Biliary complications after liver transplantation: With special reference to the biliary cast syndrome and techniques of secondary duct repair

In 93 consecutive cases of orthotopic liver transplantation, there were 24 examples of biliary obstruction and eight of bile fistula formation. Six of the obstructed livers developed biliary cast formation so extensive that the smaller intrahepatic ducts became plugged to an extent that they could no longer have been treated by surgical means. In each of the six cases, the most important causative factor was neglected obstruction of the large bile ducts with the intrahepatic lesions apparently being late and secondary. Stone and/or cast formation also occurred in other obstructed livers in the presence of bile fistulas, but these deposits were limited to the large ducts where they could have been or were removed. Although homograft bile undoubtedly has increased lithogenicity at certain postoperative times, the data from the present study have shown that biliary sludge formation essentially is always associated with defective bile duct reconstruction, and the observations have underscored the urgency with which reoperation must be considered. Techniques of secondary intervention have been described, with emphasis on conversion of cholecystojejunostomy to choledochojejunostomy. This operation has permitted salvage of homografts in eight of nine trials and the survival of seven patients. © 1977

Liver Transplantation for Budd-Chiari Syndrome

Orthotopic liver transplantation was accomplished in a 22-year-old woman dying of the Budd-Chiari syndrome. She is well and has normal liver function 16 months postoperatively. In view of the good early result, it will be appropriate to consider liver replacement for this disease in further well-selected cases. © 1976, American Medical Association. All rights reserved

The Impact of Non-Equipartition on Cosmological Parameter Estimation from Sunyaev-Zel'dovich Surveys

The collisionless accretion shock at the outer boundary of a galaxy cluster should primarily heat the ions instead of electrons since they carry most of the kinetic energy of the infalling gas. Near the accretion shock, the density of the intracluster medium is very low and the Coulomb collisional timescale is longer than the accretion timescale. Electrons and ions may not achieve equipartition in these regions. Numerical simulations have shown that the Sunyaev-Zel'dovich observables (e.g., the integrated Comptonization parameter Y) for relaxed clusters can be biased by a few percent. The Y-mass relation can be biased if non-equipartition effects are not properly taken into account. Using a set of hydrodynamical simulations, we have calculated three potential systematic biases in the Y-mass relations introduced by non-equipartition effects during the cross-calibration or self-calibration when using the galaxy cluster abundance technique to constraint cosmological parameters. We then use a semi-analytic technique to estimate the non-equipartition effects on the distribution functions of Y (Y functions) determined from the extended Press-Schechter theory. Depending on the calibration method, we find that non-equipartition effects can induce systematic biases on the Y functions, and the values of the cosmological parameters Omega_8, sigma_8, and the dark energy equation of state parameter w can be biased by a few percent. In particular, non-equipartition effects can introduce an apparent evolution in w of a few percent in all of the systematic cases we considered. Techniques are suggested to take into account the non-equipartition effect empirically when using the cluster abundance technique to study precision cosmology. We conclude that systematic uncertainties in the Y-mass relation of even a few percent can introduce a comparable level of biases in cosmological parameter measurements.Comment: 10 pages, 3 figures, accepted for publication in the Astrophysical Journal, abstract abridged slightly. Typos corrected in version

Development of a modified SEDEX phosphorus speciation method for ancient rocks and modern iron-rich sediments

We report the development of a modified method for evaluating different reservoirs of sedimentary phosphorus (P) in ancient marine sedimentary rocks and in modern Fe-rich sediments. Utilising the existing SEDEX scheme for P partitioning in modern sediments, we initially demonstrate limitations in the application of the original scheme to sediments and rocks containing crystalline hematite and magnetite. We tested additional extractions for these crystalline Fe phases, using both synthetic minerals, and modern and ancient sediments. The addition of 6 h oxalate and 6 h citrate-dithionate-acetate extractions considerably enhanced the total recovery of synthetic magnetite and hematite to 88.7 ± 1.1% and 76.9 ± 3.8%, respectively. In addition, application of the 6 h oxalate extraction to synthetic P-containing magnetite recovered 93.9 ± 1.7% of the Fe present and 88.2 ± 12.8% of the co-precipitated P. Based upon these results we developed a modified SEDEX extraction scheme. The modified scheme was applied to modern Fe-rich sediments from Golfo Dulce, Costa Rica, which resulted in 16% higher Fe-bound P recovery. Application of the scheme to a variety of ancient marine rocks increased the recovery of Fe-bound P by up to 22%. We also highlight the potential for authigenic carbonate fluorapatite to convert to more crystalline apatite in ancient rocks during deep burial and metamorphism. We suggest that in such systems minimum and maximum estimates of the total reactive P pool may be calculated with and without the inclusion of crystalline P. It is noted that the application of the revised method may have important implications for understanding the cycling of P in ancient marine environments

Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes

Background: Tobacco-related illnesses are leading causes of death and healthcare use. Our objective was to determine whether implementation of a hospitalinitiated smoking cessation intervention would reduce mortality and downstream healthcare usage. Methods: A 2-group effectiveness study was completed comparing patients who received the ‘Ottawa Model’ for Smoking Cessation intervention (n=726) to usual care controls (n=641). Participants were current smokers, >17 years old, and recruited during admission to 1 of 14 participating hospitals in Ontario, Canada. Baseline data were linked to healthcare administrative data. Competing-risks regression analysis was used to compare outcomes between groups. Results: The intervention group experienced significantly lower rates of all-cause readmissions, smoking-related readmissions, and all-cause emergency department (ED) visits at all time points. The largest absolute risk reductions (ARR) were observed for allcause readmissions at 30 days (13.3% vs 7.1%; ARR, 6.1% (2.9% to 9.3%); p<0.001), 1 year (38.4% vs 26.7%; ARR, 11.7% (6.7% to 16.6%); p<0.001), and 2 years (45.2% vs 33.6%; ARR, 11.6% (6.5% to 16.8%); p<0.001). The greatest reduction in risk of allcause ED visits was at 30 days (20.9% vs 16.4%; ARR, 4.5% (0.4% to 8.7%); p=0.03). Reduction in mortality was not evident at 30 days, but significant reductions were observed by year 1 (11.4% vs 5.4%; ARR 6.0% (3.1% to 9.0%); p<0.001) and year 2 (15.1% vs 7.9%; ARR, 7.3% (3.9% to 10.7%); p<0.001). Conclusions: Considering the relatively low cost, greater adoption of hospital-initiated tobacco cessation interventions should be considered to improve patient outcomes and decrease subsequent healthcare usage

Effects of the Non-Equipartition of Electrons and Ions in the Outskirts of Relaxed Galaxy Clusters

(abridged) We have studied the effects of electron-ion non-equipartition in the outer regions of relaxed clusters for a wide range of masses in the \LambdaCDM cosmology using one-dimensional hydrodynamic simulations. The effects of the non-adiabatic electron heating efficiency, \beta, on the degree of non-equipartition are also studied. Using the gas fraction f_gas = 0.17 (which is the upper limit for a cluster), we give a conservative lower limit of the non-equipartition effect on clusters. Beyond the virial radius, the non-equipartition effect depends rather strongly on \beta, and such a strong dependence at the shock radius can be used to distinguish shock heating models or constrain the shock heating efficiency of electrons. We have also studied systematically the signatures of non-equipartition on X-ray and SZ observables. We have calculated the effect of non-equipartition on the projected temperature and X-ray surface brightness profiles using the MEKAL emission model. The non-equipartition effect can introduce a ~10% bias in the projected temperature at R_vir for a wide range of \beta. We also found that the effect of non-equipartition on the projected temperature profiles can be enhanced by increasing metallicity. We found that for our model in the \LambdaCDM Universe, the integrated SZ bias, Y_{non-eq}/Y_{eq}, evolves slightly (at a percentage level) with redshift, which is in contrast to the self-similar model in the Einstein-de Sitter Universe. This may introduce biases in cosmological studies using the f_gas technique. We discussed briefly whether the equipartition and non-equipartition models near the shock region can be distinguished by future radio observations with, for example, ALMA.Comment: 28 pages, 19 figures, accepted for publication in the Astrophysical Journal. Typos corrected in version

The gravity duals of SO/USp superconformal quivers

We study the gravity duals of SO/USp superconformal quiver gauge theories realized by M5-branes wrapping on a Riemann surface ("G-curve") together with a Z_2-quotient. When the G-curve has no punctures, the gravity solutions are classified by the genus g of the G-curve and the torsion part of the four-form flux G_4. We also find that there is an interesting relation between anomaly contributions from two mysterious theories: T_{SO(2N)} theory with SO(2N)^3 flavor symmetry and \tilde{T}_{SO(2N)} theory with SO(2N) x USp(2N-2)^2 flavor symmetry. The dual gravity solutions for various SO/USp-type tails are also studied.Comment: 27 pages, 13 figures; v2 minor corrections, typos corrected, Figure 13 replaced, references adde

Whole genome sequence analysis of Australian avian pathogenic Escherichia coli that carry the class 1 integrase gene

© 2019 The Authors. Avian pathogenic Escherichia coli (APEC) cause widespread economic losses in poultry production and are potential zoonotic pathogens. Genome sequences of 95 APEC from commercial poultry operations in four Australian states that carried the class 1 integrase gene intI1, a proxy for multiple drug resistance (MDR), were characterized. Sequence types ST117 (22/95), ST350 (10/95), ST429 and ST57 (each 9/95), ST95 (8/95) and ST973 (7/95) dominated, while 24 STs were represented by one or two strains. FII and FIB repA genes were the predominant (each 93/95, 98 %) plasmid incompatibility groups identified, but those of B/O/K/Z (25/95, 26 %) and I1 (24/95, 25 %) were also identified frequently. Virulence-associated genes (VAGs) carried by ColV and ColBM virulence plasmids, including those encoding protectins [iss (91/95, 96 %), ompT (91/95, 96 %) and traT (90/95, 95 %)], iron-acquisition systems [sitA (88/95, 93 %), etsA (87/95, 92 %), iroN (84/95, 89 %) and iucD/iutA (84/95, 89 %)] and the putative avian haemolysin hylF (91/95, 96 %), featured prominently. Notably, mobile resistance genes conferring resistance to fluoroquinolones, colistin, extended-spectrum b-lactams and carbapenems were not detected in the genomes of these 95 APEC but carriage of the sulphonamide resistance gene, sul1 (59/95, 63 %), the trimethoprim resistance gene cassettes dfrA5 (48/95, 50 %) and dfrA1 (25/95, 27 %), the tetracycline resistance determinant tet(A) (51/95, 55 %) and the ampicillin resistance genes bla TEM-1A/B/C (48/95, 52 %) was common. IS26 (77/95, 81 %), an insertion element known to capture and mobilize a wide spectrum of antimicrobial resistance genes, was also frequently identified. These studies provide a baseline snapshot of drug-resistant APEC in Australia and their role in the carriage of ColV-like virulence plasmids

Cumulative Risk Effects in the Bullying of Children and Young People with Autism Spectrum Conditions

Students with autism are more likely to be bullied than their typically developing peers. However, several studies have shown that their likelihood of being bullied increases in the context of exposure to certain risk factors (e.g. behaviour difficulties, poor peer relationships). This study explores vulnerability to bullying from a cumulative risk perspective, where the number of risks rather than their nature is considered. 722 teachers and 119 parents of young people with ASC participated in the study. Established risk factors were summed to form a cumulative risk score in teacher and parent models. There was evidence of a cumulative risk effect in both models, suggesting that as the number of risks increased, so did exposure to bullying. A quadratic effect was found in the teacher model, indicating that there was a disproportionate increase in the likelihood of being bullied in relation to the number of risk factors to which a young person was exposed. In light of these findings, it is proposed that more attention needs to be given to the number of risks to which children and young people with ASC are exposed when planning interventions and providing a suitable educational environment