To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center.
Using the International Classification of Diseases, Ninth Revision ...diagnosis code of 275.49 and the keyword "calciphylaxis" in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme.
The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio HR=1.99; 95% CI, 0.96-4.15; P=.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P=.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P=.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P=.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P=.02).
Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.
Summary Background Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and ...CHALICE) in a large sample of children. Methods In this prospective observational study, we included children and adolescents (aged <18 years) with head injuries of any severity who presented to the emergency departments of ten Australian and New Zealand hospitals. We assessed the diagnostic accuracy of PECARN (stratified into children aged <2 years and ≥2 years), CATCH, and CHALICE in predicting each rule-specific outcome measure (clinically important traumatic brain injury TBI, need for neurological intervention, and clinically significant intracranial injury, respectively). For each calculation we used rule-specific predictor variables in populations that satisfied inclusion and exclusion criteria for each rule (validation cohort). In a secondary analysis, we compiled a comparison cohort of patients with mild head injuries (Glasgow Coma Scale score 13–15) and calculated accuracy using rule-specific predictor variables for the standardised outcome of clinically important TBI. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000463673. Findings Between April 11, 2011, and Nov 30, 2014, we analysed 20 137 children and adolescents attending with head injuries. CTs were obtained for 2106 (10%) patients, 4544 (23%) were admitted, 83 (<1%) underwent neurosurgery, and 15 (<1%) died. PECARN was applicable for 4011 (75%) of 5374 patients younger than 2 years and 11 152 (76%) of 14 763 patients aged 2 years and older. CATCH was applicable for 4957 (25%) patients and CHALICE for 20 029 (99%). The highest point validation sensitivities were shown for PECARN in children younger than 2 years (100·0%, 95% CI 90·7–100·0; 38 patients identified of 38 with outcome 38/38) and PECARN in children 2 years and older (99·0%, 94·4–100·0; 97/98), followed by CATCH (high-risk predictors only; 95·2%; 76·2–99·9; 20/21; medium-risk and high-risk predictors 88·7%; 82·2–93·4; 125/141) and CHALICE (92·3%, 89·2–94·7; 370/401). In the comparison cohort of 18 913 patients with mild injuries, sensitivities for clinically important TBI were similar. Negative predictive values in both analyses were higher than 99% for all rules. Interpretation The sensitivities of three clinical decision rules for head injuries in children were high when used as designed. The findings are an important starting point for clinicians considering the introduction of one of the rules. Funding National Health and Medical Research Council, Emergency Medicine Foundation, Perpetual Philanthropic Services, WA Health Targeted Research Funds, Townsville Hospital Private Practice Fund, Auckland Medical Research Foundation, A + Trust.
Inflammatory bowel disease (IBD) is associated with anaemia and oral iron replacement to correct this can be problematic, intensifying inflammation and tissue damage. The intestinal microbiota also ...plays a key role in the pathogenesis of IBD, and iron supplementation likely influences gut bacterial diversity in patients with IBD. Here, we assessed the impact of dietary iron, using chow diets containing either 100, 200 or 400 ppm, fed ad libitum to adult female C57BL/6 mice in the presence or absence of colitis induced using dextran sulfate sodium (DSS), on (i) clinical and histological severity of acute DSS-induced colitis, and (ii) faecal microbial diversity, as assessed by sequencing the V4 region of 16S rRNA. Increasing or decreasing dietary iron concentration from the standard 200 ppm exacerbated both clinical and histological severity of DSS-induced colitis. DSS-treated mice provided only half the standard levels of iron ad libitum (i.e. chow containing 100 ppm iron) lost more body weight than those receiving double the amount of standard iron (i.e. 400 ppm); p<0.01. Faecal calprotectin levels were significantly increased in the presence of colitis in those consuming 100 ppm iron at day 8 (5.94-fold) versus day-10 group (4.14-fold) (p<0.05), and for the 400 ppm day-8 group (8.17-fold) versus day-10 group (4.44-fold) (p<0.001). In the presence of colitis, dietary iron at 400 ppm resulted in a significant reduction in faecal abundance of Firmicutes and Bacteroidetes, and increase of Proteobacteria, changes which were not observed with lower dietary intake of iron at 100 ppm. Overall, altering dietary iron intake exacerbated DSS-induced colitis; increasing the iron content of the diet also led to changes in intestinal bacteria diversity and composition after colitis was induced with DSS.
Marine plastic is a major worldwide challenge, for which many solutions are being proposed. However, most of the solutions focus on the prevention and collection of the plastic, with little emphasis ...on the development of waste treatment options.
This review seeks to propose areas where further studies could assist to close gaps in knowledge. Some identified gaps include a poor understanding of the quantities and composition of marine plastics, a lack of information about existing marine plastic treatment technologies, and the environmental impact of the available options. To better understand the capabilities of the current South African plastics recycling industry, data from the South African Waste Information Centre (SAWIC) are reported and discussed.
While there is a lack of technology development for the treatment of marine plastic globally, the intention of this review is to drive research in this area by creating awareness and encouraging implementation of possible treatment technologies.
•A review of the waste management hierarchy for marine plastics•Marine plastic treatment options in South Africa•Knowledge gaps in marine plastic treatment options•Means by which knowledge gaps in marine plastic treatment can be filled
It is fundamentally important for many animal ecologists to quantify the costs of animal activities, although it is not straightforward to do so. The recording of triaxial acceleration by ...animal‐attached devices has been proposed as a way forward for this, with the specific suggestion that dynamic body acceleration (DBA) be used as a proxy for movement‐based power.
Dynamic body acceleration has now been validated frequently, both in the laboratory and in the field, although the literature still shows that some aspects of DBA theory and practice are misunderstood. Here, we examine the theory behind DBA and employ modelling approaches to assess factors that affect the link between DBA and energy expenditure, from the deployment of the tag, through to the calibration of DBA with energy use in laboratory and field settings.
Using data from a range of species and movement modes, we illustrate that vectorial and additive DBA metrics are proportional to each other. Either can be used as a proxy for energy and summed to estimate total energy expended over a given period, or divided by time to give a proxy for movement‐related metabolic power. Nonetheless, we highlight how the ability of DBA to predict metabolic rate declines as the contribution of non‐movement‐related factors, such as heat production, increases.
Overall, DBA seems to be a substantive proxy for movement‐based power but consideration of other movement‐related metrics, such as the static body acceleration and the rate of change of body pitch and roll, may enable researchers to refine movement‐based metabolic costs, particularly in animals where movement is not characterized by marked changes in body acceleration.
Quantifying the costs of animal activities is important yet difficult to achieve. Dynamic body acceleration, derived from triaxial acceleration sensors, is a powerful method with which to examine the energetic implications of animal decision‐making in a wide range of systems, including with respect to the effects of individual experience, state and the abiotic/ biotic environment.
Research investigating female gaming has begun to emerge despite gaming being traditionally more popular with males. Research in the 21st century has drawn attention to the role of women in culture, ...society, and technology, and female gaming is one of the growing phenomena not to have been researched in depth. The aim of the present paper was to review female gaming (i.e., the role of females within video game culture) and identify any associated psychopathological symptomatology. The review adapted the Sample, Phenomenon of Interest, Design, Evaluation, Research (SPIDER) model in conducting a narrative literature review. A search of three scientific electronic databases yielded 49 papers for further evaluation. From a methodological perspective, studies had to fulfill the following criteria to be included: i) published between the years 2000 and 2018; ii) assessed female gaming or the female position within gaming culture, iii) contained quantitative, qualitative, or mixed methods approaches to produce empirical data or discuss theoretical implications through reviews, iv) be retrievable as a full-text peer-reviewed journal paper, and v) published in English, German, Polish, Spanish, Italian, Portuguese, or French. Four categories emerged from the papers: i) the benefits of female gaming, ii) why women might play video games less than men, iii) perceptions and realities of female characters within video games, and iv) women's position in gaming culture. The main findings showed playing video games has benefits for women in terms of enhancing cognitive, social, and physical abilities. However, they are less encouraged to play video games due to negative expectations based on gender and/or experiences during game play. Video games are associated with stereotypical male characteristics, such as being overly aggressive, and frequently contain sexualized content. Female gamers appear to require coping strategies to handle online harassment. Females look for different things in video games, which are not often included in game designs thereby limiting their abilities. For instance, female avatar representation-which is exaggerated and hypersexualized-can prompt social comparisons and lead to feelings of decreased self-esteem, depression, and other impacts on well-being. Overall, there are still obstacles for women playing video games even though they comprise half of the gaming population.
Stimuli-responsive materials are vital for addressing emerging demands in the advanced technology sector as well as current industrial challenges. Here, we report for the first time that coordinative ...integration of photoresponsive building blocks possessing photochromic spiropyran and diarylethene moieties within a rigid scaffold of metal–organic frameworks (MOFs) could control photophysics, in particular, cycloreversion kinetics, with a level of control that is not accessible in the solid state or solution. On the series of photoactive materials, we demonstrated for the first time that photoisomerization rates of photochromic compounds could be tuned within almost 2 orders of magnitude. Moreover, cycloreversion rates of photoresponsive derivatives could be modulated as a function of the framework structure. Furthermore, through MOF engineering we were able to achieve complete isomerization for coordinatively immobilized spiropyran derivatives, typically exhibiting limited photoswitching behavior in the solid state. For instance, spectroscopic analysis revealed that the novel monosubstituted spiropyran derivative grafted to the backbone of the MOF pillar exhibits a remarkable photoisomerization rate of 0.16 s–1, typical for cycloreversion in solution. We also applied the acquired fundamental principles toward mapping of changes in material properties, which could provide a pathway for monitoring material aging or structural deterioration.
The sweet potato is one of the world’s most widely consumed crops, yet its evolutionary history is poorly understood. In this paper, we present a comprehensive phylogenetic study of all species ...closely related to the sweet potato and address several questions pertaining to the sweet potato that remained unanswered. Our research combined genome skimming and target DNA capture to sequence whole chloroplasts and 605 single-copy nuclear regions from 199 specimens representing the sweet potato and all of its crop wild relatives (CWRs). We present strongly supported nuclear and chloroplast phylogenies demonstrating that the sweet potato had an autopolyploid origin and that Ipomoea trifida is its closest relative, confirming that no other extant species were involved in its origin. Phylogenetic analysis of nuclear and chloroplast genomes shows conflicting topologies regarding the monophyly of the sweet potato. The process of chloroplast capture explains these conflicting patterns, showing that I. trifida had a dual role in the origin of the sweet potato, first as its progenitor and second as the species with which the sweet potato introgressed so one of its lineages could capture an I. trifida chloroplast. In addition, we provide evidence that the sweet potato was present in Polynesia in pre-human times. This, together with several other examples of long-distance dispersal in Ipomoea, negates the need to invoke ancient human-mediated transport as an explanation for its presence in Polynesia. These results have important implications for understanding the origin and evolution of a major global food crop and question the existence of pre-Columbian contacts between Polynesia and the American continent.
•The sweet potato had a single origin (monophyletic) by autopolyploidy•Ipomoea trifida is most probably the progenitor of the sweet potato•Ipomoea trifida had a dual role in the origin of the sweet potato•The sweet potato arrived in Polynesia by long-distance dispersal in pre-human times
Muñoz-Rodríguez et al. clarify several questions on the origin and evolution of the sweet potato that remained unanswered. They demonstrate that the sweet potato had a single origin by autopolyploidy and reveal a dual role of its progenitor. They also show that the sweet potato most likely arrived in Polynesia by long-distance dispersal in pre-human times.
In this paper, a photochromic diarylethene-based derivative that is coordinatively immobilized within an extended porphyrin framework is shown to maintain its photoswitchable behavior and to direct ...the photophysical properties of the host. In particular, emission of a framework composed of bis(5-pyridyl-2-methyl-3-thienyl)cyclopentene (BPMTC) and tetrakis(4-carboxyphenyl)porphyrin (H4TCPP) ligands anchored by Zn2+ ions can be altered as a function of incident light. We attribute the observed cyclic fluorescence behavior of the synthesized porphyrin–BPMTC array to activation of energy transfer (ET) pathways through BPMTC photoisomerization. Time-resolved photoluminescence measurements show a decrease in average porphyrin emission lifetime upon BPMTC insertion, consistent with an ET-based mechanism. These studies portend the possible utilization of photochromic ligands to direct chromophore behavior in large light-harvesting ensembles.
Background
The outcomes of shoulder arthroplasties in younger patients (55 years or younger) are not as reliable compared with those of the general population. Greater risk of revision and higher ...complication rates in younger patients present direct costs to the healthcare system and indirect costs to the patient in terms of quality of life. Previous studies have suggested an increased demand for shoulder arthroplasties overall, but to our knowledge, the demand in younger patients has not been explored.
Questions/purposes
We asked: (1) What was the demand for shoulder arthroplasties between 2002 and 2011 in the United States for all patients and a specific subpopulation of patients who were 55 years old or younger? (2) How is the demand for shoulder arthroplasties in younger patients projected to change through 2030? (3) How is procedural demand projected to change in younger patients through 2030, and specifically, what can we anticipate in terms of hemiarthroplasty volume compared with that of total shoulder arthroplasty?
Methods
We used the National Inpatient Sample database to identify primary shoulder arthroplasties performed between 2002 and 2011. A Poisson regression model was developed using the National Inpatient Sample data and United States Census Bureau projections on future population changes to predict estimated national demand for total shoulder arthroplasties and hemiarthroplasties in all patients and in the subpopulation 55 years old or younger. This model was projected until 2030, with associated 95% CIs. We then specifically analyzed the projected demand of hemiarthroplasties and compared this with demand for all arthroplasty procedures in the younger patient population.
Results
Demand for shoulder arthroplasties in patients 55 years or younger is increasing at a rate of 8.2% per year (95% CI, 7.06%–9.35%), compared with a growth rate of 12.1% (95% CI, 8.35%–16.02%) per year for patients older than 55 years. In 2002, 15.9% (3587 of 22,617 captured in the National Inpatient Sample) of primary shoulder arthroplasties were performed in patients 55 years old or younger. In 2011, the relative size of the younger patient population had decreased to 11.0% (7001 of 63,784) of all recipients of shoulder arthroplasties. The demand for primary shoulder arthroplasties among younger patients is projected to increase by 333.3% (95% CI, 257.0%–432.5%) from 2011 to 2030. However, in patients older than 55 years demand is projected to increase by 755.4% (95% CI, 380.7%–1511.1%). Therefore, despite the increased predicted demand for shoulder arthroplasties in younger patients, they are predicted to account for only 4% of all recipients by 2030. The rate of hemiarthroplasties in patients 55 years or younger showed a 16.5% decline per year (95% CI, 16.1%–17.1%) from 2002 (53.6% of all arthroplasties) to 2011 (34.2% of all arthroplasties). By 2030, hemiarthroplasties are projected to account for only 23.5% of all shoulder arthroplasties in patients 55 years or younger.
Conclusions
The demand for shoulder arthroplasties in younger patients continues to increase in the United States; however, rates of hemiarthroplasties are declining. The demand has substantial implications for future revision arthroplasties, which include the direct healthcare costs of revision arthroplasty, the indirect societal burden of missed productivity owing to time away from work, and the increased burden of the need for qualified surgeons to meet the demand. Despite the increasing rate of arthroplasties performed in younger patients, current and projected demands remain greater for older patients, indicating a disproportionately greater need for shoulder arthroplasties in older patients. This is in contrast to the trends observed in the literature regarding hip and knee arthroplasties that show projected demands to be greater in younger patients. Factors responsible for the difference in demand require further investigation but may be related to changing indications, reported poorer outcomes in younger patients, the increased popularity of reverse shoulder arthroplasties in the elderly, or the evolution of nonarthroplasty options.
Level of Evidence
Level III, prognostic study.
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