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Abstract Background Brain computer tomography (brain CT) is an important imaging tool in patients with intracranial disorders. In ICU patients, a brain CT implies an intrahospital transport which has inherent risks. The proceeds and consequences of a brain CT in a critically ill patient should outweigh these risks. The aim of this study was to critically evaluate the diagnostic and therapeutic yield of brain CT in ICU patients. Methods In a prospective observational study data were collected during one year on the reasons to request a brain CT, expected abnormalities, abnormalities found by the radiologist and consequences for treatment. An “expected abnormality” was any finding that had been predicted by the physician requesting the brain CT. A brain CT was “diagnostically positive”, if the abnormality found was new or if an already known abnormality was increased. It was “diagnostically negative” if an already known abnormality was unchanged or if an expected abnormality was not found. The treatment consequences of the brain CT, were registered as “treatment as planned”, “treatment changed, not as planned”, “treatment unchanged”. Results Data of 225 brain CT in 175 patients were analyzed. In 115 (51%) brain CT the abnormalities found were new or increased known abnormalities. 115 (51%) brain CT were found to be diagnostically positive. In the medical group 29 (39%) of brain CT were positive, in the surgical group 86 (57%), p 0.01. After a positive brain CT, in which the expected abnormalities were found, treatment was changed as planned in 33%, and in 19% treatment was changed otherwise than planned. Conclusions The results of this study show that the diagnostic and therapeutic yield of brain CT in critically ill patients is moderate. The development of guidelines regarding the decision rules for performing a brain CT in ICU patients is needed.

Abstract Background Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP) and electroencephalogram (EEG). Methods Patients with acute PHM (focal myoclonus or status myoclonus) within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used). Good outcome was defined as good recovery or moderate disability after 6 months. Results Acute PHM was reported in 79/391 patients (20%). SEPs were available in 51/79 patients and in 27 of them (53%) N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64%) patients fulfilling criteria for a cortical origin. Nine patients (12%) had a good outcome. A broad variety of drugs was used for treatment. Conclusions The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.

Uranium ditelluride (UTe 2 ) is the strongest contender to date for a p -wave superconductor in bulk form. Here we perform a spectroscopic study of the ambient pressure superconducting phase of UTe 2 , measuring conductance through point-contact junctions formed by metallic contacts on different crystalline facets down to 250 mK and up to 18 T. Fitting a range of qualitatively varying spectra with a Blonder-Tinkham-Klapwijk (BTK) model for p -wave pairing, we can extract gap amplitude and interface barrier strength for each junction. We find good agreement with the data for a dominant p y -wave gap function with amplitude 0.26 ± 0.06 meV. Our work provides spectroscopic evidence for a gap structure consistent with the proposed spin-triplet pairing in the superconducting state of UTe 2 ., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s) 2024.)

The title compound, {[Cu 2 (C 7 H 4 O 3 ) 2 (H 2 O) 2 ]·2H 2 O} n , contains two copper(II) cations in special positions (one on a twofold rotation axis and one on an inversion centre) and the the salicylate ligand in its dianionic form. By four- and six-coordinate metal coordination, chains are formed parallel to [001], which are extended by O-H⋯O hydrogen bonding into sheets extending parallel to (100). These sheets are weakly connected by O-H⋯O hydrogen bonding via the non-coordinating lattice water mol-ecules into a three-dimensional network.

Magic Angle Coil Spinning (MACS) aids improving the intrinsically low NMR sensitivity of heterogeneous microscopic samples. We report on the design and testing of a new type of monolithic 2D MACS resonators to overcome known limitations of conventional micro coils. The resonators' conductors were printed on dielectric substrate and tuned without utilizing lumped element capacitors. Self-resonance conditions have been computed by a hybrid FEM-MoM technique. Preliminary results reported here indicate robust mechanical stability, reduced eddy currents heating and negligible susceptibility effects. The gain in B1/P is in agreement with the NMR sensitivity enhancement according to the principle of reciprocity. A sensitivity enhancement larger than 3 has been achieved in a monolithic micro resonator inside a standard 4mm rotor at 500MHz. These 2D resonators could offer higher performance micro-detection and ease of use of heterogeneous microscopic substances such as biomedical samples, microscopic specimens and thin film materials., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Uterine spiral arteriole (SA) remodeling in early pregnancy involves a coordinated series of events including decidual immune cell recruitment, vascular cell disruption and loss, and colonization by placental-derived extravillous trophoblast (EVT). During this process, decidual SA are converted from narrow, muscular vessels into dilated channels lacking vasomotor control. We hypothesized that this extensive alteration in SA architecture must require significant reorganization and/or breakdown of the vascular extracellular matrix (ECM). First trimester decidua basalis (30 specimens) was immunostained to identify spiral arterioles undergoing trophoblast-independent and -dependent phases of remodeling. Serial sections were then immunostained for a panel of ECM markers, to examine changes in vascular ECM during the remodeling process. The initial stages of SA remodeling were characterized by loss of laminin, elastin, fibrillin, collagen types III, IV and VI from the basement membrane, vascular media and/or adventitia, and surrounding decidual stromal cells. Loss of ECM correlated with disruption and disorganization of vascular smooth muscle cells, and the majority of changes occurred prior to extensive colonization of the vessel wall by EVT. The final stages of SA remodeling, characterized by the arrival of EVT, were associated with the increased mural deposition of fibronectin and fibrinoid. This study provides the first detailed analysis of the spatial and temporal loss of ECM from the walls of remodeling decidual SA in early pregnancy.

This work is motivated by the recent developments in online minerals analysis in the mining and minerals processing industry via nuclear quadrupole resonance (NQR). Here we describe a nuclear magnetic resonance (NMR) and NQR study of the minerals tennantite (Cu12As4S13) and tetrahedrite (Cu12 Sb4S13). In the first part NQR lines associated with (75)As in tennantite and (121,123)Sb isotopes in tetrahedrite are reported. The spectroscopy has been restricted to an ambient temperature studies in accord with typical industrial conditions. The second part of this contribution reports nuclear quadrupole-perturbed NMR findings on further, only partially characterised, metal arsenides. The findings enhance the detection capabilities of NQR based analysers for online measurement applications and may aid to control arsenic and antimony concentrations in metal processing stages., (Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.)

(75)As NQR spectra and relaxation times of synthetic and natural FeAs2 samples have been studied at variable static magnetic field and temperature. FeAs2 is a well understood diamagnetic semiconductor and occurs as the natural mineral lollingite in selected ore deposits. We observed a spin-spin relaxation time enhancement of up to five in synthetic powders in the presence of a weak external static magnetic field. The effect is of interest with regard to signal-to-noise ratio improvement for materials characterization applications where broad NQR absorption lines are excited with wideband pulse sequences., (Copyright © 2015 Elsevier Inc. All rights reserved.)

p32 is a conserved eukaryotic protein which is primarily expressed in the mitochondria and regulates cell proliferation, migration and metabolism in various tissues. In this study, we sought to examine the expression and function of p32 in the human placenta. p32 was highly expressed in the syncytiotrophoblast, the underlying cytotrophoblast (CTB), the vascular endothelium and by a proportion of cells in the villous stroma in first trimester and term placenta. p32 mRNA and protein expression was significantly higher in the first trimester of pregnancy than at term, and expression in the trophoblast was significantly reduced in placentas from women with fetal growth restriction (FGR). Small interfering RNA (siRNA)-mediated knockdown of p32 in term placental explants significantly reduced the number of Ki67-positive CTB, but did not alter CTB apoptosis or necrosis. p32 knockdown increased lactate production, reduced glucose extraction from culture medium and was associated with reduced MitoTracker dye accumulation in trophoblast mitochondria. p32 knockdown was also associated with a significant reduction in expression of the mitochondrial respiratory complexes I and IV. These data suggest that p32 expression is important for CTB proliferation, via a mechanism involving regulation of normal mitochondrial function. As p32 expression is reduced in FGR placentas, this may contribute to some of the observed placental pathology, such as reduced CTB proliferation and mitochondrial dysfunction., (© The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.)

The direct measurement and identification of solid state arsenic phases using (75)As NMR is made difficult by the simultaneous conditions of large quadrupole moment and low coordination symmetry in many compounds. However, specific arsenic minerals can efficiently be detected and discriminated via nuclear quadrupolar resonance (NQR). We report on the first NMR and NQR measurements in the natural minerals enargite (Cu3AsS4), niccolite (NiAs), arsenopyrite (FeAsS) and loellingite (FeAs2). The NQR frequencies have been determined from both high-field NMR powder patterns and via zero-field frequency sweeps. Density functional theory (DFT) based ab initio calculations support the experimental results. The compounds studied here are common in terms of the known set of As-containing minerals. They are sometimes encountered in the context of base metal or gold mining. The study represents a significant addition to the list of arsenic minerals that can now be detected with NQR techniques., (© 2013 Elsevier Inc. All rights reserved.)

Understanding multi-phase fluid flow and transport processes under various pressure, temperature, and salinity conditions is a key feature in many remote monitoring applications, such as long-term storage of carbon dioxide (CO(2)) or nuclear waste in geological formations. We propose a low-field NMR tomographic method to non-invasively image the water-content distribution in electrically conductive formations in relatively large-scale experiments (∼1 m(3) sample volumes). Operating in the weak magnetic field of Earth entails low Larmor frequencies at which electromagnetic fields can penetrate electrically conductive material. The low signal strengths associated with NMR in Earth's field are enhanced by pre-polarization before signal recording. To localize the origin of the NMR signal in the sample region we do not employ magnetic field gradients, as is done in conventional NMR imaging, because they can be difficult to control in the large sample volumes that we are concerned with, and may be biased by magnetic materials in the sample. Instead, we utilize the spatially dependent inhomogeneity of fields generated by surface coils that are installed around the sample volume. This relatively simple setup makes the instrument inexpensive and mobile (it can be potentially installed in remote locations outside of a laboratory), while allowing spatial resolution of the order of 10 cm. We demonstrate the general feasibility of our approach in a simulated CO(2) injection experiment, where we locate and quantify the drop in water content following gas injection into a water-saturated cylindrical sample of 0.45 m radius and 0.9 m height. Our setup comprises four surface coils and an array consisting of three volume coils surrounding the sample. The proposed tomographic NMR methodology provides a more direct estimate of fluid content and properties than can be achieved with acoustic or electromagnetic methods alone. Therefore, we expect that our proposed method is relevant for geophysical applications, such as for monitoring CO(2) injections in saline aquifers or detecting water leakage into nuclear waste deposit sites installed in electrically conductive formations., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The quantities of waste generated by the healthcare sector in the United Kingdom (UK) have been shown to be amongst the highest in Europe. Based on a case study undertaken within the Cornwall NHS (National Health Service) in the UK, this paper reports on the results of waste minimisation trials. The schemes were able to achieve significant waste reductions in both clinical and domestic waste quantities. Indeed, a reduction in domestic bag waste in the range of 1.6-33.4%, with an average of 14.8% was realised. For clinical waste, the reduction ranged from 1.8% to 38.3%, at an average of 15.7%, with net cost benefits of nearly US$ 25,000 over the period of 1-3 years. The outcomes suggest that significant resource and financial efficiencies can be attained, but due to the many factors involved, there is a need to focus both on containment and logistics, as well as social factors for success.

Malnutrition adversely affects mortality and morbidity before and after liver transplantation. Outcome might be improved if liver transplant recipients were in a better nutritional state at the time of transplantation. In this review, we will examine the potential use of GH and IGF-I to improve nutritional status in patients with cirrhosis. Patients with cirrhosis have low circulating IGF-I levels in the face of elevated serum GH concentrations. IGFBP-3 levels are low while IGFBP-1 levels are high. In patients with cirrhosis, IGF-I levels do not increase in response to treatment with GH. Patients with cirrhosis are insensitive to GH, and rhGH treatment is not likely to reverse malnutrition. The pathobiology of GH insentivity may reflect decreased nutritional intake, low GH receptor density, decreased IGF-I half-life and hepatic insensitivity to insulin.

Malnutrition is a critical predictor of mortality and morbidity in children with biliary atresia who undergo orthotopic liver transplantation. Growth hormone (GH) enhances nitrogen retention in patients with chronic obstructive lung disease, sepsis, and in fasted adult volunteers. The goal of this study was to assess the acute response to recombinant human GH (rhGH) treatment in children with biliary atresia to determine whether GH therapy was likely to improve pretransplant nutritional status. Five children, aged 10-32 months, with biliary atresia and persistent cholestasis despite surgical attempts to reestablish bile flow, were studied. All five children had portal hypertension, conjugated hyperbilirubinemia, and decreased serum albumin concentrations. Length, weight, and growth velocity were decreased in all five children. Despite adequate energy and protein intake, fat stores were depleted in all five subjects, and somatic protein stores were diminished in all except one child. Baseline serum concentrations of insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were low (8.4 +/- 2 ng/ml and 0.2 +/- 0.1 mg/l respectively). In the four children who completed the study, serum IGF-I and IGFBP-3 levels did not change after treatment with rhGH (0.1 mg/kg/day) for 4 days. Our findings indicate that children with biliary atresia awaiting liver transplantation are insensitive to GH and that treatment with GH is unlikely to promote anabolism. A rationale exists for examining the effect of treatment with IGF-I, which mediates the anabolic effects of GH.

Objective: Human GH treatment of short children who had intrauterine growth retardation (IUGR) results in a highly variable growth response. The object of this study was to test the hypothesis that differences in responsiveness to exogenously administered GH might reflect differences in endogenous GH secretion or sensitivity., Design: Prospective study evaluating th growth response to GH therapy in short individuals with prior IUGR., Patients: Ten short, prepubertal children with prior IUGR were studied. Mean age was 6 years (3.39-8.61). Mean bone age was 4.6 years (2.3-8.3). Mean body mass index was 13.2 kg/m2 (9.9-14.0; normal 13.5-19.0)., Measurements: Overnight spontaneous GH release was measured using a constant withdrawal pump and stimulated GH release was measured following clonidine (0.15 mg/m2) administration. IGF-I concentrations were measured at baseline and 12, 24, 36 and 48 hours after sequential doses of GH (0.05 and 0.2 mg/kg/dose) given 48 hours apart. Patients were treated with GH (0.125 mg/kg three times a week) and growth response was assessed. In the second and third year, attempts were made to improve the growth rate by nutritional supplementation and increasing the dose of GH to 0.25 mg/kg three times a week., Results: All patients had normal integrated nocturnal GH secretion (> 3 micrograms/l, 6mU/l) and normal peak GH secretion in response to clonidine (> 7 micrograms/l). In the first year of the trial, mean growth velocity (GV) increased from 5.39 cm/year +/- 0.29 to 7.32 cm/year +/- 0.39 (P = 0.004). Changes in GV correlated inversely with integrated GH (r = -0.69; P = 0.038), baseline IGF-I concentration (r = -0.88; P = 0.002) and baseline GV-SDS (r = -0.68; P = 0.043). There was no correlation between change in GV and GH binding protein, baseline height SDS or age. The effect of GH waned in the second year, but tended to remain greater than the pretreatment growth rate (6.54 +/- 0.49 vs 5.53 cm/year +/- 0.29; P = 0.09). No significant advancement of bone age over chronological age was observed over the first 2 years. Increasing nutritional intake by 17% did not result in significant weight gain nor increase in height velocity. Doubling the dose of GH in the second or third year did not result in a significant increase in GV., Conclusion: The variable response to GH therapy in short children with a history of intrauterine growth retardation may partly reflect relative sufficiency or insufficiency of GH. Baseline IGF-I levels and baseline growth velocity appear to be useful and practical predictors of response to GH.

Increased angle of insertion of the fingernails is known to be a common finding in girls with Ullrich-Turner syndrome (UTS), but there are few data on the frequency of this finding and no quantitative data that define what is a normal fingernail angle. To assess the usefulness of this measurement in evaluating patients with suspected UTS, we obtained tracings of 6 different fingernails to determine the mean fingernail angle (MFA) in 40 patients with UTS and compared the results with control girls and adults. As a group, the 24 girls with 45,X had an average MFA of 8.9 degrees, compared to 6.8 degrees for the 16 mosaics and variants, 3.0 degrees for normal children and 1.3 degrees for normal adults. Although there was overlap between the groups, 79% of 45,X girls and 56% of variants had an MFA of > 6 degrees, whereas only 8% of the combined control individuals had an MFA of > 6 degrees. Reproducibility of MFA determinations based on tracings obtained at consecutive visits was excellent (r = 0.92). There was no clear correlation between the MFA and the severity of the UTS phenotype. Determination of MFA is a simple, objective measurement which, when combined with other clinical findings, may aid the clinician in making a diagnosis of UTS.

The purpose of this study was to assess GH sensitivity in children with Alagille syndrome (syndromic intrahepatic bile duct paucity) by examining their response to short term administration of recombinant human GH (rhGH). Serum levels of insulin-like growth factor-I (IGF-I) were low despite elevated overnight integrated serum GH concentrations. Administration of rhGH (0.05 mg/kg.day for 3 days) to four growth-retarded children with Alagille syndrome did not significantly alter the serum concentrations of IGF-I and insulin, blood urea nitrogen, or urinary calcium excretion. In contrast, circulating IGF-I increased 2-fold in two children with Alagille syndrome and normal stature. In the control group, consisting of seven prepubertal children with GH deficiency, the predicted changes in response to rhGH in serum concentrations of IGF-I and insulin, urea nitrogen, and urinary calcium excretion were observed. Serum GH-binding protein levels, measured by a ligand-mediated immunofunctional assay, were significantly higher in children with Alagille syndrome than in children with cirrhosis or GH deficiency. We conclude that growth-retarded children with Alagille syndrome are insensitive to GH. The growth disturbances and metabolic defects may be due in part to failure to increase IGF-I concentrations in response to GH, implying that growth-retarded children with Alagille syndrome may benefit from IGF-I treatment.