IntroductionAcute exacerbations of interstitial lung disease (AE-ILD) often lead to hospitalisation but have limited evidence-based treatment options. Patient-specific outcomes from AE-ILD are ...difficult to predict, making decisions regarding prioritisation for specialist palliative care input challenging. The PCR (PaO2/FiO2 ratio, C-reactive protein (CRP), and CT chest pattern) score has been shown to predict mortality risk in AE-idiopathic pulmonary fibrosis (AE-IPF),1 however this has not been assessed in AEs of non-IPF ILDs.AimsDescribe a real-world patient population with AE-ILD and establish the relationship between PCR score and mortality.MethodsClinical records of ILD patients admitted to six NHS trusts over one year were reviewed. Patients with a deterioration in respiratory symptoms not explained by heart failure or pulmonary embolism were included. Demographic, treatment, investigation, and mortality data were collected. Participating hospitals provided information on local services.The PCR score, where one point is gained for each of CRP >55 mg/l, PaO2/FiO2 ratio <250, and diffuse ground glass changes on CT chest, was calculated.Results443 patients with 602 admissions were included. IPF was the commonest ILD (29.8%), and other ILD diagnoses were represented (table 1). Antibiotics and steroids were prescribed in 82.9% and 66.9% of admissions, respectively. Just one participating hospital had a protocol for the management of AE-ILD, which was specific to AE-IPF.Mortality after AE-ILD was high, with 14% in-hospital, 21.7% 30-day, 39.8% 6-month, and 53.9% 12-month mortality. Higher PCR scores were associated with increased in-hospital (p=0.03), 30-day (p=0.01), and 6-month mortality (p=0.003), with a trend towards increased 12-month mortality (p=0.07) (88 index admissions, p for trend).No specialist palliative care input was recorded in 29.3% of admissions with in-hospital mortality, and 49.2% of admissions where death occurred within 30 days. This could be explained by hetereogeneity in specialist palliative care availability, particularly out-of-hours (table 1).Abstract S7 Table 1Patient and participating hospital characteristics Patient characteristics Total number 443 Number with repeated admissions during study period 98 (22.1%) Median age (years) (n, IQR) 77 (67–83) Male (n,%) 254 (57.3%) Ethnicity (n,%) White British 331 (74.7%) Indian or British Indian 35 (7.9%) Other 77 (17.4%) ILD diagnosis (n,%) Hypersensitivity pneumonitis 46 (10.4%) Connective tissue disease-related ILD (CTD-ILD) 27 (6.1%) Idiopathic pulmonary fibrosis (IPF) 132 (29.8%) Non-specific interstitial pneumonia (NSIP) 40 (9.0%) Progressive fibrotic ILD, unspecified 31 (7.0%) Rheumatoid arthritis-associated ILD (RA-ILD) 26 (5.9%) Not previously diagnosed, but evidence of established ILD 40 (9.0%) Sarcoidosis 17 (3.8%) Post-COVID ILD 13 (2.9%) Other 71 (16.0%) Treatment characteristics Total number of admissions 602 Admissions where antibiotics given 499 (82.9%) Admissions where steroids given 403 (66.9%) Admissions where diuretics given 227 (37.7%) Hospital characteristics Total number 6 Index admissions recorded (range) 10–149 Antifibrotic prescribing site (n,%) 2 (33.3%) Local guideline for management of AE-ILD 1 (specific to AE-IPF) (16.7%) Specialist palliative care service availability Usual office hours 6 (100%) Weekday evenings 1 (16.7%) Weekday nights 1 (16.7%) Weekend days 4 (66.7%) Weekend nights 1 (16.7%) ConclusionsAE-ILDs are associated with significant mortality, limited standardised treatment and heterogeneous palliative care provision. Higher PCR scores were associated with increased mortality in AE-ILD and may have utility when prioritising patients for palliative care input and advanced care planning.ReferenceSakamoto, et al. Scientific Reports 2022;12:1134
Constructed wetland treatment systems are used to remove selenium (Se) from flue-gas desulfurization (FGD) wastewater (WW). However, direct confirmation of the mechanism responsible for FGD WW Se ...retention in soil is lacking. A laboratory-based soil column study was performed to develop an evidence-based mechanism of Se retention and to study the behavior and the retention capacity of FGD WW constituents in water-saturated soil. A deoxygenated 1:1 mixture of FGD WW and raw water was delivered to the columns bottom-up at a flux of 1.68 cm d for 100 d. Some of the columns were flushed with the raw water at the same rate for an additional 100 d. Column effluent was analyzed for constituents of concern. Results showed a complete retention of FGD WW Se in the soil materials. Boron and fluorine were partially retained; however, sulfur, sodium, and chlorine retention was poor, agreeing with field observations. The FGD WW Se was retained in soil near the inlet end of the columns, indicating its limited mobility under reduced conditions. Sequential extraction procedure revealed that retained Se was mainly sequestered as stable/residual forms. Bulk- and micro-X-ray absorption near-edge structure spectroscopy confirmed that Se was mainly retained as reduced/stable species Se(IV), organic Se, and Se(0). This study provides direct evidence for FGD WW Se retention in water-saturated soil via the transformation of oxidized Se into reduced/stable forms.
To determine long-term outcomes for islet-alone and islet-after-kidney transplantation in adults with type 1 diabetes complicated by impaired awareness of hypoglycemia.
This was a prospective ...interventional and observational cohort study of islet-alone (n = 48) and islet-after-kidney (n = 24) transplant recipients followed for up to 8 years after intraportal infusion of one or more purified human pancreatic islet products under standardized immunosuppression. Outcomes included duration of islet graft survival (stimulated C-peptide ≥0.3 ng/mL), on-target glycemic control (HbA1c <7.0%), freedom from severe hypoglycemia, and insulin independence.
Of the 48 islet-alone and 24 islet-after-kidney transplantation recipients, 26 and 8 completed long-term follow-up with islet graft function, 15 and 7 withdrew from follow-up with islet graft function, and 7 and 9 experienced islet graft failure, respectively. Actuarial islet graft survival at median and final follow-up was 84% and 56% for islet-alone and 69% and 49% for islet-after-kidney (P = 0.007) with 77% and 49% of islet-alone and 57% and 35% of islet-after-kidney transplantation recipients maintaining posttransplant HbA1c <7.0% (P = 0.0017); freedom from severe hypoglycemia was maintained at >90% in both cohorts. Insulin independence was achieved by 74% of islet-alone and islet-after-kidney transplantation recipients, with more than one-half maintaining insulin independence during long-term follow-up. Kidney function remained stable during long-term follow-up in both cohorts, and rates of sensitization against HLA were low. Severe adverse events occurred at 0.31 per patient-year for islet-alone and 0.43 per patient-year for islet-after-kidney transplantation.
Islet transplantation results in durable islet graft survival permitting achievement of glycemic targets in the absence of severe hypoglycemia for most appropriately indicated recipients having impaired awareness of hypoglycemia, with acceptable safety of added immunosuppression for both islet-alone and islet-after-kidney transplantation.
A method is described for rearing two introduced parasitoids; Cotesia kazak (Telenga) (Hymenoptera: Braconidae) on Helicoverpa spp. (Lepidoptera: Noctuidae) and Hyposoter didymator Thunberg ...(Hymenoptera: Ichneumonidae) on cluster caterpillar, Spodoptera litura (F.) (Lepidoptera: Noctuidae). It facilitates the production of large numbers of parasitoids for field release.
Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, whilst deaths related to other non-liver disease areas are ...declining. Portal hypertension is the primary sequelae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hepatic encephalopathy and infection, collectively termed hepatic decompensation, which leads to hospitalisation and mortality. It remains uncertain whether administering a non-selective beta-blocker (NSBB), specifically carvedilol, at an earlier stage, i.e. when oesophageal varices are small, can prevent VH and reduce all-cause decompensation (ACD).
The BOPPP trial is a pragmatic, multicentre, placebo-controlled, triple-blinded, randomised controlled trial (RCT) in England, Scotland, Wales and Northern Ireland. Patients aged 18 years or older with cirrhosis and small oesophageal varices that have never bled will be recruited, subject to exclusion criteria. The trial aims to enrol 740 patients across 55 hospitals in the UK. Patients are allocated randomly on a 1:1 ratio to receive either carvedilol 6.25 mg (a NSBB) or a matched placebo, once or twice daily, for 36 months, to attain adequate power to determine the effectiveness of carvedilol in preventing or reducing ACD. The primary outcome is the time to first decompensating event. It is a composite primary outcome made up of variceal haemorrhage (VH, new or worsening ascites, new or worsening hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, an increase in Child-Pugh grade by 1 grade or MELD score by 5 points, and liver-related mortality. Secondary outcomes include progression to medium or large oesophageal varices, development of gastric, duodenal, or ectopic varices, participant quality of life, healthcare costs and transplant-free survival.
The BOPPP trial aims to investigate the clinical and cost-effectiveness of carvedilol in patients with cirrhosis and small oesophageal varices to determine whether this non-selective beta-blocker can prevent or reduce hepatic decompensation. There is clinical equipoise on whether intervening in cirrhosis, at an earlier stage of portal hypertension, with NSBB therapy is beneficial. Should the trial yield a positive result, we anticipate that the administration and use of carvedilol will become widespread with pathways developed to standardise the administration of the medication in primary care.
The trial has been approved by the National Health Service (NHS) Research Ethics Committee (REC) (reference number: 19/YH/0015). The results of the trial will be submitted for publication in a peer-reviewed scientific journal. Participants will be informed of the results via the BOPPP website ( www.boppp-trial.org ) and partners in the British Liver Trust (BLT) organisation.
EUDRACT reference number: 2018-002509-78. ISRCTN reference number: ISRCTN10324656. Registered on April 24 2019.
A physical map of the human genome McPherson, J D; Marra, M; Waterston, R H ...
Nature,
02/2001, Letnik:
409, Številka:
6822
Journal Article
Recenzirano
Odprti dostop
The human genome is by far the largest genome to be sequenced, and its size and complexity present many challenges for sequence assembly. The International Human Genome Sequencing Consortium ...constructed a map of the whole genome to enable the selection of clones for sequencing and for the accurate assembly of the genome sequence. Here we report the construction of the whole-genome bacterial artificial chromosome (BAC) map and its integration with previous landmark maps and information from mapping efforts focused on specific chromosomal regions. We also describe the integration of sequence data with the map.
Death or Damnation: Surrogacy and Religious Beliefs Baumrucker, Steven J.; Stolick, Matt; Hutchinson, Laura ...
American journal of hospice & palliative medicine,
08/2019, Letnik:
36, Številka:
8
Journal Article
Recenzirano
MC is a 42-year-old female who was in a motor vehicle accident and suffered multiple contusions as well as a fracture of the left femur, pelvic ramus, and left orbit. Due to contusion of the brain, ...MC has been comatose for over a week and is on mechanical ventilation to protect her airway. There is no written declaration of surrogacy. During the admission, surgery to repair the left femoral fracture was performed and was complicated by severe blood loss. Currently, MC’s hematocrit is 24% with a hemoglobin of 7.4. The trauma team asserts that a blood transfusion would be in MC’s best interests. Since MC lacks capacity for decision making, she cannot consent to blood transfusion. Her parents are Jehovah’s Witnesses and refuse to approve blood transfusion, stating that it is against their faith. MC’s brother, however, states that MC is not a practicing Jehovah’s Witness and wants the medical team to provide the blood transfusion. The parents insist that decision making is their right; MC’s brother feels he should be making decisions. The trauma teams calls for an emergency consultation with the hospital ethics committee.
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