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

Colliding Worlds: Asteroid research and the legitimization of war in space

Accepted versio

Differential Expression of BARD1 Isoforms in Melanoma

Melanoma comprises &lt;5% of cutaneous malignancies, yet it causes a significant proportion of skin cancer-related deaths worldwide. While new therapies for melanoma have been developed, not all patients respond well. Thus, further research is required to better predict patient outcomes. Using long-range nanopore sequencing, RT-qPCR, and RNA sequencing analyses, we examined the transcription of BARD1 splice isoforms in melanoma cell lines and patient tissue samples. Seventy-six BARD1 mRNA variants were identified in total, with several previously characterised isoforms (γ, φ, δ, ε, and η) contributing to a large proportion of the expressed transcripts. In addition, we identified four novel splice events, namely, Δ(E3_E9), ▼(i8), IVS10+131▼46, and IVS10▼176, occurring in various combinations in multiple transcripts. We found that short-read RNA-Seq analyses were limited in their ability to predict isoforms containing multiple non-contiguous splicing events, as compared to long-range nanopore sequencing. These studies suggest that further investigations into the functional significance of the identified BARD1 splice variants in melanoma are warranted

Constraining timing of brittle deformation and fault gouge formation in the Sydney Basin

Structural and K–Ar dating studies of gouge in N–S, NNE and E–W-trending faults in four locations in the Sydney–Hunter region are reported. The fault zones are manifest as joint swarms and highly brecciated zones containing gouge with authigenic illite produced as a result of fluid infiltration. Strike-slip movement accompanied by minor dip-slip, normal movement occurred on the NNE faults, with dip slip on N–S and E–W-trending faults. In this study, gouge from a NE-trending, steep, SE-dipping fault showing dip-slip movement at Cut 10, on the Hunter Expressway and from an E–W-trending, steep south-dipping, normal fault at the Westside Open Cut, Lake Macquarie have been analysed. K–Ar dating of illite and illite–smectite in fractions extracted from fault gouges in areas unaffected by a thermal overprint reveals ages varying from 166 to 119 Ma for the <2 μm and finer fractions, and a mean age of ca 120 Ma for the <0.4 μm fraction. In the Sydney area and the Westside Open Cut coal mine, Lake Macquarie, the ages obtained from similar size fractions both for the gouge and for the host rocks are younger (134–76 Ma; av. <0.4 μm = 111 Ma). The data indicate influence of a thermal overprint associated with subsurface magmas emplaced during the early stages of the rifting of eastern Gondwana during the early Cretaceous

Voluntary control and the dynamics of perceptual bi-stability

van Ee R, van Dam L, Brouwer GJ. Voluntary control and the dynamics of perceptual bi-stability. VISION RESEARCH. 2005;45(1):41-55