280 research outputs found

    Is there a renoprotective value to leukodepletion during heart valve surgery? A randomized controlled trial (ROLO)

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    Background: Acute Kidney Injury (AKI) adversely affects outcomes after cardiac surgery. A major mediator of AKI is the activation of leukocytes through exposure to the cardiopulmonary bypass circuit. We evaluate the use of leukodepletion filters throughout bypass to protect against post-operative AKI by removing activated leukocytes during cardiac surgery. Methods: This is a single-centre, double-blind, randomized controlled trial comparing the use of leukodepletion versus a standard arterial filter throughout bypass. Elective adult patients undergoing heart valve surgery with or without concomitant procedures were investigated. The primary clinical outcome measured was the development of AKI according to the KDIGO criteria. Secondary measures included biomarkers of renal tubular damage (urinary Retinol Binding Protein and Kidney Injury Molecule-1), glomerular kidney injury (urinary Micro Albumin and serum Cystatin C) and urinary Neutrophil Gelatinase Associated Lipocalin, as well as the length of hospital stay and quality of life measures through EQ-5D-5L questionnaires. Results: The ROLO trial randomized 64 participants with a rate of recruitment higher than anticipated (57% achieved, 40% anticipated). The incidence of AKI was greater in the leukodepletion filter group (44% versus 23%, risk difference 21, 95% CI − 2 to 44%). This clinical finding was supported by biomarker levels especially by a tendency toward glomerular insult at 48 h, demonstrated by a raised serum Cystatin C (mean difference 0.11, 95% CI 0.00 to 0.23, p = 0.068) in the leukodepleted group. There was however no clear association between the incidence or severity of AKI and length of hospital stay. On average, health related quality of life returned to pre-operative levels in both groups within 3 months of surgery. Conclusions: Leukocyte depletion during cardiopulmonary bypass does not significantly reduce the incidence of AKI after valvular heart surgery. Other methods to ameliorate renal dysfunction after cardiac surgery need to be investigated. Trial registration: The trial was registered by the International Standard Randomized Controlled Trial Number Registry ISRCTN42121335. Registered on the 18 February 2014. The trial was run by the Bristol Clinical Trials and Evaluation Unit. This trial was financially supported by the National Institute of Health Research (Research for Patient Benefit), award ID: PB-PG-0711-25,090

    Van der Waals SnSe2(1-x)S2x alloys: composition-dependent bowing coefficient and electron-phonon interaction

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    The design of advanced functional materials with customized properties often requires the use of an alloy. This approach has been used for decades, but only recently to create van der Waals (vdW) alloys for applications in electronics, optoelectronics, and thermoelectrics. A route to engineering their physical properties is by mixing isoelectronic elements, as done for the SnSe2(1−x)S2x alloy. Here, by experiment and first‐principles modeling, it is shown that the value of x can be adjusted over a wide range, indicating good miscibility of the SnS2 and SnSe2 compounds. The x‐dependence of the indirect bandgap energy from Eind = 1.20 eV for SnSe2 to Eind = 2.14 eV for SnS2, corresponds to a large bowing coefficient b ≈ 1 eV, arising from volume deformation and charge exchange effects due to the different sizes and orbital energies of the S‐ and Se‐atoms. This also causes composition‐dependent phonon energy modes, electron–phonon interaction, and temperature dependence of Eind. The alloys are exfoliable into thin layers with properties that depend on the composition, but only weakly on the layer thickness. This work shows that the electronic and vibrational properties of the SnSe2(1−x)S2x alloy and its thin layers provide a versatile platform for development and exploitation

    A missed orthopaedic injury following a seizure: a case report

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    Numerous orthopaedic injuries can follow a seizure and are often diagnosed late. This is the first documented case of a missed bilateral anterior shoulder dislocation following a seizure. The possible reasons for the greater incidence of posterior dislocations are examined and why bilateral anterior dislocations following a seizure are so rare. The article discusses the reasons for the delay and highlights potential pitfalls and learning points for junior emergency department doctors

    Circulating 25-Hydroxyvitamin D and the Risk of Rarer Cancers: Design and Methods of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers

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    The Cohort Consortium Vitamin D Pooling Project of Rarer Cancers (VDPP), a consortium of 10 prospective cohort studies from the United States, Finland, and China, was formed to examine the associations between circulating 25-hydroxyvitamin D (25(OH)D) concentrations and the risk of rarer cancers. Cases (total n = 5,491) included incident primary endometrial (n = 830), kidney (n = 775), ovarian (n = 516), pancreatic (n = 952), and upper gastrointestinal tract (n = 1,065) cancers and non-Hodgkin lymphoma (n = 1,353) diagnosed in the participating cohorts. At least 1 control was matched to each case on age, date of blood collection (1974–2006), sex, and race/ethnicity (n = 6,714). Covariate data were obtained from each cohort in a standardized manner. The majority of the serum or plasma samples were assayed in a central laboratory using a direct, competitive chemiluminescence immunoassay on the DiaSorin LIAISON platform (DiaSorin, Inc., Stillwater, Minnesota). Masked quality control samples included serum standards from the US National Institute of Standards and Technology. Conditional logistic regression analyses were conducted using clinically defined cutpoints, with 50–<75 nmol/L as the reference category. Meta-analyses were also conducted using inverse-variance weights in random-effects models. This consortium approach permits estimation of the association between 25(OH)D and several rarer cancers with high accuracy and precision across a wide range of 25(OH)D concentrations

    Correlation of Serotype-Specific Dengue Virus Infection with Clinical Manifestations

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    Dengue virus (DENV) causes disease in millions of people annually and disproportionately affects those in the developing world. DENVs may be divided into four serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) and a geographical region may be affected by one or more DENV serotypes simultaneously. Infection with DENV may cause life-threatening disease such as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), but more often causes less severe manifestations affecting a wide range of organs. Although many previous reports have explored the role of the different DENV serotypes in the development of severe manifestations, little attention has focused on the relative role of each DENV serotype in the development of cutaneous, respiratory, gastrointestinal, musculoskeletal, and neurological manifestations. We recruited a large group of participants from four countries in South America to compare the prevalence of more than 30 manifestations among the four different DENV serotypes. We found that certain DENV serotypes were often associated with a higher prevalence of a certain manifestation (e.g., DENV-3 and diarrhea) or manifestation group (e.g., DENV-4 and cutaneous manifestations)

    The Double Intentionality of Emotional Experience

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    © 2017 John Wiley & Sons Ltd.I argue that while the feeling of bodily responses is not necessary to emotion, these feelings contribute significant meaningful content to everyday emotional experience. Emotional bodily feelings represent a 'state of self', analysed as a sense of one's body affording certain patterns of interaction with the environment. Recognising that there are two sources of intentional content in everyday emotional experience allows us to reconcile the diverging intuitions that people have about emotional states, and to understand better the long-standing debate between bodily feeling-based and appraisal-based theories of emotion

    A high-resolution daily global dataset of statistically downscaled CMIP6 models for climate impact analyses

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    AbstractA large number of historical simulations and future climate projections are available from Global Climate Models, but these are typically of coarse resolution, which limits their effectiveness for assessing local scale changes in climate and attendant impacts. Here, we use a novel statistical downscaling model capable of replicating extreme events, the Bias Correction Constructed Analogues with Quantile mapping reordering (BCCAQ), to downscale daily precipitation, air-temperature, maximum and minimum temperature, wind speed, air pressure, and relative humidity from 18 GCMs from the Coupled Model Intercomparison Project Phase 6 (CMIP6). BCCAQ is calibrated using high-resolution reference datasets and showed a good performance in removing bias from GCMs and reproducing extreme events. The globally downscaled data are available at the Centre for Environmental Data Analysis (https://doi.org/10.5285/c107618f1db34801bb88a1e927b82317) for the historical (1981–2014) and future (2015–2100) periods at 0.25° resolution and at daily time step across three Shared Socioeconomic Pathways (SSP2-4.5, SSP5-3.4-OS and SSP5-8.5). This new climate dataset will be useful for assessing future changes and variability in climate and for driving high-resolution impact assessment models.</jats:p
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