Background
Medullary sponge kidney (MSK) disease predisposes patients to recurrent nephrolithiasis, which affects one in every 5000 people in the United States.
Methods
We report a rare case of a ...pediatric recipient of a living donor MSK transplant and discuss considerations when discussing risks and benefits of accepting MSK allografts for this population.
Results
The recipient was admitted due to concerns for nephrolithiasis, hydronephrosis, and urinary tract infection at 1‐month post‐transplant. The hydronephrosis was resolved by surgical removal of an encrusted ureteral stent; this was followed by supplementation with oral medications to prevent future episodes of nephrolithiasis. The recipient did not have any further episodes after this as seen at a 1‐year follow‐up. The donor has remained well through this period.
Conclusions
With increasing organ shortages, the use of variety of donors may need to be considered to enlarge the organ pool.
Background
Studies have demonstrated the Timed Up and Go Test's (TUGT) ability to forecast postoperative outcomes for several surgical specialties. Evaluations of the TUGT for waitlist and ...posttransplant outcomes have yet to be examined in kidney transplantation.
Objective
To assess the prognostic utility of the TUGT and its associations with waitlist and posttransplant outcomes for kidney transplant candidates.
Design and Methods
Single‐center, prospective study of 518 patients who performed TUGT during their transplant evaluation between 9/1/2013‐11/30/2014. TUGT times were evaluated as a continuous variable or 3‐level discrete categorical variable with TUGT times categorized as long (>9 seconds), average (8‐9 seconds), or short (5‐8 seconds).
Results
Transplanted individuals had shorter TUGT times than those who remained on the waitlist (8.99 vs 9.79 seconds, P < 0.001). Bivariable and multivariable logistic regression showed that after adjusting for age, there was no association between TUGT times and probability of waitlist removal (OR 0.997 0.814‐1.221), prolonged length of stay posttransplant (OR 1.113 0.958‐1.306 for deceased donor, OR 0.983 0.757‐1.277 for living donor), and 30‐day readmissions (OR 0.984 0.845‐1.146 for deceased donor, OR 1.254 0.976‐1.613 for living donor).
Conclusions
The TUGT was not associated with waitlist removal or prolonged hospitalization for kidney transplant candidates. Alternative assessments of global health, such as functional status or frailty, should be considered for evaluation of potential kidney transplant candidates.
Background
Discard rate of Public Health Service Increased Risk (PHS‐IR) organs is high despite the absence of worse kidney transplant outcomes.
Methods
We conducted a retrospective, single‐center ...study of PHS‐IR kidney offers made to kidney transplant‐only potential recipients from 6/2004 to 5/2015. Overall mortality and transplant outcomes between potential recipients were stratified by response to PHS‐IR kidney offers. Cox regression and Kaplan‐Meier analyses of mortality and allograft failure were performed.
Results
A total of 2423 potential recipients were offered a PHS‐IR kidney, with 1502 transplanted, with or without a PHS‐IR kidney. Predictors of accepting a PHS‐IR kidney included higher Estimated Post Transplant Survival (EPTS) score, prior kidney transplant, and lower educational achievement on multivariable analysis (P = 0.025, P = 0.004, P = 0.023). A positive response to a PHS‐IR kidney was associated with lower risk of mortality (3.63% vs 11.6%; aHR 0.467, P = 0.0008). PHS‐IR kidney recipients had decreased risk of allograft loss compared to non‐PHS‐IR recipients (P = 0.007), though mortality outcomes were not significantly different based on PHS‐IR status (P = 0.38). No transmission of HIV, HBV, or HCV occurred from PHS‐IR kidney donors in this cohort.
Conclusions
Efforts must be made to increase awareness of the beneficial outcomes of PHS‐IR organs to maximize appropriate donor allocation.
BACKGROUNDMedullary sponge kidney (MSK) disease predisposes patients to recurrent nephrolithiasis, which affects one in every 5000 people in the United States. METHODSWe report a rare case of a ...pediatric recipient of a living donor MSK transplant and discuss considerations when discussing risks and benefits of accepting MSK allografts for this population. RESULTSThe recipient was admitted due to concerns for nephrolithiasis, hydronephrosis, and urinary tract infection at 1-month post-transplant. The hydronephrosis was resolved by surgical removal of an encrusted ureteral stent; this was followed by supplementation with oral medications to prevent future episodes of nephrolithiasis. The recipient did not have any further episodes after this as seen at a 1-year follow-up. The donor has remained well through this period. CONCLUSIONSWith increasing organ shortages, the use of variety of donors may need to be considered to enlarge the organ pool.
Wind power is a major candidate in the search for clean, renewable energy. Beyond the technical and economic challenges of wind energy development are environmental issues that may restrict its ...growth. Avian fatalities due to collisions with rotating turbine blades are a leading concern and there is considerable uncertainty surrounding avian collision risk at wind facilities. This uncertainty is not reflected in many models currently used to predict the avian fatalities that would result from proposed wind developments. We introduce a method to predict fatalities at wind facilities, based on pre-construction monitoring. Our method can directly incorporate uncertainty into the estimates of avian fatalities and can be updated if information on the true number of fatalities becomes available from post-construction carcass monitoring. Our model considers only three parameters: hazardous footprint, bird exposure to turbines and collision probability. By using a Bayesian analytical framework we account for uncertainties in these values, which are then reflected in our predictions and can be reduced through subsequent data collection. The simplicity of our approach makes it accessible to ecologists concerned with the impact of wind development, as well as to managers, policy makers and industry interested in its implementation in real-world decision contexts. We demonstrate the utility of our method by predicting golden eagle (Aquila chrysaetos) fatalities at a wind installation in the United States. Using pre-construction data, we predicted 7.48 eagle fatalities year-1 (95% CI: (1.1, 19.81)). The U.S. Fish and Wildlife Service uses the 80th quantile (11.0 eagle fatalities year-1) in their permitting process to ensure there is only a 20% chance a wind facility exceeds the authorized fatalities. Once data were available from two-years of post-construction monitoring, we updated the fatality estimate to 4.8 eagle fatalities year-1 (95% CI: (1.76, 9.4); 80th quantile, 6.3). In this case, the increased precision in the fatality prediction lowered the level of authorized take, and thus lowered the required amount of compensatory mitigation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sequencing studies of diffuse large B cell lymphoma (DLBCL) have identified hundreds of recurrently altered genes. However, it remains largely unknown whether and how these mutations may contribute ...to lymphomagenesis, either individually or in combination. Existing strategies to address this problem predominantly utilize cell lines, which are limited by their initial characteristics and subsequent adaptions to prolonged in vitro culture. Here, we describe a co-culture system that enables the ex vivo expansion and viral transduction of primary human germinal center B cells. Incorporation of CRISPR/Cas9 technology enables high-throughput functional interrogation of genes recurrently mutated in DLBCL. Using a backbone of BCL2 with either BCL6 or MYC, we identify co-operating genetic alterations that promote growth or even full transformation into synthetically engineered DLBCL models. The resulting tumors can be expanded and sequentially transplanted in vivo, providing a scalable platform to test putative cancer genes and to create mutation-directed, bespoke lymphoma models.
Black vultures (Coragyps atratus) have been increasing in density and expanding their range in the eastern United States since at least the 1960s. In many areas, their densities have increased to the ...level where they are causing damage to property and livestock and the number of requests for allowable take permits has increased throughout these areas. The United States Fish and Wildlife Service (USFWS) requires updated information to help inform the number of take permits that could reduce conflicts while meeting obligations under the Migratory Bird Treaty Act. We expanded analyses used to estimate allowable take in Virginia to cover the range of black vultures in the eastern United States. We used the prescribed take level approach, which integrates demographic rates, population size estimates, and management objectives into an estimate of allowable take. We provide estimates of allowable take at 4 different scales: individual states, Bird Conservation Regions, USFWS administrative regions, and flyways. Our updated population time series provides evidence of rapidly increasing black vulture populations in many regions of the eastern United States, with an overall population estimate of approximately 4.26 million in 2015 in the Atlantic and Mississippi Flyways. Estimated allowable take ranged from a few hundred individuals per year in states at the northern end of the species range to approximately 287,000/year over the entire eastern United States. The USFWS has no legal mandate regarding the spatial scale at which take should be managed and we found little biological evidence of subpopulation structure for black vultures in the eastern United States. We suggest that allowable take for the species be implemented at a scale that meets stakeholder objectives (e.g., reducing conflict, and ensuring that black vultures are not extirpated from local areas) and is efficient for administrative and monitoring purposes.
After assessing patient perspectives on the success of current diabetes therapies and the factors that have the greatest impact on daily life, we show that time-in-range is a crucial outcome for ...people with diabetes and that current therapies are falling short on this metric. We also show that patients feel significant stress and worry, and they believe they are falling short in diet, exercise, and weight maintenance. In addition, they believe diet and exercise and in-range blood glucose are the biggest drivers of improved diabetes management and mindset. Together, these findings support the need for therapies that improve outcomes including and beyond A1C.
To evaluate the impact of substance abuse on pediatric hepatitis C virus (HCV) prevalence, we examined geographic and demographic data on inpatient hospitalizations in children with HCV.
We examined ...hospitalizations in children using the Kids' Inpatient Database, a part of the Healthcare Cost and Utilization Project. We identified cases using the International Classification of Diseases, 9th edition, codes for HCV infection during 2006, 2009, and 2012. Nonparametric tests for trend were used to calculate trend statistics.
From 2006 to 2012 nationally, the number of hospitalizations of children with HCV increased 37% (2.69 to 3.69 per 10 000 admissions; P < .001). The mean age of children hospitalized was 17.6 years (95% CI, 17.4-17.8). HCV cases among those 19-20 years of age represented 68% of the total HCV diagnoses, with a 54% increase over the years sampled (P < .001 for trend). The burden of HCV in children was highest in whites, those in the lowest income quartile, and in the Northeast and Southern regions of the US (all P < .0001). The prevalence of substance use among children with HCV increased from 25% in 2006 to 41% in 2012 (P < .001).
The increases of HCV in hospitalized children are largely in teenagers, highly associated with substance abuse, and concentrated in Northeast and Southern states. These results strongly suggest that public health efforts to prevent and treat HCV will also need to include adolescents.
Calanus finmarchicus
is a predominant planktonic copepod in the northern North Atlantic Ocean, where it is a fundamental link in the transfer of energy from phytoplankton to fish. Here, we ...investigate whether ocean acidification at present-day and future levels will cause a significant decrease in the egg hatching success (HS) of
C. finmarchicus
in the Gulf of Maine. Eggs spawned by female
C. finmarchicus
collected from the coastal Gulf of Maine were incubated in seawater acidified by addition of CO
2
to selected pH levels at 3.5 °C (in a single experiment), 6 °C and 14–15 °C (in multiple experiments). HS was unaffected by pH between 6.58 and 8.0 at 3.5 and 6 °C, and between 7.1 and 8.0 when incubated at 15 °C. A significant interactive effect between temperature and pH on HS was found using a two-way ANOVA of the data from experiments at 6 °C and 14–15 °C, temperatures that are experienced in summer in the Gulf of Maine. HS of eggs spawned from
C. finmarchicus
females immediately after capture from a coastal station was significantly reduced at pH ≤ 7.0 when incubated at 14–15 °C, although HS of eggs collected from well-fed females in the laboratory in water from the Damariscotta Estuary was not significantly reduced at pH levels as low as 6.6 at 15 °C. This finding is consistent with the hypothesis that parental history and possibly maternal provisioning can influence capability of eggs to adjust to lower pH environments. While an interaction between pH and temperatures experienced by
C. finmarchicus
at the southern edge of its biogeographic range was observed, the pH at which this interaction occurred is substantially lower than pH levels predicted for the surface ocean over the surface ocean.
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