Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO

Economic Development and Logistics Performance. A Probabilistic Approach

There is not a consensus about a complete set of explanatory variables that could ultimately explain the linkages behind achieving economic development. In spite of this, determinants of economic development and especially the linkages between economic development and logistics performance are topics of growing interest within the recent literature, both in economic growth theory and maritime studies. In this paper our attention is focused on the importance of logistics performance as one of the explanatory variables for economic development. To this end, we have estimated different econometric models in an attempt to explain the probability of a country being economically developed, based on a number of traditional explanatory variables (including natural endowments, economic openness, and institutional framework, among others) along with logistics performance as the major theoretical innovation. The applied methodology follows the binary choice framework described in probit models. In the next step the research is concentrated on the determination of possible endogenous causalities of the economic development. In the last section we estimate the logistics gap, measured as a probability of reaching economic development that varies due to differences in the levels of logistics performance. Our main finding shows that logistics performance is closely related to the probability of a country being developed. Specifically, the probability of being a developed country increases when logistics performance is improved

Desarrollo económico y desempeño logístico : un enfoque probabilístico

There is not a consensus about a complete set of explanatory variables that could ultimately explain the linkages behind achieving economic development. In spite of this, determinants of economic development and especially the linkages between economic development and logistics performance are topics of growing interest within the recent literature, both in economic growth theory and maritime studies. In this paper our attention is focused on the importance of logistics performance as one of the explanatory variables for economic development. To this end, we have estimated different econometric models in an attempt to explain the probability of a country being economically developed, based on a number of traditional explanatory variables (including natural endowments, economic openness, and institutional framework, among others) along with logistics performance as the major theoretical innovation. The applied methodology follows the binary choice framework described in probit models. In the next step the research is concentrated on the determination of possible endogenous causalities of the economic development. In the last section we estimate the logistics gap, measured as a probability of reaching economic development that varies due to differences in the levels of logistics performance. Our main finding shows that logistics performance is closely related to the probability of a country being developed. Specifically, the probability of being a developed country increases when logistics performance is improved.En la literatura económica, no existe un pleno consenso acerca del conjunto de variables explicativas que inciden sobre el desarrollo económico. Por otra parte, la vinculación entre el crecimiento y desarrollo económico y el desempeño logístico son tópicos de creciente interés en la literatura especializada. En este documento prestamos especial atención al papel del desempeño logístico como una de las variables explicativas del desarrollo económico. Para este fin, hemos estimado diferentes modelos econométricos que buscan explicar cómo se afecta la probabilidad de un país de ser desarrollado al considerar algunas variables explicativas tradicionales (la dotación de recursos naturales, la apertura económica, y variables institucionales, entre otras), junto con el desempeño logístico. La metodología aplicada se basó en la utilización de modelos probit. El principal hallazgo del trabajo ha sido el de encontrar una incidencia positiva entre el desempeño logístico y la probabilidad de un país de ser desarrollado. Particularmente, la probabilidad de un país de ser desarrollado se incrementa cuando mejora el desempeño logístico

Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure

Predictors of early and late failure of pericardiectomy for constrictive pericarditis (CP) have not been established. Early and late outcomes of a cumulative series of 81 (mean age 60\ua0years; mean EuroSCORE II, 3.3%) consecutive patients from three European cardiac surgery centers were reviewed. Predictors of a combined endpoint comprising in-hospital death or major complications (including multiple transfusion) were identified with binary logistic regression. Non-parametric estimates of survival were obtained with the Kaplan\u2013Meier method. Predictors of poor late outcomes were established using Cox proportional hazard regression. There were 4 (4.9%) in-hospital deaths. Preoperative central venous pressure > 15\ua0mmHg (p = 0.005) and the use of cardiopulmonary bypass (p = 0.016) were independent predictors of complicated in-hospital course, which occurred in 29 (35.8%) patients. During follow-up (median, 5.4\ua0years), preoperative renal impairment was a predictor of all-cause death (p = 0.0041), cardiac death (p = 0.0008), as well as hospital readmission due to congestive heart failure (p = 0.0037); while partial pericardiectomy predicted all-cause death (p = 0.028) and concomitant cardiac operation predicted cardiac death (p = 0.026), postoperative central venous pressure < 10\ua0mmHg was associated with a low risk both of all-cause and cardiac death (p < 0.0001 for both). Ten-year adjusted survival free of all-cause death, cardiac death, and hospital readmission were 76.9%, 94.7%, and 90.6%, respectively. In high-risk patients with CP, performing pericardiectomy before severe constriction develops and avoiding cardiopulmonary bypass (when possible) could contribute to improving immediate outcomes post-surgery. Complete removal of cardiac constriction could enhance long-term outcomes

Queer Youth and the Culture Wars: From Classroom to Courtroom in Australia, Canada and the United States

This article builds on Lugg\u27s (2006) discussion of surveillance in public schools and how queer youth are resisting schools\u27 current efforts to regulate sexual orientation and gender expression in the U.S. and internationally. Legal complaints initiated by queer youth against their schools for harassment and access to extra-curricular activities are discussed. The number of cases in the past five years has increased significantly and the courts are siding with the youth and their allies, demonstrating that queer youth are significantly impacting the dismantling of heteronormative regulatory regimes and improving the school experiences for themselves and queer adults

Sediment Cores from White Pond, South Carolina, contain a Platinum Anomaly, Pyrogenic Carbon Peak, and Coprophilous Spore Decline at 12.8 ka

A widespread platinum (Pt) anomaly was recently documented in Greenland ice and 11 North American sedimentary sequences at the onset of the Younger Dryas (YD) event (~12,800 cal yr BP), consistent with the YD Impact Hypothesis. We report high-resolution analyses of a 1-meter section of a lake core from White Pond, South Carolina, USA. After developing a Bayesian age-depth model that brackets the late Pleistocene through early Holocene, we analyzed and quantified the following: (1) Pt and palladium (Pd) abundance, (2) geochemistry of 58 elements, (3) coprophilous spores, (4) sedimentary organic matter (OC and sedaDNA), (5) stable isotopes of C (δ13C) and N (δ15N), (6) soot, (7) aciniform carbon, (8) cryptotephra, (9) mercury (Hg), and (10) magnetic susceptibility. We identified large Pt and Pt/Pd anomalies within a 2-cm section dated to the YD onset (12,785 ± 58 cal yr BP). These anomalies precede a decline in coprophilous spores and correlate with an abrupt peak in soot and C/OC ratios, indicative of large-scale regional biomass burning. We also observed a relatively large excursion in δ15N values, indicating rapid climatic and environmental/hydrological changes at the YD onset. Our results are consistent with the YD Impact Hypothesis and impact-related environmental and ecological changes

Cardiovascular disease in immune-mediated inflammatory diseases: a cross-sectional analysis of 6 cohorts

Observational study[Abstract] To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic and clinical-related variables on the prevalence of cardiovascular disease (CVD), and compare their standardized prevalences.Cross-sectional study, including consecutive patients diagnosed with rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn disease, or ulcerative colitis, from rheumatology, gastroenterology, and dermatology tertiary care outpatient clinics located throughout Spain, between 2007 and 2010. Our main outcome was defined as previous diagnosis of angina, myocardial infarction, peripheral vascular disease, and/or stroke. Bivariate and multivariate logistic and mixed-effects logistic regression models were performed for each condition and the overall cohort, respectively. Standardized prevalences (in subjects per 100 patients, with 95% confidence intervals) were calculated using marginal analysis.We included 9951 patients. For each IMID, traditional cardiovascular risk factors had a different contribution to CVD. Overall, older age, longer disease duration, presence of traditional cardiovascular risk factors, and male sex were independently associated with a higher CVD prevalence. After adjusting for demographic and traditional cardiovascular risk factors, systemic lupus erythematosus exhibited the highest CVD standardized prevalence, followed by rheumatoid arthritis, psoriasis, Crohn disease, psoriatic arthritis, and ulcerative colitis (4.5 [95% confidence interval (CI): 2.2, 6.8], 1.3 [95% CI: 0.8, 1.8], 0.9 [95% CI: 0.5, 1.2], 0.8 [95% CI: 0.2, 1.3], 0.6 [95% CI: 0.2, 1.0], and 0.5 [95% CI: 0.1, 0.8], respectively).Systemic lupus erythematosus, rheumatoid arthritis, and psoriasis are associated with higher prevalence of CVD compared with other IMIDs. Specific prevention programs should be established in subjects affected with these conditions to prevent CVD

ReSETting PP2A tumour suppressor activity in blast crisis and imatinib-resistant chronic myelogenous leukaemia

The deregulated kinase activity of p210-BCR/ABL oncoproteins, hallmark of chronic myelogenous leukaemia (CML), induces and sustains the leukaemic phenotype, and contributes to disease progression. Imatinib mesylate, a BCR/ABL kinase inhibitor, is effective in most of chronic phase CML patients. However, a significant percentage of CML patients develop resistance to imatinib and/or still progresses to blast crisis, a disease stage that is often refractory to imatinib therapy. Furthermore, there is compelling evidence indicating that the CML leukaemia stem cell is also resistant to imatinib. Thus, there is still a need for new drugs that, if combined with imatinib, will decrease the rate of relapse, fully overcome imatinib resistance and prevent blastic transformation of CML. We recently reported that the activity of the tumour suppressor protein phosphatase 2A (PP2A) is markedly inhibited in blast crisis CML patient cells and that molecular or pharmacologic re-activation of PP2A phosphatase led to growth suppression, enhanced apoptosis, impaired clonogenic potential and decreased in vivo leukaemogenesis of imatinib-sensitive and -resistant (T315I included) CML-BC patient cells and/or BCR/ABL+ myeloid progenitor cell lines. Thus, the combination of PP2A phosphatase-activating and BCR/ABL kinase-inhibiting drugs may represent a powerful therapeutic strategy for blast crisis CML patients