Trends in serum citrulline and acute rejection among recipients of small bowel transplants

A test for detecting acute cellular rejection (ACR) of small intestinal transplants (ITx) would be a major advance. Small preliminary studies suggest that serum citrulline levels correlate with ACR. The results for a group of 26 isolated intestinal and multivisceral transplant recipients are summarized here. Serum citrulline concentrations were determined by ion exchange chromatography and compared to biopsy-based grade of ACR. Other factors considered included patient and donor age and sex, ischemia time, and serum creatinine. Straight-line fits were employed to describe how each patient's citrulline levels changed over time. Estimated times to achieve normal citrulline (≥30 μmol/L) ranged from 1 to 730 days posttransplant for 21 patients demonstrating increasing citrulline levels over time. Using stepwise linear regression, patients' ranks for time required to achieve normal citrulline levels were the only independent predictors of both maximum ACR ( P < .0001) and average ACR ( P = .0059) after 14 days posttransplant. The rate and direction of change in citrulline over time may be an indicator of the risk of acute rejection. We plan to further examine the use of citrulline as a marker for rejection in larger prospective studies

Um modelo de otimização para o problema integrado de dimensionamento de lotes e programação da produção em fábricas de refrigerantes

O presente artigo apresenta, modela matematicamente e soluciona um problema multi-nível integrado de dimensionamento de lotes e programação da produção em um ambiente industrial com máquinas paralelas que apresentam restrições de capacidade, custos e tempos de preparo dependentes da seqüência. O problema é motivado pela realidade encontrada em alguns setores industriais, em particular o de fabricação e engarrafamento de bebidas. Nesse tipo de indústria a produção envolve dois níveis interdependentes com decisões relativas à armazenagem das matérias-primas e ao engarrafamento das bebidas. As diversas matérias-primas são armazenadas em tanques de onde escoam para as linhas de engarrafamento. O desafio é determinar simultaneamente o dimensionamento e a programação de custo mínimo das matérias-primas nos tanques e o envasamento de bebidas nas linhas, onde tempos e custos de trocas dependem do tipo de item previamente armazenado e envasado. É proposto um modelo matemático inteiro-misto que introduz diversas restrições combinadas que até então costumavam ser tratadas separadamente na literatura. A não existência de testes com modelos similares nos obrigou a criar um conjunto de instâncias para avaliar o modelo e as técnicas de solução propostas. As instâncias foram solucionadas otimamente por meio do pacote computacional GAMS/Cplex. A solução exata se mostrou viável apenas em instâncias de pequena dimensão devido à complexidade do problema em estudo. Os resultados computacionais obtidos pelo GAMS/Cplex são apresentados e analisados.<br>The present paper establishes, describes mathematically and solves a multi-level lot sizing and scheduling problem in an industrial set with parallel machines and sequence-dependent setup cost and time. The problem is motivated by real situations found in some industrial settings mainly the soft drink industry. In this kind of industry, the production involves two interdependent levels with decisions about raw material storage and soft drink bottling. The several raw materials are stored in tanks from which they flow to the bottling lines. The challenge is to determine simultaneously the minimum cost lot sizing and scheduling of raw material in tanks and also in the bottling lines, where setup costs and time depend on the previous items stored and bottled. A mixed-integer mathematical model with several combined constrains that use to be handled apart in the literature is proposed. The lack of similar models led us to create a set of instances to evaluate the model and the solution techniques developed. The instances were optimally solved by the GAMS/Cplex software. Due to the problem complexity, it is demonstrated that the use of this optimization package is only viable for small-sized instances. The computational results are showed and analyzed

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 447 Patients with Tubercular Intermediate Uveitis and Panuveitis

Purpose: Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP. Methods: Multicentre retrospective analysis. Results A total of 138 TIU and 309 TBP patients were included. A total of 382 subjects received antitubercular therapy (ATT) (n&nbsp;=&nbsp;382/447; 85.4%) and 382 received corticosteroids (n&nbsp;=&nbsp;382/447; 85.4%). Treatment failure was observed in 78 individuals (n&nbsp;=&nbsp;78/447; 17.4%), occurring less frequently in patients receiving ATT (n&nbsp;=&nbsp;66/382; 17.2%) compared to those who did not (n&nbsp;=&nbsp;12/65; 18.5%). The study did not show any statistically significant therapeutic effect of ATT in patients with TIU and TBP. Conclusion Taking into account the limitations of the retrospective, non-randomized study design, resultant reliance on reported data records, and unequal size of the samples, the current study cannot provide conclusive evidence on the therapeutic benefit of ATT in TIU and TBP

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Descriptive Review of Tubercular Uveitis in Paediatric Population

Purpose: To examine disease profile of tubercular uveitis (TBU) in Paediatric population. Methods: Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed. Results: Mean age of disease presentation was 12.8 (range 4\u201318&nbsp;years), with predominance of males (n&nbsp;=&nbsp;14/20; 70.0%) and Asian ethnicity (n&nbsp;=&nbsp;25/29; 86.2%). Posterior uveitis (n&nbsp;=&nbsp;14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n&nbsp;=&nbsp;11/17). Incidence of optic disc edema and macular edema was higher in children (n&nbsp;=&nbsp;8/18; 44.4% and n =&nbsp;5/18; 27.8%, respectively) than in adults (n&nbsp;=&nbsp;160/942; 16.9% and n =&nbsp;135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n&nbsp;=&nbsp;1/21). Conclusions: Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome

Twenty-four Month Outcomes in the Collaborative Ocular Tuberculosis Study (COTS)-1: Defining the &#8220;Cure&#8221; in Ocular Tuberculosis

Purpose: To report the clinical findings, anatomical features, and treatment outcomes in subjects with ocular tuberculosis (OTB) at 24&nbsp;months in the Collaborative Ocular Tuberculosis Study (COTS)-1. Methods: Of the 945 subjects included in COTS-1, those who completed a 24-month follow-up after completion of treatment were included. The main outcome measure was a number of patients with treatment failure (TF). Results: 228 subjects (120 males; mean age of 42.82&nbsp;\ub1&nbsp;14.73&nbsp;years) were included. Most common phenotype of uveitis was posterior (n =&nbsp;81; 35.53%), and panuveitis (n =&nbsp;76; 33.33%). Fifty-two patients (22.81%) had TF. On univariable analysis, odds of high TF was observed with bilaterality (OR: 3.46, p =&nbsp;.003), vitreous haze (OR: 2.14, p =&nbsp;.018), and use of immunosuppressive therapies (OR: 5.45, p =&nbsp;.003). However, only bilaterality was significant in the multiple regression model (OR: 2.84; p =&nbsp;.02). Conclusions: Majority of subjects (&gt;75%) achieved cure in the COTS-1 at 24-month follow-up. The concept of \u201ccure\u201d may be a valuable clinical endpoint in trials for OTB

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 165 Patients with Tubercular Anterior Uveitis

Purpose: The Collaborative Ocular Tuberculosis Study (COTS) Group sought to address the diagnostic uncertainty through retrospective cohort analysis of treatment regimens and therapeutic outcomes for patients with tubercular Anterior Uveitis (TAU) across international centers. Methods: Multicentre retrospective analysis of&nbsp;patients diagnosed with TAU between January 2004 to December 2014 that had a minimum follow-up of 1 year. Results: One hundred and sixty-five patients were included. One hundred and seven subjects received antitubercular therapy (ATT) (n&nbsp;=&nbsp;107/165; 64.9%) with all the patients receiving topical steroid therapy. Treatment failure was noted in 17 patients (n&nbsp;=&nbsp;17/165; 10.3%), more frequently described in patients that received ATT (n&nbsp;=&nbsp;13/107, 12.2%), than those that did not receive ATT (n&nbsp;=&nbsp;4/58, 6.9%). Conclusion: In this retrospective study, addition of ATT did not have any statistically significant impact on outcome in patients with TAU

Visual Morbidity in Ocular Tuberculosis&#8211;Collaborative Ocular Tuberculosis Study (COTS)-1: Report #6

Objective: Aim of the study was to examine extent, natural history, and clinical features associated with visual impairment (VI) in patients diagnosed with ocular tuberculosis (OTB) by the Collaborative Ocular Tuberculosis Study (COTS)-1. Methods: Multi-center retrospective cohort study. Main outcomes were VI. Results: A total of 302 patients were included in the study, including 175 patients whose data related to BCVA were available throughout the 2\ua0years of follow up. Mean BCVA grossly improved at 12, 18, and 24\ua0months of follow-up (p <\ua0.001). Mean BCVA was worse at 12\u201318th month follow-up for patients treated with ATT versus patients who were not treated with ATT, but patients treated with ATT had a statistically significant improvement in BCVA at the 24-month endpoint. Conclusions: OTB is associated with significant visual morbidity, future well-designed prospective studies are warranted to establish the causal association between OTB and visual loss

Intentions to be Vaccinated Against COVID-19: The Role of Prosociality and Conspiracy Beliefs across 20 Countries

Understanding the determinants of COVID-19 vaccine uptake is important to inform policy decisions and plan vaccination campaigns. The aims of this research were to: (1) explore the individual- and country-level determinants of intentions to be vaccinated against SARS-CoV-2, and (2) examine worldwide variation in vaccination intentions. This cross-sectional online survey was conducted during the first wave of the pandemic, involving 6697 respondents across 20 countries. Results showed that 72.9% of participants reported positive intentions to be vaccinated against COVID-19, whereas 16.8% were undecided, and 10.3% reported they would not be vaccinated. At the individual level, prosociality was a significant positive predictor of vaccination intentions, whereas generic beliefs in conspiracy theories and religiosity were negative predictors. Country-level determinants, including cultural dimensions of individualism/collectivism and power distance, were not significant predictors of vaccination intentions. Altogether, this study identifies individual-level predictors that are common across multiple countries, provides further evidence on the importance of combating conspiracy theories, involving religious institutions in vaccination campaigns, and stimulating prosocial motives to encourage vaccine uptake. © 2022 Taylor & Francis Group, LLC