Methemoglobinemia: An unusual cause of postoperative cyanosis

AbstractMethemoglobinemia, although rare, must be considered in surgical patients presenting with acute respiratory distress and cyanosis. We report two cases of methemoglobinemia in patients undergoing aortic reconstruction. The first patient developed methemoglobinemia while on a nitroglycerin infusion, and the second after receiving benzocaine spray before intubation. Both patients were treated with methylene blue and ascorbic acid, with resolution of their hypoxia and cyanosis. The pathophysiology, etiology, diagnosis, and treatment of methemoglobinemia are reviewed

Using analytic morphomics to describe body composition associated with post‐kidney transplantation diabetes mellitus

BackgroundBetter risk assessment tools are needed to predict post‐transplantation diabetes mellitus (PTDM). Using analytic morphomic measurements from computed tomography (CT) scans, we aimed to identify specific measures of body composition associated with PTDM.MethodsWe retrospectively reviewed 99 non‐diabetic kidney transplant recipients who received pre‐transplant CT scans at a single institution between 1/2005 and 5/2014. Analytic morphomic techniques were used to measure abdominal adiposity, abdominal size, and psoas muscle area and density, standardized by gender. We measured the associations of these morphomic factors with PTDM.ResultsOne‐year incidence of PTDM was 18%. The morphomic factors significantly associated with PTDM included visceral fat area (OR=1.84 per standard deviation increase, P=.020), body depth (OR=1.79, P=.035), and total body area (OR=1.67, P=.049). Clinical factors significantly associated with PTDM included African American race (OR=3.01, P=.044), hypertension (OR=2.97, P=.041), and dialysis vintage (OR=1.24 per year on dialysis, P=.048). Body mass index was not associated with PTDM (OR=1.05, P=.188). On multivariate modeling, visceral fat area was an independent predictor of PTDM (OR=1.91, P=.035).ConclusionsAnalytic morphomics can identify pre‐transplant measurements of body composition that are predictive of PTDM in kidney transplant recipients. Pre‐transplant imaging contains a wealth of underutilized data that may inform PTDM prevention strategies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138207/1/ctr13040.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138207/2/ctr13040_am.pd

The impact of intraoperative fluid management during laparoscopic donor nephrectomy on donor and recipient outcomes

BackgroundIntraoperative fluid management during laparoscopic donor nephrectomy (LDN) may have a significant effect on donor and recipient outcomes. We sought to quantify variability in fluid management and investigate its impact on donor and recipient outcomes.MethodsA retrospective review of patients who underwent LDN from July 2011 to January 2016 with paired kidney recipients at a single center was performed. Patients were divided into tertiles of intraoperative fluid management (standard, high, and aggressive). Donor and recipient demographics, intraoperative data, and postoperative outcomes were analyzed.ResultsOverall, 413 paired kidney donors and recipients were identified. Intraoperative fluid management (mL/h) was highly variable with no correlation to donor weight (kg) (R = 0.017). The aggressive fluid management group had significantly lower recipient creatinine levels on postoperative day 1. However, no significant differences were noted in creatinine levels out to 6 months between groups. No significant differences were noted in recipient postoperative complications, graft loss, and death. There was a significant increase (P < 0.01) in the number of total donor complications in the aggressive fluid management group.ConclusionsAggressive fluid management during LDN does not improve recipient outcomes and may worsen donor outcomes compared to standard fluid management.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149691/1/ctr13542_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149691/2/ctr13542.pd

Impact of functional status on outcomes of simultaneous pancreas-kidney transplantation: Risks and opportunities for patient benefit

Background. The impact of functional status on survival among simultaneous pancreas-kidney transplant (SPKT) candidates and recipients is not well described. Methods. We examined national Scientific Registry of Transplant Recipients (SRTR) data for patients listed for SPKT in the United States (2006-2019). Functional status was categorized by center-reported Karnofsky Performance Score (KPS). We used Cox regression to quantify associations of KPS at listing and transplant with subsequent patient survival, adjusted for baseline patient and transplant factors (adjusted hazard ratio,(95% LCL)aHR(95%UCL)). We also explored time-dependent associations of SPKT with survival risk after listing compared with continued waiting in each functional status group. Results. KPS distributions among candidates (N = 16 822) and recipients (N = 10 316), respectively, were normal (KPS 80-100), 62.0% and 57.8%; capable of self-care (KPS 70), 23.5% and 24.7%; requires assistance (KPS 50-60), 12.4% and 14.2%; and disabled (KPS 10-40), 2.1% and 3.3%. There was a graded increase in mortality after listing and after transplant with lower functional levels. Compared with normal functioning, mortality after SPKT rose progressively for patients capable of self-care (aHR,(1.00)1.18(1.41)), requiring assistance (aHR,(1.06)1.31(1.60)), and disabled (aHR,(1.10)1.55(2.19)). In time-dependent regression, compared with waiting, SPKT was associated with 2-fold mortality risk within 30 days of transplant. However, beyond 30 days, SPKT was associated with reduced mortality, from 52% for disabled patients (aHR,(0.26)0.48(0.88)) to 70% for patients with normal functioning (aHR,(0.26)0.30(0.34)). Conclusions. While lower functional status is associated with increased mortality risk among SPKT candidates and recipients, SPKT can provide long-term survival benefit across functional status levels in those selected for transplant

Organizational linkages for new product development: Implementation of innovation projects

Effective external and internal organization linkage characterizes new product development. Although prior research covers the external linkages to gain operational efficiencies and develop new products, the current body of scholarship on internal cross-functional linkages requires further attention. This study provides a certain level of inquiry into the antecedents of such internal linkages and presents a framework to establish the relationship between two internal functions at major fast-moving consumer goods (FMCG). The study examines the implementation of 150 innovation projects in 6 different countries over a period of three years. The objective is to study the influence of trust dimension on the perceived effectiveness of cross-functional linkage to highlight how organizational mechanisms like the amount and quality of shared communication affect trust and relationship between two functions

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe