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Three intermediate-range shots from a Browning, model 1955, 7.65 mm caliber, pistol were fired from the driver’s seat of a car at a woman in the passenger seat. She sustained three wounds: An, ultimately fatal, penetrating head wound, a graze wound across her forehead, and a tangential, perforating, wound, with bullet entry over the medial sternum and exit through the right flank. Neither postmortem CT nor forensic autopsy discovered bony thoracic injuries or perforations of the thoracoabdominal cavities. There was pulmonary contusion in the medial lobe of the right lung and hemorrhage in the adipose tissue around the right kidney. The tangential bullet had left an almost 40-cm-long wound channel through a pronounced layer of subcutaneous fat. Based on 3D reconstructed CT-data determinations, a straight bullet trajectory between entry and exit wounds would have traversed the abdominothoracic cavities, right lung, and liver. The actual trajectory, however, described a prominent curve, without signs of deflection by bone. Postulated explanations for this unusual bullet track are that the woman was twisting her body in a dynamic scene when the bullet struck; further, due to its shallow angle of incidence on the skin, the bullet was deflected to an intracutaneous path. Additionally, soft tissue resistance may have caused the bullet to yaw. Caution should, thus, be exercised when reconstructing bullet trajectories solely from entry and exist wounds, also for bullet wounds through basically homogenous soft tissues.

Acknowledgements: We thank all our study participants and research study teams for their involvement in providing resources for this research. This article is supported by the members of COST Action “CA17112 - Prospective European Drug-Induced Liver Injury Network” supported by COST (European Cooperation in Science and Technology), www.cost.eu including J.I.G., C.S., M.R.-D., M.I.L., R.J.A., E.A., A.L.G., S.W., H.C.-P., E.S.B., G.S. and G.P.A. We acknowledge support from the members of the PRO-EURO-DILI Network for input on aligning protocols across multiple centers as well as in the case adjudication. We acknowledge Melanie Lingaya, Ryan Criswell, Deborah Hart, James Stejskal, Richard Giovanelli, Kelly Fader, and Heather Llewellyn for their assistance with sample processing. Funding was made available from the Drug Safety Research and Development department within Pfizer’s Worldwide Research Development and Medical. J.I.G., E.A., and G.P.A. are supported by NIHR Nottingham Biomedical Research Centre [BRC-1215-20003]. The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health., Funder: Funding was made available from the Drug Safety Research and Development department within Pfizer’s Worldwide Research Development and Medical. JIG, EA and GPA are supported by NIHR Nottingham Biomedical Research Centre [BRC-1215-6 20003]., Diagnosis of drug-induced liver injury (DILI) and its distinction from other liver diseases are significant challenges in drug development and clinical practice. Here, we identify, confirm, and replicate the biomarker performance characteristics of candidate proteins in patients with DILI at onset (DO; n = 133) and follow-up (n = 120), acute non-DILI at onset (NDO; n = 63) and follow-up (n = 42), and healthy volunteers (HV; n = 104). Area under the receiver operating characteristic curve (AUC) for cytoplasmic aconitate hydratase, argininosuccinate synthase, carbamoylphosphate synthase, fumarylacetoacetase, fructose-1,6-bisphosphatase 1 (FBP1) across cohorts achieved near complete separation (range: 0.94-0.99) of DO and HV. In addition, we show that FBP1, alone or in combination with glutathione S-transferase A1 and leukocyte cell-derived chemotaxin 2, could potentially assist in clinical diagnosis by distinguishing NDO from DO (AUC range: 0.65-0.78), but further technical and clinical validation of these candidate biomarkers is needed.

During the recent pandemic with the severe acute respiratory syndrome-corona virus‑2 the first messenger ribonucleic acid (mRNA) vaccines were approved. To facilitate mass vaccination, confidence of the general population in these new vaccines is mandatory, which is in turn strongly dependent on the availability of reliable data on complications.Summary of the current knowledge on mRNA vaccination-associated myocarditis as a potentially fatal side effect.Systematic literature review.Diagnostic algorithm for the postmortem diagnosis of mRNA vaccination-associated myocarditis.Autopsy series of fatalities following mRNA SARS-CoV‑2 vaccination up to 6 weeks with subsequent sophisticated and interdisciplinary work-up are necessary to complement clinical data on vaccination-associated myocarditis, especially regarding the incidence of fatal courses.The online version of this article (10.1007/s00194-022-00587-9) includes a PDF file with supplemental clinical features.Mit der aktuellen Pandemie mit dem severe acute respiratory syndrome-corona virus‑2 (SARS-CoV‑2) wurden die ersten messenger Ribonukleinsäure (mRNA)-Impfstoffe zugelassen. Der Erfolg der Impfkampagne hängt vom Vertrauen der Bevölkerung in die neuen Impfstoffe, und dieses wiederum von der Verfügbarkeit reliabler Daten zu Komplikationen ab.Zusammenfassung des aktuellen Kenntnisstandes zu impfassoziierten Myokarditiden, als potenziell letalen Nebenwirkungen der mRNA-Impfstoffe.Systematischer Literatur-Review.Diagnostischer Algorithmus zur systematischen postmortalen Aufarbeitung von Todesfällen im zeitlichen Zusammenhang mit einer mRNA-Impfung hinsichtlich einer impfassoziierten Myokarditis.Die impfassoziierte Myokarditis ist eine Ausschlussdiagnose, die lediglich durch eine differenzierte und interdisziplinäre Aufarbeitung gestellt werden kann. Autopsieserien von Todesfällen bis zu 6 Wochen nach der Impfung sind erforderlich, um die klinischen Daten hinsichtlich letaler Komplikationen zu ergänzen.

Background Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently. Methods Twenty-two participants were recruited and non-randomly assigned to an intervention group ($$n=$$ n = 11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ($$n =$$ n = 11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. Results Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ($$p =$$ p = 0.020) and 6-minute walking test ($$p =$$ p = 0.001) as well as for the Berg Balance Scale ($$p =$$ p = 0.041) and Mini motor test ($$p =$$ p = 0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ($$p =$$ p = 0.009 and $$p p < 0.001, respectively). No significant differences were found between the groups at the same time points. Conclusions Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued. Trial registration Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.

BackgroundDeep convolutional neural networks have demonstrated robust and reliable PET attenuation correction (AC) as an alternative to conventional AC methods in integrated PET/MRI systems. However, its whole-body implementation is still challenging due to anatomical variations and the limited MRI field of view. The aim of this study is to investigate a deep learning (DL) method to generate voxel-based synthetic CT (sCT) from Dixon MRI and use it as a whole-body solution for PET AC in a PET/MRI system.Materials and methodsFifteen patients underwent PET/CT followed by PET/MRI with whole-body coverage from skull to feet. We performed MRI truncation correction and employed co-registered MRI and CT images for training and leave-one-out cross-validation. The network was pretrained with region-specific images. The accuracy of the AC maps and reconstructed PET images were assessed by performing a voxel-wise analysis and calculating the quantification error in SUV obtained using DL-based sCT (PETsCT) and a vendor-provided atlas-based method (PETAtlas), with the CT-based reconstruction (PETCT) serving as the reference. In addition, region-specific analysis was performed to compare the performances of the methods in brain, lung, liver, spine, pelvic bone, and aorta.ResultsOur DL-based method resulted in better estimates of AC maps with a mean absolute error of 62 HU, compared to 109 HU for the atlas-based method. We found an excellent voxel-by-voxel correlation between PETCTand PETsCT(R2 = 0.98). The absolute percentage difference in PET quantification for the entire image was 6.1% for PETsCTand 11.2% for PETAtlas. The regional analysis showed that the average errors and the variability for PETsCTwere lower than PETAtlasin all regions. The largest errors were observed in the lung, while the smallest biases were observed in the brain and liver.ConclusionsExperimental results demonstrated that a DL approach for whole-body PET AC in PET/MRI is feasible and allows for more accurate results compared with conventional methods. Further evaluation using a larger training cohort is required for more accurate and robust performance.

Background The homeobox gene homeobrain (hbn) is located in the 57B region together with two other homeobox genes, Drosophila Retinal homeobox (DRx) and orthopedia (otp). All three genes encode transcription factors with important functions in brain development. Hbn mutants are embryonic lethal and characterized by a reduction in the anterior protocerebrum, including the mushroom bodies, and a loss of the supraoesophageal brain commissure. Results In this study we conducted a detailed expression analysis of Hbn in later developmental stages. In the larval brain, Hbn is expressed in all type II lineages and the optic lobes, including the medulla and lobula plug. The gene is expressed in the cortex of the medulla and the lobula rim in the adult brain. We generated a new hbnKOGal4 enhancer trap strain by reintegrating Gal4 in the hbn locus through gene targeting, which reflects the complete hbn expression during development. Eight different enhancer-Gal4 strains covering 12 kb upstream of hbn, the two large introns and 5 kb downstream of the gene, were established and hbn expression was investigated. We characterized several enhancers that drive expression in specific areas of the brain throughout development, from embryo to the adulthood. Finally, we generated deletions of four of these enhancer regions through gene targeting and analysed their effects on the expression and function of hbn. Conclusion The complex expression of Hbn in the developing brain is regulated by several specific enhancers within the hbn locus. Each enhancer fragment drives hbn expression in several specific cell lineages, and with largely overlapping patterns, suggesting the presence of shadow enhancers and enhancer redundancy. Specific enhancer deletion strains generated by gene targeting display developmental defects in the brain. This analysis opens an avenue for a deeper analysis of hbn regulatory elements in the future.

Risk of superior vena cava (SVC) obstruction following repair of anomalous right upper pulmonary veins in children is unclear. The incidence and outcome of subclinical obstruction remained unknown. Retrospective single institutional study (07/1993-02/2017) in a pediatric population (N = 42, median age 3.9-year, range 0.1-15.3 years). 33 (79%) children had repair without SVC translocation ("non-Warden") and 9 (21%) had Warden-type surgery. Echocardiographic SVC obstruction was defined as (I) turbulent flow across SVC and (II) continuous flow pattern without return to baseline velocity (0 m/s); severe obstruction was defined as loss of distinct biphasic profile ± mean gradient ≥ 5 mmHg. 3 (7%) patients required intra-operative revision due to obstruction (non-Warden: 1, Warden: 2). After discharge, 2 (5%) patients required reintervention (3 and 6-month post-op) for severe symptomatic obstruction (non-Warden: 1, Warden-type: 1). Both patients responded to balloon angioplasty with symptomatic resolution (one required repeat catheter reintervention). 10 (24%) patients had subclinical echocardiographic obstruction (2, 22% Warden vs. 8, 24% non-Warden; p = 1.0; 8 of 10 patients had mild gradient), which resolved and remained well without reintervention. At follow-up (mean 7.2-year, range 0-23 years), all patients were alive. Freedom from SVC reintervention at 10 and 20-year is 95% (97% at 10, 20-year in non-Warden and 89% at 5, 8-year in Warden-type group; log-rank p = 0.34). Surgical repair for anomalous right upper pulmonary veins is associated with risk of SVC obstruction in children. The need for reintervention for severe obstruction is rare at late follow-up. Patients with subclinical obstruction remain asymptomatic and demonstrate echocardiographic improvement.

Information about novel environments or foods can be gathered via individual or social learning. Whereas individual learning is assumed to be more costly and less effective than social learning, it also yields more detailed information. Juveniles are often found to be more explorative than adults. Still under the protection of their parents, this allows them to sample their environment in preparation for later in life. We tested individual and social learning in jackdaws (Corvus monedula) of different age groups in a semi-natural group setting. Juvenile and adult jackdaws differed in their learning propensity. Juveniles spent more time at the test apparatus, were more explorative, and caused the apparatus to open. Almost all the openings at the apparatus matched the demonstrated method. As more observers became available, the juveniles could observe each other. Individuals preferentially watched successful conspecifics and those they could scrounge food from. Lower-ranking individuals tended to watch higher ranking ones; higher ranking individuals preferentially watched conspecifics of similar rank. The control group did not manipulate the apparatus. Due to the lack of this baseline, it was difficult to determine for certain whether the opening technique was acquired via individual or social learning. We conclude that if social learning played a role, the underlying mechanism was most likely local or stimulus enhancement. It is, however, more parsimonious to assume that juveniles were more explorative than adults, and that their opening technique was potentially easier to acquire than the one demonstrated to adults.

Gas transfer through hollow fiber membranes (HFM) can be increased via fiber oscillation. Prior work, however, does not directly translate to present-day, full-scale artificial lungs. This in vitro study characterized the effects of HFM oscillations on oxygenation and hemolysis for a pediatric-sized HFM bundle. Effects of oscillation stroke length (2–10 mm) and frequency (1–25 Hz) on oxygen transfer were measured according to established standards. The normalized index of hemolysis was measured for select conditions. All measurements were performed at a 2.5 L min(−1) blood flow rate. A lumped parameter model was used to predict oscillation-induced blood flow and elucidate the effects of system parameters on oxygenation. Oxygen transfer increased during oscillations, reaching a maximum oxygenation efficiency of 510 mL min(−1) m(−2) (97% enhancement relative to no oscillation). Enhancement magnitudes matched well with model-predicted trends and were dependent on stroke length, frequency, and physical system parameters. A 40% oxygenation enhancement was achieved without significant hemolysis increase. At a constant enhancement magnitude, a larger oscillation frequency resulted in increased hemolysis. In conclusion, HFM oscillation is a feasible approach to increasing artificial lung gas transfer efficiency. The optimal design for maximizing efficiency at small fiber displacements should minimize bundle resistance and housing compliance.

MV-NIS is an Edmonston lineage oncolytic measles virus expressing the human sodium iodide symporter-a means for monitoring by non-invasive imaging of radioiodine. Patients with relapsed, refractory myeloma who had explored all other treatment options were eligible for this Phase I trial. Cohort 1 was treated with intravenous MV-NIS, and Cohort 2 received cyclophosphamide 2 days prior to MV-NIS. Thirty-two patients were treated. Cohort 1 initially enrolled to four dose levels without reaching maximum tolerated dose (MTD) and subsequently to two higher dose levels when improved virus manufacture technology made it possible. MTD was not reached in Cohort 1, and TCID50 1011 is the dose being used in a Phase II trial of single agent MV-NIS. Grade 3-4 adverse events in both cohorts at all dose levels were: neutropenia (n=9); leukocyte count decreased (n=5); thrombocytopenia (n=2); and CD4 lymphocytes decreased, anemia and lymphopenia (each n=1). MV-N RNA sequences were amplified from gargle specimens, blood and urine. 123I scans were positive in eight patients. One patient achieved a complete response; transient drops in serum free light chains were seen in other patients. MV-NIS is capable of replicating before being cleared by the immune system. Oncolytic viruses offer a promising new modality for the targeted infection and destruction of disseminated myeloma.

Die Bedeutung des Hochwasserrisikomanagements im Alpenraum nimmt immer starker zu. Ziel der Planung ist die Verringerung der hochwasserbedingten nachteiligen Folgen auf die menschliche Gesundheit, die Umwelt, das Kulturerbe und wirtschaftliche Tatigkeiten. Der Inn im Tiroler Unterinntal steht gegenwartig im Mittelpunkt intensiver Untersuchungen zur Verbesserung des Hochwasserschutzes der angrenzenden Siedlungsraume. Die Betrachtung des Feststoffhaushaltes eines Fliesgewassers bzw. die sich im Verlauf eines Hochwassers einstellenden Sohllagenanderungen konnen einen masgeblichen Einfluss auf die Wirkung von Hochwasserschutzmasnahmen und die Dotierung von Retentionsraumen haben. Der vorliegende Artikel befasst sich mit der Bedeutung des Geschiebetransportes fur die schutzwasserbaulichen Planungen am Inn, welche Masnahmen zum Schutz von Siedlungs- und Gewerbegebieten, wie Linearmasnahmen, Erhalt der naturlichen Uberflutungsraume und ungesteuerte und uber ein Pegelkollektiv gesteuerte Retentionsraume umfasst. Anhand einer fraktionierten Geschiebetransportberechnung fur den 73,5 km langen Gewasserabschnitt konnten sensible Bereiche fur die Dotierung der Retentionsraume ausgemacht werden. Der Einfluss der morphologischen Anderungen bzw. der sich einstellenden Sohllagenanderungen wahrend eines 100-jahrlichen Hochwasserereignisses auf die Planung der Hochwasserschutz- und Retentionsmasnahmen konnte aufgezeigt werden. Die aus dem durchgefuhrten Projekt gewonnenen Modellierungsergebnisse bilden eine wichtige Grundlage fur die weiteren Planungsschritte, um eine hinreichende und optimale Scheitelreduktion im Hochwasserfall sicher zu stellen.

The research was funded by a FP7-PEOPLE-2013-IRSES research staff exchange grant to TB, SH, OG and ASG. OG was additionally supported by Gu227/16-1 and IF by an FWF grant (Y366-B17) to TB. Establishment in urbanized environments is associated with changes in physiology, behaviour, and problem-solving. We compared the speed of learning in urban and rural female common mynas, Acridotheres tristis, using a standard visual discrimination task followed by a reversal learning phase. We also examined how quickly each bird progressed through different stages of learning, including sampling and acquisition within both initial and reversal learning, and persistence following reversal. Based on their reliance on very different food resources, we expected urban mynas to learn and reversal learn more quickly but to sample new contingencies for proportionately longer before learning them. When quantified from first presentation to criterion achievement, urban mynas took more 20-trial blocks to learn the initial discrimination, as well as the reversed contingency, than rural mynas. More detailed analyses at the level of stage revealed that this was because urban mynas explored the novel cue-outcome contingencies for longer, and despite transitioning faster through subsequent acquisition, remained overall slower than rural females. Our findings draw attention to fine adjustments in learning strategies in response to urbanization and caution against interpreting the speed to learn a task as a reflection of cognitive ability. Postprint

Background There is increasing evidence demonstrating the value of partial extracorporeal CO2 removal (ECCO2R) for the treatment of hypercapnia in patients with acute exacerbations of chronic obstructive pulmonary disease and acute respiratory distress syndrome. Mechanical ventilation has traditionally been used to treat hypercapnia in these patients, however, it has been well-established that aggressive ventilator settings can lead to ventilator-induced lung injury. ECCO2R removes CO2 independently of the lungs and has been used to permit lung protective ventilation to prevent ventilator-induced lung injury, prevent intubation, and aid in ventilator weaning. The Low-Flow Pittsburgh Ambulatory Lung (LF-PAL) is a low-flow ECCO2R device that integrates the fiber bundle (0.65 m2) and centrifugal pump into a compact unit to permit patient ambulation. Methods A blood analog was used to evaluate the performance of the pump at various impeller rotation rates. In vitro CO2 removal tested under normocapnic conditions and 6-h hemolysis testing were completed using bovine blood. Computational fluid dynamics and a mass-transfer model were also used to evaluate the performance of the LF-PAL. Results The integrated pump was able to generate flows up to 700 mL/min against the Hemolung 15.5 Fr dual lumen catheter. The maximum vCO2 of 105 mL/min was achieved at a blood flow rate of 700 mL/min. The therapeutic index of hemolysis was 0.080 g/(100 min). The normalized index of hemolysis was 0.158 g/(100 L). Conclusions The LF-PAL met pumping, CO2 removal, and hemolysis design targets and has the potential to enable ambulation while on ECCO2R.

Social comparisons are a fundamental characteristic of human behaviour, yet relatively little is known about their evolutionary foundations. Adapting the co-acting paradigm from human research (Seta in J Pers Soc Psychol 42:281–291, 1982. doi:10.1037//0022-3514.42.2.281), we examined how the performance of a partner influenced subjects’ performance in long-tailed macaques (Macaca fascicularis). Using parallel testing in touch screen setups in which subjects had to discriminate familiar and novel photographs of men and women, we investigated whether accuracy and reaction time were influenced by partner performance and relationship quality (affiliate vs. non-affiliate). Auditory feedback about the alleged performance of the co-actor was provided via playback; partner performance was either moderately or extremely better or worse than subject performance. We predicted that subjects would assimilate to moderately different comparison standards as well as to affiliates and contrast away from extreme standards and non-affiliates. Subjects instantly generalized to novel pictures. While accuracy was not affected by any of the factors, long reaction times occurred more frequently when subjects were tested with a non-affiliate who was performing worse, compared to one who was doing better than them (80 % quantile worse: 5.1, better: 4.3 s). For affiliate co-actors, there was no marked effect (worse: 4.4, better: 4.6 s). In a control condition with no auditory feedback, subjects performed somewhat better in the presence of affiliates (M = 77.8 % correct) compared to non-affiliates (M = 71.1 %), while reaction time was not affected. Apparently, subjects were sensitive to partner identity and performance, yet variation in motivation rather than assimilation and contrast effects may account for the observed effects. Electronic supplementary material The online version of this article (doi:10.1007/s10071-015-0943-4) contains supplementary material, which is available to authorized users.

Background Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for the acute respiratory distress syndrome. Methods Participants in the NHLBI ARDS Network SAILS multicenter trial who developed AKI were included in this analysis and divided into groups based on AKI duration. Differences in outcomes were evaluated using t test and Chi-square test. Competing risks regression and Cox regression were used to evaluate factors associated with resolving AKI and recurrent AKI. Results In total, 238 patients were included in the study. Seventy-seven patients had short duration AKI (1–2 days), 47 medium duration AKI (3–7 days), 87 persistent AKI (> 7 days) and 38 died during their AKI episode. Persistent AKI was associated with worse outcomes including increased ICU length of stay, time on the ventilator and days with cardiovascular failure. We found no clinical differences between patients with short and medium duration AKI, even when accounting for AKI severity and recurrent AKI. Patients with resolving AKI were less likely to have oliguria or moderate/severe ARDS on the day AKI criteria were met. Recurrent AKI was associated with poorer clinical outcomes. No baseline clinical factors were found to predict development of recurrent AKI. Conclusions In critically ill patients with sepsis-associated ARDS and AKI, the impact of short and medium duration AKI on clinical outcomes was modest. Persistent and recurrent AKI were both associated with worse clinical outcomes, emphasizing the importance of identifying these patients, who may benefit from novel interventions. Electronic supplementary material The online version of this article (10.1186/s13613-018-0374-x) contains supplementary material, which is available to authorized users.

Background Critically ill patients with acute respiratory distress syndrome and acute exacerbations of chronic obstructive pulmonary disease often develop hypercapnia and require mechanical ventilation. Extracorporeal carbon dioxide removal can manage hypercarbia by removing carbon dioxide directly from the bloodstream. Respiratory hemodialysis uses traditional hemodialysis to remove CO2 from the blood, mainly as bicarbonate. In this study, Stewart’s approach to acid-base chemistry was used to create a dialysate that would maintain blood pH while removing CO2 as well as determine the blood and dialysate flow rates necessary to remove clinically relevant CO2 volumes. Methods Bench studies were performed using a scaled down respiratory hemodialyzer in bovine or porcine blood. The scaling factor for the bench top experiments was 22.5. In vitro dialysate flow rates ranged from 2.2 to 24 mL/min (49.5–540 mL/min scaled up) and blood flow rates were set at 11 and 18.7 mL/min (248–421 mL/min scaled up). Blood inlet CO2 concentrations were set at 50 and 100 mmHg. Results Results are reported as scaled up values. The CO2 removal rate was highest at intermittent hemodialysis blood and dialysate flow rates. At an inlet pCO2 of 50 mmHg, the CO2 removal rate increased from 62.6 ± 4.8 to 77.7 ± 3 mL/min when the blood flow rate increased from 248 to 421 mL/min. At an inlet pCO2 of 100 mmHg, the device was able to remove up to 117.8 ± 3.8 mL/min of CO2. None of the test conditions caused the blood pH to decrease, and increases were ≤0.08. Conclusions When the bench top data is scaled up, the system removes a therapeutic amount of CO2 standard intermittent hemodialysis flow rates. The zero bicarbonate dialysate did not cause acidosis in the post-dialyzer blood. These results demonstrate that, with further development, respiratory hemodialysis can be a minimally invasive extracorporeal carbon dioxide removal treatment option.

Measuring quality of life (QoL) in alcohol related brain damaged individuals (ARBDs) is challenging, mostly because patients are characterized by important cognitive impairments and are generally unaware of their defects. However, quality of life assessments are essential to help inform care and rehabilitative settings; thus introducing and including views from healthcare professionals on ARBDs’ quality of life is a reasonable approach. We examine QoL and the perception of cognitive defects among ARBDs and compare them to expert appraisals by acquainted healthcare professionals. We hypothesize that ARBDs self-assessments outscore QoL expert-ratings by professionals and demonstrate an unawareness of their cognitive deficits, with anosognosia being related to the QoL domains of interest. Six domains of QoL and the occurrence of cognitive problems in 14 detoxified alcoholics are investigated by means of self-ratings and expert-ratings from two acquainted healthcare professionals. Anosognosia is assessed by using difference scores between self- and expert-ratings on the manifestation of everyday executive dysfunctions. We find that ARBDs experience anosognosia (ps < .001) and outscore systematically expert-ratings on the investigated QoL domains (ps < .03). Complex patterns of relationships between self-/expert-rated QoL relate mostly negatively and moderately with anosognosia, confirming some of our assumptions and informing others. ARBDs are characterized by anosognosia and differ largely from expert’s views on patient QoL. Professionals relate compromised patient QoL to the inability of the patient to have insight of his/her dysfunctions; whereas among patients, QoL relates less strongly to anosognosia. Remaining doubts on the validity of QoL self-/expert-ratings in ARBDs are discussed.

Vesicular stomatitis virus (VSV) is neuropathogenic in rodents but can be attenuated 50-fold by engineering the mouse interferon-beta (IFN-β) gene into its genome. Intravenously administered VSVs encoding IFN-β have potent activity against subcutaneous tumors in the 5TGM1 mouse myeloma model, without attendant neurotoxicity. However, when 5TGM1 tumor cells were seeded intravenously, virus-treated mice with advanced myeloma developed clinical signs suggestive of meningoencephalitis. Co-administration of a known active antimyeloma agent did not prolong survival, further suggesting that deaths were due to viral toxicity, not tumor burden. Histological analysis revealed that systemically administered 5TGM1 cells seed to the CNS, forming meningeal tumor deposits, and that VSV infects and destroys these tumors. Death is presumably a consequence of meningeal damage and/or direct transmission of virus to adjacent neural tissue. In light of these studies, extreme caution is warranted in clinical testing of attenuated VSVs, particularly in patients with CNS tumor deposits.