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Concept: 25th century

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Background Intravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy. Methods Using a 2-by-2 factorial design, we randomly assigned 5177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and 5 days of oral acetylcysteine or oral placebo; of these patients, 4993 were included in the modified intention-to-treat analysis. The primary end point was a composite of death, the need for dialysis, or a persistent increase of at least 50% from baseline in the serum creatinine level at 90 days. Contrast-associated acute kidney injury was a secondary end point. Results The sponsor stopped the trial after a prespecified interim analysis. There was no interaction between sodium bicarbonate and acetylcysteine with respect to the primary end point (P=0.33). The primary end point occurred in 110 of 2511 patients (4.4%) in the sodium bicarbonate group as compared with 116 of 2482 (4.7%) in the sodium chloride group (odds ratio, 0.93; 95% confidence interval [CI], 0.72 to 1.22; P=0.62) and in 114 of 2495 patients (4.6%) in the acetylcysteine group as compared with 112 of 2498 (4.5%) in the placebo group (odds ratio, 1.02; 95% CI, 0.78 to 1.33; P=0.88). There were no significant between-group differences in the rates of contrast-associated acute kidney injury. Conclusions Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury. (Funded by the U.S. Department of Veterans Affairs Office of Research and Development and the National Health and Medical Research Council of Australia; PRESERVE ClinicalTrials.gov number, NCT01467466 .).

Concepts: Renal failure, Kidney, Nephrology, Renal physiology, Sodium chloride, Placebo, 3rd millennium, 25th century

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Skin lesions are often submitted to oral and maxillofacial pathology practices. The purpose of this study is to evaluate the frequency, distribution, variability, and composition of dermatologic lesions within a large oral and maxillofacial pathology biopsy service. An IRB-approved retrospective search of skin lesions diagnosed at University of Florida oral and maxillofacial pathology biopsy service between 1994 and 2015 was performed. 2487 cases were included in the study. Gender was reported in 2466 cases, of which 59% were male and 41% female. Age was provided in 2367 cases and ranged from 2 weeks to 96 years with an average of 55 years. Location was indicated in 2473 cases. Lips were the most common (41.7%), followed by face (25.3%), neck (7.4%), nose (6.5%), periorbital (5.3%), ear (4.1%), and scalp (3.8%). Of the 2487 cases, five diagnoses (actinic keratosis/cheilitis, intradermal nevus, epidermal inclusion cyst, seborrheic keratosis, and basal cell carcinoma) constituted 84.4% of the cases. 69 of 2487 cases (2.8%) resulted in dermatopathologic consultation prior to final reporting. Skin lesions accounted for ~ 1.0% of all lesions submitted to an oral and maxillofacial pathology biopsy service. This study found a large variation in the dermatologic lesions submitted to an oral pathology biopsy service. Although most were routine in complexity, dermatopathology consultation was an important tool in the diagnosis of the more challenging cases. This study may help pathologists gain a better understanding of the frequency and variability of dermatologic lesions submitted to an oral and maxillofacial pathology biopsy service and promote more interdisciplinary consultation within the field. This study evaluated the incidence and scope of dermatologic lesions submitted to a large oral and maxillofacial pathology biopsy service over a long time period. A wide scope of lesions was found, and dermatopathology consultation was important to quality assurance.

Concepts: Cancer, Pathology, Anatomical pathology, Squamous cell carcinoma, Basal cell carcinoma, 3rd millennium, Nevus, 25th century

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The accuracy of low-level hydrogen measurements with prompt gamma-ray activation analysis (PGAA) depends on identifying and accounting for all background H signals, including interfering signals. At the cold-neutron (CN)PGAA facility at the NIST Center for Neutron Research, the sources of background H signals were investigated in the context of titanium-based matrices containing low-levels of H (<300 mg H per kg Ti) with the measurements of prepared standards (mixtures of polyvinyl chloride and titanium oxide) and Ti alloy (Ti6Al4V) samples. The sensitivity ratio, defined as the ratio of the H signal to the Ti signal per unit mass ratio of H in Ti, was determined (1) with the measurements of prepared standards and (2) based on partial gamma-ray production cross sections and full-energy detection efficiencies. The resulting calibrations from these two approaches agreed within experimental uncertainty. A series of Ti alloy NIST Standard Reference Materials (SRMs) previously certified for the H content (SRMs 2452, 2453, 2453a, 2454) were used as test cases, with the mass fractions determined based on the sensitivity ratios derived from method 1 and method 2, respectively. The results agreed with the certified values within experimental uncertainties, validating the analysis performed on the new instrument with newly-prepared standards at low H mass fractions (method 1), and with the standard-independent analysis (method 2). Various sample mounting improvements were made to lower the background H signal. Spectral interferences near the H peak were identified as potential sources of bias and as a limiting factor in the detection limit of H in Ti alloy samples.

Concepts: Measurement, Metrology, Mass, Neutron, Ratio, Test method, Standard, 25th century

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Culicinomyces spp. (Hypocreales: Cordycipitaceae) are facultative fungal pathogens affecting the larval stages from a range of mosquito species and are especially notable in their ability to infect hosts through the digestive tract after conidial ingestion. While Culicinomyces spp. were studied mainly in the 1980s, little is yet known about inter- and intraspecific variability of the in vitro development of these fungi at different temperatures, and nothing is known about the impact of serial host-passage on the development or virulence against Aedes aegypti larvae. The development of ten isolates of C. clavisporus (ARSEF 372, 582, 644, 706, 964, 1260, 2471, 2478, 2479 and 2480) and one of C. bisporalis (ARSEF 1479) was assessed on solid SDAY/4 and liquid SDY/4 at 15, 20, 25, 30 and 35°C. Based on the results of these assays, three isolates were selected (ARSEF 644, 964 and 2479) for three serial host-passage/reisolation cycles, and comparison of the reisolates with the original stock isolates for their virulence, vegetative growth and conidiogenesis. The highest germination rates (≥ 95%) after 48 h incubation were obtained at 25 and 20°C, and the lowest germination (≤ 12%) at 35°C after the same time. The optimal temperature for radial growth was 25°C (≥ 11.8 mm), followed by 20°C for all isolates. ARSEF 706, 582 and 372 showed the greatest vegetative growth (≥ 20 mm). In general, there was little radial growth of colonies at 30°C (≤ 2.5mm), and none at 35°C. Isolates, especially ARSEF 964, 2479, and 644, generally produced the highest numbers of conidia at 25°C (≥ 1.42 x 10(5) conidia/plate) after 15 days. After two host-passages, conidiogenesis increased significantly on SDAY/4 for ARSEF 2479 but not for ARSEF 644 or 964. All larvae exposed to these three isolates of C. clavisporus died within 7 days regardless of the concentration or host-passage; C. bisporalis was not tested in these experiments. The virulence of ARSEF 964 increased at lower concentrations (10(6)-3 x 10(5) conidia/ml) after the first host-passage.

Concepts: Larva, Mosquito, Aedes aegypti, Aedes, 3rd millennium, 25th century

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A total of 13 short DNA sequences of quality control strains (MCC 2052, MCC 2077, MCC 2078, MCC 2080, MCC 2309, MCC 2322, MCC 2408, MCC 2409, MCC 2412, MCC 2413, MCC 2415, MCC 2483 and MCC 2515) were retrieved from NCBI BioSample database and generated quick response (QR) codes for sequences. 16S rRNA was used for creation of Chaose Game representation (CGR), Chaose Game Representation of Frequencies (FCGR) and measurement of GC percentage. Digital data in the form of QR codes, CGR, FCGR and GC plot would be useful for identification, visual comparison and evaluation of newly isolated strains with quality control strains. The digital data of QR codes, CGR, FCGR and GC content all the quality control strains are made available to users through this paper. This generated digital data helps to evaluate and compare newly isolated strains, less laborious and avoid misinterpretation of newly isolated species.

Concepts: DNA, 3rd millennium, Years in the future, 25th century

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Ischemic Optic Neuropathies Review Article, N Engl J Med 2015;372:2428-2436. Figure 1 (page 2430), Figure 4 (page 2434), and the video have been modified to more accurately represent the blood supply to the optic nerve. The article is correct at NEJM.org.

Concepts: Blood vessel, 25th century

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Revision hip arthroplasty in the presence of severe acetabular bone loss is challenging and requires a solid understanding of current techniques. A literature search of multiple databases applying specific criteria revealed a total of 50 articles of level IV scientific evidence comprising 2415 patients (2480 hips) managed with reinforcement devices (roof-reinforcement rings and anti-protrusio cages), custom-made triflanged acetabular components (CTACs), jumbo cups and tantalum metal ™ systems. Overall, patients had improved postoperative hip scores for each technique. The use of reinforcement devices resulted in a mean revision rate of 8.2% and a mean complication rate of 29.21%. CTACs were associated with a revision rate of 15.9% and had a complication rate of 24.5%. Jumbo cups were revised in 8.8% of patients and had a complication rate of 18.4%. TM systems had an overall revision rate of 8.5% with complications seen in 18.5% of patients. CTACs had considerably higher revision rates compared to the other techniques. Jumbo cups and TM systems had lower complication rates compared to the use of reinforcement devices and CTACs. The most frequently occurring complications seen throughout the series were aseptic loosening, dislocation and infection.

Concepts: Osteoporosis, Rates, Hip replacement, Hip, Pelvis, Orthopedic surgery, Hip dysplasia, 25th century