Detrital Zircon Evidence for Non-Laurentian Provenance, Mesoproterozoic (ca. 1490-1450 Ma) Deposition and Orogenesis in a Reconstructed Orogenic Belt, Northern New Mexico, USA: Defining the Picuris Orogeny

Detrital zircon and igneous zircon U-Pb ages are reported from Proterozoic metamorphic rocks in northern New Mexico. These data give new insight into the provenance and depositional age of a >3-km-thick metasedimentary succession and help resolve the timing of orogenesis within an area of overlapping accretionary orogens and thermal events related to the Proterozoic tectonic evolution of southwest Laurentia. Three samples from the Paleoproterozoic Vadito Group yield narrow, unimodal detrital zircon age spectra with peak ages near 1710 Ma. Igneous rocks that intrude the Vadito Group include the Cerro Alto metadacite, the Picuris Pueblo granite, and the Penasco quartz monzonite and yield crystallization ages of 1710 +/- 10 Ma, 1699 +/- 3 Ma, and 1450 +/- 10 Ma, respectively. Within the overlying Hondo Group, a metamorphosed tuff layer from the Pilar Formation yields an age of 1488 +/- 6 Ma and represents the first direct depositional age constraint on any part of the Proterozoic metasedimentary succession in northern New Mexico. Detrital zircon from the overlying Piedra Lumbre Formation yield a minimum age peak of 1475 Ma, and similar to 60 grains (similar to 25%) yield ages between 1500 Ma and 1600 Ma, possibly representing non-Laurentian detritus originating from Australia and/or Antarctica. Detrital zircons from the basal metaconglomerate and the middle quartzite member of the Marquenas Formation yield minimum age peaks of 1472 Ma and 1471 Ma, consistent with earlier results. We interpret the onset of ca. 1490-1450 Ma deposition followed by tectonic burial, regional Al2SiO5 triple-point metamorphism, and ductile deformation at depths of 12-18 km to reflect a Mesoproterozoic contractional orogenic event, possibly related to the final suturing of the Mazatzal crustal province to the southern margin of Laurentia. We propose to call this event the Picuris orogeny.

Complicating the Local: Defining the Aymara at Tiwanaku, Bolivia

The archaeological site of Tiwanaku, Bolivia, is commonly held to be the "Spiritual Capital of the Aymara People." But negotiating who qualifies as Aymara, and in what contexts, is decidedly more complicated. Local political divisions between residents of the village of Tiahuanacu (who are seen locally as less-Aymara but not as not-Aymara) and residents of the surrounding rural communities (who are considered to be unquestionably Aymara) structure discussions about who has the right to earn income at the Tiwanaku archaeological site, who manages major public events, and who is responsible for the site's maintenance and security. The situation is complicated further by national-level events such as the Winter Solstice, where urban Aymara travel to Tiwanaku to seek their roots, and Bolivian Presidents and politicians come to participate in national Aymara "culture." I focus on the intervencin ("Intervention") that took place in Tiahuanacu in August 2000, which resulted in the transfer of management of the Tiwanaku archaeological site from the Bolivian state to local municipal and indigenous authorities. Heritage researchers should take such local divisions into account, rather than assuming that "locals" are politically unified or easily delineated by geographical boundaries.

Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy

Objective: To compare clinical outcomes after laparoscopic cholecystectomy (LC) for acute cholecystitis performed at various time-points after hospital admission. Background: Symptomatic gallstones represent an important public health problem with LC the treatment of choice. LC is increasingly offered for acute cholecystitis, however, the optimal time-point for LC in this setting remains a matter of debate. Methods: Analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery and included patients undergoing emergency LC for acute cholecystitis between 1995 and 2006, grouped according to the time-points of LC since hospital admission (admission day (d0), d1, d2, d3, d4/5, d ≥6). Linear and generalized linear regression models assessed the effect of timing of LC on intra- or postoperative complications, conversion and reoperation rates and length of postoperative hospital stay. Results: Of 4113 patients, 52.8% were female, median age was 59.8 years. Delaying LC resulted in significantly higher conversion rates (from 11.9% at d0 to 27.9% at d ≥6 days after admission, P < 0.001), surgical postoperative complications (5.7% to 13%, P < 0.001) and re-operation rates (0.9% to 3%, P = 0.007), with a significantly longer postoperative hospital stay (P < 0.001). Conclusions: Delaying LC for acute cholecystitis has no advantages, resulting in significantly increased conversion/re-operation rate, postoperative complications and longer postoperative hospital stay. This investigation—one of the largest in the literature—provides compelling evidence that acute cholecystitis merits surgery within 48 hours of hospital admission if impact on the patient and health care system is to be minimized.

Fluids and barriers of the CNS establish immune privilege by confining immune surveillance to a two-walled castle moat surrounding the CNS castle

Neuronal activity within the central nervous system (CNS) strictly depends on homeostasis and therefore does not tolerate uncontrolled entry of blood components. It has been generally believed that under normal conditions, the endothelial blood-brain barrier (BBB) and the epithelial blood-cerebrospinal fluid barrier (BCSFB) prevent immune cell entry into the CNS. This view has recently changed when it was realized that activated T cells are able to breach the BBB and the BCSFB to perform immune surveillance of the CNS. Here we propose that the immune privilege of the CNS is established by the specific morphological architecture of its borders resembling that of a medieval castle. The BBB and the BCSFB serve as the outer walls of the castle, which can be breached by activated immune cells serving as messengers for outside dangers. Having crossed the BBB or the BCSFB they reach the castle moat, namely the cerebrospinal fluid (CSF)-drained leptomeningeal and perivascular spaces of the CNS. Next to the CNS parenchyma, the castle moat is bordered by a second wall, the glia limitans, composed of astrocytic foot processes and a parenchymal basement membrane. Inside the castle, that is the CNS parenchyma proper, the royal family of sensitive neurons resides with their servants, the glial cells. Within the CSF-drained castle moat, macrophages serve as guards collecting all the information from within the castle, which they can present to the immune-surveying T cells. If in their communication with the castle moat macrophages, T cells recognize their specific antigen and see that the royal family is in danger, they will become activated and by opening doors in the outer wall of the castle allow the entry of additional immune cells into the castle moat. From there, immune cells may breach the inner castle wall with the aim to defend the castle inhabitants by eliminating the invading enemy. If the immune response by unknown mechanisms turns against self, that is the castle inhabitants, this may allow for continuous entry of immune cells into the castle and lead to the death of the castle inhabitants, and finally members of the royal family, the neurons. This review will summarize the molecular traffic signals known to allow immune cells to breach the outer and inner walls of the CNS castle moat and will highlight the importance of the CSF-drained castle moat in maintaining immune surveillance and in mounting immune responses in the CNS.

Active surveillance of antibiotic resistance prevalence in urinary tract and skin infections in the outpatient setting

The aim of the study was to evaluate the need for active surveillance of antibiotic resistance in ambulatory infections. We measured the prevalence of antibiotic resistance in urinary tract infections (UTIs) (n = 1018) and skin infections (n = 213) diagnosed in outpatients between September 2008 and February 2009 in the Canton of Bern, Switzerland. Samples were stratified into 'solicited' (diagnostic work-up for study purpose only) and 'routine' (diagnostic work-up as part of standard care). Susceptibility patterns were compared for 463 Escherichia coli isolates from UTIs (231 solicited; 232 routine) and 87 Staphylococcus aureus isolates from skin infections (35 solicited; 52 routine). Overall, E. coli showed higher susceptibility to ampicillin, amoxicillin-clavulanic acid and norfloxacin in solicited than in routine samples. Among 15-45-year-old patients, susceptibility rates were comparable between solicited and routine samples for all antibiotics except for amoxicillin-clavulanic acid. However, among patients >45 years old, isolates from routine samples showed lower susceptibility to all β-lactams tested and quinolones than those from solicited samples. Extended-spectrum β-lactamase (ESBL)-producing E. coli isolates were rare (solicited, 0.4%; routine, 1.7%; p 0.4). Susceptibility patterns of S. aureus were comparable between solicited and routine samples. Therefore, in the outpatient setting, susceptibility rates for E. coli isolates differ by indication for urinary culture and age. Surveillance based on samples taken during standard care may underestimate susceptibility rates for uncomplicated infections, especially among the elderly. Reports of resistance data should include age stratification.

Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results registry

Management and outcomes of patients with invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas are not well established. We investigated whether adjuvant radiotherapy (RT) improved cancer-specific survival (CSS) and overall survival (OS) among patients undergoing surgical resection for invasive IPMN.

Disruption of SIRPα signaling in macrophages eliminates human acute myeloid leukemia stem cells in xenografts

Although tumor surveillance by T and B lymphocytes is well studied, the role of innate immune cells, in particular macrophages, is less clear. Moreover, the existence of subclonal genetic and functional diversity in some human cancers such as leukemia underscores the importance of defining tumor surveillance mechanisms that effectively target the disease-sustaining cancer stem cells in addition to bulk cells. In this study, we report that leukemia stem cell function in xenotransplant models of acute myeloid leukemia (AML) depends on SIRPα-mediated inhibition of macrophages through engagement with its ligand CD47. We generated mice expressing SIRPα variants with differential ability to bind human CD47 and demonstrated that macrophage-mediated phagocytosis and clearance of AML stem cells depend on absent SIRPα signaling. We obtained independent confirmation of the genetic restriction observed in our mouse models by using SIRPα-Fc fusion protein to disrupt SIRPα-CD47 engagement. Treatment with SIRPα-Fc enhanced phagocytosis of AML cells by both mouse and human macrophages and impaired leukemic engraftment in mice. Importantly, SIRPα-Fc treatment did not significantly enhance phagocytosis of normal hematopoietic targets. These findings support the development of therapeutics that antagonize SIRPα signaling to enhance macrophage-mediated elimination of AML.