Transplantation in children

Kidney transplantation in very young children, less than 2 years of age, has usually failed, mainly because of difficulties maintaining these patients on hemodialysis long enough to permit retransplantation after loss of the original graft. Liver replacement in the very young child has been associated with a higher frequency of vascular and biliary obstruction than in the older child, due to the small size of these structures. Such accidents have contributed to unsatisfactory results with biliary atresia. Transplantation of kidney or liver into older children has been more successful than transplantation of these organs into adults. Related or cadaveric kidney transplantation in the child has been followed by at least a 60 per cent patient survival for 6 to 13 years and a very acceptable quality of life. Liver replacement for diseases other than biliary atresia has been followed by a 56 per cent 1 year survival rate, and two children have survived for more than 5 years

Spring-Summer Temperatures Since AD 1780 Reconstructed from Stable Oxygen Isotope Ratios in White Spruce Tree-Rings from the Mackenzie Delta, Northwestern Canada

High-latitude delta(exp 18)O archives deriving from meteoric water (e.g., tree-rings and ice-cores) can provide valuable information on past temperature variability, but stationarity of temperature signals in these archives depends on the stability of moisture source/trajectory and precipitation seasonality, both of which can be affected by atmospheric circulation changes. A tree-ring delta(exp 18)O record (AD 1780-2003) from the Mackenzie Delta is evaluated as a temperature proxy based on linear regression diagnostics. The primary source of moisture for this region is the North Pacific and, thus, North Pacific atmospheric circulation variability could potentially affect the tree-ring delta(exp 18)O-temperature signal. Over the instrumental period (AD 1892-2003), tree-ring delta(exp 18)O explained 29% of interannual variability in April-July minimum temperatures, and the explained variability increases substantially at lower-frequencies. A split-period calibration/verification analysis found the delta(exp 18)O-temperature relation was time-stable, which supported a temperature reconstruction back to AD 1780. The stability of the delta(exp 18)O-temperature signal indirectly implies the study region is insensitive to North Pacific circulation effects, since North Pacific circulation was not constant over the calibration period. Simulations from the NASA-GISS ModelE isotope-enabled general circulation model confirm that meteoric delta(exp 18)O and precipitation seasonality in the study region are likely insensitive to North Pacific circulation effects, highlighting the paleoclimatic value of tree-ring and possibly other delta(exp 18)O records from this region. Our delta(exp 18)O-based temperature reconstruction is the first of its kind in northwestern North America, and one of few worldwide, and provides a long-term context for evaluating recent climate warming in the Mackenzie Delta region

A new class of large-amplitude radial-mode hot subdwarf pulsators

Using high-cadence observations from the Zwicky Transient Facility at low Galactic latitudes, we have discovered a new class of pulsating, hot compact stars. We have found four candidates, exhibiting blue colors (g − r ≤ −0.1 mag), pulsation amplitudes of >5%, and pulsation periods of 200–475 s. Fourier transforms of the light curves show only one dominant frequency. Phase-resolved spectroscopy for three objects reveals significant radial velocity, T eff, and log(g) variations over the pulsation cycle, which are consistent with large-amplitude radial oscillations. The mean T eff and log(g) for these stars are consistent with hot subdwarf B (sdB) effective temperatures and surface gravities. We calculate evolutionary tracks using MESA and adiabatic pulsations using GYRE for low-mass, helium-core pre-white dwarfs (pre-WDs) and low-mass helium-burning stars. Comparison of low-order radial oscillation mode periods with the observed pulsation periods show better agreement with the pre-WD models. Therefore, we suggest that these new pulsators and blue large-amplitude pulsators (BLAPs) could be members of the same class of pulsators, composed of young ≈0.25–0.35 M ⊙ helium-core pre-WDs.Published versio

A New Class of Changing-Look LINERs

We report the discovery of six active galactic nuclei (AGN) caught "turning on" during the first nine months of the Zwicky Transient Facility (ZTF) survey. The host galaxies were classified as LINERs by weak narrow forbidden line emission in their archival SDSS spectra, and detected by ZTF as nuclear transients. In five of the cases, we found via follow-up spectroscopy that they had transformed into broad-line AGN, reminiscent of the changing-look LINER iPTF 16bco. In one case, ZTF18aajupnt/AT2018dyk, follow-up HST UV and ground-based optical spectra revealed the transformation into a narrow-line Seyfert 1 (NLS1) with strong [Fe VII, X, XIV] and He II 4686 coronal lines. Swift monitoring observations of this source reveal bright UV emission that tracks the optical flare, accompanied by a luminous soft X-ray flare that peaks ~60 days later. Spitzer follow-up observations also detect a luminous mid-infrared flare implying a large covering fraction of dust. Archival light curves of the entire sample from CRTS, ATLAS, and ASAS-SN constrain the onset of the optical nuclear flaring from a prolonged quiescent state. Here we present the systematic selection and follow-up of this new class of changing-look LINERs, compare their properties to previously reported changing-look Seyfert galaxies, and conclude that they are a unique class of transients well-suited to test the uncertain physical processes associated with the LINER accretion state.Comment: Submitted to ApJ, 31 pages, 17 Figures (excluding Appendix due to file size constraints but will be available in electronic version

Cytoplasmic dynein nomenclature

A variety of names has been used in the literature for the subunits of cytoplasmic dynein complexes. Thus, there is a strong need for a more definitive consensus statement on nomenclature. This is especially important for mammalian cytoplasmic dyneins, many subunits of which are encoded by multiple genes. We propose names for the mammalian cytoplasmic dynein subunit genes and proteins that reflect the phylogenetic relationships of the genes and the published studies clarifying the functions of the polypeptides. This nomenclature recognizes the two distinct cytoplasmic dynein complexes and has the flexibility to accommodate the discovery of new subunits and isoforms

Fifteen years of clinical liver transplantation

Liver transplantation in humans was first attempted more than 15 yr ago. The 1-yr survival has slowly improved until it has now reached about 50%. In our experience, 46 patients have lived for at least 1 yr, with the longest survival being 9 yr. The high acute mortality in early trials was due in many cases to technical and management errors and to the use of damaged organs. With elimination of such factors, survival increased. Further improvements will depend upon better immunosuppression. Orthotopic liver transplantation (liver replacement) is the preferred operation in most cases, but placement of an extra liver (auxiliary transplantation) may have a role under special circumstances. © 1979

The use of microbubbles to target drug delivery

Ultrasound-mediated microbubbles destruction has been proposed as an innovative method for noninvasive delivering of drugs and genes to different tissues. Microbubbles are used to carry a drug or gene until a specific area of interest is reached, and then ultrasound is used to burst the microbubbles, causing site-specific delivery of the bioactive materials. Furthermore, the ability of albumin-coated microbubbles to adhere to vascular regions with glycocalix damage or endothelial dysfunction is another possible mechanism to deliver drugs even in the absence of ultrasound. This review focuses on the characteristics of microbubbles that give them therapeutic properties and some important aspects of ultrasound parameters that are known to influence microbubble-mediated drug delivery. In addition, current studies involving this novel therapeutical application of microbubbles will be discussed

Identifying nonprescription antibiotic users with screening questions in a primary care setting

Background: Antibiotic use without a prescription (nonprescription use) leads to antibiotic overuse, with negative consequences for patient and public health. We studied whether screening patients for prior nonprescription antibiotic use in the past 12 months predicted their intentions to use them in the future. Methods: A survey asking respondents about prior and intended nonprescription antibiotic use was performed between January 2020 and June 2021 among patients in waiting rooms of 6 public clinics and 2 private emergency departments in economically and socially diverse urban and suburban areas. Respondents were classified as prior nonprescription users if they reported previously taking oral antibiotics without contacting a doctor, dentist, or nurse. Intended use was defined as answering “yes” or “maybe” to the question, “Would you use antibiotics without contacting a doctor, nurse, or dentist?” We calculated the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of prior nonprescription antibiotic use in the past 12 months for future intended nonprescription use. Bayes PPV and NPV were also calculated, considering the prevalence of nonprescription antibiotic use (24.8%) in our study. Results: Of the 564 patients surveyed, the median age was 51 years (SD, 19–92), with 72% of patients identifying as female. Most were from the public healthcare system (72.5%). Most respondents identified as Hispanic or Latino(a) (47%) or African American (33%), and 57% received Medicaid or the county financial assistance program. Prior nonprescription use was reported by 246 (43%) of 564 individuals, with 91 (16%) reporting nonprescription use within the previous 12 months. Intention to use nonprescription antibiotics was reported by 140 participants (25%). The sensitivity and specificity of prior nonprescription use in the past 12 months to predict the intention to use nonprescription antibiotics in the future were 75.9% (95% CI, 65.3–84.6) and 91.4% (95% CI, 87.8–94.2), respectively. After the Bayes’ adjustment, the PPV and NPV of prior use to predict future intention were 74.5% (95% CI, 66.7–80.9) and 92.0% (95% CI, 88.7–94.4) (Table 1). Conclusions: These results show that prior nonprescription antibiotic use in the past 12 months predicted the intention to use nonprescription antibiotics in the future (PPV of 75%). As a stewardship effort, we suggest clinicians use a simple question about prior nonprescription antibiotic use in primary-care settings as a screening question for patients at high risk for future nonprescription antibiotic use

Design and On-Orbit Operation of the Adiabatic Demagnetization Refrigerator on the Hitomi Soft X-Ray Spectrometer Instrument

The Soft X-ray Spectrometer instrument on the Astro-H observatory contains a 6x6 array of x-ray microcalorimeters that is cooled to 50 mK by an adiabatic demagnetization refrigerator (ADR). The ADR consists of three stages in order to provide stable detector cooling using either a 1.2 K superfluid helium bath or a 4.5 K Joule-Thomson (JT) cryocooler as its heat sink. When liquid helium is present, two of the ADR's stages are used to single-shot cool the detectors while rejecting heat to the helium. After the helium is depleted, all three stages are used to continuously cool the helium tank (to about 1.5 K) and single-shot cool the detectors (to 50 mK), using the JT cryocooler as its heat sink. The Astro-H observatory, renamed Hitomi after its successful launch in February 2016, carried approximately 36 liters of helium into orbit. On day 5, the helium had cooled sufficiently (<1.4 K) to allow operation of the ADR. This paper describes the design, operation and on-orbit performance of the ADR, and the use of the ADR's heat rejection as a tool for mass gauging the helium tank