and Immunochemistry in a Cohort of 21 Large Academic Medical Centers
Abstract
Objectives
In the United States, minimum standards for quality control (QC) are specified in federal law under the Clinical Laboratory Improvement Amendment and its revisions. Beyond meeting this required standard, laboratories have flexibility to determine their overall QC program.
Methods
We surveyed chemistry and immunochemistry QC procedures at 21 clinical laboratories within leading academic medical centers to assess if standardized QC practices exist for chemistry and immunochemistry testing.
Results
We observed significant variation and unexpected similarities in practice across laboratories, including QC frequency, cutoffs, number of levels analyzed, and other features.
Conclusions
This variation in practice indicates an opportunity exists to establish an evidence-based approach to QC that can be generalized across institutions.
Journal Article
Conformational investigations on three large dinuclear triple helicates by single crystal X-ray diffraction
Three new dinuclear triple helicates were synthesised using a ditopic semi-rigid pyridylylimine ligand
L
, separated by a diphenoxy-biphenol spacer providing considerable length to the backbone.
L
and the new large dinuclear triple helicate complexes [Fe
2
L
3
](BF
4
)
4
(
1
), [Ni
2
L
3
](BF
4
)
4
(
2
) and [Zn
2
L
3
](BF
4
)
4
(
3
) have been characterised in solution and solid state. Single crystal X-ray diffraction was used to investigate overall complex ion shape as the coordination sphere was modulated by metal ion selection. Small differences in complex shape were seen to arise due to subtle distortions in coordination sphere environments. This study sheds light on how the length and twist of dinuclear triple helicates can be tuned by selection of coordinating metal ion.
Journal Article
Case 3-2017: A Man with Cardiac Sarcoidosis and New Diplopia and Weakness
To the Editor:
In the Case Record discussed by Samuels et al. (Jan. 26 issue),
1
the autopsy of the unfortunate patient who died of granulomatous amebic encephalitis revealed numerous perivascular radiating hemorrhagic areas. This finding is typical in patients with meningoencephalitis caused by acanthamoeba species but unusual in patients with neurosarcoidosis, in whom intracranial hemorrhages are extremely rare and if present are readily seen on computed tomography (CT).
2
,
3
The initial findings on CT and CT angiography of the head in the patient in this Case Record were reported to be normal.
An analytic sensitivity test to detect brain hemorrhages . . .
Journal Article
Case 40-2013
A 36-year-old man was seen in the emergency department because of severe agitation and paranoia. He had reportedly been taking psychoactive “bath salts” intranasally and consuming alcohol. He was restrained by security officers. A diagnostic test was performed.
Presentation of Case
Dr. David P. Curley
(Emergency Medicine): A 36-year-old man with a history of alcohol and substance abuse was admitted to this hospital because of severe agitation and paranoia.
The patient's girlfriend reported that the patient had been sober for approximately 20 months, until he lost his job. Three days before admission, he began drinking alcohol and taking “bath salts” (psychoactive drugs) intranasally after having had no sleep and minimal oral intake. The night before admission, increasing agitation developed and was associated with apparent auditory and visual hallucinations that people were trying to harm him. On the morning . . .
Journal Article
Self-publishing Biodiversity Data Products on the Web
Biodiversity informatics workbenches and aggregators that make their data externally accessible via application programming interfaces (APIs) facilitate the development of customized applications that fit the needs of a diverse range of communities. In the past, the technical skills required to host web-facing applications placed constraints on many researchers: they either needed to find technical help, or expand their own skills. These limits are now significantly reduced when free or low-cost web-site hosting is combined with small, well-documented applications that require minimal configuration to setup. We illustrate two applications that take advantage of this approach: an interactive key engine (presently named \"distinguish\") and TaxonPages, a taxon page service application. Both applications make use of TaxonWorks' API. We discuss the limits, e.g., the user must be online to access the data behind the application, and advantages of this approach, e.g., the application server can be served locally, on the users' own computer, and the underlying data are all accessible in more technical formats.
Journal Article
TaxonWorks 1.0?
TaxonWorks is an open-source workbench for biodiversity researchers. With several years of development behind it, we highlight its present status, and discuss if and when it makes sense to release a version 1.0, i.e. software completed to specific stage. TaxonWorks' scope is broad; it seeks to touch nearly all areas that might be of interest to taxonomists, i.e. those who integrate everything that is known about a taxon into a single resource. Its role as a software platform is placed in a broader context, where many instances of TaxonWorks each can support multiple research projects. Instances may be supported by individuals or organizations. A suite of technical tools including containerization and unit tests facilitate collaboration at many different levels. TaxonWorks is a research tool, mechanisms for analyzing the results of data curation including its application programing interface are described. The long-term development of TaxonWorks is supported by an endowment to the Species File Group. Its source is available on Github.
Journal Article
Measurement of Mercury Levels in Concentrated Over-the-Counter Fish Oil Preparations: Is Fish Oil Healthier Than Fish?
Context.—Fish consumption has been associated with a decreased risk of coronary artery disease. Recent studies have illustrated that the high mercury content in cold-water fish may negate the cardiovascular benefits of fish meals. Fish oils have similar antiatherogenic properties to fish, and similar studies should be performed to determine the level of mercury in fish oils. Objective.—To determine the concentration of mercury in 5 over-the-counter brands of fish oil. Results.—The levels of mercury in the 5 different brands of fish oil ranged from nondetectable (<6 μg/L) to negligible (10–12 μg/L). The mercury content of fish oil was similar to the basal concentration normally found in human blood. Conclusions.—Fish are rich in omega-3 fatty acids, and their consumption is recommended to decrease the risk of coronary artery disease. However, fish such as swordfish and shark are also a source of exposure to the heavy metal toxin, mercury. The fish oil brands examined in this manuscript have negligible amounts of mercury and may provide a safer alternative to fish consumption.
Journal Article