Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition

Background.Heart transplantation is an established treatment for advanced heart failure. Primary allograft dysfunction (PGD) is reported in up to 40 % of transplants and is associated with a poor outcome.Methods.As part of Heart Evaluation and Retrieval for Transplantation study, an investigation of the assessment of donor hearts for transplantation, we proposed a clinical definition ffecting one or both ventricles accompanied by hypotension, low 72 hours (in the absence of hyper acute rejection and technical mine the prospective application of this definition to 290 heart d non-PGD cases. Results. Ninety-four of 290 transplants the PGD group at 24, 48, and 72 hours after transplantation fo ra o c ty. have acceptable function before organ retrieval may be ex-OriginalClinicalScienceçGeneral30 years.6 This has been attributed to improvements in dono

Results from EDGES High-Band: II. Constraints on Parameters of Early Galaxies

We use the sky-average spectrum measured by EDGES High-Band ($90-190$ MHz) to constrain parameters of early galaxies independent of the absorption feature at $78$~MHz reported by Bowman et al. (2018). These parameters represent traditional models of cosmic dawn and the epoch of reionization produced with the 21cmFAST simulation code (Mesinger & Furlanetto 2007, Mesinger et al. 2011). The parameters considered are: (1) the UV ionizing efficiency ($\zeta$), (2) minimum halo virial temperature hosting efficient star-forming galaxies ($T^{\rm min}_{\rm vir}$), (3) integrated soft-band X-ray luminosity ($L_{\rm X\,<\,2\,keV}/{\rm SFR}$), and (4) minimum X-ray energy escaping the first galaxies ($E_{0}$), corresponding to a typical H${\rm \scriptstyle I}$ column density for attenuation through the interstellar medium. The High-Band spectrum disfavors high values of $T^{\rm min}_{\rm vir}$ and $\zeta$, which correspond to signals with late absorption troughs and sharp reionization transitions. It also disfavors intermediate values of $L_{\rm X\,<\,2\,keV}/{\rm SFR}$, which produce relatively deep and narrow troughs within the band. Specifically, we rule out $39.4<\log_{10}\left(L_{\rm X\,<\,2\,keV}/{\rm SFR}\right)<39.8$ ($95\%$ C.L.). We then combine the EDGES High-Band data with constraints on the electron scattering optical depth from Planck and the hydrogen neutral fraction from high-$z$ quasars. This produces a lower degeneracy between $\zeta$ and $T^{\rm min}_{\rm vir}$ than that reported in Greig & Mesinger (2017a) using the Planck and quasar constraints alone. Our main result in this combined analysis is the estimate $4.5$~$\leq \log_{10}\left(T^{\rm min}_{\rm vir}/\rm K\right)\leq$~$5.7$ ($95\%$ C.L.). We leave for future work the evaluation of $21$~cm models using simultaneously data from EDGES Low- and High-Band.Comment: Accepted in Ap

Fetal liver blood flow distribution: role in human developmental strategy to prioritize fat deposition versus brain development

Among primates, human neonates have the largest brains but also the highest proportion of body fat. If placental nutrient supply is limited, the fetus faces a dilemma: should resources be allocated to brain growth, or to fat deposition for use as a potential postnatal energy reserve? We hypothesised that resolving this dilemma operates at the level of umbilical blood distribution entering the fetal liver. In 381 uncomplicated pregnancies in third trimester, we measured blood flow perfusing the fetal liver, or bypassing it via the ductus venosus to supply the brain and heart using ultrasound techniques. Across the range of fetal growth and independent of the mother's adiposity and parity, greater liver blood flow was associated with greater offspring fat mass measured by dual-energy X-ray absorptiometry, both in the infant at birth (r = 0.43, P&lt;0.001) and at age 4 years (r = 0.16, P = 0.02). In contrast, smaller placentas less able to meet fetal demand for essential nutrients were associated with a brain-sparing flow pattern (r = 0.17, p = 0.02). This flow pattern was also associated with a higher degree of shunting through ductus venosus (P = 0.04). We propose that humans evolved a developmental strategy to prioritize nutrient allocation for prenatal fat deposition when the supply of conditionally essential nutrients requiring hepatic inter-conversion is limited, switching resource allocation to favour the brain if the supply of essential nutrients is limited. Facilitated placental transfer mechanisms for glucose and other nutrients evolved in environments less affluent than those now prevalent in developed populations, and we propose that in circumstances of maternal adiposity and nutrient excess these mechanisms now also lead to prenatal fat deposition. Prenatal developmental influences play important roles in the human propensity to deposit fa

Faecal Microbiota Transplantation plus selected use of antibiotics for severe-complicated Clostridium difficile infection: description of a protocol with high success rate

Background Severe and severe/complicated Clostridium difficile infection (CDI) can result in ICU admission, sepsis, toxic megacolon and death. In this setting, colectomy is the standard of care but it is associated with a 50% mortality. Aim To evaluate safety and efficacy of a sequential faecal microbiota transplantation (FMT) and antibiotic protocol in severe and severe/complicated CDI patients who are at high risk for colectomy. Methods All patients with severe and severe/complicated CDI refractory to oral vancomycin ± rectal vancomycin and intravenous metronidazole therapy were offered FMT. Treatment consisted of sequential FMTs via colonoscopy with the need for repeat FMT and continued vancomycin guided by clinical response and pseudomembranes at colonoscopy. Results A total of 29 patients underwent FMT between July 2013 and August 2014. The overall treatment response of endoscopic sequential FMT was 93% (27/29), with 100% (10/10) for severe CDI and 89% (17/19) for severe/complicated CDI. A single FMT was performed in 62%, two FMTs were performed in 31% and three FMTs in 7% of patients. The use of non-CDI antibiotics predicted repeat FMT (odds ratio = 17.5). The 30-day all-cause mortality after FMT was 7%, and the cumulative 3-month survival was 76%. Of the two patients who died within 30 days, one underwent colectomy and succumbed to sepsis; the other died from septic shock related to CDI. Conclusion The success of a treatment protocol for severe and severe/complicated involving faecal microbiota transplantation and continued vancomycin in selected patients was high, and it warrants further evaluation

Investigation of conduction band structure, electron scattering mechanisms and phase transitions in indium selenide by means of transport measurements under pressure

In this work we report on Hall effect, resistivity and thermopower measurements in n-type indium selenide at room temperature under either hydrostatic and quasi-hydrostatic pressure. Up to 40 kbar (= 4 GPa), the decrease of carrier concentration as the pressure increases is explained through the existence of a subsidiary minimum in the conduction band. This minimum shifts towards lower energies under pressure, with a pressure coefficient of about -105 meV/GPa, and its related impurity level traps electrons as it reaches the band gap and approaches the Fermi level. The pressure value at which the electron trapping starts is shown to depend on the electron concentration at ambient pressure and the dimensionality of the electron gas. At low pressures the electron mobility increases under pressure for both 3D and 2D electrons, the increase rate being higher for 2D electrons, which is shown to be coherent with previous scattering mechanisms models. The phase transition from the semiconductor layered phase to the metallic sodium cloride phase is observed as a drop in resistivity around 105 kbar, but above 40 kbar a sharp nonreversible increase of the carrier concentration is observed, which is attributed to the formation of donor defects as precursors of the phase transition.Comment: 18 pages, Latex, 10 postscript figure

Dynamic responses of B acteroides thetaiotaomicron during growth on glycan mixtures

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98163/1/mmi12228-sup-0001-si.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/98163/2/mmi12228.pd

Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol

&lt;b&gt;Background&lt;/b&gt; Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Objectives&lt;/b&gt; The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Discussion&lt;/b&gt; The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices