Pig-to-human xenotransplantation is rapidly approaching the clinical arena; however, it is unclear which immunomodulatory regimens will effectively control human immune responses to pig xenografts. ...Here, we transplant a gene-edited pig kidney into a brain-dead human recipient on pharmacologic immunosuppression and study the human immune response to the xenograft using spatial transcriptomics and single-cell RNA sequencing. Human immune cells are uncommon in the porcine kidney cortex early after xenotransplantation and consist of primarily myeloid cells. Both the porcine resident macrophages and human infiltrating macrophages express genes consistent with an alternatively activated, anti-inflammatory phenotype. No significant infiltration of human B or T cells into the porcine kidney xenograft is detectable. Altogether, these findings provide proof of concept that conventional pharmacologic immunosuppression may be able to restrict infiltration of human immune cells into the xenograft early after compatible pig-to-human kidney xenotransplantation.
Infection is a known complication of the placement of cardiac implantable electronic devices. In this randomized, controlled trial involving 6983 patients undergoing cardiac-device placement, an ...antibacterial envelope was studied to determine infection prevention. The envelope reduced infection by 40%.
High thermal conductivity materials show promise for thermal mitigation and heat removal in devices. However, shrinking the length scales of these materials often leads to significant reductions in ...thermal conductivities, thus invalidating their applicability to functional devices. In this work, we report on high in-plane thermal conductivities of 3.05, 3.75, and 6 μm thick aluminum nitride (AlN) films measured via steady-state thermoreflectance. At room temperature, the AlN films possess an in-plane thermal conductivity of ∼260 ± 40 W m–1 K–1, one of the highest reported to date for any thin film material of equivalent thickness. At low temperatures, the in-plane thermal conductivities of the AlN films surpass even those of diamond thin films. Phonon–phonon scattering drives the in-plane thermal transport of these AlN thin films, leading to an increase in thermal conductivity as temperature decreases. This is opposite of what is observed in traditional high thermal conductivity thin films, where boundaries and defects that arise from film growth cause a thermal conductivity reduction with decreasing temperature. This study provides insight into the interplay among boundary, defect, and phonon–phonon scattering that drives the high in-plane thermal conductivity of the AlN thin films and demonstrates that these AlN films are promising materials for heat spreaders in electronic devices.
Continuous urban developments have resulted in increased demand for street furniture, one of which is street light columns. Artificial light at night (ALAN) pose significant impacts on insect ...diversity in urban and rural areas. The ALAN is a significant driver of decline in insect diversity. This study evaluated the impact of light intensity and sky quality at night on insect diversity in rural and urban areas of the Asir province, Saudi Arabia. Insect traps were installed in both areas during night. Light intensity of nearby road lamps was measured using light meter, while sky quality was measured using sky quality meter. Rural areas exhibited low light intensity (10.33 flux/f.candle) and good sky quality (18.80 magnitude/arcsec2). Urban areas exhibited intense light (89.33 flux/f.candle) and poor sky quality (15.49 magnitude/arcsec2). Higher insect diversity was recorded for rural areas where insects belonging to seven orders (i.e., Diptera, Lepidoptera, Hemiptera, Hymenoptera, Coleoptera, Neuroptera, and Dermaptera) were collected. However, insects of four orders (i.e., Diptera, Lepidoptera, Hemiptera, and Neuroptera) were found in urban areas indicating low diversity. Lepidopteran insects were frequently recorded from rural areas indicating they are attracted to artificial light. It is concluded that excessive ALAN and poor sky quality at night disrupt insect biodiversity. Therefore, ALAN and sky quality must be considered responsible for decline in insect biodiversity along with other known factors.
In the WRAP-IT trial (Worldwide Randomized Antibiotic Envelope Infection Prevention), adjunctive use of an absorbable antibacterial envelope resulted in a 40% reduction of major cardiac implantable ...electronic device infection without increased risk of complication in 6983 patients undergoing cardiac implantable electronic device revision, replacement, upgrade, or initial cardiac resynchronization therapy defibrillator implant. There is limited information on the cost-effectiveness of this strategy. As a prespecified objective, we evaluated antibacterial envelope cost-effectiveness compared with standard-of-care infection prevention strategies in the US healthcare system.
A decision tree model was used to compare costs and outcomes of antibacterial envelope (TYRX) use adjunctive to standard-of-care infection prevention versus standard-of-care alone over a lifelong time horizon. The analysis was performed from an integrated payer-provider network perspective. Infection rates, antibacterial envelope effectiveness, infection treatment costs and patterns, infection-related mortality, and utility estimates were obtained from the WRAP-IT trial. Life expectancy and long-term costs associated with device replacement, follow-up, and healthcare utilization were sourced from the literature. Costs and quality-adjusted life years were discounted at 3%. An upper willingness-to-pay threshold of $150 000 per quality-adjusted life year was used to determine cost-effectiveness, in alignment with the American College of Cardiology/American Heart Association practice guidelines and as supported by the World Health Organization and contemporary literature.
The base case incremental cost-effectiveness ratio of the antibacterial envelope compared with standard-of-care was $112 603/quality-adjusted life year. The incremental cost-effectiveness ratio remained lower than the willingness-to-pay threshold in 74% of iterations in the probabilistic sensitivity analysis and was most sensitive to the following model inputs: infection-related mortality, life expectancy, and infection cost.
The absorbable antibacterial envelope was associated with a cost-effectiveness ratio below contemporary benchmarks in the WRAP-IT patient population, suggesting that the envelope provides value for the US healthcare system by reducing the incidence of cardiac implantable electronic device infection. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02277990.
Study Design:
Retrospective cohort.
Objectives:
To determine how the number of fused intervertebral levels affects radiographic parameters and clinical outcomes in patients undergoing open ...posterolateral lumbar fusion (PLF) for low-grade degenerative spondylolisthesis.
Methods:
This was a retrospective cohort study on patients who underwent open PLF for low-grade spondylolisthesis at a single institution from 2011 to 2018. Patients were divided into groups based on number of levels fused during their procedure (1, 2, or 3 or more). Preoperative and postoperative spinopelvic radiographic parameters, patient-reported outcomes (Visual Analog Scale VAS-back, VAS-leg, Oswestry Disability Index ODI), and postoperative complications were compared.
Results:
Of the 316 patients eligible (203 one-level, 95 two-level, 18 three or more levels), change in initial postoperative to final pelvic incidence-lumbar lordosis was greatest in 2-level fusions (P = .039), while 3 or more level fusions had worse final pelvic tilt measures (P = .021). In addition, multilevel fusions had worse final VAS-back scores (2-level: P = .015; 3 or more levels: P = .011), higher rates of dural tears (2-level: P = .001), reoperation (2-level: P = .039), and discharge to facility (3 or more levels: P = .047) when compared with 1-level fusions.
Conclusions:
Patients in multilevel fusions experienced less improvement in back pain, had more complications, and were more commonly discharged to a facility compared with single-level PLF patients. These findings are important for operative planning, for setting appropriate preoperative expectations, and for risk stratification in patients undergoing posterior lumbar fusion for low-grade spondylolisthesis.
Study Design:
Retrospective cohort study.
Objective:
To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing ...posterior lumbar spinal fusion.
Methods:
Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected.
Results:
A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger (P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery (P = .018). No differences were observed in reoperation or postoperative complication.
Conclusions:
While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.
A gap in the literature exists regarding the association of clinical and radiographic outcomes with specific number of allergies for patients undergoing lumbar spinal fusions; which is necessary to ...close in order to better understand the prognostic value of patient-reported allergies.
The purpose of this present study was therefore to determine the impact of specific number of allergies with clinic and radiographic outcomes following lumbar spinal fusion.
Retrospective cohort analysis.
Analysis of patients who underwent an open posterior lumbar fusion from 2011 to 2017 was conducted. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, presented with a lumbar vertebral body fracture, tumor, or infection, or underwent a fusion surgery that extended to the thoracic spine, high-grade spondylolisthesis, or concomitant deformity.
Patient-reported outcomes were recorded at preoperative and final clinic visits that included: Visual Analog Scale (VAS) Back/Leg pain, and Oswestry Disability Index (ODI). Achievement of minimal clinically important difference (MCID) was analyzed, along with rates of postoperative complication and reoperation.
Preoperative and final patient-reported outcomes were obtained. Achievement of MCID was evaluated using following thresholds: ODI 14.9, VAS-back pain 2.1, VAS-leg pain 2.8. For analysis, patients were divided into two groups based on number of allergies: less than three allergies and greater than or equal to three allergies.
A total of 504 patients met inclusion criteria. There were 472 (93.65%) patients who reported fewer than three allergies, while 32 (6.35%) patients presented with three or more allergies. Patients with three or more reported allergies were more often older (p=0.026), female (p<0.001), and had American Society of Anesthesiologists Physical Status Score (ASA) equal to or greater than three (p=0.038). Otherwise, there were no significant differences in baseline demographic between the two groups. There was no significant difference between other values for radiographic measurements or postoperative length of stay. Patients with more allergies had significantly higher VAS leg scores preoperatively and lower improvement in ODI scores from preoperative to final visit (p=0.001). Postoperatively, patients with three or more allergies presented significantly more often with high ODI MCID scores (p=0.008).
Patients with more than three reported allergies have significantly less improvement of ODI scores from preoperative to final assessment and have significantly high ODI MCID scores postoperatively despite no significant difference in psychiatric condition or radiographic measurements between the two groups. These results suggest a lower perceived improvement of disability in patients with more than three reported allergies when compared with patients with a lower number of allergies. This study underscores the importance of considering the number of allergies as a prognostic factor, similar to psychiatric disorders. Furthermore, these findings can be used in discussion with patients regarding expectations of disability improvement prior to surgery.
This abstract does not discuss or include any applicable devices or drugs.
Primary biliary cirrhosis (PBC) is an autoimmune cholestatic disorder of the liver. A diagnostic serum marker for PBC is an anti-mitochondrial antibody. Most prominent histologic findings of PBC are ...portal inflammation and destruction of interlobular bile ducts. The PBC occurs only in 40 to 400 individuals per million in the general population. About 1.8 - 5.6% of individuals with this rare disorder have rheumatoid arthritis (RA). This case report describes a 56-year-old female with concurrent rheumatoid arthritis and primary biliary cirrhosis. The patients with RA are at higher risk of developing PBC compared to the general population. Thus, abnormal liver function test in the patients with RA, especially in the absence of alternative cause, warrants thorough investigation for PBC. Early diagnosis and treatment will improve the outcome of patients who develop PBC.
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