Serological evidence of cross infection in a dialysis unit hepatitis-B epidemic

Serological evidence of cross infection in a dialysis unit hepatitis-B epidemic. This study provides serological as well as epidemiological evidence that a dialysis unit hepatitis-B epidemic was spread by cross contamination. There were 74 patients and staff who developed HB-Ag-positive hepatitis during a 28-month hospital surveillance period. Twenty-six of these cases were intimately related to the dialysis unit (21 dialysis/transplant patients and five hospital staff) and 58 were not. Representative sera from each group of cases were further tested for HB-Ag subtype specificity. Thirteen of 14 dialysis/transplant patients had subtype ay whereas ten of 15 general hospital patients had the alternate phenotype ad. All four staff who had probably acquired their infection from dialysis/transplant patients were ay subtype. Eight of the dialysis/transplant patients had never received blood. Transfusion rate in the infected dialysis patients was one-third that of leukemic patients but the hepatitis rate was higher.Preuve sérologique d'une contamination croisée dans une unité de dialyse par le virus B de l'hépatite. Ce travail apporte les preuves sérologiques et épidémiologiques de la contamination croisée d'une unité d'hémodialyse par le virus B de l'hépatite. Soixante-quatorze malades et membres de l'équipe ont développé une hépatite HB-Ag positive dans les 28 mois de la surveillance de l'hôpital. Vingt-six de ces cas ont été liés étroitement à la dialyse (21 malades de dialyse ou transplantation et 5 membres de l'équipe) et 58 ne l'étaient pas. Dans chaque groupe de cas le sérum a été étudié pour identifier les phénotypes de HB-Ag. Treize des 14 malades de dialyse ou transplantation avaient le phénotype ay alors que 10 parmi 15 des malades de l'hôpital général avaient l'autre phénotype ad. Les quatre membres de l'équipe qui avaient probablement contracté leur infection à partir de malades de transplantation ou de dialyse avaient le phénotype ay. Huit des malades de dialyse ou de transplantation n'avaient jamais reçu de sang. Le débit transfusions chez les malades en dialyse atteints par l'hépatite était le tiers de celui des malades leucémiques mais l'incidence de l'hépatite a été plus grande chez les premiers

Cardiac outcomes 12 months post percutaneous coronary intervention

Cardiovascular disease (CVD) has over the last decade emerged as the single most important cause for death worldwide [1]. Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). Despite advancement in surgical technology, PCI is associated with a range of post-procedural complications, including physical [2] and psychological morbidity [3]. Research findings are inconclusive as to the impact of PCI on quality of life post-procedure. There also appears to be no studies that have examined the notion of personal resilience in this group of patients. The aim of this longitudinal prognostic study was to evaluate cardiac outcomes including - health related quality of life (HRQoL), personal resilience, mental health and adherence behaviours in patients who have had undergone a PCI measured at two time points (6 months and 12 months) post-intervention

An Australian longitudinal pilot study examining health determinants of cardiac outcomes 12 months post percutaneous coronary intervention

Background Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure. Methods A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated. Results All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p < 0.001); and the physical component score of the SF-12 instrument (r = -0.437; p = 0.054). Conclusions Men were performing better than women in the 6 months post-PCI, particularly in the areas of mood (depression) and physical health. This pilot results indicate gender-sensitive practices are recommended particularly up to 6 months post-PCI. Any gender differences observed at 6 month appear to disappear at 12 months post-PCI. Further research into the management of mood particularly for women post-PCI is warranted. A more detailed inquiry related to access/attendance to secondary prevention is also warranted

Controlled comparison of hemodialysis and peritoneal dialysis: Veterans Administration multicenter study

Controlled comparison of hemodialysis and peritoneal dialysis: Veterans Administration multicenter study. We measured mortality and morbidity among 114 patients assigned randomly to home hemodialysis (HD) and home intermittent peritoneal dialysis (IPD). Data were collected during the time of home training and for 12 months after initiation of home dialysis. Training time was shorter for the IPD than for the HD patients (P < 0.001) with median time 1.8 months for IPD and 3.9 months for HD. Switching to the alternative mode of treatment was more frequent for the IPD group (29/59 vs. 5/55, P < 0.001). Survival time was not different, perhaps because of the modality change. More IPD patients were hospitalized in the first 6 months (20 for IPD vs. 9 for HD, P = 0.02), but they had fewer troublesome cardiovascular events in the first year (0 vs. 12, P < 0.001). The HD patients maintained better nutritional status as reflected in body weight and arm muscle circumference and possibly in urea appearance rate. Thus, these data suggest that for most patients, IPD is a less satisfactory form of therapy than HD, but certain advantages of IPD did emerge. Applications of this information to the currently more popular mode of CAPD await further study.Comparaison contrôlée entre l'hémodialyse et la dialyse péritonéale: Étude multicentrique de l'Administration des Veterans. Nous avons mesuré la mortalité et la morbidité chez 114 malades, pris au hasard, en hémodialyse à domicile (HD) ou en dialyse péritonéale intermittente à domicile (IPD). Les données ont été recueillies pendant l'entrainement à domicile et pendant les 12 mois suivant le début de la dialyse à domicile. La durée d'entrainement était plus brève pour les malades en IPD que pour ceux en HD (P < 0,001), avec un temps médian de 1,8 mois pour l'IPD et de 3,9 mois pour l'HD. Le changement pour l'autre mode de traitement était plus fréquent pour le groupe IPD (29/59 contre 5/55, P < 0,001). La durée de suivi n'était pas différente, peut-être à cause du changement de modalité. Plus de malades en IPD ont été hospitalisés dans les 6 premiers mois (20 en IPD, contre 9 en HD, P = 0,02), mais ils ont eu moins d'ennuis cardiovasculaires gênants au cours de la première année (0 contre 12, P < 0,001). Les malades HD conservaient un meilleur état nutritionnel, reflété par le poids corporel, la circonférence musculaire du bras, et probablement la vitesse d'apparition de l'urée. Ainsi ces données suggèrent que pour la plupart des malades, l'IPD est une forme de traitement moins satisfaisante que l'HD, mais certains avantages de l'IPD sont apparus. Les applications de cette information au mode actuellement le plus répandu de CAPD requièrent d'autres études

Rokhlin Dimension for Flows

This research was supported by GIF Grant 1137/2011, SFB 878 Groups, Geometry and Actions and ERC Grant No. 267079. Part of the research was conducted at the Fields institute during the 2014 thematic program on abstract harmonic analysis, Banach and operator algebras, and at the Mittag–Leffler institute during the 2016 program on Classification of Operator Algebras: Complexity, Rigidity, and Dynamics.Peer reviewedPostprin

Establishing a core outcome set for peritoneal dialysis : report of the SONG-PD (standardized outcomes in nephrology-peritoneal dialysis) consensus workshop

Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities of all stakeholders. We convened an international SONG-PD stakeholder consensus workshop in May 2018 in Vancouver, Canada. Nineteen patients/caregivers and 51 health professionals attended. Participants discussed core outcome domains and implementation in trials in PD. Four themes relating to the formation of core outcome domains were identified: life participation as a main goal of PD, impact of fatigue, empowerment for preparation and planning, and separation of contributing factors from core factors. Considerations for implementation were identified: standardizing patient-reported outcomes, requiring a validated and feasible measure, simplicity of binary outcomes, responsiveness to interventions, and using positive terminology. All stakeholders supported inclusion of PD-related infection, cardiovascular disease, mortality, technique survival, and life participation as the core outcome domains for PD

Long-Term Locoregional Vascular Morbidity After Isolated Limb Perfusion and External-Beam Radiotherapy for Soft Tissue Sarcoma of the Extremity

Background: Isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNF-alpha) and melphalan, followed by delayed surgical resection and adjuvant external-beam radiotherapy is a limb salvage treatment strategy for locally advanced soft tissue sarcomas. The long-term vascular side effects of this combined procedure were evaluated. Methods: Thirty-two patients were treated for a locally advanced sarcoma of the upper (n = 5) or lower limb (n = 27). All patients underwent a noninvasive vascular work-up. Results: Five patients underwent a leg amputation, in two cases due to critical leg ischemia 10 years after ILP. With a median follow-up of 88 (range, 17-159) months, none of the patients with a salvaged lower leg (n = 22) experienced peripheral arterial occlusive disease. Ankle-brachial index (ABI) measurements in the involved leg (median, 1.02; range, .50-1.20) showed a significant decrease compared with the contralateral leg (median, 1.09; range, .91-1.36, P = .001). Pulsatility index (PI) was decreased in the treated leg in 17 of 22 patients at the femoral level (median, 6.30; range, 2.1-23.9 vs. median, 7.35; range, 4.8-21.9; P = .011) and in 19 of 20 patients at popliteal level (median, 8.35; range, 0-21.4 vs. median, 10.95; range, 8.0-32.6; P <.0005). In patients with follow-up of > 5 years, there was more often a decrease in ABI (P = .024) and PI at femoral level (P = .011). Conclusions: ILP followed by resection and external-beam radiotherapy can lead to major late vascular morbidity that requires amputation. Objective measurements show a time-related decrease of ABI and femoral PI in the treated extremity

Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop.

There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes

Fetal Demise and Failed Antibody Therapy During Zika Virus Infection of Pregnant Macaques

Zika virus (ZIKV) infection of pregnant women is associated with pathologic complications of fetal development. Here, we infect pregnant rhesus macaques (Macaca mulatta) with a minimally passaged ZIKV isolate from Rio de Janeiro, where a high rate of fetal development complications was observed. The infection of pregnant macaques with this virus results in maternal viremia, virus crossing into the amniotic fluid (AF), and in utero fetal deaths. We also treated three additional ZIKV-infected pregnant macaques with a cocktail of ZIKV-neutralizing human monoclonal antibodies (nmAbs) at peak viremia. While the nmAbs can be effective in clearing the virus from the maternal sera of treated monkeys, it is not sufficient to clear ZIKV from AF. Our report suggests that ZIKV from Brazil causes fetal demise in non-human primates (NHPs) without additional mutations or confounding co-factors. Treatment with a neutralizing anti-ZIKV nmAb cocktail is insufficient to fully stop vertical transmission

Precision medicine driven by cancer systems biology

Molecular insights from genome and systems biology are influencing how cancer is diagnosed and treated. We critically evaluate big data challenges in precision medicine. The melanoma research community has identified distinct subtypes involving chronic sun-induced damage and the mitogen-activated protein kinase driver pathway. In addition, despite low mutation burden, non-genomic mitogen-activated protein kinase melanoma drivers are found in membrane receptors, metabolism, or epigenetic signaling with the ability to bypass central mitogen-activated protein kinase molecules and activating a similar program of mitogenic effectors. Mutation hotspots, structural modeling, UV signature, and genomic as well as non-genomic mechanisms of disease initiation and progression are taken into consideration to identify resistance mutations and novel drug targets. A comprehensive precision medicine profile of a malignant melanoma patient illustrates future rational drug targeting strategies. Network analysis emphasizes an important role of epigenetic and metabolic master regulators in oncogenesis. Co-occurrence of driver mutations in signaling, metabolic, and epigenetic factors highlights how cumulative alterations of our genomes and epigenomes progressively lead to uncontrolled cell proliferation. Precision insights have the ability to identify independent molecular pathways suitable for drug targeting. Synergistic treatment combinations of orthogonal modalities including immunotherapy, mitogen-activated protein kinase inhibitors, epigenetic inhibitors, and metabolic inhibitors have the potential to overcome immune evasion, side effects, and drug resistance