Obesity as a risk factor following cadaveric renal transplantation

Obesity has generally been thought to increase the risk of operative mortality and postoperative complications in surgical patients. No data examining obesity as a factor in cadaveric renal transplantation were available. We therefore matched obese patients undergoing cadaveric renal transplantation with nonobese control patients and retrospectively analyzed mortality, morbidity, and graft survival in each group. Patients were matched for age, sex, diabetes mellitus, PRA, graft number, cardiovascular disease, date of transplantation, and posttransplant immunosuppression. There were significant differences found in mortality (11% in obese vs. 2% in nonobese patients, P<0.01), immediate graft function (38% in obese vs. 64% in nonobese patients, P<0.01), 1-year graft survival (66% in obese vs. 84% in nonobese patients, P<0.05), and postoperative complications. Wound complications (20% vs. 2%, P<0.01), intensive-care-unit admissions (10% vs. 2%, P<0.01), reintubations (16% vs. 2%, P<0.03), and new-onset diabetes (12% vs. 0%, P<0.02) were all significantly more common in the obese group. These results suggest that an attempt at significant weight reduction is indicated in obese patients prior to renal transplantation. © 1990 by Williams & Wilkins

Augmentation of chimerism in whole organ recipients by simultaneous infusion of donor bone marrow cells

We had previously demonstrated the persistence of donor leukocytes in the peripheral blood and tissues of long-surviving kidneyl and live2-4 recipients who had stable graft function many years after transplantation.1-6 Donor cell chimerism has since been noted by other investigators in recipients of heart,7 liver,8 kidney,9 and lungl0 transplants. In an attempt to augment chimerism, and thereby facilitate graft function, we initiated a prospective trial to enhance this phenomenon by infusing 3 × l0(8)/kg unaltered donor bone marrow cells perioperatively into an unmodified recipient of whole organ from the same donor. Additionally, 53 recipients of whole organ alone were monitored as controls. Reported herein are the first 20 of 64 study patients and 33 of 53 control patients who are more than 120 days posttransplantation

Schwarzschild black hole levitating in the hyperextreme Kerr field

The equilibrium configurations between a Schwarzschild black hole and a hyperextreme Kerr object are shown to be described by a three-parameter subfamily of the extended double-Kerr solution. For this subfamily, its Ernst potential and corresponding metric functions, we provide a physical representation which employs as arbitrary parameters the individual Komar masses and relative coordinate distance between the sources. The calculation of horizon's local angular velocity induced in the Schwarzschild black hole by the Kerr constituent yields a simple expression inversely proportional to the square of the distance parameter.Comment: 6 pages, 1 figure; improved versio

Compact High-Velocity Clouds at High Resolution

Six examples of the compact, isolated high-velocity clouds catalogued by Braun & Burton (1999) and identified with a dynamically cold ensemble of primitive objects falling towards the barycenter of the Local Group have been imaged with the Westerbork Synthesis Radio Telescope; an additional ten have been imaged with the Arecibo telescope. The imaging reveals a characteristic core/halo morphology: one or several cores of cool, relatively high-column-density material, are embedded in an extended halo of warmer, lower-density material. Several of the cores show kinematic gradients consistent with rotation; these CHVCs are evidently rotationally supported and dark-matter dominated. The imaging data allows several independent estimates of the distances to these objects, which lie in the range 0.3 to 1.0 Mpc. The CHVC properties resemble what might be expected from very dark dwarf irregular galaxies.Comment: 12 pages, 7 figures, to appear in "The Chemical Evolution of the Milky Way: Stars versus Clusters", eds. F. Matteuchi and F. Giovannelli, Kluwer Academic Publisher

Size of third and fourth ventricle in obstructive and communicating acute hydrocephalus after aneurysmal subarachnoid hemorrhage

In patients with acute hydrocephalus after aneurysmal subarachnoid haemorrhage (SAH), lumbar drainage is possible if the obstruction is in the subarachnoid space (communicating hydrocephalus). In case of intraventricular obstruction (obstructive hydrocephalus), ventricular drainage is the only option. A small fourth ventricle is often considered a sign of obstructive hydrocephalus. We investigated whether the absolute or relative size of the fourth ventricle can indeed distinguish between these two types of hydrocephalus. On CT-scans of 76 consecutive patients with acute headache but normal CT and CSF, we measured the cross-sectional surface of the third and fourth ventricle to obtain normal planimetric values. Subsequently we performed the same measurements on 117 consecutive SAH patients with acute hydrocephalus. These patients were divided according to the distribution of blood on CT-scan into three groups: mainly intraventricular blood (n = 15), mainly subarachnoid blood (n = 54) and both intraventricular and subarachnoid blood (n = 48). The size of the fourth ventricle exceeded the upper limit of normal in 2 of the 6 (33%) patients with intraventricular blood but without haematocephalus, and in 15 of the 54 (28%) patients with mainly subarachnoid blood. The mean ratio between the third and fourth ventricle was 1.45 (SD 0.66) in patients with intraventricular blood and 1.42 (SD 0.91) in those with mainly subarachnoid blood. Neither fourth ventricular size nor the ratio between the third and fourth ventricles discriminates between the two groups. A small fourth ventricle does not necessarily accompany obstructive hydrocephalus and is therefore not a contraindication for lumbar drainage

Scenario trees and policy selection for multistage stochastic programming using machine learning

We propose a hybrid algorithmic strategy for complex stochastic optimization problems, which combines the use of scenario trees from multistage stochastic programming with machine learning techniques for learning a policy in the form of a statistical model, in the context of constrained vector-valued decisions. Such a policy allows one to run out-of-sample simulations over a large number of independent scenarios, and obtain a signal on the quality of the approximation scheme used to solve the multistage stochastic program. We propose to apply this fast simulation technique to choose the best tree from a set of scenario trees. A solution scheme is introduced, where several scenario trees with random branching structure are solved in parallel, and where the tree from which the best policy for the true problem could be learned is ultimately retained. Numerical tests show that excellent trade-offs can be achieved between run times and solution quality

Al Qaeda at the bar: coordinating ideologues and mercenaries in terrorist organizations

Most terrorist groups have limited lifespans. A number of scholars and casual observers have noted that terrorist organizations often are comprised of two types of participants: ideologues or "true believers" dedicated to the group's cause, and mercenaries, who are adept at raising money through illegal means. The latter are interested primarily in their personal gains and have relatively little ideological commitment. Terrorist groups need both participants in order to function effectively. The purpose of the study is to understand the impact of communication on the compositions of terrorist groups. Three experimental treatments consider a coordination problem, and focus on the behavior of the mercenaries. Participants choose whether or not to participate in a terrorist attack. Payoffs are U-shaped in the number of participants, and increase with the number of successful attacks. The treatments allow communication between a leader and frontline fighters ("leader" treatment) or among the frontline fighters themselves ("communication" treatment). In the first treatment, a group leader can post messages to the members, which has a 19 % coordination success rate. For the communication treatment, all participants can post messages anonymously to each other, which yields a 27 % coordination success rate. By contrast, the baseline ("no communication" treatment) shows a success rate of 11 %. We conclude from our experimental evidence that disrupting communications among the frontline fighters is more effective in terminating terrorist organizations