No abstract

Pseudomonas aeruginosa culture filtrates varied in their ability to slow human ciliary beat frequency (7-71%). This activity did not correlate with known virulence factors. However, a close correlation (r = 0.97) existed between ciliary slowing and pigment content. In a prolonged culture, the increase in activity correlated (r = 0.94) with pigment accumulation. Gel filtration of lyophilized filtrate yielded a single peak of activity corresponding to the pigment fraction. Pyocyanin extracted from an active strain, and 1-hydroxyphenazine were purified by high performance liquid chromatography, and characterized by ultraviolet absorbance spectra and mass spectrometry. Both slowed cilia in a dose-dependent manner, and were synthesized and shown to be indistinguishable from the biological compounds. Pyocyanin caused gradual onset of slowing and ultimate widespread ciliostasis with epithelial disruption. 1-hydroxyphenazine caused rapid onset of ciliary slowing associated with dyskinesia and ciliostasis. Pyocyanin assayed within filtrates accounted for a significant proportion of the bioactivity present.

Hydraulic systems of plants have evolved in the context of carbon allocation and fitness tradeoffs of maximizing carbon gain and water transport in the face of short and long-term fluctuations in environmental conditions. The resulting diversity of traits include a continuum of isohydry-anisohydry or high to low relative stomatal closure during drought, shedding of canopy foliage or disconnecting roots from soil to survive drought, and adjusting root areas to efficiently manage canopy water costs associated with photosynthesis. These traits are examined within TREES, an integrated model that explicitly couples photosynthesis and carbon allocation to soil-plant hydraulics and canopy processes. Key advances of the model are its ability to account for differences in soil and xylem cavitation, transience of hydraulic impairment associated with delayed or no refilling of xylem, and carbon allocation to plant structures based on photosynthetic uptake of carbon and hydraulic limitations to water transport. The model was used to examine hydraulic traits of cooccurring isohydric (piñon pine) and anisohydric (one-seed juniper) trees from a fieldbased experimental drought. Model predictions of both transpiration and leaf water potential were improved when there was no refilling of xylem over simulations where xylem was able refill in response to soil water recharge. Model experiments with alternative root-to-leaf area ratios (R R/L ) showed the R R/L that supports maximum cumulative water use is not beneficial for supporting maximum carbon gain during extended drought, illustrating how a process model reveals trade-offs in plant traits.

No abstract

Objective-To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital.

Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods and results A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

ABSTRACI Ciliary activity protects the respiratory tract against inhaled particles, including bacteria, by transporting them trapped in mucus towards the pharynx. We have studied the effect of bacteria (Haemophilus influenzae, Staphylococcus aureus, and Pseudomonas aeruginosa) on human nasal cilia, measuring their in vitro ciliary beat frequency by a photometric technique. Supernatant fluids were obtained from 18 hour broth cultures by centrifugation alone, by filtration, and by lysis. Supernatants obtained from Ps aeruginosa and H influenzae caused a significantly lower ciliary beat frequency than controls (broth alone). Slowed cilia were dyskinetic and at times of maximal slowing ciliostasis occurred in some areas of the epithelium. A dose related effect was demonstrated. Abrogation of cilioinhibitory properties was achieved by heating the lysate to 56°C for 30 minutes and by allowing the filtrate to stand at 37°C for 120 minutes. Staphylococcal products were not cilioinhibitory. It is concluded that Ps aeruginosa and H influenzae release a factor (or factors) which causes slowing of human nasal cilia in vitro. The role of this factor in the pathogenesis of infection is discussed.Ciliary activity protects the respiratory tract against inhaled particles, including bacteria, by transporting them trapped in mucus towards the pharynx. Cilia beat in a coordinated manner in the periciliary fluid layer beneath overlying mucus. They have a stiff downstroke which propels the mucus forward, and are then withdrawn in a curved fashion within the periciliary fluid so as not to disturb the mucus layer.

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