SUMMARY Biological systems must possess mechanisms that prevent inappropriate responses to spurious environmental inputs. Caenorhabditis elegans has two breakdown pathways for the short-chain fatty acid propionate: a canonical, vitamin B12-dependent pathway and a propionate shunt that is used when vitamin B12 levels are low. The shunt pathway is kept off when there is sufficient flux through the canonical pathway, likely to avoid generating shunt-specific toxic intermediates. Here, we discovered a transcriptional regulatory circuit that activates shunt gene expression upon propionate buildup. Nuclear hormone receptor 10 (NHR-10) and NHR-68 function together as a “persistence detector” in a type 1, coherent feed-forward loop with an AND-logic gate to delay shunt activation upon propionate accumulation and to avoid spurious shunt activation in response to a non-sustained pulse of propionate. Together, our findings identify a persistence detector in an animal, which transcriptionally rewires propionate metabolism to maintain homeostasis.

This novel risk-stratified comparison using a national clinical database showed that EVAR of RAAA has a lower mortality and morbidity compared with OR in low-risk and medium-risk patients and that EVAR should be used to treat these patients when anatomically feasible. For RAAA patients at the highest preoperative risk, there is no benefit to using EVAR compared with OR.

No abstract

Diabetes increases the risk of major amputation and all-cause death at 12 months following endovascular revascularization in patients with symptomatic PAD. These risks are especially heightened in patients presenting with CLI.

No abstract

No abstract

Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagnose various orthopaedic diseases, including fractures. We aim to derive a definitive estimate of the diagnostic accuracy of ultrasonography in clinically suspected scaphoid fractures. Methods: We undertook a systematic review and meta-analysis of included diagnostic cohort studies that discussed the use of ultrasonography in the diagnosis of occult scaphoid fractures. We searched the National Institute for Health and Care Excellence database using the Healthcare Databases Advanced Search tool. In addition, we utilized the PubMed database to search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index of Nursing and Allied Health and Allied and Complimentary Medicine databases. Studies were included if they discuss the role of ultrasound imaging in the diagnosis of scaphoid fractures based on cortical interruption, radio-carpal effusion and scapho-trapezium-trapezoid effusion. Quality assessment was performed using the methodological index for non-randomized studies scoring system. Results: 6 non-randomized control studies met the inclusion criteria. Collectively, these included 236 patients with a mean age ranging from 18 to 41.2 years. The quality of these articles ranged between moderate and high based on the methodological index for non-randomized studies score. The mean sensitivity was 88.95% (standard deviation 10.03) and mean specificity was 89.50% (standard deviation 12.21). Conclusion: The current literature reveals high sensitivity and specificity in the use of ultrasonography in scaphoid fracture diagnosis. However, multiple factors including technical differences in ultrasound machines and probes, small sample sizes and variability of subsequent confirmatory tests have created a challenge in determining the ultimate reliability of ultrasonography in the diagnosis of occult scaphoid fractures. Considering these factors and limitations, large-sample and high-quality clinical trials are needed to adequately assess its reliability for this purpose. One stop clinics, in the authors’ opinion, would be an ideal setting for its introduction as well as for future trials.

No abstract