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

Time to Change What to Sow: Risk Preferences and Technology Adoption Decisions of Cotton Farmers in China

The slow diffusion of new technology in the agricultural sector of developing countries has long puzzled development economists. While most of the current empirical research on technology adoption focuses on credit constraints and learning spillovers, this paper examines the role of individual risk attitudes in the decision to adopt a new form of agricultural biotechnology in China. I conducted a survey and a field experiment to elicit the risk preferences of 320 Chinese farmers, who faced the decision of whether to adopt genetically modified Bt cotton a decade ago. Bt cotton is more effective in pest prevention and thus requires less pesticides than traditional cotton. In my analysis, I expand the measurement of risk preferences beyond expected utility theory to incorporate prospect theory parameters such as loss aversion and nonlinear probability weighting. Using the parameters elicited from the experiment, I find that farmers who are more risk averse or more loss averse adopt Bt cotton later. Farmers who overweight small probabilities adopt Bt cotton earlier.Technology Adoption, Risk Preferences, Prospect Theory

Community empowerment through integration of service, learning, and research : City-Youth Empowerment Project

City-Youth Empowerment Project (CYEP) was established in 2005 as a non-credit bearing service-learning project open to all students at the City University of Hong Kong, with a mission to mobilize students to serve the underprivileged, to enhance civic and global social commitment, and to integrate community practice-oriented knowledge to the academic field. With over 30 community organization partnerships, CYEP provides ongoing services for underprivileged children and youth affected by poverty, new arrivals status, minor crime, and disabilities; as well as hidden elderly, mental health consumers, while actively involved in environmental protection and disability rights. As part of the transformative pedagogical experience, students actively participate in the research process that represents a rich “transaction” with living veins of social and academic exchanges. Research goals are focused on effective convergent outcomes of the students, communities, and academic institution; grounded in cross-cultural perspectives. 1) The definitional model study seeks the understanding of a working definition of volunteerism and its operational boundaries for practice implications. 2) The investigating of implicit motivations in volunteerism has yet to be explored. In partnership with the University of Tilburg, the mixed-method study of motivational systems focuses on how the interaction of the implicit and explicit motivations can affect the volunteers’ experience and outcomes. Previous research has pointed to the significance of organizational support as integral to generate optimal volunteer outcomes. Segued from the study on motivational systems, CYEP studies the impact of organizational support in the form of motivation-service matching & supervision and group matching on volunteers’ satisfaction, commitment, and performance - giving helpful insight into effective volunteer management strategies. 3) Based on the operational principle that young adults will be particularly responsive to working with children and youth as they can capitalize on the “well of coping reserve” from their own experience, it can also be a correctional experience and reconstruction of the volunteers’ negative childhood narrative. Integrating aspects of attachment theories, holding environment, and other psychodynamic elements- qualitative studies conducted are focused on the impact of children and youth work on the development of young adults

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

Molecular Analysis Of Amyotrophic Lateral Sclerosis And Frontotemporal Degeneration Brain Tissue Identifies Disease Mechanisms Associated With Repetitive Dna Elements

Aging-related neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS) and frontotemporal degeneration (FTD) are two fatal progressive neurodegenerative diseases that carry genetic and pathologic overlap: a hexanucleotide G4C2 repeat expansion in C9orf72 and loss of a nuclear RNA binding protein, TAR DNA binding protein-43 (TDP-43), into cytoplasmic aggregates. The C9orf72 expansion is the most common genetic cause of ALS/FTD and is associated with reduced C9orf72 expression and accumulation of toxic RNA and protein aggregates. In Chapter 2 of my thesis, using molecular analyses from human post-mortem ALS/FTD brain, I show that the C9orf72 promoter is hypermethylated within a subset of expansion carriers. C9orf72 promoter hypermethylation is associated with reduced C9orf72 pathology and may be protective in these patients. Another key feature in ALS/FTD is the characteristic pathology of nuclear TDP-43 loss in degenerating neurons. TDP-43 is a ubiquitous nuclear RNA binding protein and is heavily involved in RNA processing. TDP-43 has been shown to bind genic elements and repetitive transposable elements such as long interspersed nuclear elements (LINE). Considering that TDP-43 is a ubiquitous RNA binding protein, I hypothesize that nuclear TDP-43 loss can lead to large transcriptomic changes and may contribute to alterations in LINE elements. For Chapters 3 and 4 of my thesis, I use a novel method of subcellular fractionation and fluorescent activated cell sorting (FACS) from post-mortem ALS/FTD human brain to perform high-throughput sequencing analyses to study neuronal molecular changes. In Chapter 3 of my thesis, I use FACS coupled with RNA-seq on neuronal nuclei with and without TDP-43 to show that loss of nuclear TDP-43 is associated with large transcriptome changes and increased LINE accessibility. Furthermore, loss of nuclear TDP-43 leads to increased retrotransposition. I also extend this subcellular fractionation-FACS method to study the effects of the C9orf72 expansion in neuronal nuclei. In Chapter 4, I demonstrate that the C9orf72 expansion is linked to mild gene expression changes that reflect C9orf72 protein loss and not gain of toxic C9orf72 RNA. Through my work, I have shown disease mechanisms linked to repetitive DNA elements, in that I propose (1) the C9orf72 repeat expansion may contribute to disease primarily via a gain of toxic C9orf72 pathology (2) loss of neuronal nuclear TDP-43 may be associated with increase retrotransposon activity which may contribute to disease. Overall, my work has broadened the field of neurodegeneration in my implementation of cell-type specific molecular analyses on post-mortem brain of ALS/FTD patients to identify disease mechanisms with the intent of discovering new therapeutics and biomarkers that can be extended into the clinic

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