Sirolimus is an effective therapy for children with kaposiform hemangioendothelioma with or without the Kasabach-Merritt phenomenon. We report the case of a child with kaposiform hemangioendothelioma ...and the Kasabach-Merritt phenomenon who developed
pneumonia (PCP) while on sirolimus and a prednisolone taper, after lack of adequate response to prednisolone, propranolol, and vincristine. He had a prompt positive clinical and laboratory response to sirolimus, but 4 weeks after starting it, at the age of 4 months, he developed PCP. This led to respiratory failure, which required extracorporeal membrane oxygenation. Sirolimus was temporarily discontinued, and he was successfully treated for PCP with sulfamethoxazole-trimethoprim and methylprednisolone. He was restarted on sirolimus 3 weeks after discharge and given sulfamethoxazole-trimethoprim prophylaxis. At the age of 22 months, while still on sirolimus, the lesion continued to improve with test results revealing stable hemoglobin and platelet counts. PCP is a rare but life-threatening side effect of sirolimus therapy, especially in the setting of concurrent steroid treatment.
prophylaxis should be considered for patients receiving sirolimus.
In experiments performed with the OMEGA EP laser system, magnetic field generation in double ablation fronts was observed. Proton radiography measured the strength, spatial profile, and temporal ...dynamics of self-generated magnetic fields as the target material was varied between plastic, aluminum, copper, and gold. Two distinct regions of magnetic field are generated in midZ targets-one produced by gradients from electron thermal transport and the second from radiation-driven gradients. Extended magnetohydrodynamic simulations including radiation transport reproduced key aspects of the experiment, including field generation and double ablation front formation.
Amyotrophic lateral sclerosis, or motor neuron disease, is an uncommon progressive neurological disorder. Professionals working in the perioperative field may encounter patients with amyotrophic ...lateral sclerosis only rarely. The relevant published literature on amyotrophic lateral sclerosis is broad in scope, but a contemporary review focused on the perioperative period is absent. This structured narrative review seeks to provide a summary of the contemporary management of patients and then focuses on eliciting if there are perioperative management considerations specific to amyotrophic lateral sclerosis that can be optimised. A comprehensive structured narrative literature review, including grey literature searching, indicated worsening ventilatory failure is of prime concern but that patients may present with a broad range of neurological symptoms, and that cardiovascular and cognitive dysfunction specific to amyotrophic lateral sclerosis may exist and be occult. Exacerbation of neuromuscular weakness during the perioperative period is multifaceted and requires the application of a high standard of the core principles of surgical and anaesthetic management of neuromuscular disease. Standard perioperative approaches require rigorous attention and potential exists for significant alteration. There is a potential high risk of postoperative increased morbidity from neurological decline and mortality from pulmonary complications. A meticulous approach to planning preoperative assessment, shared decision-making, intraoperative and postoperative care is required.
Older adults have worse outcomes after sepsis than young adults. Additionally, alterations of the gut microbiota have been demonstrated to contribute to sepsis-related mortality. We sought to ...determine if there were alterations in the gut microbiota with a novel sepsis model in old adult mice, which enter a state of persistent inflammation, immunosuppression, and catabolism (PICS), as compared with young adult mice, which recover with the sepsis model.
Mixed sex old (∼20 mo) and young (∼4 mo) C57Bl/6J mice underwent cecal ligation and puncture with daily chronic stress (CLP+DCS) and were compared with naive age-matched controls. Mice were sacrificed at CLP+DCS day 7 and feces collected for bacterial DNA isolation. The V3-V4 hypervariable region was amplified, 16S rRNA gene sequencing performed, and cohorts compared. α-Diversity was assessed using Chao1 and Shannon indices using rarefied counts, and β-diversity was assessed using Bray-Curtis dissimilarity.
Naive old adult mice had significantly different α and β-diversity compared with naive adult young adult mice. After CLP+DCS, there was a significant shift in the α and β-diversity (FDR = 0.03 for both) of old adult mice (naive vs. CLP+DCS). However, no significant shift was displayed in the microbiota of young mice that underwent CLP+DCS in regards to α-diversity (FDR = 0.052) and β-diversity (FDR = 0.12), demonstrating a greater overall stability of their microbiota at 7 days despite the septic insult. The taxonomic changes in old mice undergoing CLP+DCS were dominated by decreased abundance of the order Clostridiales and genera Oscillospira.
Young adult mice maintain an overall microbiome stability 7 days after CLP+DCS after compared with old adult mice. The lack of microbiome stability could contribute to PICS and worse long-term outcomes in older adult sepsis survivors. Further studies are warranted to elucidate mechanistic pathways and potential therapeutics.
The extinct passenger pigeon was once the most abundant bird in North America, and possibly the world. Although theory predicts that large populations will be more genetically diverse, passenger ...pigeon genetic diversity was surprisingly low. To investigate this disconnect, we analyzed 41 mitochondrial and 4 nuclear genomes from passenger pigeons and 2 genomes from band-tailed pigeons, which are passenger pigeons’ closest living relatives. Passenger pigeons’ large population size appears to have allowed for faster adaptive evolution and removal of harmful mutations, driving a huge loss in their neutral genetic diversity. These results demonstrate the effect that selection can have on a vertebrate genome and contradict results that suggested that population instability contributed to this species’s surprisingly rapid extinction.
Abstract Direct laser acceleration of electrons during a high-energy, picosecond laser interaction with an underdense plasma has been demonstrated to be substantially enhanced by controlling the ...laser focusing geometry. Experiments using the OMEGA EP facility measured electrons accelerated to maximum energies exceeding 120 times the ponderomotive energy under certain laser focusing, pulse energy, and plasma density conditions. Two-dimensional particle-in-cell simulations show that the laser focusing conditions alter the laser field evolution, channel fields generation, and electron oscillation, all of which contribute to the final electron energies. The optimal laser focusing condition occurs when the transverse oscillation amplitude of the accelerated electron in the channel fields matches the laser beam width, resulting in efficient energy gain. Through this observation, a simple model was developed to calculate the optimal laser focal spot size in more general conditions and is validated by experimental data.
The prevalence of hepatitis C virus (HCV) in correctional facilities in Australia among people who inject drugs is 60%, with disproportionate effects observed in Aboriginal and Torres Strait Islander ...people. Following the micro‐elimination of HCV in a Queensland correctional facility (QCF), newly acquired cases began to increase in mid‐2019. Here we discuss the public health response to increasing HCV in a QCF.
Enhanced surveillance was performed to obtain contextual outbreak data on risk factors including injecting drug use, sharing of personal hygiene equipment and do‐it‐yourself‐tattooing.
In the sixteen months, there were 250 notifications of new and re‐infected HCV infections in prisoners in the QCF. Qualitative data revealed the leading factor in transmission to be injecting drug use.
Drivers for increased HCV transmission in correctional facilities include boredom, waiting lists for opioid substitution programs, changes in injecting behaviours and sharing of injecting paraphernalia. Point‐of‐care testing combined with education and the development of a needle and syringe program may be promising ways forward for managing HCV in correctional facilities.
Correctional facilities are key locations to target sexually transmitted infection (STI) and blood‐borne virus (BBV) testing and treatment as well as health promotion to improve the health of inmates and the communities they return to.
Clinical trials during public health emergencies of novel medical products such as therapeutics and vaccines in resource-limited settings are daunting due to the limited capacity for regulatory ...assessment. Regulating clinical trials during the Ebola outbreak in Sierra Leone required expedited evaluation to identify medical products that could be promptly introduced to combat the epidemic in the absence of approved treatment or prevention. This article explored the decisions taken by the Pharmacy Board of Sierra Leone through its Expert Committee on Medicine Safety and Clinical Trials regarding clinical trials oversight during the Ebola epidemic and the lessons learned. This independent expert committee assessed and provided scientific opinions to the Pharmacy Board of Sierra Leone to inform approval of all clinical trials within 10-15 working days. We also requested for assisted review from the African Vaccine Regulatory Forum and support from the US Food and Drug Administration through a unilateral recognition and reliance memorandum of understanding. In addition, the Agency-ensured structures and systems were in place for reporting and reviewing adverse events and serious adverse events, management of biological samples, submission and review of progress reports, and good clinical practice inspections. Unfortunately, the Ebola epidemic revealed many weaknesses in the country's clinical trials regulatory structure and processes. Government and partners should further offer more resources to build the clinical trial structures and systems so that the Agency will be better poised to handle future public health emergencies.
Rainwater harvesting (RWH) systems in the United States vary in terms of design and operation. To better understand common practices in the RWH community and motivation for collecting harvested ...rainwater, an electronic survey was used to poll members of the American Rainwater Catchment Systems Association (ARCSA). Two hundred and twenty-two members of ARCSA responded to the survey; the responses were representative of approximately 2700 RWH systems across the United States that the respondents own, have installed, or have observed in the field. Survey questions focused on system setup, catchment materials (for the roof, cistern storage tank, gutters, and downspouts), motivation for harvesting rainwater, uses for the water, treatment methods, and water quality testing practices. Results indicate that composite asphalt shingles and metal are the most commonly used roofing materials for RWH, and polyethylene is the most common cistern material for the surveyed population. The most commonly reported use for harvested rainwater was irrigation although greater than 25% of the respondents use their rainwater for potable purposes. Of the potable users, greater than 70% utilize ultraviolet (UV) light as their primary treatment method, and approximately 21% conduct no water quality testing. This survey provides critical data about current non-potable and potable RWH practices in the United States and can be used to guide future RWH research. In particular, the low frequency of water quality testing and the efficacy of UV treatment should be investigated further as the number of RWH systems installed in the United States and elsewhere continues to grow.
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•We surveyed 222 rainwater harvesters in the United States.•Common rainwater harvesting practices were assessed.•The most commonly reported use for harvested rainwater was irrigation.•Ultraviolet light disinfection of harvested rainwater was common for potable use.
Background
Pancreatoduodenectomy (PD) remains the only curative‐intent treatment option for patients with cancer affecting the head of the pancreas. It is high‐risk and overall morbidity is around ...40%. Due to the necessary resection and subsequent anastomoses required, multiple procedure‐specific complications are possible. An in‐depth understanding of the recent evidence on these will guide the consenting process and allow surgeons to evaluate their own performance.
We aimed to consolidate the recent literature on preselected PD complications (postoperative pancreatic fistula (POPF), bile leak (BL), gastrojejunal leak, postpancreatectomy haemorrhage (PPH), cholangitis, and chyle leak (CL)).
Methods
A search of the PubMed database was carried out on 1st July 2021. Articles from July 2011 through to July 2021 were included.
The initial search returned 297 results. After screening, 226 articles were excluded. The remaining 71 were assessed for eligibility and a further 34 were excluded. 37 were included in the final synthesis (two meta‐analyses and 35 single/multicentre studies).
Results
Due to recently updated diagnostic criteria, differing definitions among authors and subclinical cases, true incidence rates are difficult to appreciate. The following were obtained: POPF (excluding biochemical leak): 10.0–25.9%, BL: 3.0–7.9%, gastrojejunal anastomotic leak: 0.4–1.2%, PPH: 7.3–13.6%, cholangitis: 0.05–21.1% and CL: 2.6–19.0%. Numerous risk factors, both modifiable and non‐modifiable, were identified for each.
Conclusion
Most of the recent evidence on the studied complications comes from single institution studies of retrospective design. Robust case–control studies are required so predictive models can estimate the likelihood of specific complications in individual patients.
This article consolidates the recent evidence on the incidence of, and risk factors for, preselected procedure‐specific complications of pancreatoduodenectomy. An in‐depth understanding of these will guide the consenting process and allow surgeons to consider their operative technique.
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