Hypotensive resuscitation versus standard fluid resuscitation for the management of trauma patients in hemorrhagic shock: The safety phase of a randomized controlled trial

Trauma is a leading cause of death worldwide, and is thus a major public health concern. Improving current resuscitation strategies may help to reduce morbidity and mortality from trauma, and clinical research plays an important role in addressing these issues. This thesis is a secondary analysis of data that was collected for a randomized clinical trial being conducted at Ben Taub General Hospital. The trial is designed to compare a hypotensive resuscitation strategy to standard fluid resuscitation for the early treatment of trauma patients in hemorrhagic shock. This thesis examines the clinical outcomes from the first 90 subjects enrolled in the study, with the primary aim of assessing the safety of hypotensive resuscitation within the trauma population. ^ Patients in hemorrhagic shock who required emergent surgery were randomized to one of two arms of the study. Those in the experimental (LMAP) arm were managed with a hypotensive resuscitation strategy in which the target mean arterial pressure was 50mmHg. Those in the control (HMAP) arm were managed with standard fluid resuscitation to a target mean arterial pressure of 65mmHg. Patients were followed for 30 days. Mortality, post-operative complications, and other clinical data were prospectively gathered by the Ben Taub surgical staff and then secondarily analyzed for the purpose of this thesis.^ Subjects in the LMAP group had significantly lower early post-operative mortality compared to those in the HMAP group. 30-day mortality was also lower in the LMAP group, although this did not reach statistical significance. There were no statistically significant differences between the two groups with regards to development of ischemic, hematologic or infectious complications, length of hospitalization, length of ICU stay or duration of mechanical ventilation. ^ Based upon the data presented in this thesis, it appears that hypotensive resuscitation is a safe strategy for use in the trauma population. Specifically, hypotensive resuscitation reduced the risk of early post-operative death from coagulopathic bleeding and did not result in an increased risk of ischemic or other post-operative complications. The preliminary results described in this thesis provide convincing evidence support the continued investigation and use of hypotensive resuscitation in a trauma setting.^

Report on the practice based culminating experience as teaching assistant for "Pathology and Public Health" class taught at University of Texas School of Public Health, Houston

Objectives. The objectives of this report were to describe current best standards in online education, class competencies, class objectives, class activities and to compare the class competencies, objectives and activities undertaken with the current best practices in online teaching and to provide a list of recommendations based on the most efficacious practices. ^ Methods. Utilizing the key words- online teaching, national standards, quality, online courses, I: (1) conducted a search on Google to find the best standard for quality online courses; the search yielded National Standards for Quality Online Teaching as the gold standard in online course quality; (2) specified class objectives and competencies as well as major activities undertaken as a part of the class. Utilizing the Southern Regional Education Board evaluation checklist for online courses, I: (1) performed an analysis comparing the class activities, objectives, and competencies with the current best standards; (2) utilized the information obtained from the analysis and class experiences to develop recommendations for the most efficacious online teaching practices. ^ Results. The class met the criteria set by the Southern Regional Education Board for evaluating online classes completely in 75%, partially in 16% and did not meet the criteria in 9% cases. The majority of the parameters in which the class did not meet the standards (4 of 5) were due to technological reasons beyond the scope of the class instructor, teaching assistant and instructional design. ^ Discussion. Successful online teaching requires awareness of technology, good communication, methods, collaboration, reflection and flexibility. Creation of an online community, engaging online learners and utilizing different learning styles and assessment methods promote learning. My report proposes that online teaching should actively engage the students and teachers with multiple interactive strategies as evidenced from current best standards of online education and my “hands-on” work experience. ^ Conclusion. The report and the ideas presented are intended to create a foundation for efficacious practice on the online teaching platform. By following many of the efficacious online practices described in the report and adding from their own experiences, online instructors and teaching assistants can contribute to effective online learning. ^

Regulation of the heat shock response by thiol-reactive compounds in the yeast Saccharomyces cerevisiae

Cells govern their activities and modulate their interactions with the environment to achieve homeostasis. The heat shock response (HSR) is one of the most well studied fundamental cellular responses to environmental and physiological challenges, resulting in rapid synthesis of heat shock proteins (HSPs), which serve to protect cellular constituents from the deleterious effects of stress. In addition to its role in cytoprotection, the HSR also influences lifespan and is associated with a variety of human diseases including cancer, aging and neurodegenerative disorders. In most eukaryotes, the HSR is primarily mediated by the highly conserved transcription factor HSF1, which recognizes target hsp genes by binding to heat shock elements (HSEs) in their promoters. In recent years, significant efforts have been made to identify small molecules as potential pharmacological activators of HSF1 that could be used for therapeutic benefit in the treatment of human diseases relevant to protein conformation. However, the detailed mechanisms through which these molecules drive HSR activation remain unclear. In this work, I utilized the baker's yeast Saccharomyces cerevisiae as a model system to identify a group of thiol-reactive molecules including oxidants, transition metals and metalloids, and electrophiles, as potent activators of yeast Hsf1. Using an artificial HSE-lacZ reporter and the glucocorticoid receptor system (GR), these diverse thiol-reactive compounds are shown to activate Hsf1 and inhibit Hsp90 chaperone complex activity in a reciprocal, dose-dependent manner. To further understand whether cells sense these reactive compounds through accumulation of unfolded proteins, the proline analog azetidine-2-carboxylic acid (AZC) and protein cross-linker dithiobis(succinimidyl propionate) (DSP) were used to force misfolding of nascent polypeptides and existing cytosolic proteins, respectively. Both unfolding reagents display kinetic HSP induction profiles dissimilar to those generated by thiol-reactive compounds. Moreover, AZC treatment leads to significant cytotoxicity, which is not observed in the presence of the thiol-reactive compounds at the concentrations sufficient to induce Hsf1. Additionally, DSP treatment has little to no effect on Hsp90 functions. Together with the ultracentrifugation analysis of cell lysates that detected no insoluble protein aggregates, my data suggest that at concentrations sufficient to induce Hsf1, thiol-reactive compounds do not induce the HSR via a mechanism based on accumulation of unfolded cytosolic proteins. Another possibility is that thiol-reactive compounds may influence aspects of the protein quality control system such as the ubiquitin-proteasome system (UPS). To address this hypothesis, β-galactosidase reporter fusions were used as model substrates to demonstrate that thiol-reactive compounds do not inhibit ubiquitin activating enzymes (E1) or proteasome activity. Therefore, thiol-reactive compounds do not activate the HSR by inhibiting UPS-dependent protein degradation. I therefore hypothesized that these molecules may directly inactivate protein chaperones, known as repressors of Hsf1. To address this possibility, a thiol-reactive biotin probe was used to demonstrate in vitro that the yeast cytosolic Hsp70 Ssa1, which partners with Hsp90 to repress Hsf1, is specifically modified. Strikingly, mutation of conserved cysteine residues in Ssa1 renders cells insensitive to Hsf1 activation by cadmium and celastrol but not by heat shock. Conversely, substitution with the sulfinic acid and steric bulk mimic aspartic acid led to constitutive activation of Hsf1. Cysteine 303, located in the nucleotide-binding/ATPase domain of Ssa1, was shown to be modified in vivo by a model organic electrophile using Click chemistry technology, verifying that Ssa1 is a direct target for thiol-reactive compounds through adduct formation. Consistently, cadmium pretreatment promoted cells thermotolerance, which is abolished in cells carrying SSA1 cysteine mutant alleles. Taken together, these findings demonstrate that Hsp70 acts as a sensor to induce the cytoprotective heat shock response in response to environmental or endogenously produced thiol-reactive molecules and can discriminate between two distinct environmental stressors.

Reflections: Historical Perspectives on Pathology in Houston and Galveston

“This account of pathology in the Houston and Galveston area … examines important themes in the development of pathology in this area, using selected details from the careers of individuals and institutions to illustrate how pathologists, as practitioners, teachers, and researchers, dealt with the challenges they faced in finding and keeping a niche for pathology in the medical world.” - Preface This book was written to commemorate the 50th anniversary of Houston Society of Clinical Pathologists. Bibliographic references and other resources are included.

The History of Pathology in Texas

The History of Pathology in Texas is the study of the changes of disease in Texas from the frontier days to the 1990s. Marilyn Miller Baker wrote the book for the Texas Society of Pathologists. The book was published in 1996 with a forward by Vernie A. Stembridge, MD, the Ashbel Smith Professor and Chairman Emeritus of Pathology at the University of Texas Southwestern Medical Center at Dallas. The book covers the story of pathology from the "performance of crude autopsies" on the frontier through the emergence of bacteriology and immunology and beyond.

The function of the murine complement *C3a and *C5a anaphylatoxin receptors in endotoxemia, bacteremia and septic shock

The complement system functions as a major effector for both the innate and adaptive immune response. Activation of the complement cascade by either the classical, alternative, or lectin pathway promotes the proteolysis of C3 and C5 thereby generating C3a and C5a. Referred to as anaphylatoxins, the C3a and C5a peptides mediate biological effects upon binding to their respective receptors; C3a binds to the C3a receptor (C3aR) while C5a binds to the C5a receptor (C5aR, CD88). Both C3a and C5a are known for their broad proinflammatory effects. Elevated levels of both peptides have been isolated from patients with a variety of inflammatory diseases such as COPD, asthma, RA, SLE, and sepsis. Recent studies suggest that C5a is a critical component in the acquired neutrophil dysfunction, coagulopathy, and progressive multi-organ dysfunction characteristic of sepsis. The primary hypothesis of this dissertation was that preventing C3a-C3aR and C5a-C5aR mediated pro-inflammatory effects would improve survival in endotoxic, bacteremic and septic shock. To test this hypothesis, the murine C3aR and C5aR genes were disrupted. Following disruption of both the C3aR and C5aR genes, no abnormalities were identified other than the absence of their respective mRNA and protein. In models of both endotoxic and bacteremic shock, C3aR deficient mice suffered increased mortality when compared to their wild type littermates. C3aR deficient mice also had elevated circulating IL-1β levels. Using a model of sepsis, C3aR deficient mice had a higher circulating concentration of IL-6 and decreased peritoneal inflammatory infiltration. While these results were unexpected, they support an emerging role for C3a in immunomodulation. In contrast, following endotoxic or bacteremic shock, C5aR deficient mice experienced increased survival, less hemoconcentration and less thrombocytopenia. It was later determined that C5a mediated histamine release significantly contributes to host morbidity and mortality in bacteremic shock. These studies provide evidence that C5a functions primarily as a proinflammatory molecule in models of endotoxic and bacteremic shock. In the same models, C3a-C3aR interactions suppress the inflammatory response and protect the host. Collectively, these results present in vivo evidence that C3a and C5a have divergent biological functions. ^

Susy Shock trans piradx : El inclasificable género colibrí

Mensualmente, en Buenos Aires, la artista trans Susy Shock presenta su arte performativo en Poemarios Trans Pirados y Noches Bizarras. Su reivindicación a lo monstruoso se inscribe en lo queer pues propone la imposibilidad de rotular, clasificar, o clausurar las derivas de deseo, género y sexo. Vislumbramos lo ?mascufemenino? en disputa: una deconstrucción de categorías naturalizadas que invita a repensarnos en cada escrito, canción y presentación. Su construcción de género deviene en "colibrí", recordando el Parakultural y al "clown-travesti-literario" Batato Barea. Así, advertimos la destrucción de binarismos en un cuerpo deseante y una militancia trans que transgrede la "matriz heterosexual"

Susy Shock trans piradx : El inclasificable género colibrí

Mensualmente, en Buenos Aires, la artista trans Susy Shock presenta su arte performativo en Poemarios Trans Pirados y Noches Bizarras. Su reivindicación a lo monstruoso se inscribe en lo queer pues propone la imposibilidad de rotular, clasificar, o clausurar las derivas de deseo, género y sexo. Vislumbramos lo ?mascufemenino? en disputa: una deconstrucción de categorías naturalizadas que invita a repensarnos en cada escrito, canción y presentación. Su construcción de género deviene en "colibrí", recordando el Parakultural y al "clown-travesti-literario" Batato Barea. Así, advertimos la destrucción de binarismos en un cuerpo deseante y una militancia trans que transgrede la "matriz heterosexual"

Susy Shock trans piradx : El inclasificable género colibrí

Mensualmente, en Buenos Aires, la artista trans Susy Shock presenta su arte performativo en Poemarios Trans Pirados y Noches Bizarras. Su reivindicación a lo monstruoso se inscribe en lo queer pues propone la imposibilidad de rotular, clasificar, o clausurar las derivas de deseo, género y sexo. Vislumbramos lo ?mascufemenino? en disputa: una deconstrucción de categorías naturalizadas que invita a repensarnos en cada escrito, canción y presentación. Su construcción de género deviene en "colibrí", recordando el Parakultural y al "clown-travesti-literario" Batato Barea. Así, advertimos la destrucción de binarismos en un cuerpo deseante y una militancia trans que transgrede la "matriz heterosexual"

Rapid acclimation of juvenile corals to CO2-mediated acidification by upregulation of heat shock protein and Bcl-2 genes

Corals play a key role in ocean ecosystems and carbonate balance, but their molecular response to ocean acidification remains unclear. The only previous whole-transcriptome study documented extensive disruption of gene expression, particularly of genes encoding skeletal organic matrix proteins, in juvenile corals (Acropora millepora) after short-term (3 d) exposure to elevated pCO2. In this study, whole-transcriptome analysis was used to compare the effects of such 'acute' (3 d) exposure to elevated pCO2 with a longer ('prolonged'; 9 d) period of exposure beginning immediately post-fertilization. Far fewer genes were differentially expressed under the 9-d treatment, and although the transcriptome data implied wholesale disruption of metabolism and calcification genes in the acute treatment experiment, expression of most genes was at control levels after prolonged treatment. There was little overlap between the genes responding to the acute and prolonged treatments, but heat shock proteins (HSPs) and heat shock factors (HSFs) were over-represented amongst the genes responding to both treatments. Amongst these was an HSP70 gene previously shown to be involved in acclimation to thermal stress in a field population of another acroporid coral. The most obvious feature of the molecular response in the 9-d treatment experiment was the upregulation of five distinct Bcl-2 family members, the majority predicted to be anti-apoptotic. This suggests that an important component of the longer term response to elevated CO2 is suppression of apoptosis. It therefore appears that juvenile A. millepora have the capacity to rapidly acclimate to elevated pCO2, a process mediated by upregulation of specific HSPs and a suite of Bcl-2 family members.

Heat shock resistance traits in specimens of the seaweed Gracilaria vermiculophylla originating from native and non-native populations

We compared the responses of native and non-native populations of the seaweed Gracilaria vermiculophylla to heat shock in common garden-type experiments. Specimens from six native populations in East Asia and from eight non-native populations in Europe and on the Mexican Pacific coast were acclimated to two sets of identical conditions before their resistance to heat shock was examined. The experiments were carried out twice - one time in the native range in Qingdao, China and one time in the invaded range in Kiel, Germany - to rule out effects of specific local conditions. In both testing sites the non-native populations survived heat shock significantly better than the native populations, The data underlying this statement are presented in https://doi.pangaea.de/10.1594/PANGAEA.859335. After three hours of heat shock G. vermiculophylla exhibited increased levels of heat shock protein 70 (HSP70) and of a specific isoform of haloperoxidase, suggesting that both enzymes could be required for heat shock stress management. However, the elevated resistance toward heat shock of non-native populations only correlated with an increased constitutive expression of heat shock protein 70 (HSP70). The haloperoxidase isoform was more prominent in native populations, suggesting that not only increased HSP70 expression, but also reduced allocation into haloperoxidase expression after heat shock was selected during the invasion history. The data describing expression of HSP70 and three different isoforms of haloperoxidase are presented in https://doi.pangaea.de/10.1594/PANGAEA.859358.

Combined effects of short-term ocean acidification and heat shock in a benthic copepod Tigriopus japonicus Mori

Warming of the world's oceans is predicted to have many negative effects on organisms as they have optimal thermal windows. In coastal waters, however, both temperatures and pCO2 (pH) exhibit diel variations, and biological performances are likely to be modulated by physical and chemical environmental changes. To understand how coastal zooplankton respond to the combined impacts of heat shock and increased pCO2, the benthic copepod Tigriopus japonicus were treated at temperatures of 24, 28, 32 and 36 °C to simulate natural coastal temperatures experienced in warming events, when acclimated in the short term to either ambient (LC, 390 µatm) or future CO2 (HC, 1000 µatm). HC and heat shock did not induce any mortality of T. japonicus, though respiration increased up to 32 °C before being depressed at 36 °C. Feeding rate peaked at 28 °C but did not differ between CO2 treatments. Expression of heat shock proteins (hsps mRNA) was positively related to temperature, with no significant differences between the CO2 concentrations. Nauplii production was not affected across all treatments. Our results demonstrate that T. japonicus responds more sensitively to heat shocks rather than to seawater acidification; however, ocean acidification may synergistically act with ocean warming to mediate the energy allocation of copepods.