Study of safety and efficacy of injection ferric carboxymaltose in iron deficiency anemia in pregnancy

Background: Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anemia (IDA) is associated with significant maternal, fetal and infant morbidity. Ferric carboxymaltose (FCM) may be better tolerated than the conventional blood transfusions and oral iron supplements. The study was designed to assess the safety and efficacy of IDA correction with intravenous (I.V.) FCM in pregnant women with mild, moderate and severe anemia in their second and third trimesters and their post-partum period. Methods: Prospective observational study; Treatment effectiveness was assessed by repeat hemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.Results: Intravenous FCM infusion significantly increased Hb values above baseline levels in all women. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. No serious adverse effects were found Conclusions: Our prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anemia in peri-partum period

Primary biliary cholangitis has the highest waitlist mortality in patients with cirrhosis and acute on chronic liver failure awaiting liver transplant

Background: Data are sparse on etiology specific outcomes on waitlist (WL) and post-transplant outcomes among patients with acute on chronic liver failure (ACLF). / Methods and results: In a retrospective cohort of 14,774 adults from United network for organ sharing (UNOS) database listed for Liver transplantation (LT) with cirrhosis and ACLF (January 2013–June 2019), 40% were due to alcohol-associated liver disease (ALD), followed by hepatitis C virus (HCV) at 20%, non-alcoholic steatohepatitis (19%), cryptogenic cirrhosis (7%), autoimmune hepatitis (5%), primary sclerosing cholangitis (PSC) at 3%, and 2% each for hepatitis B, primary biliary cholangitis (PBC), and metabolic etiology. Using competing risk analysis, cumulative risk of WL mortality was highest for PBC at 20.5% and lowest for PSC at 13.3%, P < .001. Compared with ALD as reference, WL mortality was higher for PBC (1.45 [1.16–1.82]), and similar for other etiologies, P < .001. Of this cohort, 9650 (65.3%) patients received LT, with 1-year. patient survival of 91.6% for PBC, worst for cryptogenic cirrhosis (89.5%) and best for PSC and ALD (93.4%), P < .001. / Conclusion: Among listed candidates with ACLF, those with PBC have highest WL mortality 1-year. post-transplant survival was excellent among recipients for PBC. If these findings are validated in prospective studies, liver disease etiology should be considered for LT selection among patients in ACLF

Selective laser trabeculoplasty reduces mean IOP and IOP variation in normal tension glaucoma patients

Mohammed K El Mallah1, Molly M Walsh2, Sandra S Stinnett2, Sanjay G Asrani21Ocala Eye, Ocala, Florida, USA; 2Duke University Eye Center, Durham, North Carolina, USAPurpose: To evaluate the effect of selective laser trabeculoplasty (SLT) in normal tension glaucoma (NTG) patients.Patients and methods: A retrospective review was performed of NTG patients who had undergone SLT at the Duke University Eye Center between 12/2002 and 7/2005. For each eye of each patient at pre-laser and post-laser time points, the IOP measurements were summarized by mean, standard deviation, and range. Then for each of these descriptive statistics, the differences between pre-laser and post-laser values were obtained. Statistical analysis was performed using a random effects model. Main outcome measures: difference in mean IOP, standard deviation of IOP, and range of IOP.Results: Thirty-one eyes of 18 patients were included for analysis. The average of the mean &amp;shy;pre-operative IOP measurements was 14.3 &amp;plusmn; 2.6 mmHg compared to 12.2 &amp;plusmn; 1.7 mmHg (P &amp;lt; 0.001) post-operatively. The mean pre-operative standard deviation was 1.9 &amp;plusmn; 0.9 mmHg compared to 1.0 &amp;plusmn; 0.6 mmHg (P = 0.002) post-operatively while the mean IOP range prior to treatment was 4.5 &amp;plusmn; 2.5 mmHg compared to 2.5 &amp;plusmn; 1.9 mmHg (P = 0.017) after treatment.Conclusion: In this pilot study, SLT was found to lower mean IOP and intervisit IOP &amp;shy;variation in NTG patients. Given the importance of IOP variation and its association with glaucoma &amp;shy;progression, measurement of IOP variation following treatment with SLT may be considered.Keywords: SLT, NTG, laser, glaucom

Protecting the Kidney in Liver Transplant Recipients: Practice‐Based Recommendations From the American Society of Transplantation Liver and Intestine Community of Practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134132/1/ajt13765_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134132/2/ajt13765.pd

On the Impact of Routing and Network Size for Wireless Network-on-Chip Performance

Wireless Network-on-Chip or WiNoC is an alternative to traditional planar on-chip networks. On-chip wireless links are utilized to reduce latency between distant nodes due to its capability to communicate with far-away node within a single hop. This paper analyzes the impact of various routing schemes and the effect of WiNoC sizes on network traffic distributions compared to conventional mesh NoC. Radio hubs (4×4) are evenly placed on WiNoC to analyze global average delay, throughput, energy consumption and wireless utilization. For validation, three various network sizes (8×8, 16×16 and 32×32) of mesh NoC and WiNoC architectures are simulated on cycle-accurate Noxim simulator under numerous traffic load distributions. Simulation results show that WiNoC architecture with the 16×16 network size has better average speedup (∼1.2×) and improved network throughputs by 6.36% in non-uniform transpose traffic distribution. However, as the trade-off, WiNoC requires 63% higher energy consumption compared to the classical wired NoC mesh

Validating a novel score based on interaction between ACLF grade and MELD score to predict waitlist mortality

Background and Aim: Among candidates listed for liver transplant (LT), MELD score may not capture acute on chronic liver failure (ACLF) severity. Data on interaction between ACLF and MELD score in predicting waitlist (WL) mortality are scanty. / Methods: UNOS database (01/2002 to 06/2018) on LT listings for adults with cirrhosis and ACLF (without HCC) was analyzed. ACLF grades 1, 2, 3a, and 3b- were defined using modified EASL-CLIF criteria. / Results: Of 18,416 candidates with ACLF at listing (mean age 54 years, 69% males, 63% Caucasians), 90-d WL mortality (patient death or being too sick for LT) was 21.6% (18%, 20%, 25%, and 39% for ACLF grades 1, 2, 3a, and 3b respectively). Fine and Gray regression model identified interaction between MELD and ACLF grade, with higher impact of ACLF at lower MELD score. Other variables included candidate’s age, gender, liver disease etiology, listing MELD, ACLF grade, obesity, and performance status. A score developed using parameter estimates from the interaction model on the derivation cohort (N=9181) stratified the validation cohort (N=9235) to four quartiles Q1 (score 15.50). WL mortality increased with each quartile from 13%, 18%, 23%, and 36% respectively. Observed versus expected deciles on WL mortality in validation cohort showed good calibration (goodness of fit P=0.98) and correlation (R=0.99). / Conclusion: Among selected candidates who are in ACLF at listing, MELD score and ACLF interact in predicting cumulative risk of 90-d WL mortality, with higher impact of ACLF grade at lower listing MELD score. Validating these findings in large prospective studies will support to factor in both MELD and ACLF in prioritizing transplant candidates and allocation of liver grafts

Area Optimization for Networks-on-Chip Architectures using Deep Network Partitioning

This paper presents an area optimization for Network-on-Chip (NoC) architecture using deep Network Par- titioning technique. Among the hardest problems in NoC design is customizing the topological structure and application mapping on on-chip network in order to cater for application demand at minimal cost. The area cost of NoC is cut down by utilizing multi- level network partitioning where it partitions large networks into smaller segments. The enhancement in area cost is obtained by reducing both router area and the number of global links. In terms of performance, the multi-level network partitioning offers a better solution by assigning computational cores with heavy inter-core communications into the same segment. Therefore, the average inter-node distances would be minimized. This directly results in better performance due to its shortest path. For verification, the proposed technique has been tested on various System-on-Chip (SoC) applications case studies. The proposed technique results in the reduction of more than 7% router area, 19% global links, and 12% average inter-node distance

Chylous Pericardial Effusion and Tamponade Due to Catheter Induced Superior Vena Caval Obstruction in a Premature Infant

Abstract Chylous pericardial effusion and tamponade in children are rare complications of thoracic duct injury during cardiothoracic surgeries or as a result of superior vena cava (SVC) obstruction. We report a rare case of chylous tamponade in a premature infant as a complication of long standing central venous catheterization resulting in SVC obstruction. Urgent pericardiocentesis and then surgical creation of a pericardial window resulted in complete resolution of the effusion and recovery of the patient. Introduction Central venous catheters (CVCs) are more frequently used in the neonatal intensive care units as the birth rate and survival of premature infants increase. They provide long-standing central venous access for the administration of fluids, medications and nutrition. The most common complications of CVC placement are mechanical dislodgment, perforation, thrombosis, catheter obstruction and sepsis Case Report A thirty-six week gestation premature female infant was born via cesarean section. The pregnancy was complicated with a congenital diaphragmatic hernia and cardiac dextroposition. Postnatal 2-D echocardiogram showed normal cardiac anatomy and function and severe pulmonary hypertension. She required ECMO for the first 8 days of life. Surgical repair of the diaphragmatic hernia was performed at 2 weeks of age. A central venous catheter was needed for the administration of medications and for hyper-alimentation. The CVC was inserted in the SVC via the right internal jugular vein. At 3 months of age, she developed respiratory distress and edema of the upper chest, head and neck. A CXR showed an enlarged cardiac silhouette Journal of Pediatrics &amp; Child Care Figure 1: A chest X-Ray showing an enlarged cardiac silhouette due to pericardial effusion and obliteration of the left costophrenic angle due to pleural effusion

Epigenomic profiling of newborns with isolated orofacial clefts reveals widespread DNA methylation changes and implicates metastable epiallele regions in disease risk.

Cleft lip with or without cleft palate (CL/P) is a common human birth defect whose etiologies remain largely unknown. Several studies have demonstrated that periconceptional supplementation of folic acid can reduce risk of CL/P in offspring. In this study, we tested the hypothesis that the preventive effect of folic acid is manifested through epigenetic modifications by determining whether DNA methylation changes are associated with CL/P. To more readily observe the potential effects of maternal folate on the offspring epigenome, we focused on births prior to mandatory dietary folate fortification in the United States (i.e. birth year 1997 or earlier). Genomic DNA methylation levels were assessed from archived newborn bloodspots in a 182-member case-control study using the Illumina® Human Beadchip 450K array. CL/P cases displayed striking epigenome-wide hypomethylation relative to controls: 63% of CpGs interrogated had lower methylation levels in case newborns, a trend which held up in racially stratified sub-groups. 28 CpG sites reached epigenome-wide significance and all were case-hypomethylated. The most significant CL/P-associated differentially methylated region encompassed the VTRNA2-1 gene, which was also hypomethylated in cases (FWER p = 0.014). This region has been previously characterized as a nutritionally-responsive, metastable epiallele and CL/P-associated methylation changes, in general, were greater at or near putative metastable epiallelic regions. Gene Set Enrichment Analysis of CL/P-associated DMRs showed an over-representation of genes involved in palate development such as WNT9B, MIR140 and LHX8. CL/P-associated DNA methylation changes may partly explain the mechanism by which orofacial clefts are responsive to maternal folate levels