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

The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles

2017-2018 > Academic research: refereed > Publication in refereed journal201805 bcrcVersion of RecordSelf-fundedPublishe

Data Analytic Framework on Student Participation in Generic Competence Development Activities

202210 bcchAuthor’s OriginalOthersUGC/FDS24/E09/20Publishe

Single-cell transcriptomics reveal that PD-1 mediates immune tolerance by regulating proliferation of regulatory T cells

We have previously reported an antigen-specific protocol to induce transplant tolerance and linked suppression to human embryonic stem cell (hESC)-derived tissues in immunocompetent mice through coreceptor and costimulation blockade. However, the exact mechanisms of acquired immune tolerance in this model have remained unclear.We utilize the NOD.Foxp3hCD2 reporter mouse line and an ablative anti-hCD2 antibody to ask if CD4+FOXP3+ regulatory T cells (Treg) are required for coreceptor and costimulation blockade-induced immune tolerance. We also perform genome-wide single-cell RNA-sequencing to interrogate Treg during immune rejection and tolerance and to indicate possible mechanisms involved in sustaining Treg function.We show that Treg are indispensable for tolerance induced by coreceptor and costimulation blockade as depletion of which with an anti-hCD2 antibody resulted in rejection of hESC-derived pancreatic islets in NOD.Foxp3hCD2 mice. Single-cell transcriptomic profiling of 12,964 intragraft CD4+ T cells derived from rejecting and tolerated grafts reveals that Treg are heterogeneous and functionally distinct in the two outcomes of transplant rejection and tolerance. Treg appear to mainly promote chemotactic and ubiquitin-dependent protein catabolism during transplant rejection while seeming to harness proliferative and immunosuppressive function during tolerance. We also demonstrate that this form of acquired transplant tolerance is associated with increased proliferation and PD-1 expression by Treg. Blocking PD-1 signaling with a neutralizing anti-PD-1 antibody leads to reduced Treg proliferation and graft rejection.Our results suggest that short-term coreceptor and costimulation blockade mediates immune tolerance to hESC-derived pancreatic islets by promoting Treg proliferation through engagement of PD-1. Our findings could give new insights into clinical development of hESC-derived pancreatic tissues, combined with immunotherapies that expand intragraft Treg, as a potentially sustainable alternative treatment for T1D

A recursive operations strategy model for managing sustainable chemical product development and production

Sustainable consumption and production is a critical issue in the chemical industry due to increasing public concerns on environmental and safety issues. Organizations are urged to improve the quality of chemical products while minimizing the environmental impacts during production. In current practice, chemists and formulators have to determine both the ingredients to be used and the machine parameter settings during product development and production. Without appropriate operations strategies for managing sustainable consumption and production, a significant portion of the ingredients, toxic materials and pollutants are wasted or emitted during the trial-and-error processes when developing chemical products. In addition, inappropriate machine parameter settings, such as blending speed and blending temperature, result in inefficient energy use. Motivated by these issues, this paper describes a recursive operations strategy (ROS) model for achieving sustainable consumption and production in the chemical industry. The ROS model first identifies the business strategy, and then defines operations strategies by assessing the competitive priorities and policies with the use of artificial intelligence, including case-based reasoning and fuzzy logic, so as to manage the operations functions. The effectiveness of the model is verified by means of a case study. The results indicate that the model can provide direct guidelines for the users to develop products based on previously developed products. By so doing, the number of trials for testing various ingredient formulae can be reduced, minimizing the ingredient waste. The proposed model is also capable of achieving continuous improvement and determining the optimal production process conditions for avoiding unnecessary energy consumption.Department of Industrial and Systems Engineerin

Cerebral grey, white matter and csf in never-medicated, first-episode schizophrenia

We report the first voxel-based morphometric (VBM) study to examine cerebral grey and white matter and cerebrospinal fluid (CSF) using computational morphometry in never-medicated, first-episode psychosis (FEP). Region-of-interest (ROI) analysis was also performed blind to group membership. 26 never-medicated individuals with FEP (23 with DSM-IV schizophrenia) and 38 healthy controls had MRI brain scans. Groups were balanced for age, sex, handedness, ethnicity, paternal socio-economic status, and height. Healthy controls were recruited from the local community by advertisement. Grey matter, white matter, and CSF: global brain volume ratios were significantly smaller in patients. Patients had significantly less grey matter volume in L and R caudate nuclei, cingulate gyri, parahippocampal gyri, superior temporal gyri, cerebellum and R thalamus, prefrontal cortex. They also had significantly less white matter volume in the R anterior limb of the internal capsule fronto-occipital fasciculus and L and R fornices, and significantly greater CSF volume especially in the R lateral ventricle. Excluding the 3 subjects with brief psychotic disorder did not alter our results. Our data suggest that fronto-temporal and subcortical-limbic circuits are morphologically abnormal in never-medicated, schizophrenia. ROI analysis comparing the schizophrenia group (n = 23) with the healthy controls (n = 38) confirmed caudate volumes were significantly smaller bilaterally by 11%, and lateral ventricular volume was significantly larger on the right by 26% in the patients. Caudate nuclei and lateral ventricular volume measurements were uncorrelated (Pearson correlation coefficient 0.30, p = 0.10), ruling out the possibility of segmentation artefact. Ratio of lateral ventricle to caudate volume was bilaterally significantly increased (p < 0.005, 2-tailed), which could represent an early biomarker in first-episode, never-medicated schizophrenia. © 2006 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex

Early cerebral grey matter excess in basal ganglia after early treatment in first-onset, never-medicated schisophrenia

Introduction: In the early weeks following neuroleptic treatment, patients never previously been exposed to antipsychotic medication and presenting with first-episode of schizophrenia may already demonstrate brain volumetric differences. Method: We used a comprehensive computational morphometry analysis of the brain. 38 individuals with first-episode psychosis were balanced for age, sex, handedness, ethnicity, height, education in years, paternal socio-economic status and PANSS score. They were a consecutive series presenting to their local hospital for treatment. BAMM (Brain activation and morphological mapping) software was used to measure grey matter, white matter and CSF volumes. 12 were treated with neuroleptics (NT) and 26 were neuroleptic-naìve (NN). The NT group had been scanned in the earlier stage of the project as a pilot group and did not differ in MRI scanning parameters. Groups did not differ in age, sex, socioeconomic class, handedness, ethnicity. In the NT group, significant clusters of volume excess in grey matter was detected bilaterally in the caudate, putamen, cingulate, cerebellum, and brainstem after around 18 days of neuroleptic treatment. Region-of-interest measurement of the caudate using T1 scans, 1.2mm, contiguous, 128 slices was done by a single operator blind to group membership. Results: It showed caudate volume significantly larger by 16% (on the left, p 0.012, 2 tailed) and 13% (on the right, p 0.028, 2 tailed) in the NT group. Conclusion: This is the first study to demonstrate that basal ganglia and extrastriatal grey matter excess is likely to occur early on within three weeks of initiating neuroleptic treatment

Early psychosis services for rural, remote and coastal communities in Australia

BACKGROUND: An effective means of reducing disability from psychotic disorders is the provision of early detection and intervention targeted at the prodromal phase. Current research and clinical programs for early psychosis (EP) have failed to encapsulate the specific needs of rural and remote communities (RARC) such as limited availability of mental health providers and long distances to travel for care (Fox et al, 1995). This study investigated access to care and service delivery for rural youths experiencing EP. METHODS: Routine clinical mental health service data were analysed for 10–25 year old patients across three rural regions of New South Wales. A large data set (N=1562) for the Central West (CW) rural region was compared to smaller data sets for the Far West (FW) remote and the North Coast (NC) coastal regions. Demographic, clinical and service features were analysed against characteristics specific to RARC. Clinical measures included the HoNOSCA, HoNOS and SDQ. RESULTS: EP patients in the CW represented 10.4% of patients accessing mental health services, but utilised services twice as often as non EP patients and absorbed 37.6% of inpatient service encounters. While the median distance to access service for CW EP patients was 88km, an absence of inpatient services for FW resulted in FW EP patients travelling as far as 895km for hospitalisation. CONCLUSIONS: The results emphasise the importance of developing specific EP services to address the diversity across RARC. The lack of appropriate and timely treatment for rural youths is likely to increase the impairment associated with EP