Intra-operative blood salvage in total hip and knee arthroplasty

Purpose To review records of 371 patients who underwent total hip or knee arthroplasty (THA or TKA) with intra-operative blood salvage to determine the allogeneic blood transfusion rate and the predictors for allogeneic blood transfusion. Methods Records of 155 male and 216 female consecutive patients aged 17 to 95 (mean, 70) years who underwent primary THA or TKA by a single surgeon with the use of intra-operative blood salvage were reviewed. Results The preoperative haemoglobin level was &lt;120 g/dl in 15% of THA patients and 5% of TKA patients; the allogeneic transfusion rate was 24% in THA patients and 12% in TKA patients. Despite routine use of intra-operative blood salvage, only 59% of THA patients and 63% of TKA patients actually received salvaged blood, as a minimum of 200 ml blood loss was required to activate blood salvage. In multivariable analysis, predictors for allogeneic blood transfusion were female gender (adjusted odds ratio [OR]=2.8, p=0.02), age &gt;75 years (adjusted OR=5.9, p&lt;0.001), and preoperative haemoglobin level &lt;120 g/l (adjusted OR=30.1, p&lt;0.001), despite the use of intra-operative blood salvage. Patients who received allogeneic blood transfusion had a longer hospital stay and greater complication rate. Conclusion Intra-operative blood salvage is not effective in preventing allogeneic blood transfusion in patients with a preoperative haemoglobin level &lt;120 g/l. It should be combined with preoperative optimisation of the haemoglobin level or use of tranexamic acid. </jats:sec

Maternal bargaining power, parental compensation and non-cognitive skills in rural China

The importance of non-cognitive skills in determining long-term human capital and labor market outcomes is widely acknowledged, but relatively little is known about how non-cognitive skills may shape educational investments by parents early in life. This paper evaluates the parental response to variation in non-cognitive skills among their children in rural Gansu province, China, employing a household fixed effects specification. The results suggest that on average, parents invest no more in terms of educational expenditure in children who have better non-cognitive skills relative to their siblings. However, there is significant heterogeneity with respect to maternal education; less educated mothers appear to reinforce differences in non-cognitive skills between their children, while more educated mothers compensate for these differences. The evidence is consistent with this pattern corresponding to greater bargaining power for more educated mothers and different preferences for compensation among more educated women. In addition, there is evidence that these compensatory investments lead to catch-up in non-cognitive skills over time for children of more educated mothers

Blood loss in primary total knee arthroplasty-body temperature is not a significant risk factor-a prospective, consecutive, observational cohort study

BACKGROUND: Hypothermia related to anaesthesia and operating theatre environment is associated with increased blood loss in a number of surgical disciplines, including total hip arthroplasty. The influence of patient temperature on blood loss in total knee arthroplasty (TKA) has not been previously studied. METHODS: We recorded patient axillary temperature in the peri-operative period, up to 24 h post-operatively, and analysed the effect on transfusion rate and blood loss from a consecutive cohort of 101 patients undergoing primary TKA. RESULTS: No relationship between peri-operative patient temperature and blood loss was found within the recorded patient temperature range of 34.7–37.8 °C. Multivariable analysis found increasing age, surgical technique, type of anaesthesia and the use of anti-platelet and anticoagulant medications as significant factors affecting blood loss following TKA. CONCLUSION: Patient temperature within a clinically observed range does not have a significant impact on blood loss in primary TKA patients. As long as patient temperature is maintained within a reasonable range during the intra-operative and post-operative periods, strategies other than rigid temperature control above 36.5 °C may be more effective in reducing blood loss following TKA

Interstitial inflammation and fibrosis in rats with diet-induced hypercholesterolemia

Interstitial inflammation and fibrosis in rats with diet-induced hypercholesterolemia. Abnormalities in lipid metabolism appear to play a pathogenic role in progressive renal disease. To elucidate the cellular and molecular basis of renal interstitial fibrosis in uninephrectomized rats with diet-induced hypercholesterolemia, we fed experimental rats with standard rat chow supplemented with 4% cholesterol and 1% cholic acid. Control rats were fed an isocaloric diet. Groups of 7 control and 7 experimental rats were killed after 4, 8, and 12 weeks. Hypercholesterolemic rats developed albuminuria; serum creatinine was elevated at 12 weeks. By 12 weeks numerous oil red O-positive cells were present throughout the interstitium and to a lesser extent in tubules. Total renal lipid-peroxidation products were significantly increased (172 ± 15, 198 ± 28, and 197 ± 13mmol malondialdehyde/kidney at 4, 8, and 12 weeks vs. 123 ± 17, 144 ± 6, and 125 ± 10mmol in controls). Immunostaining revealed oxidatively modified lipoproteins within tubular and interstitial cells. The interstitial disease was characterized by an interstitial infiltrate of monocytes. Significant increases were detected in renal cortical mRNA levels for monocyte chemoattractant protein-1 (MCP-1), osteopontin, and vascular cell adhesion molecule-1 (VCAM-1), associated with changes in the pattern of immunostaining for each encoded proteins. Total kidney collagen was significantly increased at 12 weeks (9.8 ± 0.9mg/kidney vs. 7.8 ± 0.9mg in controls). At 12 weeks there was a significant increase in interstitial immunostaining for collagen I, collagen III, collagen IV, fibronectin and tenascin. A significant threefold increase in renal cortical mRNA levels for transforming growth factor beta-1 (TGF-β1) at 4 and 12 weeks was associated with the appearance of TGF-β1-positive interstitial cells. Renal matrix protein mRNA levels were measured at 4, 8, and 12 weeks. The only statistically significant elevations were procollagen α1(I) and procollagen α1(III) at weeks 8 and 12. In contrast, renal cortical mRNA levels for the tissue inhibitor of metalloproteinases-1 (TIMP-1) were significantly increased at 4, 8 and 12 weeks (1.4 ± 0.5, 2.7 ± 0.9 and 2.7 ± 1.4 arbitrary densitometric units, respectively, vs. 1.0 ± 0.4, 1.0 ± 0.5 and 1.0 ± 0.4 units for controls), and urokinase-type plasminogen activator (μPA) mRNA levels were significantly decreased at 4, 8, and 12 weeks (0.4 ± 0.1 arbitrary densitometric units for all three experimental groups vs. 1.0 ± 0.4, 1.0 ± 0.3, and 1.0 ± 0.4 units for the control groups). In summary, rats with diet-induced hypercholesterolemia develop renal interstitial fibrosis over several weeks. Following the accumulation of lipids within tubulointerstitial cells, interstitial nephritis develops. The fibrotic phase is characterized by modest changes in matrix protein mRNA levels, up-regulated TIMP-1, and down-regulated μPA levels, suggesting that altered matrix degradation plays a role in the interstitial fibrogenesis in this model

Neuronal Transcriptome from C9orf72 Repeat Expanded Human Tissue is Associated with Loss of C9orf72 Function

A hexanucleotide G4C2 repeat expansion in C9orf72 is the most common genetic cause of familial and sporadic cases of amyotrophic lateral sclerosis (ALS) and frontotemporal degeneration (FTD). The mutation is associated with a reduction of C9orf72 protein and accumulation of toxic RNA and dipeptide repeat aggregates. The accumulation of toxic RNA has been proposed to sequester RNA binding proteins thereby altering RNA processing, consistent with previous transcriptome studies that have shown that the C9orf72 repeat expansion is linked to abundant splicing alterations and transcriptome changes. Here, we used a subcellular fractionation method and FACS to enrich for neuronal nuclei from C9orf72 repeat expanded post-mortem human ALS/FTD brains, and to remove neuronal nuclei with TDP-43 pathology which are observed in nearly all symptomatic C9orf72 repeat expanded cases. We show that the C9orf72 expansion is associated with relatively mild gene expression changes. Dysregulated genes were enriched for vesicle transport pathways, which is consistent with the known functions of C9orf72 protein. Further analysis suggests that the C9orf72 transcriptome is not driven by toxic RNA but is rather shaped by the depletion of pathologic TDP-43 nuclei and the loss of C9orf72 expression. These findings argue against RNA binding protein sequestration in neurons as a major contributor to C9orf72 mediated toxicity

The Induction of Meningeal Inflammation by Components of the Pneumococcal Cell Wall

Pneumococcal cell wall induces meningeal inflammation in rabbits injected intracisternally with >105 cell equivalents. Both of the major cell wall components, teichoic acid and peptidoglycan, contribute to this inflammatory activity although responses differ depending on the chemical nature, size, and complexity of these fractions. Challenge with teichoic acid (membrane or wall associated) results in greater inflammation at 5 hr than at 24 hr. Degraded teichoic acid is inactive. In contrast, the inflammation caused by whole cell wall or high-molecular-weight peptidoglycan-containing fractions increases in intensity from 5 to 24 hr. Peptidoglycan fractions lose activity at 24 hr when hydrolyzed to disaccharide-stem peptide moieties. Generation of free cell wall components in cerebrospinal fluid as, for example, during treatment with antibiotics that are bacteriolytic as well as bactericidal, could contribute to increased inflammation in the subarachnoid spac

Carbapenem-Resistant Klebsiella pneumoniae Infection in Three New York City Hospitals Trended Downwards From 2006 to 2014

Background. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a rising public health threat since its first outbreaks in New York City (NYC) in the early 2000s. We investigated annual trends of CRKP infection in hospital-acquired infections (HAIs) and community-onset infections (COIs) treated in 3 NYC hospitals from 2006 to 2014. Methods. We extracted K pneumoniae infection data including carbapenem susceptibility and anatomical sites, compared clinical characteristics between CRKP and carbapenem-susceptible K pneumoniae infections, and determined CRKP infection proportions in total K pneumoniae infections in HAI and COI to identify statistically significant trends from 2006 to 2014 using the Cochran-Armitage trend test. Results. Carbapenem-resistant K pneumoniae contributed 17.3% (601 of 3477) of hospital-acquired K pneumoniae infection compared with 7.7% (149 of 1926) in COI from 2006 to 2014. Carbapenem-resistant K pneumoniae proportions in HAI and COI were positively correlated over time (r = 0.83, P < .01), and there were downward annual trends of CRKP proportions from 2006 to 2014 in both HAI and COI (25.8% to 10.5% in HAI, P < .001; 13.6% to 3.1% in COI, P < .001). By anatomical site, significant downward annual trends were present only in urinary tract infection (P < .001 for both HAI and COI) from 2006 to 2014. Conclusions. Annual trends of CRKP proportions from 2006 to 2014 were downward in both HAI and COI, and HAI and COI were positively correlated. Efforts to reduce and prevent CRKP infections in both hospital and community settings were successful and warrant continuation

Predicting the Quality of Revisions in Argumentative Writing

The ability to revise in response to feedback is critical to students' writing success. In the case of argument writing in specific, identifying whether an argument revision (AR) is successful or not is a complex problem because AR quality is dependent on the overall content of an argument. For example, adding the same evidence sentence could strengthen or weaken existing claims in different argument contexts (ACs). To address this issue we developed Chain-of-Thought prompts to facilitate ChatGPT-generated ACs for AR quality predictions. The experiments on two corpora, our annotated elementary essays and existing college essays benchmark, demonstrate the superiority of the proposed ACs over baselines.Comment: In The 18th BEA Workshop, held in conjunction with The Association for Computational Linguistics (ACL), July 202