Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia

Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period

siDirect 2.0: updated software for designing functional siRNA with reduced seed-dependent off-target effect

<p>Abstract</p> <p>Background</p> <p>RNA interference (RNAi), mediated by 21-nucleotide (nt)-length small interfering RNAs (siRNAs), is a powerful tool not only for studying gene function but also for therapeutic applications. RNAi, requiring perfect complementarity between the siRNA guide strand and the target mRNA, was believed to be extremely specific. However, a recent growing body of evidence has suggested that siRNA could down-regulate unintended genes whose transcripts possess complementarity to the 7-nt siRNA seed region. This off-target gene silencing may often provide incongruous results obtained from knockdown experiments, leading to misinterpretation. Thus, an efficient algorithm for designing functional siRNAs with minimal off-target effect based on the mechanistic features is considered of value.</p> <p>Results</p> <p>We present siDirect 2.0, an update of our web-based software siDirect, which provides functional and off-target minimized siRNA design for mammalian RNAi. The previous version of our software designed functional siRNAs by considering the relationship between siRNA sequence and RNAi activity, and provided them along with the enumeration of potential off-target gene candidates by using a fast and sensitive homology search algorithm. In the new version, the siRNA design algorithm is extensively updated to eliminate off-target effects by reflecting our recent finding that the capability of siRNA to induce off-target effect is highly correlated to the thermodynamic stability, or the melting temperature (Tm), of the seed-target duplex, which is formed between the nucleotides positioned at 2-8 from the 5' end of the siRNA guide strand and its target mRNA. Selection of siRNAs with lower seed-target duplex stabilities (benchmark Tm < 21.5°C) followed by the elimination of unrelated transcripts with nearly perfect match should minimize the off-target effects.</p> <p>Conclusion</p> <p>siDirect 2.0 provides functional, target-specific siRNA design with the updated algorithm which significantly reduces off-target silencing. When the candidate functional siRNAs could form seed-target duplexes with Tm values below 21.5°C, and their 19-nt regions spanning positions 2-20 of both strands have at least two mismatches to any other non-targeted transcripts, siDirect 2.0 can design at least one qualified siRNA for >94% of human mRNA sequences in RefSeq. siDirect 2.0 is available at <url>http://siDirect2.RNAi.jp/</url>.</p

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery:An Individual Patient Data Meta-Analysis

IMPORTANCE: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.OBJECTIVE: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.DATA SOURCES: MEDLINE, EMBASE, and CINAHL from inception to May 2020.STUDY SELECTION: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.DATA EXTRACTION AND SYNTHESIS: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.MAIN OUTCOMES AND MEASURES: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.RESULTS: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for &gt;85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index &lt;18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for &gt;10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.</p

New Cell Balancing Technique Using SIMO Two-Switch Flyback Converter with Multi Cells

Recently, as the perception of eco-friendliness has changed, the demand for energy storage devices has been rapidly increasing due to the growth of the electric vehicle industry and smart grid facilities, which are emerging as an alternative to next-generation electricity supply and demand. Therefore, the importance of battery management technology is growing, and various voltage balancing techniques between battery cells are being studied in order to maintain high efficiency and continuous performance of batteries. This paper proposes a voltage balancing topology using a single input-multiple output (SIMO) two-switch flyback converter in a series battery configuration to resolve voltage imbalance between batteries. The characteristic of the proposed topology is that each cell on the secondary side of the two-switch flyback converter is connected to one high-frequency transformer to share the magnetic flux, and voltage balancing is performed according to the switch operation of the converter. At this time, the accumulated excess energy of the converter is refluxed to the power supply side through the freewheeling diode and converted into reactive power. The verification of the usefulness of the theoretical analysis in this paper was based on the analysis of the dynamic characteristics and steady state of the circuit through PSIM and experiments, and was conducted for one module composed of four cells

Factors affecting outcomes after endovascular treatment for femoropopliteal atherosclerotic lesions

Summary: Background/Objective: : This study aimed to investigate the outcomes of femoropopliteal interventions in relation to various influencing factors. Methods: A retrospective review of 243 endovascular procedures for femoropopliteal atherosclerotic lesions on 243 limbs of 197 patients was performed. Results: In patients with claudication, the TLR free rates at 1-, 3-, and 5-year intervals were 89.1%, 82.2%, and 78.9%, respectively. Amputation-free survival rates in the claudicants at 1-, 3-, and 5-year intervals were 95.3%, 81.1%, and 65.2%, respectively. Freedom from ischemia at 1-, 3-, and 5-year follow-ups was 77.8%, 69.0%, and 61.3%, respectively. In patients with critical limb ischemia, the TLR free rates at 1-, 3-, and 5-year intervals were 91.3%, 87.4%, and 65.4%, respectively, amputation free survival rates were 72.5%, 44.2%, and 36.8%, respectively, and their freedom from ischemia was 64.6%, 63.4%, and 49.7%, respectively. In the multivariate analysis of influencing factors related to freedom from ischemia, renal insufficiency (hazard ratio [HR] 1.623; 95% confidence interval [CI] 0.999–2.636; p = 0.050), TASC C/D lesion (HR 1.903; 95% CI 1.151–3.148; p = 0.012), and poor tibial runoff (HR 1.770; 95% CI 1.037–3.023; p = 0.036) were statistically significant risk factors. TASC C/D lesion and poor tibial runoff were significant risk factors for recurrent or persistent ischemia in claudication (p = 0.015) and in critical limb ischemia (p = 0.05), respectively. Conclusion: Endovascular treatment for femoropopliteal atherosclerotic lesions showed acceptable intermediate-term and long-term outcomes. Renal insufficiency, TASC C/D lesions, and poor tibial runoff adversely affected freedom from ischemia. Keywords: Femoropopliteal artery, Outcomes, Endovascula

Implementation of the ATLAS-EXOT-2018-030 analysis in the MadAnalysis 5 framework (W′W′ boson into a lepton and a neutrino; 139 fb−1^{−1})

We present the MadAnalysis 5 implementation of the heavily charged gauge boson search to recast the analysis of its decay into one charged lepton and missing transverse momentum. Signal events describing pp → W′→ lν l (l = e or μ) at s = 13 TeV in the sequential standard model are generated by the MadGraph5_aMC@NLO at leading order. The corresponding signal cross-sections for both electron and muon channels vary from 195 fb to 0.238 fb depending on the pole mass of the W′ boson in the range of 2 TeV to 6 TeV. We validate our implementation by comparing the transverse mass distributions of our signal prediction to those of the ATLAS analysis for an integrated luminosity of 139 fb−1

Is Routine Screening Using Duplex Ultrasonography for Deep Vein Thrombosis Necessary after Shoulder Arthroplasty?

The aims of this study were to examine the incidence, risk factors, and outcomes of deep vein thrombosis (DVT) after shoulder arthroplasty in Korean patients. A total of 265 patients who underwent shoulder arthroplasty were included. The mean age of the patients was 74.6 years, and there were 195 females and 70 males. Clinical data including patient demographics, blood tests, and previous and current medical history were investigated. For screening of DVT, duplex ultrasonography of the operative arm was performed 2 to 5 days after surgery. Of the 265 patients, 10 patients (3.8%) were diagnosed with DVT using postoperative duplex ultrasonography. There were no cases of pulmonary embolism. There were no significant differences between the DVT and no DVT groups regarding all clinical data, except for the Charlson comorbidity index (CCI), which was significantly higher in the DVT group than in the no DVT group (5.0 vs. 4.1; p = 0.029). All patients had asymptomatic DVT that showed complete resolution after administration of antithrombotic agents or close observation without medications. The overall incidence of DVT was 3.8% during a period of 3 months after shoulder arthroplasty in Korean patients, and most cases were asymptomatic. Routine screening for DVT using duplex ultrasonography after shoulder arthroplasty may not be necessary except in patients with high CCI