The optimal hormonal replacement modality selection for multiple organ procurement from brain-dead organ donors

The management of brain-dead organ donors is complex. The use of inotropic agents and replacement of depleted hormones (hormonal replacement therapy) is crucial for successful multiple organ procurement, yet the optimal hormonal replacement has not been identified, and the statistical adjustment to determine the best selection is not trivial. Traditional pair-wise comparisons between every pair of treatments, and multiple comparisons to all (MCA), are statistically conservative. Hsu’s multiple comparisons with the best (MCB)-adapted from the Dunnett’s multiple comparisons with control (MCC)-has been used for selecting the best treatment based on continuous variables. We selected the best hormonal replacement modality for successful multiple organ procurement using a two-step approach. First, we estimated the predicted margins by constructing generalized linear models (GLM) or generalized linear mixed models (GLMM), and then we applied the multiple comparison methods to identify the best hormonal replacement modality given that the testing of hormonal replacement modalities is independent. Based on 10-year data from the United Network for Organ Sharing (UNOS), among 16 hormonal replacement modalities, and using the 95% simultaneous confidence intervals, we found that the combination of thyroid hormone, a corticosteroid, antidiuretic hormone, and insulin was the best modality for multiple organ procurement for transplantation

Anthropometric and Performance Characteristics of Elite Hurling Players

The purpose of the present study was to examine variations in the anthropometric and performance characteristics of elite hurling players in relation to playing position. Forty-one male, elite intercounty hurlers (25 ± 4 years), 4 goalkeepers, 8 full-backs, 8 halfback, 6 midfielders, 8 half-forwards and 7 full-forwards underwent measurements of standard anthropometric (stature, body mass, sum of five skinfolds and adipose tissue percentage estimates (%AT)) and performance characteristics (counter-movement jump (CMJ), CMJ peak power, CMJ relative peak power, 5-, 10-, 20-m sprint times and estimated V•O2max) during the later stages of the competitive season. A clear hierarchical anthropometric profile is evident with goalkeepers being the taller (184.3 ± 3.7 m), possessing the highest body mass (88.7 ± 5.7 kg) and adiposity (13.2 ± 3.1 %AT) than their outfield colleagues. Half-backs (47.4 ± 2.4 cm) and half-forwards (50.7 ± 5.9 cm) produced the highest CMJ scores; a similar profile was evident for sprint times. Midfielders (60.1 ± 1.4 mL.kg-1.min-1) exhibited a significantly (p<0.05) greater maximal oxygen uptake than all other playing positions. Differences in the anthropometric and performance characteristics of other playing positions whilst evident were non-significant. This study provides novel data, as it is the first report to present normative anthropometric and performance data for elite hurling players which to date has not been present in the literature. The enhanced maximal oxygen uptake in midfield players is likely due to different performance, technical and tactical demands associated with this position

Bare Below the Elbows: A comparative study of a tertiary and district general hospital.

A \u27Bare Below the Elbows\u27 (BBTE) dress code policy has been introduced by the majority of NHS trusts in the UK. The aim of this Irish study was to evaluate the impact of an educational intervention on perception of medical attire. The study was carried out in two centres: a tertiary referral centre (Beaumont Hospital) and a district hospital (MRH, Portlaoise). Two questionnaires, incorporating photographic evaluation of appropriate attire for consultants and junior doctors, were completed pre and post BBTE education. One hundred and five patients participated. Analysis pre BBTE education indicated patients considered formal attire and white coats most appropriate for consultants and junior doctors respectively. Post-intervention analysis revealed a significant reduction in the popularity of both (

The Work-Rate of Elite Hurling Match-Play

This study describes the global work-rate of elite hurling match-play and the influence which positional difference has on workrate is considered. The movement of ninety-four players was recorded using global positioning system, sampling at 4 Hz in a total of 12 games. Data were classified according to the positional line on the field and period of the match. The total and high-speed distance of match-play was 7,617 6 1,219 m (95% confidence interval [CI], 7,367–7,866) and 1,134 6 358 m (95% CI, 1,060–1,206), respectively. The maximum speed attained was 29.8 6 2.3 km.h-1 with a mean speed of 6.1 6 1 kmh 21. The second {271 6 107 m (p = 0.001; effect size [ES] = 0.25)}, third (278 6 118 m [p = 0.001; ES = 0.21]), and fourth quarter (255 6 108 m [p = 0.001; ES = 0.31]) high-speed running distance differed significantly from that of the first quarter (330 6 120 m). There was a significant difference in total (p = 0.001; ES = 0.01–0.85), high-speed running (p = 0.001; ES = 0.21–0.76), and sprint (p = 0.013; ES = 0.01–0.39) distance across the positions, with midfielders undertaking the highest volume of work, followed by the half-forward and half-back lines and finally the full-forward and full-back lines. A decrease in high-speed running distance seems to occur through out the game and in particular at the latter stages of each half. Distinct positional work profiles are evident. The present finding provide a context on which training which replicates the work-rate of match-play may be formulated, thus helping to improve the physical preparation of elite players

Mid-Upper Arm Circumference based Nutrition Programming: evidence for a new approach in regions with high burden of Acute Malnutrition

In therapeutic feeding programs (TFP), mid-upper arm circumference (MUAC) shows advantages over weight-for-height Z score (WHZ) and is recommended by the World Health Organization (WHO) as an independent criterion for screening children 6-59 months old. Here we report outcomes and treatment response from a TFP using MUAC ≤118 mm or oedema as sole admission criteria for severe acute malnutrition (SAM)

Signal Propagation in Feedforward Neuronal Networks with Unreliable Synapses

In this paper, we systematically investigate both the synfire propagation and firing rate propagation in feedforward neuronal network coupled in an all-to-all fashion. In contrast to most earlier work, where only reliable synaptic connections are considered, we mainly examine the effects of unreliable synapses on both types of neural activity propagation in this work. We first study networks composed of purely excitatory neurons. Our results show that both the successful transmission probability and excitatory synaptic strength largely influence the propagation of these two types of neural activities, and better tuning of these synaptic parameters makes the considered network support stable signal propagation. It is also found that noise has significant but different impacts on these two types of propagation. The additive Gaussian white noise has the tendency to reduce the precision of the synfire activity, whereas noise with appropriate intensity can enhance the performance of firing rate propagation. Further simulations indicate that the propagation dynamics of the considered neuronal network is not simply determined by the average amount of received neurotransmitter for each neuron in a time instant, but also largely influenced by the stochastic effect of neurotransmitter release. Second, we compare our results with those obtained in corresponding feedforward neuronal networks connected with reliable synapses but in a random coupling fashion. We confirm that some differences can be observed in these two different feedforward neuronal network models. Finally, we study the signal propagation in feedforward neuronal networks consisting of both excitatory and inhibitory neurons, and demonstrate that inhibition also plays an important role in signal propagation in the considered networks.Comment: 33pages, 16 figures; Journal of Computational Neuroscience (published

Acute rejection is associated with antibodies to non-Gal antigens in baboons using Gal-knockout pig kidneys

We transplanted kidneys from α1,3-galactosyltransferase knockout (GalT-KO) pigs into six baboons using two different immunosuppressive regimens, but most of the baboons died from severe acute humoral xenograft rejection. Circulating induced antibodies to non-Gal antigens were markedly elevated at rejection, which mediated strong complement-dependent cytotoxicity against GalT-KO porcine target cells. These data suggest that antibodies to non-Gal antigens will present an additional barrier to transplantation of organs from GalT-KO pigs to humans. © 2005 Nature Publishing Group

Appendix perforation in appendix duplication in a man: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although appendix duplication is diagnosed as a rare congenital anomaly of the alimentary tract in childhood, a few adult cases have also been reported. Here we report a case of appendix duplication with perforated appendicitis co-existing with acute appendicitis in an adult patient.</p> <p>Case presentation</p> <p>A 33-year-old Caucasian man was admitted to our Emergency Department with right-sided lower-quadrant pain that we explored for presumed complicated appendicitis. On exploration, a perforated inflamed appendix was found coexisting with a second inflamed appendix which was subserosal and retrocecal. Appendectomies were performed, and the pathological examination confirmed the signs of acute inflammation in both appendixes.</p> <p>Conclusion</p> <p>Surgeons in emergency services should be aware of anatomical anomalies such as duplication and malposition of the appendix, even in patients with a history of previous appendectomy, because misdiagnosis of appendix duplication may lead to a poor clinical outcome and medicolegal issues.</p

Second chances: Investigating athletes’ experiences of talent transfer

Talent transfer initiatives seek to transfer talented, mature individuals from one sport to another. Unfortunately talent transfer initiatives seem to lack an evidence-based direction and a rigorous exploration of the mechanisms underpinning the approach. The purpose of this exploratory study was to identify the factors which successfully transferring athletes cite as facilitative of talent transfer. In contrast to the anthropometric and performance variables that underpin current talent transfer initiatives, participants identified a range of psychobehavioral and environmental factors as key to successful transfer. We argue that further research into the mechanisms of talent transfer is needed in order to provide a strong evidence base for the methodologies employed in these initiatives

WNT signaling regulates self-renewal and differentiation of prostate cancer cells with stem cell characteristics

Prostate cancer cells with stem cell characteristics were identified in human prostate cancer cell lines by their ability to form from single cells self-renewing prostaspheres in non-adherent cultures. Prostaspheres exhibited heterogeneous expression of proliferation, differentiation and stem cell-associated makers CD44, ABCG2 and CD133. Treatment with WNT inhibitors reduced both prostasphere size and self-renewal. In contrast, addition of Wnt3a caused increased prostasphere size and self-renewal, which was associated with a significant increase in nuclear Β-catenin, keratin 18, CD133 and CD44 expression. As a high proportion of LNCaP and C4-2B cancer cells express androgen receptor we determined the effect of the androgen receptor antagonist bicalutamide. Androgen receptor inhibition reduced prostasphere size and expression of PSA, but did not inhibit prostasphere formation. These effects are consistent with the androgen-independent self-renewal of cells with stem cell characteristics and the androgen-dependent proliferation of transit amplifying cells. As the canonical WNT signaling effector Β-catenin can also associate with the androgen receptor, we propose a model for tumour propagation involving a balance between WNT and androgen receptor activity. That would affect the self-renewal of a cancer cell with stem cell characteristics and drive transit amplifying cell proliferation and differentiation. In conclusion, we provide evidence that WNT activity regulates the self-renewal of prostate cancer cells with stem cell characteristics independently of androgen receptor activity. Inhibition of WNT signaling therefore has the potential to reduce the self-renewal of prostate cancer cells with stem cell characteristics and improve the therapeutic outcome.Peer reviewe