To assess whether donor kidney Mayo Adhesive probability (MAP) score is associated with (total operative time) ORT in patients undergoing hand-assisted laparoscopic donor nephrectomy (HALDN).
Three ...hundred and thirty-one patients undergoing HALDN were reviewed. Donor kidney MAP scores were recorded based on preoperative computed tomography or magnetic resonance imaging. Single variable and multiple variable regression analysis were used to evaluate the correlation between MAP score and ORT.
Three hundred and thirty-one patients underwent HALDN between January 2007 and April 2017. Median body mass index was 26.4 kg/m2 (interquartile range 23.4, 29.5) and median age at time of surgery was 45 years (interquartile range 37, 53). Two hundred and thirty-one patients had donor kidney MAP = 0. Hundred patients had donor kidney MAP >0. Mean ORT was 163 minutes for females with MAP = 0 and 166 minutes for females with MAP >0. Median ORT was 180 minutes for males with MAP =0 and 191 minutes for males with MAP >0. Donor kidney MAP score > 0 was significantly correlated with longer ORT (increase of 24.4 minutes, P = .001) in single variable analysis. In multivariable analysis, this correlation was only significant for males (increase of 28.9 minutes, P = .013).
MAP score > 0 is associated with longer ORT for males undergoing HALDN.
Abstract Objective Children with Down syndrome have a higher incidence of upper airway obstruction and laryngomalacia. We sought to determine outcomes of supraglottoplasty in this patient population. ...Methods A retrospective chart review was performed from January 2000 through January 2014. Children (n=18) at our institution with the diagnosis of Down syndrome who underwent supraglottoplasty were included. We reviewed patient characteristics, preoperative findings, and surgical outcomes (stridor, feeding problems, respiratory distress, weight, sleep apnea, and tracheostomy or feeding tube dependence). Results The average age at surgery was 7.7 months. Operative indications included feeding difficulties (n=9), noisy breathing or respiratory distress (or both) (n=16), and sleep-related symptoms (n=7). Most patients (89%) were extubated successfully on postoperative day 1. There were 2 major complications (CPAP requirement and aspiration pneumonia) deaths. Fifty percent had improved weight (mean=18 percentile points). Feedback was available from 88% of parents with 100% reporting improvement in respiratory symptoms and 93% reporting improved feeding. Eight patients (44%) subsequently required either adenoidectomy or adenotonsillectomy. Two patients later underwent tracheostomy, 2 subsequently needed a gastrostomy tube and 2 required revision supraglottoplasty. Conclusions The majority of children with Down syndrome and laryngomalacia benefit from supraglottoplasty, with outcomes of improved breathing, feeding, and sleeping. However, approximately half may require additional airway procedures. This procedure is well tolerated and associated with a low risk of complications especially given their high rate of comorbidities.
The HACEK group of fastidious gram-negative organisms is a recognized but
unusual cause of infective endocarditis, responsible for approximately
3% of cases. We report our experience with 45 cases of ...endocarditis
caused by HACEK organisms. In Olmsted County, Minnesota, the incidence of HACEK
endocarditis was 0.14 per 100,000 person-years. In patients with native valves,
33 cases occurred, and in patients with prosthetic valves, 12 cases occurred.
The most common presenting symptoms were fever, splenomegaly, new or changing
murmur, and microvascular phenomena. Symptoms were present in the majority of
patients anywhere from two weeks to six months prior to diagnosis. Blood
cultures became positive in a mean of 3.375 days, and therapy with a
beta-lactam alone or as part of a combination was given for anywhere between
three and six weeks. Within the first month of diagnosis, surgery was performed
for 13 regurgitant valves in 11 patients (24%). Echocardiography was an
insensitive predictor of subsequent major arterial embolization (odds ratio,
1.33; 95% confidence interval, 0.31-5.67). The overall survival in
our cohort of patients was 87%. These results confirm previous reports
that HACEK endocarditis portends a favorable prognosis.
Salmonid alphavirus is the aetological agent of pancreas disease (PD) in marine Atlantic salmon, Salmo salar, and rainbow trout, Oncorhynchus mykiss, with most outbreaks in Norway caused by SAV ...subtype 3 (SAV3). This atypical alphavirus is transmitted horizontally causing a significant economic impact on the aquaculture industry. This histopathological and proteomic study, using an established cohabitational experimental model, investigated the correlation between tissue damage during PD and a number of serum proteins associated with these pathologies in Atlantic salmon. The proteins were identified by two-dimensional electrophoresis, trypsin digest and peptide MS/MS fingerprinting. A number of humoral components of immunity which may act as biomarkers of the disease were also identified. For example, creatine kinase, enolase and malate dehydrogenase serum concentrations were shown to correlate with pathology during PD. In contrast, hemopexin, transferrin, and apolipoprotein, amongst others, altered during later stages of the disease and did not correlate with tissue pathologies. This approach has given new insight into not only PD but also fish disease as a whole, by characterisation of the protein response to infection, through pathological processes to tissue recovery.
Salmonid alphavirus causes pancreas disease (PD) in Atlantic salmon, Salmo salar, and has a major economic impact on the aquaculture industry. A proteomic investigation of the change to the serum proteome during PD has been made with an established experimental model of the disease. Serum proteins were identified by two-dimensional electrophoresis, trypsin digest and peptide MS/MS fingerprinting with 72 protein spots being shown to alter significantly over the 12week period of the infection. The concentrations of certain proteins in serum such as creatine kinase, enolase and malate dehydrogenase were shown to correlate with tissue pathology while other proteins such as hemopexin, transferrin, and apolipoprotein, altered in concentration during later stages of the disease and did not correlate with tissue pathologies. The protein response to infection may be used to monitor disease progression and enhance understanding of the pathology of PD.
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•A virological, histological and proteomic study of salmon alpha virus infection•The serum proteome response to infection determined by two-dimensional electrophoresis•72 protein spots show significant change during infection.•Certain serum protein changes related to tissue pathology using a general linear model•Other serum protein change related to response to infection
The drive for sustainable energy production is leading to increased deployment of land based renewables. Although there is public support, in principle, for renewable energy at a national level, ...major resistance to renewable energy technologies often occurs at a local level. Within this context, it can be useful to consider the “energyscape” which we initially define as the complex spatial and temporal combination of the supply, demand and infrastructure for energy within a landscape. By starting with a consideration of the energyscape, we can then consider the positive and negative interactions with other ecosystem services within a particular landscape. This requires a multi-disciplinary systems-approach that uses existing knowledge of landscapes, energy options, and the different perspectives of stakeholders. The approach is examined in relation to pilot case-study comprising a 155 km2 catchment in Bedfordshire, England.
► Novel approach setting the whole energy system in a real landscape context. ► Describes a method for different groups to view biomass deployment. ► Uses stakeholder perspectives of energy system interactions with ecosystem services. ► Demonstrated for Marston Vale in eastern England. ► Applicable across spatial scales and geographic zones.
The response of the CMS barrel calorimeter (electromagnetic plus hadronic) to hadrons, electrons and muons over a wide momentum range from 2 to 350 GeV/
c
has been measured. To our knowledge, this is ...the widest range of momenta in which any calorimeter system has been studied. These tests, carried out at the H2 beam-line at CERN, provide a wealth of information, especially at low energies. The analysis of the differences in calorimeter response to charged pions, kaons, protons and antiprotons and a detailed discussion of the underlying phenomena are presented. We also show techniques that apply corrections to the signals from the considerably different electromagnetic (EB) and hadronic (HB) barrel calorimeters in reconstructing the energies of hadrons. Above 5 GeV/
c
, these corrections improve the energy resolution of the combined system where the stochastic term equals 84.7±1.6% and the constant term is 7.4±0.8%. The corrected mean response remains constant within 1.3%
rms
.
The measurement of scintillation light from the lead tungstate crystals of the Compact Muon Solenoid (CMS) electromagnetic calorimeter (ECAL) poses a substantial technical challenge, particularly in ...the endcap regions, where the radiation levels are highest. The photodetectors must be fast, sensitive, radiation-hard, and operate with significant internal gain in a magnetic field of 4 Tesla. The measured performance characteristics of the first batches of series production vacuum phototriodes (VPT), developed to satisfy the needs of CMS, will be described.
To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAP
) and non-donor kidneys (MAP
) with post-donation renal function.
Three hundred thirty-one patients ...undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAP
and MAP
were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively.
Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m
(range 17.1-39.6) and median age 45 years (range 19-78). MAP
score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAP
score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/1.73m
(range 48.8-138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAP
= 0, donors with a MAP
> 0, mean eGFR was - 2.33 ml/min/1.73m
lower at postoperative day 1 (95% CI - 4.24 to - 0.41, p = 0.018), - 3.02 ml/min/1.73m
lower at 1 month (95% CI - 5.11 to - 0.93, p = 0.005), and - 2.63 ml/min/1.73m
lower at 6 months postoperatively (95% CI - 5.01 to - 0.26, p = 0.030).
MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.
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