Allosensitization as measured by presence of panel reactive antibodies (PRA) negatively impacts survival in adult heart transplant (HT) recipients. Questions remain whether these trends remain in ...more contemporary cohorts. We examined the interaction between long-term survival and pre-transplant PRA level in HT recipients from 2000-2018.
We identified adult HT recipients between 2000 and 2018 who had a pretransplant PRA in the Scientific Registry of Transplant Recipients. Study cohort was divided into groups with PRA levels; group with 0%, 1-10%, 11-24% and ≥25% PRA levels. We compared 3- and 5-year survival with the Kaplan-Meier method. We constructed Cox proportional hazards regression models to determine the risk adjusted influence of PRA category and PRA as a continuous value on survival.
We included 24,655 HT recipients. PRA was 0% in 17,391 (70.5%) recipients, 1-10% in 3,331 (13.5%) recipients, 11-24% in 1,330 (5.4%) recipients, and ≥25% in 2,603 (10.6%) recipients. Patients with a PRA ≥25% were younger, had fewer comorbidities, and were more likely to be on ECMO or LVAD prior to HT. Unadjusted 3- and 5-year estimated survival was lower with increasing PRA category (Figure). After risk-adjustment, 5-year survival was higher for the 0% cohort compared to the 1-10% (HR 1.10, 95% CI 1.02-1.18), 11-24% (HR 1.20, 95%CI 1.08-1.34), and ≥25% (HR 1.16, 95% CI 1.07-1.26). When analyzed continuously, increasing PRA was associated with a lower survival (HR 1.003, 95% CI 1.002-1.005). Sensitivity analysis of those transplanted from 2013-2018 showed similar results.
In this contemporary cohort of HT recipients, increasing pretransplant PRA was associated with lower survival. Given the appreciable portion of HT recipients with elevated PRA, improvements in recipient selection and HT management may help improve outcomes.
Focal-plane detector system for the KATRIN experiment Amsbaugh, J.F.; Barrett, J.; Beglarian, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
04/2015, Letnik:
778, Številka:
C
Journal Article
Recenzirano
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The focal-plane detector system for the KArlsruhe TRItium Neutrino (KATRIN) experiment consists of a multi-pixel silicon p-i-n-diode array, custom readout electronics, two superconducting solenoid ...magnets, an ultra high-vacuum system, a high-vacuum system, calibration and monitoring devices, a scintillating veto, and a custom data-acquisition system. It is designed to detect the low-energy electrons selected by the KATRIN main spectrometer. We describe the system and summarize its performance after its final installation.
Slow-release urea fertilisers have been shown to present acceptable values for plant yield and mitigate the harmful effect of soil emission gases. This study synthesises a slow-release fertiliser ...containing fumed-nanosilica, nanofibrillated cellulose as well as sodium alginate as a urea carrier to analyse the growth parameters of
Eucalyptus urograndis
seedlings and potential emission of soil gases, N
2
O, CH
4
, CO
2
and ammonia volatilisation. The developed supraparticles, arranged layered nanoparticle structure, presented a decrease in the normal nitrogen content of urea of 19%, which is attributed to the binding of this element. A good electrostatic interaction between the elements was confirmed by the FTIR with 20% of nitrogen content from its chemical composition and an increase in thermal degradation of the main components when synthesised. The profile of urea release presented to be as first-order with 85% of this compound was released only after 60 days. These characteristics led to statistically increased growth of
Eucalyptus
seedlings compared to the controls, which improves with higher dosages of urea. Values of biomass and characteristics of the plant were used for principal component analysis which resulted in good cluster formation based on the upward concentration of urea added to the plant. Nevertheless, flux gases were statistically higher for certain time periods on lower urea particle concentration, while increased concentration presented N
2
O emissions within standard rates with no significant variation in the other measured gases, which was attributed to the soil microbial targeted consumption. Therefore, this material can be beneficial in the agriculture industry.
In this work, we present the first AMBER observations, of the Wolf-Rayet and
O (WR+O) star binary system y2 Velorum. The AMBER instrument was used with the
telescopes UT2, UT3, and UT4 on baselines ...ranging from 46m to 85m. It delivered
spectrally dispersed visibilities, as well as differential and closure phases,
with a resolution R = 1500 in the spectral band 1.95-2.17 micron. We interpret
these data in the context of a binary system with unresolved components,
neglecting in a first approximation the wind-wind collision zone flux
contribution. We show that the AMBER observables result primarily from the
contribution of the individual components of the WR+O binary system. We discuss
several interpretations of the residuals, and speculate on the detection of an
additional continuum component, originating from the free-free emission
associated with the wind-wind collision zone (WWCZ), and contributing at most
to the observed K-band flux at the 5% level. The expected absolute separation
and position angle at the time of observations were 5.1±0.9mas and
66±15° respectively. However, we infer a separation of
3.62+0.11-0.30 mas and a position angle of 73+9-11°. Our analysis thus
implies that the binary system lies at a distance of 368+38-13 pc, in agreement
with recent spectrophotometric estimates, but significantly larger than the
Hipparcos value of 258+41-31 pc.
Recent reassessment of the use of race in estimated glomerular filtration rate (eGFR) in adults has instigated questions about the role of race in eGFR expressions for children. Little research has ...examined the associations of self-reported race with measured GFR (mGFR) adjusting for serum creatinine or cystatin C in children and young adults with chronic kidney disease (CKD). This study examined these associations and evaluated the performance of the previously published “U25” (under the age of 25 years) eGFR equations in a large cohort of children and young adults with CKD.
Observational cohort study.
Participants in the Chronic Kidney Disease in Children (CKiD) study including 190 Black and 675 non-Black participants contributing 473 and 1,897 annual person-visits, respectively.
Self- or parental-reported race (Black, non-Black). Adjustment for serum creatinine or cystatin C, body size, and socioeconomic status.
mGFR based on iohexol clearance.
Linear regression with generalized estimating equations, stratified by age (<6, 6-12, 12-18, and ≥18 years) incorporating serum creatinine or serum cystatin C. Contrasting performance in different self-reported racial groups of the U25 eGFR equations.
Self-reported Black race was significantly associated with 12.8% higher mGFR among children in regression models including serum creatinine. Self-reported Black race was significantly associated with 3.5% lower mGFR after adjustment for cystatin C overall but was not significant for those over 12 years. The results were similar after adjustment for body size and socioeconomic factors. The average of creatinine- and cystatin C–based U25 equations was unbiased by self-reported race groups.
Small number of children < 6 years; lean body mass was estimated.
Differences in the creatinine-mGFR relationship by self-reported race were observed in children and young adults with CKD and were consistent with findings in adults. Smaller and opposite differences were observed for the cystatin C–mGFR relationship, especially in the younger age group. We recommend inclusion of children for future investigations of biomarkers to estimate GFR. Importantly, for GFR estimation among those under 25 years of age, the average of the new U25 creatinine and cystatin C equations without race coefficients yields unbiased estimates of mGFR.
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Vasopressin therapy in cardiac surgery Kunkes, Jordan H.; Baker, William L.; Hammond, Jonathan A. ...
Journal of cardiac surgery,
January 2019, Letnik:
34, Številka:
1
Journal Article
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Background
Arginine vasopressin (AVP) is a naturally occurring peptide with diverse effects mediated through selective V1 and V2 receptors. About 10% of patients undergoing cardiopulmonary bypass ...develop postoperative vasodilatory shock requiring high‐dose catecholamines. We sought to examine the role of AVP therapy in cardiac surgery.
Methods
A search of Medline was conducted through September 2018 using key words and medical subject headings (MeSH) relating to AVP, copeptin, and cardiac surgery. A systematic review was performed on articles as they pertained to AVP for use as a vasopressor after cardiovascular surgery complicated by vasodilatory shock.
Results
A relative or absolute deficiency of Arginine vasopressin is associated with vasodilatory shock after cardiopulmonary bypass. Physiologic replacement with exogenous Arginine vasopressin results in significant increases in systemic vascular resistance and mean arterial pressure with decreased requirements of catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with very few adverse effects.
Conclusion
Post‐cardiopulmonary bypass vasodilatory shock is largely due to a relative deficiency of Arginine vasopressin. Exogenous administration of low‐dose Arginine vasopressin alone or in combination with traditional catecholamines is a safe and effective way to manage this type of vasodilatory shock.
ABSTRACT
Objectives
This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program.
...Methods
Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team.
Results
Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58).
Conclusion
Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.
NCHRP Project 15-35, Geometric Design of Driveways, was initiated to help address the lack of comprehensive research and national design guidance for the design of driveway connections to roadways. ...The research initiated with this project included an extensive literature review, a survey of state agencies and contacts with interest groups, and fieldwork to measure traffic attributes. The project produced two publications: a research report on the NCHRP website and NCHRP Report 659: Guide for the Geometric Design of Driveways. This paper considers the following topics: (a) What design issues were identified? Current design practices may not adequately consider the range of all driveway users: bicyclists, motorists, and pedestrians. The paper discusses the vulnerability of various users on the basis of historical crash data. (b) What user attributes were found? The research produced information about the driveway grades at which the undersides of vehicles may drag and the speeds at which vehicles on urban arterials entered commercial driveways having radii ranging from 13 to 20 ft. (c) What design practices were recommended? The guide presents a number of design practices to better meet the needs of all users. This paper provides useful information for design consultants and local government professionals.
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