Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

A review of the practical relevance of IS strategy scholarly research

While studies suggest that IS strategy is an important topic for practitioners, in-depth explorations of the potential practical relevance of this research area are lacking. In this paper, we develop a multidimensional framework of potential practical relevance and use it to conduct a multimethod descriptive review of 109 IS strategy papers published over the past 10 years in top IS journals. The framework contributes to the IS literature by synthesizing various characteristics that make a research project conducive to being practically relevant. The review highlights how IS strategy research has offered the potential for practical relevance in the past and recommends opportunities to increase this, especially in the digitalization era

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Micropropagation of Eucalyptus nitens maiden (Shining gum)

Summary Eucalyptus nitens Maiden (shining gum) is a frost-tolerant species of Eucalyptus that can be used as an alternative species to Eucalyptus globulus in some regions of Portugal where winter temperatures are too low. Seedlings and 1-yr-old shoot tips and nodes were used for micropropagation of E. nitens. The best multiplication rate (2.25) was obtained when seedling shoots (&lt;15 mm) were cultured on a medium containing the major nutrients (at half-strength) and minor elements of Murashige and Skoog (1962) medium, the organics of De Fossard medium (De Fossard et al., 1974) and a combination of benzyladenine (0.9 µM) and 1-naphthaleneacetic acid (0.05 µM). Seedling cuttings (4-,8-, and 10-wk-old) rooted well on media containing several concentrations of 3-indolebutyric acid (4.9, 9.8, and 14.8 µM) or 3-indoleacetic acid (5.7, 11.4, and 17.1 µM), giving frequencies of root induction above 80%. With this type of explant, root formation was also found on basal medium without growth regulators. Rooting of in vitro-propagated shoots obtained from seedlings (8-wk-old) after four subcultures (every 3 wk) was more difficult, with the best results obtained on a medium containing 14.7 µM 3-indolebutyric acid (60.0% root induction). No root formation was achieved when shoots from 1-yr-old explants were used. After a period of 4 mo., 96.3% of the plants transferred to the greenhouse survived acclimatization

Alphavirus replicon particles acting as adjuvants promote CD8+ T cell responses to co-delivered antigen

Alphavirus replicon particles induce strong antibody and CD8(+) T cell responses to expressed antigens in numerous experimental systems. We have recently demonstrated that Venezuelan equine encephalitis virus replicon particles (VRP) possess adjuvant activity for systemic and mucosal antibody responses. In this report, we demonstrate that VRP induced an increased and balanced serum IgG subtype response to co-delivered antigen, with simultaneous induction of antigen-specific IgG1 and IgG2a antibodies, and increased both systemic and mucosal antigen-specific CD8(+) T cell responses, as measured by an IFN-γ ELISPOT assay. Additionally, VRP further increased antigen-specific T cell immunity in an additive fashion following co-delivery with the TLR ligand, CpG DNA. VRP infection led to recruitment of CD8(+) T cells into the mucosal compartment, possibly utilizing the mucosal homing receptor, as this integrin was upregulated on CD8(+) T cells in the draining lymph node of VRP-infected animals, where VRP-infected dendritic cells reside. This newly recognized ability of VRP to mediate increased T cell response towards co-delivered antigen provides the potential to both define the molecular basis of alphavirus-induced immunity, and improve alphavirus-based vaccines