The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions.

BackgroundIn 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.MethodsData on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.ResultsOf the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).ConclusionAbout one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.Level of evidencePrognostic and Epidemiological Study, level III

Complications of right lobe living donor liver transplantation

Background/Aims: Right lobar living donor liver transplantation (LDLT) has been controversial because of donor deaths and widely variable reports of recipient and donor morbidity. Our aims were to ensure full disclosure to donors and recipients of the risks and benefits of this procedure in a large University center and to help explain reporting inconsistencies. Methods: The Clavien 5-tier grading system was applied retrospectively in 121 consecutive adult right lobe recipients and their donors. The incidence was determined of potentially (Grade III), actually (Grade IV), or ultimately fatal (Grade V) complications during the first post-transplant year. When patients had more than one complication, only the seminal one was counted, or the most serious one if complications occurred contemporaneously. Results: One year recipient/graft survival was 91%/84%. Within the year, 80 (66%) of the 121 recipients had Grade III (n = 54) Grade IV (n = 16), or Grade V (n = 10) complications. The complications involved the graft's biliary tract (42% incidence), graft vasculature (15%), or non-graft locations (9%). Complications during the first year did not decline with increased team experience, and adversely affected survival out to 5 years. All 121 donors survive. However, 13 donors (10.7%) had Grade III (n = 9) or IV (n = 4) complications of which five were graft-related. Conclusions: Despite the satisfactory recipient and graft survival at our and selected other institutions, and although we have not had a donor mortality to date, the role of right lobar LDLT is not clear because of the recipient morbidity and risk to the donors. © 2009 European Association for the Study of the Liver

Use of an alternative method to evaluate erythema severity in a clinical trial: difference in vehicle response with evaluation of baseline and postdose photographs for effect of oxymetazoline cream 1·0% for persistent erythema of rosacea in a phase IV study.

BackgroundOnce-daily topical oxymetazoline cream 1·0% significantly reduced persistent facial erythema of rosacea in trials requiring live, static patient assessments.ObjectivesTo evaluate critically the methodology of clinical trials that require live, static patient assessments by determining whether assessment of erythema is different when reference to the baseline photograph is allowed.MethodsIn two identically designed, randomized, phase III trials, adults with persistent facial erythema of rosacea applied oxymetazoline or vehicle once daily. This phase IV study evaluated standardized digital facial photographs from the phase III trials to record ≥ 1-grade Clinician Erythema Assessment (CEA) improvement at 1, 3, 6, 9 and 12 h postdose.ResultsAmong 835 patients (oxymetazoline n = 415, vehicle n = 420), significantly greater proportions of patients treated with oxymetazoline vs. vehicle achieved ≥ 1-grade CEA improvement. For the comparison between phase IV study results and the original phase III analysis, when reference to baseline photographs was allowed while evaluating post-treatment photographs, the results for oxymetazoline were similar to results of the phase III trials (up to 85.7%), but a significantly lower proportion of vehicle recipients achieved ≥ 1-grade CEA improvement (up to 29.7% [phase 4] vs. 52.3% [phase 3]; P<0.001). In the phase IV study, up to 80·2% of patients treated with oxymetazoline achieved at least moderate erythema improvement vs. up to 22·9% of patients treated with vehicle. The association between patients' satisfaction with facial skin redness and percentage of erythema improvement was statistically significant.ConclusionsAssessment of study photographs, with comparison to baseline, confirmed significant erythema reduction with oxymetazoline on the first day of application. Compared with the phase III trial results, significantly fewer vehicle recipients attained ≥ 1-grade CEA improvement, suggesting a mitigated vehicle effect. This methodology may improve the accuracy of clinical trials evaluating erythema severity

Longitudinal qPCR study of the dynamics of L. crispatus, L. iners, A. vaginae, (sialidase positive) G. vaginalis, and P. bivia in the vagina

Background: To obtain more detailed understanding of the causes of disturbance of the vaginal microflora (VMF), a longitudinal study was carried out for 17 women during two menstrual cycles. Methods: Vaginal swabs were obtained daily from 17 non-pregnant, menarchal volunteers. For each woman, Gram stains were scored, the quantitative changes of 5 key vaginal species, i.e. Atopobium vaginae, Lactobacillus crispatus, L. iners, (sialidase positive) Gardnerella vaginalis and Prevotella bivia were quantified with qPCR and hydrogen-peroxide production was assessed on TMB+ agar. Results: Women could be divided in 9 subjects with predominantly normal VMF (grades Ia, Ib and Iab, group N) and 8 with predominantly disturbed VMF (grades I-like, II, III and IV, group D). VMF was variable between women, but overall stable for most of the women. Menses were the strongest disturbing factor of the VMF. L. crispatus was present at log7-9 cells/ml in grade Ia, Iab and II VMF, but concentrations declined 100-fold during menses. L. crispatus below log7 cells/ml corresponded with poor H2O2-production. L. iners was present at log 10 cells/ml in grade Ib, II and III VMF. Sialidase negative G. vaginalis strains (average log5 cells/ml) were detected in grade I, I-like and IV VMF. In grade II VMF, predominantly a mixture of both sialidase negative and positive G. vaginalis strains (average log9 cells/ml) were present, and predominantly sialidase positive strains in grade III VMF. The presence of A. vaginae (average log9 cells/ml) coincided with grade II and III VMF. P. bivia (log4-8 cells/ml) was mostly present in grade III vaginal microflora. L. iners, G. vaginalis, A. vaginae and P. bivia all increased around menses for group N women, and as such L. iners was considered a member of disturbed VMF. Conclusions: This qPCR-based study confirms largely the results of previous culture-based, microscopy-based and pyrosequencing-based studies

Simulasi Tata Guna Lahan Terhadap Kualitas Air Sungai Dengan Metode Indeks Pencemaran ( Studi Kasus : Sungai Tuntang, Jawa Tengah )

Tuntang River is a main river of Tuntang's watershed which is located in Central Java. Administratively, Tuntang River covers seven districts with a total area of ± 139 km long rivers. Tuntang River's stream go through various hue environments namely forest, residential, agricultural and moor which potentially reduce the quality of agency ait Tuntang River. The determination of Tuntang River water quality used River Pollution Index method. The water quality monitoring carried out in five river segments. The results were obtained using the pollution index calculation with the scorings as follow: Segment 1 = Class 1: 1.56; Grade II: 1.54; Grade III: 1.54; Grade IV: 0.64. Segment 2 = Class I: 0.9, Class II: 0.88; Grade III: 0.87; Grade IV: 0.64. Segment 3 = Class I: 0.67; Grade II: 0.66; Grade III: 0.65; Grade IV: 0.64. Segment 4 = Class I: 0.67; Grade II: 0.67; Grade III: 0.66; Grade IV: 0.65. Segment 5 = Class I: 0.75; Grade II: 0.68; Grade III: 0.66; Grade IV: 0.66.The water quality is categorized quite well because the water meet the quality standards for rivers class I designation. The land use in every segment of the Watershed (DAS) Tuntang can affect the water quality. The changes of the land use giving influence for the water quality of Tuntang River, the simulation of addition of the residential land can improve the water quality corresponding the IP value become worse, the simulated reduction in agricultural land can degrade water quality corresponding IP value better. The simulation of addition of the residential land also caused the improvement of the water BOD. From the calculation of water quality by using Pollution Index based on the simulation of addition of the residential land, it was known that the quality of Tuntang River water had a quality status to Meet Quality Standards with Cemar Lightweight IP value between 3.89 to 0.66. To stimulate the reduction of agricultural, it is known that the water of Tuntang River had a quality of Meet Quality Standards with Cemar Lightweight IP value between 1.66 to 0.66

Cardiac diseases in pregnancy and its feto-maternal outcome

Background: Cardiac disease complicates 1-3% of all pregnancies. Of this Rheumatic heart disease constitute 74% and congenital heart disease 26%.Methods: A retrospective study of all patients with cardiac diseases delivered was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according the severity, NYHA classification, type of pathology, the maternal and perinatal outcome was assessed, and the maternal mortality and perinatal mortality was recorded.Results: 84% patients belonged to age group 20-29 years. 8% were teen aged and 4% patients were elderly. 64% patients were either P0+0 or P0+1. 8% patients were P0+3 and 2% patient were P3+0. 74% patients had RHD. 26% had grade I, 40% had grade II, 20% patients had grade III and 14% had grade IV heart disease. The associated complications were anemia 46%, Respiratory tract infection 12%, pregnancy induced hypertension 2% and recurrent rheumatic fever 2%. 48% had normal vaginal delivery, 20% had forceps delivery and 32% had caesarean delivery. One mother died of heart failure. All patients of grade I (100%) had term delivery. 23.07% of grade I, 30% of grade II, 60% of grade III and 100% babies of grade IV mothers were of low birth weight (˂2.5 kg). Babies weighing ˂1.5 kg were seen in 5% grade II, 10% grade III and 42.85% mothers with grade IV disease. 2 of grade IV and each of grade I, II and III died.Conclusions: Feto-maternal outcome can be improved with close supervision of obstetrician and cardiologist throughout the pregnancy by antenatal care, early diagnosis and management

Bringing high-grade arteriovenous malformations under control: clinical outcomes following multimodality treatment in children.

OBJECTIVE:Brain arteriovenous malformations (AVMs) consist of dysplastic blood vessels with direct arteriovenous shunts that can hemorrhage spontaneously. In children, a higher lifetime hemorrhage risk must be balanced with treatment-related morbidity. The authors describe a collaborative, multimodal strategy resulting in effective and safe treatment of pediatric AVMs. METHODS:A retrospective analysis of a prospectively maintained database was performed in children with treated and nontreated pediatric AVMs at the University of California, San Francisco, from 1998 to 2017. Inclusion criteria were age ≤ 18 years at time of diagnosis and an AVM confirmed by a catheter angiogram. RESULTS:The authors evaluated 189 pediatric patients with AVMs over the study period, including 119 ruptured (63%) and 70 unruptured (37%) AVMs. The mean age at diagnosis was 11.6 ± 4.3 years. With respect to Spetzler-Martin (SM) grade, there were 38 (20.1%) grade I, 40 (21.2%) grade II, 62 (32.8%) grade III, 40 (21.2%) grade IV, and 9 (4.8%) grade V lesions. Six patients were managed conservatively, and 183 patients underwent treatment, including 120 resections, 82 stereotactic radiosurgery (SRS), and 37 endovascular embolizations. Forty-four of 49 (89.8%) high-grade AVMs (SM grade IV or V) were treated. Multiple treatment modalities were used in 29.5% of low-grade and 27.3% of high-grade AVMs. Complete angiographic obliteration was obtained in 73.4% of low-grade lesions (SM grade I-III) and in 45.2% of high-grade lesions. A periprocedural stroke occurred in a single patient (0.5%), and there was 1 treatment-related death. The mean clinical follow-up for the cohort was 4.1 ± 4.6 years, and 96.6% and 84.3% of patients neurologically improved or remained unchanged in the ruptured and unruptured AVM groups following treatment, respectively. There were 16 bleeding events following initiation of AVM treatment (annual rate: 0.02 events per person-year). CONCLUSIONS:Coordinated multidisciplinary evaluation and individualized planning can result in safe and effective treatment of children with AVMs. In particular, it is possible to treat the majority of high-grade AVMs with an acceptable safety profile. Judicious use of multimodality therapy should be limited to appropriately selected patients after thorough team-based discussions to avoid additive morbidity. Future multicenter studies are required to better design predictive models to aid with patient selection for multimodal pediatric care, especially with high-grade AVMs

Pengaruh Hasil Latihan Peregangan Statis dan Dinamis terhadap Kelentukan Togok Menurut Jenis Sex Anak Kelas 3 dan 4 Sekolah Dasar

This research aims to know: 1) the different of the influence between static and dynamic stretching toward the Togok flexibility for children in the III and IV grade of elementary school; 2) the different of Togok flexibility between male and female students of III and IV grade of elementary school; 3) the interaction between the stretching exercise result and gender type toward Togok flexibility of III and IV grade students of elementary school.The research method used was experimental. The research population was all male and female students in III and IV grade of elementary school in Kulon Progo regency which was 261 elementary schools with 6.469 students. The research sample was determined by multi stage random sampling that was UPTD PAUD DIKNAS Ngemplak elementary school in Kalibawang with 20 male students and 20 female students. The research instrument used to know the level of Togok flexibility was the series of tests that had compiled by the writer and has been tested. Reliability coefficient was got by Hoyt technique, the result of total reliability coefficient for male students was 0.719 and for female students was 0. 700. Validity coefficient was got by total part technique, the result of Togok flexibility test for male students was forward r= 0.657, backwarc..l r=0.627, lo lfle riyhl ::,ic..le r=0.852 and to the left side r= 0.711. Moreover, Togok flexibility for female students was: forward r= 0.600, backward r= 0.645, to the right side r= 0.827, and to the left side r= 0.829. All significance was on the level a + 0.05. Data analysis technique used was ANA VA 2 x 2 on the significance level a= 0.05.The result ofF-test was 1) static and dynamic stretching as variable A was got Fa = 45.565 > Ft = 4.11, it means that F0 was rejected and Ha was accepted, means that there was a the different of the influence between static and dynamic stretching toward the Togok flexibility for children in the III and IV grade of elementary school, 2) male and female gender as variable 8 was got F0 = 1.865 < Ft = 4.11 means that Ho was accepted and Ha was rejected, means that there was no the different of Togok flexibility between male and female students of III and IV grade of elementary school; 3) for inter AB that was the interaction between the stretching exercise result and gender type toward Togok flexibility of III and IV grade students of elementary school was got Fa = 3.292 < Ft = 4.11 means that Ho was accepted and Ha was rejected means that there was no interaction between the stretching exercise result and gender type toward Togok flexibility of III and IV grade students of elementary school

Fertility benefits of controlled ovarian stimulation and intrauterine insemination in different stages of endometriosis in a fertility centre in Southern India: a retrospective study

Background: To determine the fertility benefit of controlled ovarian hyperstimulation and intra uterine insemination (IUI) in different stages of Endometriosis. It was a retrospective observational study done in Kinder women’s hospital and fertility centre, Cherthala, Kerala, India.Methods: A retrospective analysis of 100 patients with isolated endometriosis (I and II vs. III and IV) who underwent IUI between January 2018 to December 2019 were selected. Cycle fecundity rates and clinical pregnancy rates and pregnancies above 28 weeks were measured. Clinical pregnancy rates with COH and IUI were also compared between grade I/II vs III/IV endometriosis.Results: A total of 16 (16%) pregnancy were achieved with controlled ovarian hyperstimulation (COH) and IUI in patients with endometriosis which included 11 (11%) clinical pregnancies and 5 (5%) miscarriages. 10% clinical pregnancies were achieved in grade I/II endometriosis and 1% in grade III/IV endometriosis. 68.75% of the pregnant patients progressed to pregnancy of &gt;28 weeks.Conclusions: The grade of endometriosis affected the clinical pregnancy rate in COH with IUI. The treatment success of COH with IUI was noted to be greater in minimum or mild endometriosis i.e., grade I/II. The treatment modality is ineffective in moderate to severe grades of endometriosis i.e., III/IV