Science.gov

Sample records for 5-year graft survival

  1. Alveolar Ridge Contouring with Free Connective Tissue Graft at Implant Placement: A 5-Year Consecutive Clinical Study.

    PubMed

    Hanser, Thomas; Khoury, Fouad

    2016-01-01

    This study evaluated volume stability after alveolar ridge contouring with free connective tissue grafts at implant placement in single-tooth gaps. A total of 52 single-tooth gaps with labial volume deficiencies in the maxilla (incisors, canines, and premolars) were consecutively treated with implants and concomitant free palatal connective tissue grafts in 46 patients between 2006 and 2009. Implants had to be covered with at least 2 mm peri-implant local bone after insertion. At implant placement, a free connective tissue graft from the palate was fixed inside a labial split-thickness flap to form an existing concave buccal alveolar ridge contour due to tissue volume deficiency into a convex shape. Standardized volumetric measurements of the labial alveolar contour using a template were evaluated before connective tissue grafting and at 2 weeks, 1 year, and 5 years after implantprosthetic incorporation. Tissue volume had increased significantly (P < .05) in all six reference points representing the outer alveolar soft tissue contour of the implant before connective tissue grafting to baseline (2 weeks after implant-prosthetic incorporation). Statistically, 50% of the reference points (P > .05) kept their volume from baseline to 1 year after prosthetic incorporation and from baseline to 5 years after prosthetic incorporation, respectively, whereas reference points located within the area of the implant sulcus showed a significant (P < .05) decrease in volume. Clinically, 5 years after prosthetic incorporation the originally concave buccal alveolar contour was still convex in all implants, leading to a continuous favorable anatomical shape and improved esthetic situation. Intraoral radiographs confirmed osseointegration and stable peri-implant parameters with a survival rate of 100% after a follow-up of approximately 5 years. Implant placement with concomitant free connective tissue grafting appears to be an appropriate long-term means to contour preexisting buccal

  2. Graft and Patient Survival Outcomes of a Third Kidney Transplant

    PubMed Central

    Redfield, Robert R.; Gupta, Meera; Rodriguez, Eduardo; Wood, Alexander; Abt, Peter L.; Levine, Matthew H.

    2014-01-01

    Background The waiting time for deceased donor renal transplantation in the United States continues to grow. Retransplant candidates make up a small but growing percentage of the overall transplant waiting list and raise questions about the stewardship of scarce resources. The utility of renal transplantation among individuals with two prior renal transplants is not described in the literature and we thus sought to determine the survival benefit associated with a third kidney transplant (3KT). Methods Multivariable Cox regression models were created to determine characteristics associated with 3KT outcomes and the survival benefit of 3KT among recipients wait listed and transplanted within the United States between 1995 and 2009. Results 4,334 patients were waitlisted for a 3KT and 2,492 patients received a 3KT. In a multivariate analysis, 3KT demonstrated an overall patient survival benefit compared to the wait list (HR-0.379, CI=0.302-0.475 p<0.001) for those awaiting their first, second or third kidney transplants, although an inferior graft outcome compared to first kidney transplants. The time to survival benefit did not accrue until 8-months after transplant. Additionally we found that the duration of second graft survival was predictive of third graft survival, such that second graft survival beyond 5 years is associated with superior 3KT graft survival. Second graft loss in 30 days or less was not associated with inferior 3KT graft survival. Conclusion 3KT achieves a survival benefit over remaining on the wait list, although is associated with inferior graft outcomes compared to first kidney transplants. Graft survival of the second transplant beyond 5 years is associated with superior 3KT graft survival. PMID:25121473

  3. Erythrocyte survival following intraoperative autotransfusion in spinal surgery: an in vivo comparative study and 5-year update

    SciTech Connect

    Ray, J.M.; Flynn, J.C.; Bierman, A.H.

    1986-11-01

    A 5-year prospective study of intraoperative blood transfusion in 239 patients, most of whom had major spinal surgery, has been completed. Autotransfusion is safe, practical, and it reduces donor blood requirements and total blood loss by 50%. It eliminates host versus graft reactions and disease transmission. In 33 patients having major spinal surgery, the in vivo survival of autologous, homologous, and processed red blood cells (RBC) using the Cell Saver System were compared. The RBC survival studies were performed using chromium-51 isotope labeling technique. The long-term survival of processed RBCs was normal over a 30-day period. There was no significant difference in the survival rate of the three groups studied.

  4. Trends in 5-year survival rates among breast cancer patients by hormone receptor status and stage

    PubMed Central

    Chen, Lu; Linden, Hannah M.; Anderson, Benjamin O.; Li, Christopher I.

    2014-01-01

    Purpose Improvement in breast cancer survival has been observed in recent decades in the U.S., but it is unclear if similar survival gains are consistent across breast cancer subtypes, especially with regards to more advanced stages of the disease. Methods Data were from 13 population-based cancer registries participating in the Surveillance, Epidemiology and End Results (SEER) program, consisting of women between 20–79 years of age diagnosed with invasive breast cancer between 1992 and 2008. 2-year (1992–2008) and 5-year (1992–2006) breast cancer cause-specific survival rates were calculated and stratified by estrogen receptor (ER)/progesterone receptor (PR) status, stage and race. Annual percent changes in survival rates were assessed. Results From 1992 through 1998–1999, 5-year and 2-year cause specific survival rates significantly improved across ER+/PR+, ER−/PR− and ER+/PR− subtypes, with an annual increase ranging from 0.5%–1.0%. From 1998–1999 to 2006, different patterns were observed by ER/PR subtypes with survival rates slightly improving for ER+/PR+, continuing to improve at a rate of 0.5% per year for ER−/PR−, and dropping 0.3% annually for ER+/PR− No significant survival gains were experienced by patients with ER−/PR+ cancer during the study period. In terms of advanced diseases, greatest annual increases in survival rates were seen for patients with stage III–IV ER+/PR+ and ER−/PR− tumors but less progress was observed for advanced ER+/PR− breast cancers. Conclusion Steady improvements in survival rates for breast cancer have been achieved over the past several decades. However, 5-year survival rates for stage IV disease remained dismally below 20% for most ER/PR subtypes. PMID:25164974

  5. The impact factors on 5-year survival rate in patients operated with oral cancer

    PubMed Central

    Geum, Dong-Ho; Roh, Young-Chea; Yoon, Sang-Yong; Kim, Hyo-Geon; Lee, Jung-Han; Song, Jae-Min; Lee, Jae-Yeol; Hwang, Dae-Seok; Kim, Yong-Deok; Shin, Sang-Hun; Chung, In-Kyo

    2013-01-01

    Objectives The purpose of this study is to analyze clinical impact factors on the survival rate, and to acquire basic clinical data for the diagnosis of oral cancer, for a determination of the treatment plan with long-term survival in oral cancer patients. Materials and Methods Through a retrospective review of the medical records, the factors for long-term survival rate were analyzed. Thirty-seven patients, among patient database with oral cancer treated in the Department of Oral and Maxillofacial Surgery at Pusan National University Hospital within a period from March 1998 to March 2008, were selected within the study criteria and were followed-up for more than 5 years. The analyzed factors were gender, age, drinking, smoking, primary tumor site, type of cancer, TNM stage, recurrence of affected region, and metastasis of cervical lymph node. The 5-year survival rate on the impact factors was calculated statistically using the Kaplan-Meier method. Results By classification of clinical TNM at the 1st visit, there were 11 (29.7%) cases for stage I, 11 (29.7%) cases for stage II, 3 (8.1%) cases for stage III, and 12 (32.5%) cases for stage IV. The 5-year survival rate of total oral cancer patients after the operation were 75.7%, pathological TNM stage related 5-year survival rate were as follows: stage I 90.0%, stage II 81.8%, stage III 100% and stage IV 45.5%; in which the survival rate difference by each stage was significantly observed. The recurrence of cervical lymph node was the significant impact factor for the survival rate, because only 30.0% the survival rate in recurrent cases existed. During the follow-up, there were 15 (40.5%) patients with confirmed recurrence, and the 5-year survival rate of these patients was decreased as 46.7%. Conclusion The classification of clinical and pathological TNM stage, local recurrence after surgery, and metastasis of cervical lymph node after surgery were analyzed as the 3 most significant factors. PMID:24471047

  6. Long-term survival with diaphanospondylodysostosis (DSD): survival to 5 years and further phenotypic characteristics.

    PubMed

    Scottoline, Brian; Rosenthal, Scott; Keisari, Rami; Kirpekar, Rashmi; Angell, Cathy; Wallerstein, Robert

    2012-06-01

    We report on the natural history of diaphanospondylodysostosis (DSD) in the longest known survivor. DSD is a rare form of autosomal recessive vertebral dysotosis recently identified to be caused by a mutation in the BMPER gene. This condition is characterized by absent or severely delayed ossification of vertebral bodies, short broad thorax, short neck, protuberant abdomen, marked respiratory insufficiency, and normal appendicular skeleton. It is one of a number of spinal dysostoses, which are a heterogeneous group of axial skeletal malformations occurring during blastogenesis with continued evolution after birth. Significant medical intervention and at-home support contributed to the long-term survival of our patient. The patient had tracheomalacia, which resulted in respiratory insufficiency with thoracic insufficiency syndrome (TIS). Tracheostomy and vertical expandable prosthetic titanium rib (VEPTR) insertion operations ameliorated his symptoms. In addition, comprehensive physical and occupational therapy was performed due to chronic hypotonia. A consistent feature of all described DSD cases thus far are renal findings of dysplasia, nephrogenic rests or nephroblastomatosis, and/or cysts. The patient's renal cysts were monitored with serial ultrasounds at approximately 6-month intervals. The patient was diagnosed with bilateral renal cysts by ultrasound as a neonate, with eventual diagnosis at approximately 20 months of age with nephroblastoma suggesting this maybe an intrinsic part of DSD. The lack of other cases with nephroblastoma is likely related to the previously reported short period of survival.

  7. Disease Management Project Breast Cancer in Hesse – 5-Year Survival Data

    PubMed Central

    Jackisch, C.; Funk, A.; König, K.; Lubbe, D.; Misselwitz, B.; Wagner, U.

    2014-01-01

    Introduction: The Disease Management Project Breast Cancer (DMP Breast Cancer) was first launched in Hesse in 2004. The project is supported by the health insurance companies in Hesse and the Professional Association of Gynaecologists in Hesse. The aim is to offer structured treatment programmes to all women diagnosed with breast cancer in Hesse by creating intersectoral cooperations between coordinating clinics, associated hospitals and gynaecologists in private practice who registered in the DMP programme. Method: Between 1 January 2005 and 30 June 2011, 13 973 women were enrolled in the DMP programme. Results: After data cleansing, survival rates were calculated for a total of 11 214 women. The 5-year overall survival (OS) rate was 86.3 %; survival rates according to tumour stage on presentation were 92.2 % (pT1) and 82.3 % (pT2), respectively. The impact of steroid hormone receptor status on survival (87.8 % for receptor-positive cancers vs. 78.9 % for receptor-negative cancers) and of age at first diagnosis on survival (≤ 35 years = 91 %) were calculated. Conclusion: The project showed that intersectoral cooperation led to significant improvements in the quality of treatment over time, as measured by quality indicators and outcomes after treatment. PMID:24882878

  8. Diabetic foot reconstruction using free flaps increases 5-year-survival rate.

    PubMed

    Oh, Tae Suk; Lee, Ho Seung; Hong, Joon Pio

    2013-02-01

    The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with free flaps and analyse the preoperative risk factors. This study reviews 121 cases of reconstructed diabetic foot in 113 patients over 9 years (average follow-up of 53.2 months). Patients' age ranged from 26 to 78 years (average, 54.6 years). Free flaps used were anterolateral thigh (ALT, 90), superficial circumflex iliac artery perforator (SCIP, 20), anteromedial thigh (AMT, 5), upper medial thigh (UMT, 3), and other perforator free flaps (3). Correlation between the surgical outcome and preoperative risk factors were analysed using logistic regression model. Total loss was seen in 10 cases and 111 free-tissue transfers were successful (flap survival rate of 91.7%). During follow-up, limb was eventually lost in 17 patients and overall limb salvage rate was 84.9% and the 5-year survival was 86.8%. Correlation between flap loss and 14 preoperative risk factors (computed tomography (CT) angiogram showing intact numbers of major vessels, history of previous angioplasty, peripheral arterial disease (PAD), heart problem, chronic renal failure (CRF), American Society of Anaesthesiologists (ASA) physical status classification system, smoking, body mass index (BMI), HBA1c, lymphocyte count, ankle-brachial index (ABI), osteomyelitis, C-reactive protein (CRP) level and whether taking immunosuppressive agents) were analysed. Significant odds ratio were seen in patients who underwent lower extremity angioplasties (odds ratio: 17.590, p<0.001), with PAD (odds ratio: 10.212, p=0.032) and taking immunosuppressive agents after kidney transplantation (odds ratio: 4.857, p<0.041). Diabetic foot reconstruction using free flaps has a high chance for success and significantly increases the 5-year survival rate. Risk factors such as PAD, history of angioplasties in the extremity and using immunosuppressive agents after transplant may increase the chance for flap loss.

  9. Transvenous Embolization of a Spontaneous Femoral AVF 5 Years After an Incomplete Treatment with Arterial Stent-Grafts

    SciTech Connect

    Peynircioglu, Bora Ozkan, Murat; Dogan, Omer Faruk; Cil, Barbaros E.; Dogan, Riza

    2008-03-15

    A 66-year-old man with complex left femoral arterio-venous fistula (AVF) was first diagnosed after a deep venous thrombosis incident approximately 5 years ago. Partial treatment was performed by means of endografts along the superficial femoral artery, which remained patent for 5 years. The patient had been doing well until a couple of months ago when he developed severe venous stasis and ulcers of the left cruris, due to a high-flow nonhealing complex AVF with additional iliac vein occlusion. Therefore; the definitive treatment was performed by a unique endovascular technique combined with surgical venous bypass (femoro-femoral crossover saphenous bypass, the Palma operation). A novel percutaneous transvenous technique for occlusion of a complex high-flow AVF is reported with a review of the literature. The case is unique with spontaneous AVF, transvenous embolization with detachable coils and ONYX, and the hybrid treatment technique as well as the long-term patency of superficial femoral artery stent-grafts.

  10. Microscopy image analysis of p63 immunohistochemically stained laryngeal cancer lesions for predicting patient 5-year survival.

    PubMed

    Ninos, Konstantinos; Kostopoulos, Spiros; Kalatzis, Ioannis; Sidiropoulos, Konstantinos; Ravazoula, Panagiota; Sakellaropoulos, George; Panayiotakis, George; Economou, George; Cavouras, Dionisis

    2016-01-01

    The aim of the present study was to design a microscopy image analysis (MIA) system for predicting the 5-year survival of patients with laryngeal squamous cell carcinoma, employing histopathology images of lesions, which had been immunohistochemically (IHC) stained for p63 expression. Biopsy materials from 42 patients, with verified laryngeal cancer and follow-up, were selected from the archives of the University Hospital of Patras, Greece. Twenty six patients had survived more than 5 years and 16 less than 5 years after the first diagnosis. Histopathology images were IHC stained for p63 expression. Images were first processed by a segmentation method for isolating the p63-expressed nuclei. Seventy-seven features were evaluated regarding texture, shape, and physical topology of nuclei, p63 staining, and patient-specific data. Those features, the probabilistic neural network classifier, the leave-one-out (LOO), and the bootstrap cross-validation methods, were used to design the MIA-system for assessing the 5-year survival of patients with laryngeal cancer. MIA-system accuracy was about 90 % and 85 %, employing the LOO and the Bootstrap methods, respectively. The image texture of p63-expressed nuclei appeared coarser and contained more edges in the 5-year non-survivor group. These differences were at a statistically significant level (p < 0.05). In conclusion, this study has proposed an MIA-system that may be of assistance to physicians, as a second opinion tool in assessing the 5-year survival of patients with laryngeal cancer, and it has revealed useful information regarding differences in nuclei texture between 5-year survivors and non-survivors.

  11. Xenon treatment protects against cold ischemia associated delayed graft function and prolongs graft survival in rats.

    PubMed

    Zhao, H; Watts, H R; Chong, M; Huang, H; Tralau-Stewart, C; Maxwell, P H; Maze, M; George, A J T; Ma, D

    2013-08-01

    Prolonged hypothermic storage causes ischemia-reperfusion injury (IRI) in the renal graft, which is considered to contribute to the occurrence of the delayed graft function (DGF) and chronic graft failure. Strategies are required to protect the graft and to prolong renal graft survival. We demonstrated that xenon exposure to human proximal tubular cells (HK-2) led to activation of range of protective proteins. Xenon treatment prior to or after hypothermia-hypoxia challenge stabilized the HK-2 cellular structure, diminished cytoplasmic translocation of high-mobility group box (HMGB) 1 and suppressed NF-κB activation. In the syngeneic Lewis-to-Lewis rat model of kidney transplantation, xenon exposure to donors before graft retrieval or to recipients after engraftment decreased caspase-3 expression, localized HMGB-1 within nuclei and prevented TLR-4/NF-κB activation in tubular cells; serum pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were reduced and renal function was preserved. Xenon treatment of graft donors or of recipients prolonged renal graft survival following IRI in both Lewis-to-Lewis isografts and Fischer-to-Lewis allografts. Xenon induced cell survival or graft functional recovery was abolished by HIF-1α siRNA. Our data suggest that xenon treatment attenuates DGF and enhances graft survival. This approach could be translated into clinical practice leading to a considerable improvement in long-term graft survival.

  12. Status after 5 Years of Survival Compliance Testing in the Federal Columbia River Power System (FCRPS)

    SciTech Connect

    Skalski, John R.; Weiland, Mark A.; Ham, Kenneth D.; Ploskey, Gene R.; McMichael, Geoffrey A.; Colotelo, Alison H.; Carlson, Thomas J.; Woodley, Christa M.; Eppard, M. Brad; Hockersmith, Eric E.

    2016-06-27

    Survival studies of juvenile salmonids implanted with acoustic tags have been conducted at hydroelectric dams within the Federal Columbia River Power System (FCRPS) in the Columbia and Snake rivers between 2010 and 2014 to assess compliance with dam passage survival standards stipulated in the 2008 Biological Opinion (BiOp). For juvenile salmonids migrating downstream in the spring, dam passage survival defined as survival from the upstream dam face to the tailrace mixing zone must be ≥96% and for summer migrants, ≥93%, and estimated with a standard error ≤1.5% (i.e., 95% confidence interval of ±3%). A total of 29 compliance tests have been conducted at 6 of 8 FCRPS main-stem dams, using over 109,000 acoustic-tagged salmonid smolts. Of these 29 compliance studies, 23 met the survival standards and 26 met the precision requirements. Of the 6 dams evaluated to date, individual survival estimates range from 0.9597 to 0.9868 for yearling Chinook Salmon, 0.9534 to 0.9952 for steelhead, and 0.9076 to 0.9789 for subyearling Chinook Salmon. These investigations suggest the large capital investment over the last 20 years to improve juvenile salmon passage through the FCRPS dams has been beneficial.

  13. Survival of rock-colonizing organisms after 1.5 years in outer space.

    PubMed

    Onofri, Silvano; de la Torre, Rosa; de Vera, Jean-Pierre; Ott, Sieglinde; Zucconi, Laura; Selbmann, Laura; Scalzi, Giuliano; Venkateswaran, Kasthuri J; Rabbow, Elke; Sánchez Iñigo, Francisco J; Horneck, Gerda

    2012-05-01

    Cryptoendolithic microbial communities and epilithic lichens have been considered as appropriate candidates for the scenario of lithopanspermia, which proposes a natural interplanetary exchange of organisms by means of rocks that have been impact ejected from their planet of origin. So far, the hardiness of these terrestrial organisms in the severe and hostile conditions of space has not been tested over extended periods of time. A first long-term (1.5 years) exposure experiment in space was performed with a variety of rock-colonizing eukaryotic organisms at the International Space Station on board the European EXPOSE-E facility. Organisms were selected that are especially adapted to cope with the environmental extremes of their natural habitats. It was found that some-but not all-of those most robust microbial communities from extremely hostile regions on Earth are also partially resistant to the even more hostile environment of outer space, including high vacuum, temperature fluctuation, the full spectrum of extraterrestrial solar electromagnetic radiation, and cosmic ionizing radiation. Although the reported experimental period of 1.5 years in space is not comparable with the time spans of thousands or millions of years believed to be required for lithopanspermia, our data provide first evidence of the differential hardiness of cryptoendolithic communities in space.

  14. Effects of Metabolic Syndrome with or without Obesity on Outcomes after Coronary Artery Bypass Graft. A Cohort and 5-Year Study

    PubMed Central

    Ao, Hushan; Xu, Fei; Wang, Xianqiang; Tang, Xinran; Zheng, Zhe; Hu, Shengshou

    2015-01-01

    Background Metabolic syndrome (MetS) and obesity are risk factors for cardiovascular disease, however, it remains unclear about effects of MetS with or without obesity on perioperative and long-term morbidity and mortality after coronary artery bypass graft (CABG). Methods An observational cohort study was performed on 4,916 consecutive patients receiving isolated primary CABG in Fuwai hospital. Of all patients, 1238 patients met the inclusion criteria and were divided into three groups: control, MetS with obesity and MetS without obesity (n = 868, 76 and 294 respectively). The patient’s 5-year survival and major adverse cerebral and cardiovascular events (MACCE) were studied. Results Among all three groups, there were no significant differences in in-hospital postoperative complications, epinephrine use, stroke, ICU stay, ventilation time, atrial fibrillation, renal failure, coma, myocardial infarction, repeated revascularization, and long-term stroke. The patients in MetS without obesity group were not associated with increased perioperative or long-term morbidities and mortality. In contrast, the patients in MetS with obesity group were associated with significant increased perioperative complications including MACCE (30.26% vs. 20.75%, 16.7%, p = 0.0074) and mortality (11.84% vs. 3.74%, 3.11%, p = 0.0007) respectively. Patients in MetS with obesity group was associated with significantly increased long-term of MACCE (adjusted OR:2.040; 95%CI:1.196–3.481; P<0.05) and 5-years of mortality (adjusted HR:4.659; 95%CI:1.966–11.042; P<0.05). Conclusions Patients with metabolic syndrome and obesity are associated with significant increased perioperative and long-term complications and mortality, while metabolic syndrome without obesity do not worsen outcomes after CABG. PMID:25679397

  15. Disease Management Project Breast Cancer in Hesse - 5-Year Survival Data: Successful Model of Intersectoral Communication for Quality Assurance.

    PubMed

    Jackisch, C; Funk, A; König, K; Lubbe, D; Misselwitz, B; Wagner, U

    2014-03-01

    Introduction: The Disease Management Project Breast Cancer (DMP Breast Cancer) was first launched in Hesse in 2004. The project is supported by the health insurance companies in Hesse and the Professional Association of Gynaecologists in Hesse. The aim is to offer structured treatment programmes to all women diagnosed with breast cancer in Hesse by creating intersectoral cooperations between coordinating clinics, associated hospitals and gynaecologists in private practice who registered in the DMP programme. Method: Between 1 January 2005 and 30 June 2011, 13 973 women were enrolled in the DMP programme. Results: After data cleansing, survival rates were calculated for a total of 11 214 women. The 5-year overall survival (OS) rate was 86.3 %; survival rates according to tumour stage on presentation were 92.2 % (pT1) and 82.3 % (pT2), respectively. The impact of steroid hormone receptor status on survival (87.8 % for receptor-positive cancers vs. 78.9 % for receptor-negative cancers) and of age at first diagnosis on survival (≤ 35 years = 91 %) were calculated. Conclusion: The project showed that intersectoral cooperation led to significant improvements in the quality of treatment over time, as measured by quality indicators and outcomes after treatment.

  16. Long term survival of radiotherapy for esophageal cancer: analysis of 1136 patients surviving for more than 5 years

    SciTech Connect

    Yang, Z.Y.; Gu, X.; Zhao, S.

    1983-12-01

    One thousand one hundred and thirty-six patients surviving for more than five years after radiotherapy were studied. The important prognostic factors are: lesion less than 5 cm in length, lesion located in the upper-third segment and lesion that is radiosensitive. The radiation dose given to long term survivors varies greatly, i.e., 2700 to 9300 rad. Yet, for the sensitive type of lesion, doses lower than 5000 rad could also effect a cure. The delivery of an optimum dose determined by serial examinations during radiotherapy could improve the result of treatment. For local recurrent lesions, the value of a second course of radiation is extremely limited and surgery is the only means to offer a cure. For metastasis in the lymph nodes, radiation offers some hope of cure, although the long term outcome may not be satisfactory. For second primary cancer of the esophagus, aggressive radiation still gives encouraging results.

  17. Virtual HDR CyberKnife SBRT for Localized Prostatic Carcinoma: 5-Year Disease-Free Survival and Toxicity Observations

    PubMed Central

    Fuller, Donald Blake; Naitoh, John; Mardirossian, George

    2014-01-01

    Purpose: Prostate stereotactic body radiotherapy (SBRT) may substantially recapitulate the dose distribution of high-dose-rate (HDR) brachytherapy, representing an externally delivered “Virtual HDR” treatment method. Herein, we present 5-year outcomes from a cohort of consecutively treated virtual HDR SBRT prostate cancer patients. Methods: Seventy-nine patients were treated from 2006 to 2009, 40 low-risk, and 39 intermediate-risk, under IRB-approved clinical trial, to 38 Gy in four fractions. The planning target volume (PTV) included prostate plus a 2-mm volume expansion in all directions, with selective use of a 5-mm prostate-to-PTV expansion and proximal seminal vesicle coverage in intermediate-risk patients, to better cover potential extraprostatic disease; rectal PTV margin reduced to zero in all cases. The prescription dose covered >95% of the PTV (V100 ≥95%), with a minimum 150% PTV dose escalation to create “HDR-like” PTV dose distribution. Results: Median pre-SBRT PSA level of 5.6 ng/mL decreased to 0.05 ng/mL 5 years out and 0.02 ng/mL 6 years out. At least one PSA bounce was seen in 55 patients (70%) but only 3 of them subsequently relapsed, biochemical-relapse-free survival was 100 and 92% for low-risk and intermediate-risk patients, respectively, by ASTRO definition (98 and 92% by Phoenix definition). Local relapse did not occur, distant metastasis-free survival was 100 and 95% by risk-group, and disease-specific survival was 100%. Acute and late grade 2 GU toxicity incidence was 10 and 9%, respectively; with 6% late grade 3 GU toxicity. Acute urinary retention did not occur. Acute and late grade 2 GI toxicity was 0 and 1%, respectively, with no grade 3 or higher toxicity. Of patient’s potent pre-SBRT, 65% remained so at 5 years. Conclusion: Virtual HDR prostate SBRT creates a very low PSA nadir, a high rate of 5-year disease-free survival and an acceptable toxicity incidence, with results closely resembling those reported

  18. Survival and other clinical outcomes of maintenance hemodialysis patients in Taiwan: a 5-year multicenter follow-up study.

    PubMed

    Chen, Huan-Sheng; Cheng, Chun-Ting; Hou, Chun-Cheng; Liou, Hung-Hsiang; Lim, Paik-Seong

    2014-10-01

    The increasing aging and diabetes mellitus (DM) patients in dialysis population make the quality maintenance of dialysis an imperative issue. Recently, an increasing number of dialysis centers were run by private dialysis providers, many of which apply quality assurance programs and performance management systems to dialysis care. We studied patients in dialysis facilities in Taiwan run by a private chain to see clinical outcomes of centers operating under these systemic strategies. Hemodialysis patients from January 1, 2008 to December 31, 2012 in 25 dialysis facilities in Taiwan, which received the management and consultation from a dialysis service provider, NephroCare (NC), were included. Data pivotal to quality of dialysis were analyzed. During a 5-year interval, 5161 hemodialysis patients were included. For volume control, the proportion of patients with weight gain ≥4.5% decreases from 41.7% to 30.2%. Mean Kt/V is 1.74 ± 0.28. Mean albumin level is 3.92 ± 0.38 g/dL. Patients with phosphate <5.5 mg/dL is up to 71.8%. The mean hemoglobin level is 10.70 ± 1.40 g/dL. More than 80% of patients have adequate iron status. Further, 73% of patients use native arteriovenous fistula. Hospitalization-free survival rate was 56% at the fifth year. Patient survival rate at the fifth year was 66.4%. Overall clinical performances were maintained very stable in NC facilities from this temporal data analysis. The hospitalization and survival rate also compare favorably with those reported internationally. These results warrant further studies to justify the application of this kind of quality assurance programs and performance management systems in dialysis care.

  19. Pathologic complete response and disease-free survival are not surrogate endpoints for 5-year survival in rectal cancer: an analysis of 22 randomized trials

    PubMed Central

    Borgonovo, Karen; Cabiddu, Mary; Ghilardi, Mara; Lonati, Veronica; Barni, Sandro

    2017-01-01

    Background We performed a literature-based analysis of randomized clinical trials to assess the pathologic complete response (pCR) (ypT0N0 after neoadjuvant therapy) and 3-year disease-free survival (DFS) as potential surrogate endpoints for 5-year overall survival (OS) in rectal cancer treated with neoadjuvant (chemo)radiotherapy (CT)RT. Methods A systematic literature search of PubMed, EMBASE, the Web of Science, SCOPUS, CINAHL, and the Cochrane Library was performed. Treatment effects on 3-year DFS and 5-year OS were expressed as rates of patients alive (%), and those on pCR as differences in pCR rates (∆pCR%). A weighted regression analysis was performed at individual- and trial-level to test the association between treatment effects on surrogate (∆pCR% and ∆3yDFS) and the main clinical outcome (∆5yOS). Results Twenty-two trials involving 10,050 patients, were included in the analysis. The individual level surrogacy showed that the pCR% and 3-year DFS were poorly correlated with 5-year OS (R=0.52; 95% CI, 0.31–0.91; P=0.002; and R=0.60; 95% CI, 0.36–1; P=0.002). The trial-level surrogacy analysis confirmed that the two treatment effects on surrogates (∆pCR% and ∆3yDFS) are not strong surrogates for treatment effects on 5-year OS % (R=0.2; 95% CI, −0.29–0.78; P=0.5 and R=0.64; 95% CI, 0.29–1; P=0.06). These findings were confirmed in neoadjuvant CTRT studies but not in phase III trials were 3-year DFS could still represent a valid surrogate. Conclusions This analysis does not support the use of pCR and 3-year DFS% as appropriate surrogate endpoints for 5-year OS% in patients with rectal cancer treated with neoadjuvant therapy. PMID:28280607

  20. Fluorescence spectroscopy for assessment of liver transplantation grafts concerning graft viability and patient survival

    NASA Astrophysics Data System (ADS)

    Vollet Filho, José D.; da Silveira, Marina R.; Castro-e-Silva, Orlando; Bagnato, Vanderlei S.; Kurachi, Cristina

    2015-06-01

    Evaluating transplantation grafts at harvest is essential for its success. Laser-induced fluorescence spectroscopy (LIFS) can help monitoring changes in metabolic/structural conditions of tissue during transplantation. The aim of the present study is to correlate LIFSobtained spectra of human hepatic grafts during liver transplantation with post-operative patients' mortality rate and biochemical parameters, establishing a method to exclude nonviable grafts before implantation. Orthotopic liver transplantation, piggyback technique was performed in 15 patients. LIFS was performed under 408nm excitation. Collection was performed immediately after opening donor's abdominal cavity, after cold perfusion, end of back-table period, and 5 min and 1 h after warm perfusion at recipient. Fluorescence information was compared to lactate, creatinine, bilirubin and INR levels and to survival status. LIFS was sensitive to liver changes during transplantation stages. Study-in-progress; initial results indicate correlation between fluorescence and life/death status of patients.

  1. Long-term graft survival after conversion from cyclosporin to azathioprine 1 year after renal transplantation. A prospective, randomized study from 1 to 6 years after transplantation.

    PubMed

    Pedersen, E B; Hansen, H E; Kornerup, H J; Madsen, S; Sørensen, A W

    1993-01-01

    Cyclosporin has improved graft survival after renal transplantation, but cyclosporin nephrotoxicity is a severe clinical problem. Conversion from cyclosporin to azathioprine 1 year after transplantation might improve long-term graft survival by avoidance of cyclosporin nephrotoxicity. After treatment with cyclosporin and prednisolone during the first year after renal transplantation, 106 patients were consecutively randomized to treatment with either azathioprine and prednisolone or cyclosporin and prednisolone in a prospective, controlled study during the following 5 years, i.e. 6 years after transplantation. Actuarial estimates of graft survival rates after inclusion in the study were obtained by the product-limit method of Kaplan-Meier, and the Mantel-Cox log rank test was used to compare the two treatment regimens. When the end-points in the analyses were cessation of graft function or withdrawal of immunosuppressive treatment due to side-effects, and when patients alive with graft function or who had died with a functioning graft were treated as censored observations, graft survival 5 years after inclusion in the study was 57.7 +/- 5.2% in the total material and was the same in both the azathioprine group (52.4 +/- 7.7%) and the cyclosporin group (63.3 +/- 6.7%) (log rank = 0.40, P = 0.53). When cessation of graft function was the only end-point, graft survival 5 years after inclusion in the study was 73.7 +/- 5.2% for the total material with no significant differences between the two groups (log rank = 0.58, P = 0.45).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. The 5-year survival following the marginal resection of a primary leiomyosarcoma of the distal femur and a stump fracture.

    PubMed

    Plath, J; Gurk, S; Strophal, G; Johnson, M; Jansson, V

    2001-09-01

    In this case, we present a 5-year follow-up of a 3-fault-affected primary leiomyosarcoma of the distal femur (spontaneous fracture treated by osteosynthesis; marginal resection; stump fracture after adequate trauma) with an extended local recurrence but without metastasis.

  3. The use of contrast media in deceased kidney donors does not affect initial graft function or graft survival.

    PubMed

    Vigneau, C; Fulgencio, J-P; Godier, A; Chalem, Y; El Metaoua, S; Rondeau, E; Tuppin, P; Bonnet, F

    2006-09-01

    Patients receiving cadaveric kidney transplants often experience delayed graft function. As iodinated contrast media injection (ICMI), necessary for cerebral angiography, which is often used to diagnose brain death, can be nephrotoxic, we compared renal function recovery (RFR) and 1-year and long-term graft survival according to the method used to diagnose brain death. Data from 9921 cadaveric kidneys, transplanted between 1 January 1998 and 31 December 2003, were retrieved from the French National Registry for organ donation. We defined RFR as the number of days for the recipient to reach a plasma creatinine less than 250 mumol/l, and/or a 24-h urine output greater than 1000 ml. RFR and 1-year and long-term graft survival were compared between four different donor groups (according to ICMI and diabetes mellitus). A total of 41.5% of deceased donors received ICMI before organ procurement and 1.95% of them were diabetic. History of ICMI or diabetes in the donor did not influence RFR or 1-year graft survival. Long-term graft survival was decreased in the group of patients transplanted with a diabetic graft as compared to patients transplanted with a non-diabetic graft (P=0.001). History of ICMI in the donor did not affect long-term graft survival in the non-diabetic donor group (P=0.2); however, in the diabetic group, ICMI tended to decrease long-term graft survival (P=0.056). ICMI did not affect RFR or graft survival in non-diabetic deceased donors. However, its use in diabetic deceased donors requires further study.

  4. Alternative endpoints to the 5-year overall survival and locoregional control for nasopharyngeal carcinoma: A retrospective analysis of 2,450 patients.

    PubMed

    Chen, Chen; Yi, Wei; Gao, Jin; Li, Xiao-Hui; Shen, Lu-Jun; Li, Bo-Fei; Tu, Zi-Wei; Tao, Ya-Lan; Jiang, Chang-Bin; Xia, Yun-Fei

    2014-05-01

    The purpose of the present study was to investigate alternative endpoints to the 5-year overall survival (OS) and locoregional control (LRC) for nasopharyngeal carcinoma (NPC). A total of 2,450 NPC patients were enrolled in this study, including 1,842 patients treated with two-dimensional (2D) radiotherapy (RT), 451 treated with 3D conformal RT (CRT) and 157 treated with intensity-modulated RT (IMRT). We sequentially calculated the 1-, 2-, 3- and 4-year survival rates using a life table and compared these with the 5-year survival rate using the McNemar method, with the survival rate of the last indifferent comparison being considered as the alternative endpoint. For 2D RT, stage I patients exhibited similar survival rates at 1 and 5 years (98.9 vs. 94.4%, respectively; P=0.125 for both OS and LRC); stage N3 patients exhibited similar 4-year OS (55.2 vs. 53.5%; P=1.000) and 2-year LRC (78.3 vs. 71.2%; P=0.125) to the 5-year OS and LRC. For IMRT, the 1-, 2-, 3-, 4- and 5-year OS and LRC rates in stage I/II NPC patients were 100, 98, 96, 94 and 94% for OS and 100, 98, 96, 96 and 96% for LRC, respectively. No significant differences were observed for all the comparisons. For stage III/IV NPC patients treated with IMRT, the 1-, 2-, 3-, 4- and 5-year rates were 99.1, 96.3, 92.5, 88.8 and 85.0% for OS and 98.1, 97.2, 95.3, 90.7 and 89.7% for LRC, respectively. Only the 4-year OS and LRC rates were indifferent from those at 5 years (P=0.125 for OS and P=1.00 for LRC). In conclusion, the 1-year OS and LRC for stage I NPC patients treated with 2D RT or stage I/II NPC patients treated with IMRT, the 4-year OS and 2-year LRC for stage N3 NPC patients treated with 2D RT and the 4-year OS and LRC for stage III/IV NPC patients treated with IMRT were determined as the alternative endpoints to the 5-year OS and LRC for NPC patients.

  5. Survival and Inflammatory Response in Adipose-derived Mesenchymal Stem Cell-enriched Mouse Fat Grafts

    PubMed Central

    Begic, Anadi; Isfoss, Björn L.; Lønnerød, Linn K.; Vigen, Alexander

    2016-01-01

    Background: Adipose tissue-derived mesenchymal stem cells (ATMSCs) are currently used in grafting procedures in a number of clinical trials. The reconstructive role of such cells in fat graft enrichment is largely unclear. This study was undertaken to assess survival and inflammatory response in fat grafts enriched with ATMSCs in mice. Methods: ATMSC-enriched adipose tissue was grafted subcutaneously in a clinically relevant manner in mice, and survival and inflammatory response were determined by bioluminescence imaging of transgenic tissue constitutively expressing luciferase or driven by inflammation in wild-type animals. Results: Only a minor fraction of ATMSCs transplanted subcutaneously were found to survive long term, yet fat grafts enriched with ATMSCs showed improved survival for a limited period, compared with no enrichment. NF-κB activity was transiently increased in ATMSC-enriched grafts, and the grafts responded adequately to a proinflammatory stimulus. In one animal, cells originating from the subcutaneous graft were found at a site of inflammation distant from the site of engraftment. Conclusion: ATMSCs display limited subcutaneous survival. Still, ATMSC enrichment may improve the outcome of adipose tissue grafting procedures by facilitating short-term graft survival and adequate inflammatory responses. Migration of cells from grafted adipose tissue requires further investigation. PMID:28293494

  6. 5-Year Survival in Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia in a Randomized, Phase III Trial of Fludarabine Plus Cyclophosphamide With or Without Oblimersen

    PubMed Central

    O'Brien, Susan; Moore, Joseph O.; Boyd, Thomas E.; Larratt, Loree M.; Skotnicki, Aleksander B.; Koziner, Benjamin; Chanan-Khan, Asher A.; Seymour, John F.; Gribben, John; Itri, Loretta M.; Rai, Kanti R.

    2009-01-01

    Purpose A randomized trial of oblimersen plus fludarabine/cyclophosphamide (OBL-FC; n = 120) versus FC (n = 121) was conducted in patients with relapsed/refractory chronic lymphocytic leukemia (CLL). The primary end point was met: the complete response (CR) rate, defined as complete or nodular partial response, was significantly greater with OBL-FC than with FC (17% v 7%; P = .025). Among patients with CR, response duration was significantly longer with OBL-FC than with FC (median not reached; > 36 months v 22 months; P = .03). Maximum benefit with OBL-FC, including a four-fold increase in CR rate and a survival benefit with 3 years of follow-up (hazard ratio, 0.53; P = .05), was observed in patients with fludarabine-sensitive disease. We evaluated long-term survival and poststudy CLL therapy among all randomly assigned patients. Methods Poststudy CLL treatment information was collected. Patients were observed for survival for up to 5 years from the date of random assignment. Results Poststudy CLL treatment was balanced between arms. Intent-to-treat analysis of 5-year survival showed no significant between-treatment difference (hazard ratio, 0.87; P = .34). Among the greater than 40% of patients with complete or partial remission, a significant 5-year survival benefit was observed with OBL-FC (hazard ratio, 0.60; P = .038). Among patients with fludarabine-sensitive disease who had previously demonstrated maximum benefit with OBL-FC, the previously observed survival benefit improved: a 50% reduction in the risk of death was observed (P = .004). Conclusion In relapsed/refractory CLL, OBL combined with FC offers patients who achieve complete or partial remission, as well as those who have fludarabine-sensitive disease, a significant survival benefit. PMID:19738118

  7. Factors influencing survival in hemodialysis patients aged older than 75 years: 2.5-year outcome study.

    PubMed

    Chauveau, P; Combe, C; Laville, M; Fouque, D; Azar, R; Cano, N; Canaud, B; Roth, H; Leverve, X; Aparicio, M

    2001-05-01

    The incidence of malnutrition is widely held to be greater in the elderly, but this specific factor has not been extensively studied in elderly dialysis patients. In a 30-month follow-up prospective study, we evaluated the role of nutrition on the outcome of 290 stable hemodialysis (HD) outpatients aged older than 75 years followed up in 20 French HD centers (167 men, 123 women; age, 79.8 +/- 4.2 years; previous time on dialysis, 41 +/- 38 months). On the same day in January 1996, predialysis and postdialysis blood samples were collected according to recommended procedures for dialysis quantification. Normalized protein catabolic rate, dialysis adequacy parameters, and estimation of lean body mass (LBM; expressed as observed/expected LBM values [obs/exp LBM]) were computed from predialysis and postdialysis urea and creatinine levels. Overall survival rates were 80% and 65% after 1 and 2 years of follow-up, respectively, and were significantly less in patients with the lower quartile of obs/exp LBM. In univariate analysis using the Cox proportional hazards model, survival was significantly influenced by age, albumin level, prealbumin level, body mass index, and diabetes, but not by sex, Kt/V, duration of dialysis, cholesterol level, hemoglobin level, or obs/exp LBM. In multivariate analysis, no variable remained significant. Cardiovascular mortality accounted for 52.1% of the patient deaths. We conclude that in elderly HD patients, malnutrition influences overall survival despite adequate dialysis treatment.

  8. Efficacy of continuous positive airway pressure treatment on 5-year survival in patients with ischaemic stroke and obstructive sleep apnea: a randomized controlled trial.

    PubMed

    Parra, Olga; Sánchez-Armengol, Ángeles; Capote, Francisco; Bonnin, Marc; Arboix, Adrià; Campos-Rodríguez, Francisco; Pérez-Ronchel, José; Durán-Cantolla, Joaquín; Martínez-Null, Cristina; de la Peña, Mónica; Jiménez, Maria Carmen; Masa, Fernando; Casadon, Ignacio; Alonso, Maria Luz; Macarrón, José L

    2015-02-01

    The main purpose of the present analysis is to assess the influence of introducing early nasal continuous positive airway pressure (nCPAP) treatment on cardiovascular recurrences and mortality in patients with a first-ever ischaemic stroke and moderate-severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) ≥20 events h(-1) during a 5-year follow-up. Patients received conventional treatment for stroke and were assigned randomly to the nCPAP group (n = 71) or the control group (n = 69). Cardiovascular events and mortality were registered for all patients. Survival and cardiovascular event-free survival analysis were performed after 5-year follow-up using the Kaplan-Meier test. Patients in the nCPAP group had significantly higher cardiovascular survival than the control group (100 versus 89.9%, log-rank test 5.887; P = 0.015) However, and also despite a positive tendency, there were no significant differences in the cardiovascular event-free survival at 68 months between the nCPAP and control groups (89.5 versus 75.4%, log-rank test 3.565; P = 0.059). Early nCPAP therapy has a positive effect on long-term survival in ischaemic stroke patients and moderate-severe OSA.

  9. Evaluation of the Correlation between CD44, Tumor Prognosis and the 5-Year Survival Rate in Patients with Oral Tongue SCC

    PubMed Central

    Kaboodkhani, Reza; Karimi, Ebrahim; Khorsandi Ashtiani, Mohammad Taghi; Kowkabi, Safoura; Firouzifar, Mohammad Reza; Yazdani, Farzad; Yazdani, Nasrin

    2016-01-01

    Introduction: 90% of the tumors in the head and neck are squamous-cell carcinomas (HNSCC), which have overall 5- year survival rate between 50% -60%. CD44 has been shown to be associated with the prognosis. Materials and Methods: Biopsy specimens of 51 patients with oral tongue SCC were evaluated by Immunohistochemistry (IHC) for the CD44 antibody. Results: There was no significant correlation between CD44 and survival (P=0.77), age (P=0.4), CD44 and lymph node metastasis (P=0.87), sex (P=0.947), smoking (P=0.287) and tumor size (P=0.813). However, there was significant correlation between smoking and survival. Conclusion: There are widespread discrepancies among the findings in the literature regarding the prognosis of CD44 expression in OCSCC. Our study shows that the expression of CD44 is not a marker of aggressive behavior in oral tongue SCC. Consequently, CD44 cannot be considered as handy tool to establish the tumor behavior, prognosis and 5- year survival rate of these tumors. PMID:28008391

  10. Impact of clopidogrel on bleeding complications and survival in off-pump coronary artery bypass grafting.

    PubMed

    Bittner, Hartmuth B; Lehmann, Sven; Rastan, Ardawan; Mohr, Friedrich W

    2012-03-01

    This study investigated the impact of preoperative clopidogrel on bleeding complications and survival during and after off-pump coronary artery bypass grafting (OPCABG) and assessed the possible role of the antifibrinolytic agent aprotinin for attenuating blood loss after clopidogrel exposure. Prospectively collected data of 753 consecutive adult patients undergoing OPCABG were retrospectively reviewed; 139 (18.5%) patients received clopidogrel preoperatively. Statistical methods used were student paired t-test, Mann-Whitney U, Kruskal-Wallis, chi-square analysis and Kaplan-Meier with log-rank analysis. Clopidogrel was associated with a significant increase in perioperative blood loss (P = 0.003) and more excessive postoperative haemorrhage (P = 0.04). Overall transfusion rates (P = 0.02) and the amount of administered blood products (P = 0.01) were also higher after clopidogrel exposure. Intraoperative aprotinin reduced postoperative bleeding significantly in patients administered clopidogrel [18.7% after 24 h (P = 0.006) and 15.2% after 48 h (P = 0.03)] and attenuated excessive postoperative haemorrhaging. Five-year survival was markedly improved in clopidogrel-treated patients. Preoperative clopidogrel exposure does increase perioperative blood loss and blood transfusion requirements in patients undergoing OPCABG but has an otherwise excellent safety profile with a 94% 5-year survival rate. Aprotinin attenuated this blood loss. Based on these results a recommendation to discontinue clopidogrel prior to coronary artery bypass grafting cannot be maintained, if OPCABG strategies are considered.

  11. A practice-based clinical evaluation of the survival and success of metal-ceramic and zirconia molar crowns: 5-year results.

    PubMed

    Rinke, S; Kramer, K; Bürgers, R; Roediger, M

    2016-02-01

    This practice-based study evaluates the survival and success of conventionally luted metal-ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty-three patients were treated from 07/2008 to 07/2009 with either metal-ceramic crowns (MCC) or zirconia crowns (ZC). Forty-five patients (26 female) with 91 restorations (obser-vational period: 64.0 ± 4.8 months) participated in a clinical follow-up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan-Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0.05). Five complete failures (MCC: 2, ZC: 3) were recorded (5-year ECSv: MCC: 97.6%, (95% confidence interval (95%-CI): [93%; 100%]/ZC: 94.0%, (95%-CI): [87%; 100%]). Of the MCCs (n = 41), 85.0%, [95%-CI: (77%; 96%)] remained event-free, whereas the ECSc for the ZCs (n = 50) was 74.3% (95%-CI): [61%; 87%]. No significant differences in ECSv (P = 0.51), ECSc (P = 0.43) and ECVCSc (P = 0.36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0.035), (5-year VCF-rate: 14.8%) than crowns placed on tooth-neighboured abutments (n = 47), (5-year VCF-rate: 4.3%). In the present study, zirconia molar crowns demonstrated a 5-year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.

  12. Long-term effect of the North Carolina graduated driver licensing system on licensed driver crash incidence: a 5-year survival analysis.

    PubMed

    Masten, Scott V; Foss, Robert D

    2010-11-01

    Several studies document the success of graduated driver licensing (GDL) systems in reducing young teen crash rates, but it is not yet clear whether any portion of the crash reduction is achieved by producing more capable drivers. The purpose of this study was to determine whether young teen drivers licensed under the North Carolina GDL system remain crash-free longer than those licensed prior to GDL, independent of the crude reductions in exposure (i.e., decreasing and delaying licensure) that may be responsible for most documented effects of GDL. Survival analysis was used to compare retrospective cohorts of 16-17 year olds before (n=105,569) and after (n=327,054) the North Carolina GDL system was implemented. The crash incidence of GDL-licensed 16-17 year olds (combined) was 10% lower than that for pre-GDL teens for at least 5 years after being licensed to drive independently (hazard ratio [HR]=0.90; 95% confidence interval [CI]=0.89, 0.91). However, more refined analysis revealed the reductions to only be among females (7%; HR=0.93; CI=0.91, 0.94) and males (15%; HR=0.85, CI=0.84, 0.87) licensed at age 16 and not among females (0%; HR=1.00; CI=0.95, 1.06) and males (0%; HR=1.00; CI=0.92, 1.09) licensed at age 17. Sixteen-year-old drivers licensed under the North Carolina GDL system experienced lower first-crash incidence during the first 5 years of unsupervised driving than did those licensed under the previous system. The benefits are greater for males, who tend to have higher crash rates. The findings contradict conventional wisdom that the entire benefit of GDL results merely from decreasing or delaying licensure among young drivers.

  13. Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

    SciTech Connect

    Garcia-Monaco, R. D.; Kohan, A. A.; Martinez-Corvalan, M. P.; Cacchiarelli, N.; Peralta, O.; Wahren, C. G.

    2012-06-15

    Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

  14. The Survival of Freely Grafted Orbital Fat on Porous Polyethylene Orbital Implants in the Rabbit

    PubMed Central

    Kim, Nam Ju; Choung, Ho Kyung

    2006-01-01

    Purpose To investigate the long term survival of orbital fat grafted on a Medpor® implant as a method of preventing porous polyethylene orbital implant (Medpor®) exposure in anophthalmic sockets. Methods In one orbit in each of 8 rabbits, a small amount of retrobulbar orbital fat was grafted between the anterior surface of the Medpor® implant and overlying conjunctiva, during the enucleation and Medpor® implantation procedure. Two rabbits were sacrificed at 2, 4, 8 and 12 weeks postoperatively and grafted orbital fats were examined by light microscopy. Results Grafted orbital fat was well-maintained at 2 and 4 weeks, postoperatively. However, fat amounts were significantly reduced at 8 weeks, and viable fat was barely visible at 12 weeks. Conclusions In rabbits, orbital fat grafted on Medpor® implants was gradually resorbed, and the fat-occupied volume was not maintained. PMID:17004626

  15. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study.

    PubMed

    Girum, Tadele; Kote, Mesfin; Tariku, Befikadu; Bekele, Henok

    2017-01-01

    Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell's concordance, and fitness was checked by Cox-Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101-7.329), altered pulse rate (AHR =3.926, 95% CI =1.579-9.763), altered temperature (AHR =7.173, 95% CI =3.05-16.867), shock (AHR =3.805, 95% CI =1.829-7.919), anemia (AHR =2.618, 95% CI =1.148-5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18-8.575), hypoglycemia (AHR =2.74, 95% CI =1.279-5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638-13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions.

  16. Factors associated with graft survival and endothelial cell density after Descemet's stripping automated endothelial keratoplasty.

    PubMed

    Ishii, Nobuhito; Yamaguchi, Takefumi; Yazu, Hiroyuki; Satake, Yoshiyuki; Yoshida, Akitoshi; Shimazaki, Jun

    2016-04-28

    Postoperative endothelial cell loss leads to graft failure after corneal transplantation, and is one of the important issues for long-term prognosis. The objective of this study was to identify clinical factors affecting graft survival and postoperative endothelial cell density (ECD) after Descemet's stripping automated endothelial keratoplasty (DSAEK). A total of 198 consecutive Japanese patients (225 eyes) who underwent DSAEK were analysed using Cox proportional hazard regression and multiple linear regression models. The candidate factors included recipient age; gender; diagnosis; pre-existing iris damage state, scored based on its severity; the number of previous intraocular surgeries; graft ECD; graft diameter; simultaneous cataract surgery; surgeons experience; intraoperative iris damage; postoperative rebubbling; and graft rejection. Eyes with higher pre-existing iris damage score and more number of previous intraocular surgery had a significantly higher risk of graft failure (HR = 8.53; P < 0.0001, and HR = 2.66; P = 0.026, respectively). Higher pre-existing iris damage score, lower graft ECD, and smaller graft diameter were identified as significant predisposing factors for lower postoperative ECD. The results show that iris damage status before DSAEK may be clinically useful in predicting the postoperative course. Avoiding intraoperative iris damage, especially in eyes with low ECD can change the prognosis of future DSAEK.

  17. Racial and Ethnic Disparities in Graft and Patient Survival Among Elderly Kidney Transplant Recipients

    PubMed Central

    Ilori, Titilayo O.; Adedinsewo, Demilade A.; Odewole, Oluwaseun; Enofe, Nosayaba; Ojo, Akinlolu; McClellan, William; Patzer, Rachel E.

    2015-01-01

    Background/Objectives The rise in the number of elderly kidney transplant recipients over the past decade makes it increasingly important to understand factors affecting post-transplant outcomes in this population. Our objective was to investigate the racial/ethnic differences in graft and patient survival among elderly kidney transplant recipients. Design Retrospective Cohort. Setting & Participants All first-time, kidney-only transplant recipients ≥60 years of age at transplantation in the United Network for Organ Sharing (UNOS) database, transplanted between July 1996 and October 2010, N=44,013. Measurements Time to graft failure and death obtained from the UNOS database and linkage to the Social Security Death Index. Neighborhood poverty from 2000 U.S. Census geographic data. Results Of the 44,013 recipients in the sample, 20% were African American, 63% non-Hispanic white, 11% Hispanic, 5% Asian and the rest “other racial groups”. In adjusted Cox models, we found that compared to whites, African Americans were more likely to experience graft failure (HR: 1.23, 95%CI: 1.15, 1.32), while Hispanics, (HR: 0.77, 95%CI: 0.70, 0.85) and Asians (HR: 0.70, 95%CI: 0.61, 0.81) were less likely to experience graft failure. Secondly, compared to whites, African Americans (HR: 0.84, 95%CI: 0.80, 0.88), Hispanics (HR: 0.68, 95%CI: 0.64, 0.72), and Asians (HR: 0.62, 95%CI: 0.57, 0.68) all were less likely to die after renal transplantation. Conclusion Elderly African Americans are at increased risk of graft failure compared to white transplant recipients, but survive longer after transplantation. Asians have the highest patient and graft survival followed by the Hispanics. Further studies are needed to assess additional factors affecting graft and patient survival including outcomes such as quality of life. PMID:26660200

  18. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study

    PubMed Central

    Girum, Tadele; Kote, Mesfin; Tariku, Befikadu; Bekele, Henok

    2017-01-01

    Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell’s concordance, and fitness was checked by Cox–Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101–7.329), altered pulse rate (AHR =3.926, 95% CI =1.579–9.763), altered temperature (AHR =7.173, 95% CI =3.05–16.867), shock (AHR =3.805, 95% CI =1.829–7.919), anemia (AHR =2.618, 95% CI =1.148–5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18–8.575), hypoglycemia (AHR =2.74, 95% CI =1.279–5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638–13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions. PMID:28176953

  19. Post-transplant development of C1q-positive HLA antibodies and kidney graft survival.

    PubMed

    Piazza, Antonina; Poggi, Elvira; Ozzella, Giuseppina; Adorno, Domenico

    2013-01-01

    The development of de novo human leukocyte antigen (HLA) donor specific antibodies (DSA), detected by both cytotoxic or solid phase assays, was considered the major risk factor for allograft failure in kidney transplantation. However, it was shown that not all patients with persistent production of DSA suffered loss of their grafts. Modified Luminex-Single Antigen assays, able to identify C1q-fixing antibodies, represent a new strategy in assessing the clinical relevance of detected DSA. This study demonstrated that C1q-fixing capability of de novo DSA is a clinically relevant marker of worse outcome and inferior graft survival in kidney transplantation. In fact, our findings evidenced a very low graft survival only in the patients who developed DSA able to fix C1q during post-transplant course, while patients producing C1q-negative DSA had good graft survival, which was comparable to that found in our previous study for DSA-negative patients. Moreover, anti-HLA class II antibodies had a higher incidence than anti-HLA class I, and the ability to fix C1q was significantly more frequent among anti-DQ DSA than anti-DR DSA. Monitoring of de novo C1q-DSA production represents a useful, non-invasive tool for risk stratification and prediction of graft outcome in kidney transplantation.

  20. Biodegradable polymer composite grafts promote the survival and differentiation of retinal progenitor cells.

    PubMed

    Tomita, Minoru; Lavik, Erin; Klassen, Henry; Zahir, Tasneem; Langer, Robert; Young, Michael J

    2005-01-01

    Retinal progenitor cells (RPCs) are multipotent central nervous system precursors that give rise to all of the cell types of the retina during development. Several groups have reported that mammalian RPCs can be isolated and expanded in culture and can differentiate into retinal neurons upon grafting to the mature, diseased eye. However, cell delivery and survival remain formidable obstacles to application of RPCs in a clinical setting. Because biodegradable polymer/progenitor constructs have been shown to be capable of tissue generation in other compartments, we evaluated the survival, migration, and differentiation of RPCs delivered on PLLA/PLGA polymer substrates to the mouse subretinal space and compared these results to conventional injections of RPCs. Polymer composite grafts resulted in a near 10-fold increase in the number of surviving cells after 4 weeks, with a 16-fold increase in cell delivery. Grafted RPCs migrated into the host retina and expressed the mature markers neurofilament-200, glial fibrillary acidic protein, protein kinase C-alpha, recoverin, and rhodopsin. We conclude that biodegradable polymer/progenitor cell composite grafts provide an effective means of increasing progenitor cell survival and overall yield when transplanting to sites within the central nervous system such as the retina.

  1. Graft survival rate of renal transplantation during a period of 10 years in Iran

    PubMed Central

    Shahbazi, Fatemeh; Ranjbaran, Mehdi; Karami-far, Simin; Soori, Hamid; Manesh, Hadi Jafari

    2015-01-01

    Background: Kidney transplantation is a preferred treatment for many patients with end-stage renal disease (ESRD) and is far more profitable than hemodialysis. Analyzing renal transplantation data can help to evaluate the effectiveness of transplantation interventions. The aim of this study was to determine the organ survival rate after kidney transplantation during a period of 10 years (March 2001-March 2011) among transplanted patients in Arak, Markazi Province, Iran. Materials and Methods: In this historical cohort study, all recipients of kidney transplantation from Arak, Markazi Province, Iran who had medical records in Valiasr Hospital and “charity for kidney patients” of Arak, Markazi Province, Iran during a period of 10 years from March 2001 to March 2011 were included. Data collected by using checklists were completed from patients’ hospital records. Kaplan-Meier method was used to determine the graft cumulative survival rate, log-rank test to compare survival curves in subgroups, and Cox regression model to define the hazard ratio and for ruling out the intervening factors. Statistical analysis was conducted by Statistical Package for the Social Sciences (SPSS) 20 and Stata 11. Results: Mean duration of follow-up was 55.43 ± 42.02 months. By using the Kaplan-Meier method, the cumulative probability of graft survival at 1, 3, 5, 7, and 10 years was 99.1, 97.7, 94.3, 85.7, and 62.1%, respectively. The number of dialysis by controlling the effect of other variables had a significant association with the risk of graft failure [hazard ratios and 95% confidence interval (CI): 1.47 (1.02-2.13)]. Conclusion: This study showed that the graft survival rate was satisfactory in this community and was similar to the results of single-center studies in the world. Dialysis time after transplantation was a significant predictor of survival in the recipients of kidney transplantation that should be considered. PMID:26941807

  2. Intrastriatal Grafting of Chromospheres: Survival and Functional Effects in the 6-OHDA Rat Model of Parkinson's Disease.

    PubMed

    Boronat-García, Alejandra; Palomero-Rivero, Marcela; Guerra-Crespo, Magdalena; Millán-Aldaco, Diana; Drucker-Colín, René

    2016-01-01

    Cell replacement therapy in Parkinson's disease (PD) aims at re-establishing dopamine neurotransmission in the striatum by grafting dopamine-releasing cells. Chromaffin cell (CC) grafts produce some transitory improvements of functional motor deficits in PD animal models, and have the advantage of allowing autologous transplantation. However, CC grafts have exhibited low survival, poor functional effects and dopamine release compared to other cell types. Recently, chromaffin progenitor-like cells were isolated from bovine and human adult adrenal medulla. Under low-attachment conditions, these cells aggregate and grow as spheres, named chromospheres. Here, we found that bovine-derived chromosphere-cell cultures exhibit a greater fraction of cells with a dopaminergic phenotype and higher dopamine release than CC. Chromospheres grafted in a rat model of PD survived in 57% of the total grafted animals. Behavioral tests showed that surviving chromosphere cells induce a reduction in motor alterations for at least 3 months after grafting. Finally, we found that compared with CC, chromosphere grafts survive more and produce more robust and consistent motor improvements. However, further experiments would be necessary to determine whether the functional benefits induced by chromosphere grafts can be improved, and also to elucidate the mechanisms underlying the functional effects of the grafts.

  3. Intrastriatal Grafting of Chromospheres: Survival and Functional Effects in the 6-OHDA Rat Model of Parkinson's Disease

    PubMed Central

    Boronat-García, Alejandra; Palomero-Rivero, Marcela; Guerra-Crespo, Magdalena; Millán-Aldaco, Diana; Drucker-Colín, René

    2016-01-01

    Cell replacement therapy in Parkinson’s disease (PD) aims at re-establishing dopamine neurotransmission in the striatum by grafting dopamine-releasing cells. Chromaffin cell (CC) grafts produce some transitory improvements of functional motor deficits in PD animal models, and have the advantage of allowing autologous transplantation. However, CC grafts have exhibited low survival, poor functional effects and dopamine release compared to other cell types. Recently, chromaffin progenitor-like cells were isolated from bovine and human adult adrenal medulla. Under low-attachment conditions, these cells aggregate and grow as spheres, named chromospheres. Here, we found that bovine-derived chromosphere-cell cultures exhibit a greater fraction of cells with a dopaminergic phenotype and higher dopamine release than CC. Chromospheres grafted in a rat model of PD survived in 57% of the total grafted animals. Behavioral tests showed that surviving chromosphere cells induce a reduction in motor alterations for at least 3 months after grafting. Finally, we found that compared with CC, chromosphere grafts survive more and produce more robust and consistent motor improvements. However, further experiments would be necessary to determine whether the functional benefits induced by chromosphere grafts can be improved, and also to elucidate the mechanisms underlying the functional effects of the grafts. PMID:27525967

  4. High proportions of regulatory T cells in PBSC grafts predict improved survival after allogeneic haematopoietic SCT

    PubMed Central

    Danby, R D; Zhang, W; Medd, P; Littlewood, T J; Peniket, A; Rocha, V; Roberts, D J

    2016-01-01

    Regulatory T cells (Tregs) modulate immune responses and improve survival in murine transplant models. However, whether the Treg content of allogeneic cell grafts influences the outcome in human haematopoietic stem cell (HSC) transplantation is not well established. In a prospective study of 94 adult allogeneic PBSC transplants (60% unrelated; 85% reduced intensity conditioning), the median Treg (CD3+CD4+CD25+FOXP3+CD127dim/−) dose transplanted was 4.7 × 106/kg, with Tregs accounting for a median of 2.96% of CD4+ T cells. Patients transplanted with grafts containing a Treg/CD4+ T-cell ratio above the median had a 3-year overall survival of 75%, compared with 49% in those receiving grafts with a Treg/CD4+ T-cell ratio below the median (P=0.02), with a 3-year non-relapse mortality of 13% and 35%, respectively (P=0.02). In multivariate analysis, a high graft Treg/CD4+ T-cell ratio was an independent predictor of lower non-relapse mortality (hazard ratio (HR), 0.30; P=0.02), improved overall survival (HR, 0.45; P=0.03) and improved sustained neutrophil (HR, 0.52; P=0.002), platelet (HR, 0.51; P<0.001) and lymphocyte (HR, 0.54; P=0.009) recovery. These data support the hypothesis that the proportion of Tregs in allogeneic HSC grafts influences clinical outcome and suggest that Treg therapies could improve allogeneic HSC transplantation. PMID:26389831

  5. Effects of Treatment of Asymptomatic Hyperuricemia on Graft Survival and Mortality in Kidney Transplant Recipients.

    PubMed

    Pagonas, Nikolaos; Kor, Samad; Seibert, Felix S; Giese, Arnd; Zidek, Walter; Reinke, Petra; Babel, Nina; Bauer, Frederic; Westhoff, Timm H

    2016-06-07

    BACKGROUND Hyperuricemia is very common after renal transplantation. It is associated with an increased risk of cardiovascular events and graft loss. To date, however, treatment is only recommended in symptomatic disease. MATERIAL AND METHODS We included 503 adult patients who underwent kidney transplantation at the Charité-Universitätsmedizin Berlin in this retrospective study. Patients were followed up for up to 120 months. All-cause mortality, graft survival, changes in level of serum uric acid (SUA), and estimated glomerular filtration rate (eGFR) were analyzed. RESULTS At 12 months post-transplantation, 225 patients had a serum uric acid (SUA) level >7 mg/dl: 52 patients were treated with allopurinol, 37 with benzbromarone, and 136 patients received no medication for hyperuricemia (control). At 12 months, eGFR did not differ between groups (p=0.15) but treated patients had higher SUA levels (p<0.001) compared to the control group. SUA-lowering treatment was associated with a lower risk of all-cause mortality (p=0.013) and graft loss (p=0.014) compared to controls. At 120 months, patients in the treatment group had lower SUA levels (p=0.001) and higher eGFR (p<0.001) compared to the control group. CONCLUSIONS Treatment of asymptomatic hyperuricemia was associated with a substantial benefit in patient and graft survival.

  6. The role of temporalis fascia for free mucosal graft survival in small nasal septal perforation repair.

    PubMed

    Jeon, Eun-Ju; Choi, Jin; Lee, Joo-Hyung; Kim, Sung-Won; Nam, In-Chul; Park, Yong-Su; Jin, Sang-Gyun; Cheon, Byung-Jun

    2014-01-01

    Temporalis fascia has been used widely as a interposition graft for mucosal rotation flap in nasal septal perforation repair. However, the exact role of temporalis fascia in healing process has not yet been clarified. For the pedicle of rotation flap has been considered as a major vehicle for nutrition distribution, the role of temporalis fascia has been devaluated. In this study, we experienced small nasal septal perforation repairs using free mucosal graft not having pedicles but covered by temporalis fascia. Three patients with small nasal septal perforations not larger than 1 × 1 cm were included. In 2 patients, the perforations were repaired using free composite grafts from the inferior turbinate mucosa covered by continuous temporalis fascia not divided, and the surgical results were successful with complete healings. In 1 patient, however, the temporalis fascia was divided into 2 parts to better fit the shape of the perforation, and the graft failed to survive. These surgical results suggest that the temporalis fascia might have an important role in healing process of nasal septal defect and could be used as a beneficial options for small mucosal defect repair surgeries using free mucosal grafts.

  7. Effect of boar seminal plasma immunosuppressive factor on NK cell activity and skin graft survival.

    PubMed

    Veselsky, L; Holan, V; Soucek, J; Stanek, R; Hoskova, M

    1992-01-01

    The B 10 strain of mice was used to test the effect of the boar seminal vesicle immunosuppressive factor on the female mouse response to the male-specific transplantation antigen. Influence of this factor on human natural killer (NK) cell activity was also studied. No inhibitory effect of the immunosuppressive factor on graft survival was apparent during a time of more than 200 days, nor did the factor suppress NK cell activity.

  8. [Postoperative adjuvant chemotherapy using NCS (neocarzinostatin) and 5-FU in the treatment of gastric cancer. First report--A comparison with the 5-year survival rate of patients undergoing combined therapy with MMC and 5-FU].

    PubMed

    Yokomori, T; Taniguchi, T; Iesato, H; Sakata, Y; Watanabe, T; Kawabe, K

    1987-11-01

    As a postoperative adjuvant chemotherapy for gastric cancer, we have administered a combination of NCS (Neocarzinostatin) and 5-FU (NF treatment method) and in this paper we have compiled the results obtained in patients who were treated for 5 years in an attempt to compare the 5-year survival rate with that of patients administered a combination of MMC and 5-FU (MF treatment group) and a control group administered no anticancer agents. As the selection of either NF or MF treatment was conducted on an annual basis, this study can be considered an historical controlled study. The results obtained are summarized as follows. On comparing the survival rate of the NF treatment group and the control group, the 5-year survival rate for all patients who underwent curative resection and all patients with histological stage III cancers and the curative resection PS (+) group, as well as the survival period of the non-resected patients, showed a statistically significant difference, indicating that the survival rate was higher in the NF group. On comparing the NF group and the MF group, although no statistically significant difference was observed between then based on a stratified analysis of all resected cases, histological stage differences and n.ps factors, etc., certain values tended to indicate a higher survival rate for the NF group. Moreover, the survival rate of the non-resected patients was more favorable in the NF group. These results confirm that NCS is useful for the treatment of stomach cancer and compares favorably with MMC. The appearance of side-effects was significantly lower in the NF group in comparison with the MF group and the number of patients who had to discontinue therapy was extremely low.

  9. FTY720 treatment prolongs skin graft survival in a completely incompatible strain combination.

    PubMed

    Lima, R S M; Nogueira-Martins, M F; Silva, H T; Pestana, J O M; Bueno, V

    2004-05-01

    FTY720 has shown potent immunomodulatory activity in a variety of animal organ transplant models. However, the in vivo immunosuppressive mechanism of FTY720 is still not fully understood. It has been suggested that the marked decrease in the number of peripheral blood lymphocytes during FTY720 administration could be responsible for its immunosuppressive effects. Our aims were: (1) to study the effects of FTY720 treatment on skin graft survival using a fully mismatched strain combination and (2) to evaluate lymphocyte numbers in different sites at 5 days after skin transplant. C57BL/6 mice and BALB/c mice were the donors and recipients respectively. BALB/c mice received FTY720 (1 mg/kg/d) orally for 4 consecutive days. Drug administration started 1 day before skin transplants. A small segment of tail skin was affixed on the right dorsal side of the mouse via sutures. The administration of FTY720 (4 mg/kg) prolonged skin graft survival from 12.6 +/- 2.2 days (no treatment) to 16.6 +/- 4.2 days. The histologic findings of rejection were similar for all groups. Five days after transplant, lymphocyte numbers were significantly increased in lymph nodes compared with nontransplanted or isogenic graft mice. FTY720 decreased lymphocyte numbers only in the spleen. In conclusion, FTY720 prolonged skin graft survival in a fully mismatched strain combination when administered for 4 days (day -1 to day +2) at a dose of 1 mg/kg/d. The decreased number of lymphocytes in the spleen suggests that the spleen may be a target of FTY720 activity, during the early posttransplant period.

  10. Junctional epidermolysis bullosa incidence and survival: 5-year experience of the Dystrophic Epidermolysis Bullosa Research Association of America (DebRA) nurse educator, 2007 to 2011.

    PubMed

    Kelly-Mancuso, Geraldine; Kopelan, Brett; Azizkhan, Richard G; Lucky, Anne W

    2014-01-01

    Junctional epidermolysis bullosa (JEB) is a particularly devastating type of epidermolysis bullosa, especially in the newborn period. Data about the number of new cases of JEB in the United States were collected from the records of the Dystrophic Epidermolysis Bullosa Research Association of America (DebRA) nurse educator. Seventy-one children with JEB were reported to have been born in the 5 years between 2007 and 2011, reflecting an incidence of at least 3.59 per million per year, significantly higher than previously estimated (2.04 per million). There was a high prevalence of morbidity and infant mortality of at least 73%, as 52 of the 71 cases proved fatal by June 2012. These data emphasize the need for future research to develop treatment and ultimately a cure for this disorder.

  11. Prolonged Survival (>48 months) in a Squamous Cell Carcinoma of the Cervix After Late Skin Metastasis (>5 year) to Incision Site: A Case Report.

    PubMed

    Ozmen, Batuhan; Sükür, Yavuz Emre; Atabekoğlu, Cem; Güngör, Mete

    2009-01-01

    Metastasis to the incision site of squamous cervical cancer (SCC) is an extremely rare entity which is strictly related with extremely poor prognosis. The vast majority of the reported cases died in a year due to distant recurrences, whereby skin metastases were predominantly observed close to the primary tumor site. A SCC with skin metastasis which was diagnosed 5 years after the radical surgery and postoperative radiotherapy which involved the midline incision site was reported. Large surgical excision of the metastasis with remaining surgical free margins (>2 cm) and combined chemo-radiotherapy with single agent (cisplatinum) was performed. The patient did not show any recurrences for 4 years follow-up. Apparently, palliative combined chemo-radiotherapy along with large excision seems favorable for controlling symptoms and progression of skin metastasis of squamous cervical cancer.

  12. HEMORRHAGIC CYSTITIS AFTER ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION: RISK FACTORS, GRAFT SOURCE, AND SURVIVAL

    PubMed Central

    Lunde, Laura E.; Dasaraju, Sandhyarani; Cao, Qing; Cohn, Claudia S.; Reding, Mark; Bejanyan, Nelli; Trottier, Bryan; Rogosheske, John; Brunstein, Claudio; Warlick, Erica; Young, Jo Anne H.; Weisdorf, Daniel J.; Ustun, Celalettin

    2017-01-01

    Although hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic cell transplantation (alloHCT), its risk factors and effects on survival are not well-known. We evaluated HC in a large cohort (n=1321, 2003 – 2012) receiving alloHCT from all graft sources, including umbilical cord blood (UCB). We compared HC patients with non-HC (control) patients and examined clinical variables at HC onset and resolution. Of these 1321 patients, 219 (16.6%) developed HC at a median of 22 days after alloHCT. BK viruria was detected in 90% of 109 tested HC patients. Median duration of HC was 27 days. At the time of HC diagnosis, acute graft-versus-host disease (GVHD), fever, severe thrombocytopenia, and steroid use were more frequent than at the time of HC resolution. In univariate analysis, male sex, age <20 years, myeloablative conditioning with cyclophosphamide and acute GVHD were associated with HC. In multivariate analysis, HC was significantly more common in males and HLA-mismatched UCB graft recipients. Severe grade HC (grade III–IV) was associated with increased treatment-related mortality (TRM) but not with overall survival at 1 year. HC remains hazardous and therefore better prophylaxis and early interventions to limit its severity are still needed. PMID:26168069

  13. Low-intensity pulsed ultrasound treatment as an alternative to vascular bone graft surgery for a 5-year-long ulnar non-union in a patient with haemochromatosis.

    PubMed

    Povlsen, Sebastian Daniel; Povlsen, Bo

    2015-11-03

    We present the case of a 75-year-old woman with haemochromatosis who developed a 5-year-long right ulnar non-union after a shortening osteotomy to correct a malunited Colles' fracture. Standard surgical treatment for ulnar non-unions was attempted on 19 March 2008 and again on 20 April 2009, but the non-union persisted on 8 May 2012, as confirmed by CT scan. Vascular bone grafting and refixation was then considered, but the patient declined this extensive operation, instead choosing to try non-invasive low-intensity pulsed ultrasound treatment with an Exogen device. Just 4 months later, complete union as confirmed by CT scan was achieved. This is the first case demonstrating the efficacy of ultrasound treatment for long-standing non-unions resistant to surgery in patients with haemochromatosis, a disorder where iron deposition can provide suboptimal circumstances for bone healing. Our finding suggests that low-intensity pulsed ultrasound devices could be used as a first-line treatment for stable non-unions instead of revision surgery.

  14. Grafts of fetal dopamine neurons survive and improve motor function in Parkinson's disease

    SciTech Connect

    Lindvall, O.; Brundin, P.; Widner, H.; Rehncrona, S.; Gustavii, B.; Frackowiak, R.; Leenders, K.L.; Sawle, G.; Rothwell, J.C.; Marsden, C.D. )

    1990-02-02

    Neural transplantation can restore striatal dopaminergic neurotransmission in animal models of Parkinson's disease. It has now been shown that mesencephalic dopamine neurons, obtained from human fetuses of 8 to 9 weeks gestational age, can survive in the human brain and produce marked and sustained symptomatic relief in a patient severely affected with idiopathic Parkinson's disease. The grafts, which were implanted unilaterally into the putamen by stereotactic surgery, restored dopamine synthesis and storage in the grafted area, as assessed by positron emission tomography with 6-L-({sup 18}F)fluorodopa. This neurochemical change was accompanied by a therapeutically significant reduction in the patient's severe rigidity and bradykinesia and a marked diminuation of the fluctuations in the patient's condition during optimum medication (the on-off phenomenon). The clinical improvement was most marked on the side contralateral to the transplant.

  15. A Two-Piece Microkeratome-Assisted Mushroom Keratoplasty Improves the Outcomes and Survival of Grafts Performed in Eyes with Diseased Stroma and Healthy Endothelium (An American Ophthalmological Society Thesis)

    PubMed Central

    Busin, Massimo; Madi, Silvana; Scorcia, Vincenzo; Santorum, Paolo; Nahum, Yoav

    2015-01-01

    Purpose: To test the hypothesis that a new microkeratome-assisted penetrating keratoplasty (PK) technique employing transplantation of a two-piece mushroom-shaped graft may result in better visual outcomes and graft survival rates than those of conventional PK. Methods: Retrospective chart review of 96 eyes at low risk and 76 eyes at high risk for immunologic rejection (all with full-thickness central corneal opacity and otherwise healthy endothelium) undergoing mushroom PK between 2004 and 2012 at our Institution. Outcome measures were best-corrected visual acuity (BCVA), refraction, corneal topography, endothelial cell density, graft rejection, and survival probability. Results: Five years postoperatively, BCVA of 20/40 and 20/20 was recorded in 100% and over 50% of eyes, respectively. Mean spherical equivalent of refractive error did not vary significantly over a 5-year period; astigmatism averaged always below 4 diopters, with no statistically significant change over time, and was of the regular type in over 90% of eyes. Endothelial cell density decreased to about 40% of the eye bank count 2 years after mushroom PK and did not change significantly thereafter. Five years postoperatively, probabilities of graft immunologic rejection and graft survival were below 5% and above 95%, respectively. There was no statistically significant difference in endothelial cell loss, graft rejection, and survival probability between low-risk and high-risk subgroups. Conclusions: Refractive and visual outcomes of mushroom PK compare favorably with those of conventional full-thickness keratoplasty. In eyes at high risk for immunologic rejection, mushroom PK provides a considerably higher probability of graft survival than conventional PK. PMID:26538771

  16. Impact of Early Reoperation following Living-Donor Liver Transplantation on Graft Survival

    PubMed Central

    Kawaguchi, Yoshikuni; Sugawara, Yasuhiko; Akamatsu, Nobuhisa; Kaneko, Junichi; Hamada, Tsuyoshi; Tanaka, Tomohiro; Ishizawa, Takeaki; Tamura, Sumihito; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2014-01-01

    Background The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT) on graft and recipient survival. Methods Recipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted. Results Early reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7–96.4), and 85.2% (95%CI, 66.5–94.3), respectively, in the reoperation group (n = 27), and 95.2% (95%CI, 88.0–98.2), and 92.9% (95%CI, 85.0–96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9–99.5), and 88.3% (95%CI, 69.3–96.2), respectively, in the reoperation group, and 89.3% (95%CI, 80.7–94.3) and 88.0% (95%CI, 79.2–93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59). Conclusions Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of

  17. Grafts of extra-adrenal chromaffin cells as aggregates show better survival rate and regenerative effects on parkinsonian rats than dispersed cell grafts.

    PubMed

    Galan-Rodriguez, B; del-Marco, A; Flores, J A; Ramiro-Fuentes, S; Gonzalez-Aparicio, R; Tunez, I; Tasset, I; Fernandez-Espejo, E

    2008-03-01

    The objective was to discern the neuroregenerative effect of grafts of extra-adrenal cells of the Zuckerkandl's paraganglion (ZP) in the nigrostriatal circuit, by using the retrograde model of parkinsonism in rats. The antiparkinsonian efficacy of two types of grafting procedures was studied (cell aggregates vs. dispersed cells), and GDNF and TGFbeta(1) (dopaminotrophic factors) as well as dopamine presence in extra-adrenal tissue was analyzed. Extra-adrenal chromaffin cells are noradrenergics, tissue dopamine is low, and they express both GDNF and TGFbeta(1). Grafts of cell aggregates, not of dispersed cells, exerted a trophic regeneration of the host striatum, leading to amelioration of motor deficits. Sprouting of spared dopaminergic fibers within the striatum, reduction of dopamine axon degeneration, and/or enhanced phenotypic expression of TH would explain striatal regeneration. Grafted cells as aggregates showed a better survival rate than dispersed cells, and they express higher levels of GDNF. Higher survivability and GDNF content together with the neurorestorative and dopaminotrophic action of both GDNF and TGFbeta(1) could account for striatal recovery and functional amelioration after grafting ZP cell aggregates. Finally, nigral degeneration and partial degeneration of ventral tegmental area were not precluded after transplantation, indicating that the trophic effect of grafts was local within the host striatum.

  18. 5-Year Budget Forecasting.

    ERIC Educational Resources Information Center

    Conyers, John G.; Lingel, George; Piekarski, Robert

    2000-01-01

    Financial planning is the key to providing a high-quality instructional plan. A 5-year financial plan is typically updated by looking at district financial history, future instructional plans, staffing requirements, and revenue projections. Planning assumptions must be clearly understood by the financial team and the community. (MLH)

  19. Influence of donor–recipient gender mismatch on graft function and survival following lung transplantation†

    PubMed Central

    Alvarez, Antonio; Moreno, Paula; Illana, Jennifer; Espinosa, Dionisio; Baamonde, Carlos; Arango, Elisabet; Algar, Francisco Javier; Salvatierra, Angel

    2013-01-01

    OBJECTIVES In current practice, donors and recipients are not matched for gender in lung transplantation. However, some data have suggested a possible effect of gender combinations on lung transplant outcomes. We examined whether donor–recipient (D/R) gender mismatch is related to adverse outcomes after lung transplantation in terms of early and long-term graft function and survival. METHODS We reviewed 256 donors and lung transplant recipients over a 14-year period. Patients were distributed into four groups: Group A (D/R: female/female), Group B (D/R: male/male), Group C (D/R: female/male), Group D (D/R: male/female). Donor and recipient variables were compared among groups, including early graft function, 30-day mortality, freedom from bronchiolitis obliterans syndrome (BOS), and long-term survival. RESULTS Group A: 57 (22%), Group B: 99 (39%), Group C: 62 (24%), Group D: 38 (15%) transplants (P = 0.001). Donor age was 29 ± 14, 27 ± 12, 33 ± 13 and 23 ± 12 years for Groups A, B, C and D, respectively (P = 0.004). Recipient age was 31 ± 15, 44 ± 17, 42 ± 16 and 30 ± 16 years for Groups A, B, C and D, respectively (P = 0.000). PaO2/FiO2 (mmHg) 24 h post-transplant was: Group A: 276 ± 144, Group B: 297 ± 131, Group C: 344 ± 133 and Group D: 238 ± 138 (P = 0.015). Primary graft dysfunction developed in 23, 14, 17 and 21% of recipients from Groups A, B, C and D, respectively (P = 0.45). Operative mortality was 4.4, 6.5, 5.2 and 2%, for recipients from Groups A, B, C and D, respectively (P = 0.66). Freedom from BOS was 73, 59 and 36% for gender-matched transplants vs 76, 67 and 40% for gender-mismatched transplants at 3, 5 and 10 years, respectively (P = 0.618), without differences among groups. A non-significant survival benefit was observed for female recipients, irrespective of the donor gender. CONCLUSIONS Donor–recipient gender mismatch does not have a negative impact on early graft function and mortality following lung transplantation. There is a

  20. 8-10 year follow-up survival of dental implants in maxillae with or without autogenous bone graft reconstruction

    PubMed Central

    de Moraes, Paulo H; Olate, Sergio; Lauria, Andrezza; Asprino, Luciana; de Moraes, Márcio; de Albergaria-Barbosa, José Ricardo

    2015-01-01

    The aim of this research was to ascertain the survival of implants installed in the atrophic maxillae of patients treated with or without autogenous bone graft at 8 to 10 years of follow-up. A retrospective study was conducted using clinical and imaging analysis. 42 adult patients were selected, treated with osseointegrated implants in a fixed maxillary prosthesis model with suprastructure using 6 to 8 implants; of these, 22 underwent reconstruction with a bone graft taken from the anterior iliac crest and 20 were treated without any type of bone graft. The sequence of removal, installation and management of the grafts followed routine patterns, and the implant installation and prosthesis preparation also followed parameters established in previous publications. Variables of implant survival, stage of loss and bone stability of the implants were analyzed with the Wilcoxon signed-rank test, considering a value of P<0.05 to obtain statistical significance. After 8 to 10 years of follow-up the 306 implants installed in the 42 patients were evaluated. 162 implants were in the bone graft group, where 8.0% of implants were lost in the pre-loading stage, 3.7% in the post-loading stage and 88.7% had complete survival. In the group without bone graft, 6.17% were lost in the pre-loading stage, 1.85% in the post-loading stage and 90.97% had complete survival. There was no significant difference in the survival of the implants between the two groups (P=0.082). Cervical bone loss between the groups showed no significant differences either (P=0.241). The implants in grafted maxillae with cases of severe maxillary atrophy are just as efficient as implants installed in maxillae without bone graft. PMID:26770565

  1. Significance of anti-HLA and donor-specific antibodies in long-term renal graft survival.

    PubMed

    Saidman, S

    2007-04-01

    Numerous studies have demonstrated an association of posttransplant HLA antibodies with decreased long-term graft survival. The presence of C4d deposition in these cases supports the hypothesis that antibody and complement deposition are involved in the pathogenesis of graft failure. Development of HLA antibodies may predate the clinical manifestation of chronic rejection (CR). However, frequency of donor-specific antibody is low when all patients are screened regardless of their graft function, and it may be more valuable to look for antibody only in patients with mild dysfunction. Effective treatment for CR has not been identified, although increased immunosuppression has been shown to decrease antibody levels and stabilize graft function. Many patients have been identified with good graft function despite the presence of circulating donor-specific HLA antibody. Additional studies focusing on the mechanism behind the apparent protection from the detrimental effects of antibody in such patients are needed.

  2. Developmental milestones record - 5 years

    MedlinePlus

    ... Childhood growth milestones - 5 years; Growth milestones for children - 5 years; Well child - 5 years ... skill milestones for a typical 5-year-old child include: Gains about 4 to 5 pounds (1. ...

  3. Factors associated with graft survival and endothelial cell density after Descemet’s stripping automated endothelial keratoplasty

    PubMed Central

    Ishii, Nobuhito; Yamaguchi, Takefumi; Yazu, Hiroyuki; Satake, Yoshiyuki; Yoshida, Akitoshi; Shimazaki, Jun

    2016-01-01

    Postoperative endothelial cell loss leads to graft failure after corneal transplantation, and is one of the important issues for long-term prognosis. The objective of this study was to identify clinical factors affecting graft survival and postoperative endothelial cell density (ECD) after Descemet’s stripping automated endothelial keratoplasty (DSAEK). A total of 198 consecutive Japanese patients (225 eyes) who underwent DSAEK were analysed using Cox proportional hazard regression and multiple linear regression models. The candidate factors included recipient age; gender; diagnosis; pre-existing iris damage state, scored based on its severity; the number of previous intraocular surgeries; graft ECD; graft diameter; simultaneous cataract surgery; surgeons experience; intraoperative iris damage; postoperative rebubbling; and graft rejection. Eyes with higher pre-existing iris damage score and more number of previous intraocular surgery had a significantly higher risk of graft failure (HR = 8.53; P < 0.0001, and HR = 2.66; P = 0.026, respectively). Higher pre-existing iris damage score, lower graft ECD, and smaller graft diameter were identified as significant predisposing factors for lower postoperative ECD. The results show that iris damage status before DSAEK may be clinically useful in predicting the postoperative course. Avoiding intraoperative iris damage, especially in eyes with low ECD can change the prognosis of future DSAEK. PMID:27121659

  4. Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

    PubMed Central

    Fischer-Fröhlich, Carl-Ludwig; Kutschmann, Marcus; Feindt, Johanna; Schmidtmann, Irene; Kirste, Günter; Frühauf, Nils R.; Wirges, Ulrike; Rahmel, Axel; Schleicher, Christina

    2015-01-01

    Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with substantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated in a nationwide multicentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the original data used for allocation and graft acceptance. Methods. A nationwide deidentified multicenter study-database was created of data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ procurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance level 5%, hazard ratio [95% CI]) was conducted (n = 4411, isolated KTX). Results. Risk factors associated with graft-survival were donor age (1.020 [1.013–1.027] per year), donor size (0.985 [0.977–0.993] per cm), donor's creatinine at admission (1.002 [1.001–1.004] per µmol/L), donor treatment with catecholamine (0.757 [0.635–0.901]), and reduced graft-quality at procurement (1.549 [1.217–1.973]), as well as recipient age (1.012 [1.003–1.021] per year), actual panel reactive antibodies (1.007 [1.002–1.011] per percent), retransplantation (1.850 [1.484–2.306]), recipient's cardiovascular comorbidity (1.436 [1.212–1.701]), and use of IL2-receptor antibodies for induction (0.741 [0.619–0.887]). Conclusion. Some donor characteristics persist to impact graft-survival (e.g., age) while the effect of others could be mitigated by elaborate donor-recipient match and care. PMID:26539298

  5. Comparison of 5-Year Outcomes After Coronary Artery Bypass Grafting in Heart Failure Patients With Versus Without Preserved Left Ventricular Ejection Fraction (from the CREDO-Kyoto CABG Registry Cohort-2).

    PubMed

    Marui, Akira; Nishiwaki, Noboru; Komiya, Tatsuhiko; Hanyu, Michiya; Tanaka, Shiro; Kimura, Takeshi; Sakata, Ryuzo

    2015-08-15

    Heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) is regarded as an independent risk factor for poor outcomes after coronary artery bypass grafting (CABG). However, the impact of HF with preserved EF (HFpEF) still has been unclear. We identified 1,877 patients who received isolated CABG of 15,939 patients who underwent first coronary revascularization enrolled in the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome Study in Kyoto) Registry Cohort-2. Of them, 1,489 patients had normal LV function (LVEF >50% without a history of HF; Normal group), 236 had HFrEF (LVEF ≤50% with HF), and 152 had HFpEF (LVEF >50% with HF). Preoperative LVEF was the lowest in the HFrEF group (62 ± 12%, 36 ± 9%, and 61 ± 7% for the Normal, HFrEF, and HFpEF groups, respectively; p <0.001). Unadjusted 30-day mortality rate was the highest in the HFrEF group (0.5%, 3.0%, and 0.7%; p = 0.003). However, cumulative incidences of all-cause death at 5-year was the highest in the HFpEF group (14%, 27%, and 32%, respectively; p <0.001). After adjusting confounders, the risk of all-cause death in the HFpEF group was greater than the Normal group (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.02 to 1.97; p = 0.04). The risk of all-cause death was not different between the HFpEF and the HFrEF groups (HR 0.88; 95% CI 0.61 to 1.29; p = 0.52). In addition, the risks of cardiac death and sudden death in the HFpEF group were greater than the Normal group (HR 2.14, 95% CI 1.32 to 3.49, p = 0.002; and HR 3.60, 95% CI 1.55 to 8.36, p = 0.003, respectively), and the risks of those end points were not different between the HFrEF and the HFpEF groups. Despite low 30-day mortality rate after CABG in patients with HFpEF, HFpEF was associated with high risks of long-term death and cardiovascular events. Patients with HFpEF, as well as HFrEF, should be carefully operated and followed up.

  6. Anatomical and functional graft survival, 10 years after epikeratoplasty in keratoconus

    PubMed Central

    Panda, Anita; Gupta, Anoop K; Sharma, Namrata; Nindrakrishna, Sasikala; Vajpayee, Rasik

    2013-01-01

    Purpose: To report outcomes of epikeratoplasty in keratoconus (KC), utilizing manually-prepared plano donor lenticules in terms of flattening of the cone, reduction in astigmatism and improvement in the visual acuity. Materials and Methods: Patients with KC, having visual acuity <20/200, astigmatism >12 diopters (D) but without corneal opacity underwent epikeratoplasty, using manually prepared plano donor lenticules from fresh or M.K preserved corneas, between 1990 - 2000 and followed for 10 years, were included in this report. Visual acuity slit-lamp-biomicroscopy, keratometry, and refraction were performed at 8 weeks, 12 weeks, and 6 months for all 59 patients. The same were carried out at 1 year, 5 years, and 10 years depending upon the availability of the patient for that period. Results: Of the 59 patients, only 26 were available for follow-up after 10 years. At 3 months, 1 year and 5 years, best corrected visual acuity of (BCVA) ≥20/60 were achieved in 84.7%, 84.4% and 80.3% of eyes, respectively. BCVA was 73% at 10-year follow- up, which was due to the presence of posterior subcapsular cataract (PSC). The average keratometric astigmatism and average flattening in diopters stabilized at the end of 3 months, which remained constant at 1, 5, and 10-year follow-up. The average diopter of myopia was stabilized by 1 year, which was almost same at 10 year. Graft was clear in all but 1 eye at 10 year follow-up. Conclusion: Epikeratoplasty is a useful technique for keratoconic eyes without apical scarring who fail or unable to use contact lenses. PMID:23275216

  7. Renal Transplant Immunology in the Last 20 Years: A Revolution Towards Graft and Patient Survival Improvement.

    PubMed

    Sá, Helena; Leal, Rita; Rosa, Manuel Santos

    2016-09-28

    To deride the hope of progress is the ultimate fatuity, the last word in poverty of spirit and meanness of mind. There is no need to be dismayed by the fact that we cannot yet envisage a definitive solution of our problems, a resting-place beyond which we need not try to go. -P.B. Medawar, 1969* [Formula: see text] Thomas E. Starlz, also known as the Father of Clinical Transplantation, once said that organ transplantation was the supreme exception to the rule that most major advances in medicine spring from discoveries in basic science [Starzl T. The mystique of organ transplantation. J Am Coll Surg 2005 Aug;201(2):160-170]. In fact, the first successful identical-twin kidney transplantation performed by Murray's team in December 1954 (Murray J et al. Renal homotransplantations in identical twins. Surg Forum 1955;6:432-436) was the example of an upside down translation medicine: Human clinical transplantation began and researchers tried to understand the underlying immune response and how to control the powerful rejection pathways through experimental models. In the last 20 years, we have witnessed an amazing progress in the knowledge of immunological mechanisms regarding alloimmune response and an outstanding evolution on the identification and characterization of major and minor histocompatibility antigens. This review presents an historical and clinical perspective of those important advances in kidney transplantation immunology in the last 20 years, which contributed to the improvement in patients' quality of life and the survival of end-stage renal patients. In spite of these significant progresses, some areas still need substantial progress, such as the definition of non-invasive biomarkers for acute rejection; the continuous reduction of immunosuppression; the extension of graft survival, and finally the achievement of real graft tolerance extended to HLA mismatch donor: recipient pairs.

  8. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    PubMed

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension.

  9. Survival and Success Rates of Dental Implants Placed Using Osteotome Sinus Floor Elevation Without Added Bone Grafting: A Retrospective Study with a Follow-up of up to 10 Years.

    PubMed

    French, David; Nadji, Nabil; Shariati, Batoul; Hatzimanolakis, Penny; Larjava, Hannu

    2016-01-01

    This retrospective study with a follow-up period of 4 months to 10 years evaluated survival, success, and complication rates of implants placed using osteotome sinus floor elevation (OSFE) without added bone grafting. A total of 926 implants were placed, including 530 short implants (6 mm to 8.5 mm) and 209 implants in low residual bone height (RBH) (< 5 mm). Bone levels were evaluated at approximately 3 months and at 1, 3, and 5 years, and in some cases up to 10 years after implants were placed. The implant survival rate was 98.3% at the 5-year follow-up. Twelve of the 926 implants failed (6 preprosthetic, 6 postprosthetic). The success rate was 95.4% at a threshold of less than 1 mm of bone loss for combined systems (Straumann; Nobel Biocare). Short implant survival and success rates were statistically comparable to conventional-length implants. Low-RBH implants had a lower but acceptable survival rate of 95.7%. Adverse events were rare, with one case of infection and zero cases of vertigo reported. The findings of this study indicate that implant placement with OSFE without added bone graft is highly successful, even when short implants are used in low RBH.

  10. Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

    PubMed Central

    Guida, Gustavo A.; Fudulu, Daniel; Bruno, Vito D.; Marsico, Roberto; Sedmakov, Hristo; Zakkar, Mustafa; Rapetto, Filippo; Bryan, Alan J.; Angelini, Gianni D.

    2016-01-01

    The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches. The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events. Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in meta-analyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCAB vs. ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes. PMID:27942399

  11. Analysis of graft survival in a trial of stem cell transplant in ALS

    PubMed Central

    Tadesse, Tezeta; Gearing, Marla; Senitzer, David; Saxe, Debra; Brat, Daniel J; Bray, Robert; Gebel, Howard; Hill, Charles; Boulis, Nicholas; Riley, Jonathan; Feldman, Eva; Johe, Karl; Hazel, Thomas; Polak, Meraida; Bordeau, Jane; Federici, Thais; Glass, Jonathan D

    2014-01-01

    Objective The first US Food and Drug Administration–approved clinical trial to treat amyotrophic lateral sclerosis (ALS) with neural stem cell–based therapy is in progress. The goal of the current study was to identify and assess the survival of human spinal cord–derived neural stem cells (HSSCs) transplanted into the spinal cord in patients with ALS. Methods Spinal cords transplanted with HSSCs were examined from six autopsy cases. Homogenized tissues were interrogated for the presence of donor versus recipient DNA using real-time PCR methods (qPCR). Fluorescence in situ hybridization (FISH) was performed using DNA probes for XY chromosomes to identify male donor HSSCs in one female case, and immunohistochemistry (IHC) was used to characterize the identified donor cells. Results Genomic DNA from donor HSSCs was identified in all cases, comprising 0.67–5.4% of total tissue DNA in patients surviving 196 to 921 days after transplantation. In the one female patient a “nest” of cells identified on H&E staining were XY-positive by FISH, confirming donor origin. A subset of XY-positive cells labeled for the neuronal marker NeuN and stem cell marker SOX2. Interpretation This is the first study to identify human neural stem cells transplanted into a human spinal cord. Transplanted HSSCs survived up to 2.5 years posttransplant. Some cells differentiated into neurons, while others maintained their stem cell phenotype. This work is a proof of concept of the survival and differentiation of human stems cell transplanted into the spinal cord of ALS patients. PMID:25540804

  12. Spontaneous bacterial peritonitis prevalence in pre-transplant patients and its effect on survival and graft loss post-transplant

    PubMed Central

    Shah, Neeral L; Intagliata, Nicolas M; Henry, Zachary H; Argo, Curtis K; Northup, Patrick G

    2016-01-01

    AIM To investigate the incidence of spontaneous bacterial peritonitis (SBP) in pre-transplant patients and its effect on post transplant mortality and graft failure. METHODS We conducted a retrospective cohort study of patient records from the organ procurement and transplant network data set. Patients were identified by the presence of SBP pre-transplant. Univariate post-transplant survival models were constructed using the Kaplan-Meier technique and multivariate models were constructed using the Cox proportional hazards model. Variables that affected post-transplant graft survival were identified in the SBP population. RESULTS Forty-seven thousand eight hundred and eighty patient records were included in the analysis for both groups, and 1966 (4.11%) patients were identified in the data set as having pre-transplant SBP. Patients that had pre-transplant SBP had higher rates of graft loss from recurrent hepatitis C virus (HCV) (3.6% vs 2.0%, P < 0.0001), infections leading to graft loss (1.9% vs 1.3%, P = 0.02), primary non-function (4.3% vs 3.0%, P < 0.0001) and chronic rejection (1.1% vs 0.7%, P = 0.04). Kaplan-Meier survival analysis showed a statistically significant difference in all-cause survival in patients with a history of SBP vs those without (P < 0.0001). Pre-transplant history of SBP was independently predictive of mortality due to recurrent HCV (HR = 1.11, 95%CI: 1.02-1.21, P < 0.017) after liver transplantation. CONCLUSION HCV patients prior to the advent of directing acting anti-viral agents had a higher incidence of pre-transplant SBP than other patients on the liver transplant wait list. SBP history pre-transplant resulted in a higher rate of graft loss due to recurrent HCV infection and chronic rejection. PMID:28083084

  13. Induction Chemotherapy Improved Long-term Outcomes of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Analysis of 5-year Survival Outcomes in the Era of Intensity-modulated Radiotherapy

    PubMed Central

    Peng, Hao; Chen, Lei; Zhang, Jian; Li, Wen-Fei; Mao, Yan-Ping; Zhang, Yuan; Liu, Li-Zhi; Tian, Li; Lin, Ai-Hua; Sun, Ying; Ma, Jun

    2017-01-01

    Background: The aim of this study is to evaluate the long-term therapeutic gain of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). Methods: Data on 957 patients with stage T1-2N2-3 or T3-4N1-3 NPC treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance influence of various covariates. Patient survival between IC and non-IC groups were compared. Results: For the 318 pairs selected from the original 957 patients by PSM, the median follow-up duration was 57.13 months (range, 1.27-78.1 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and locoregional relapse-free survival (LRRFS) rates for IC group vs. non-IC group were 87.2% vs. 80.8% (P = 0.023), 88.1% vs. 83.2% (P = 0.071), 80.7% vs. 71.4% (P = 0.011) and 92.1% vs. 86.7% (P = 0.081), respectively. Multivariate analysis identify IC as an independent prognostic factor for OS (HR, 0.595; 95% CI, 0.397-0.891; P = 0.012) and DFS (HR, 0.627; 95% CI, 0.451-0.872; P = 0.006). After excluding the patients not receiving concurrent chemotherapy, IC was found to be an independent prognostic factor for OS (HR, 0.566; 95% CI, 0.368-0.872; P = 0.01), DMFS (HR, 0.580; 95% CI, 0.367-0.916; P = 0.02) and DFS (HR, 0.633; 95% CI, 0.444-0.903; P = 0.012). Conclusions: IC is an effective treatment modality for patients with stage T1-2N2-3 and T3-4N1-3 NPC, and the incorporation of IC with standard CCRT could achieve the best therapeutic gain. PMID:28261337

  14. The impact of method on kidney graft and patient survival in kidney-pancreas transplantations for type I diabetes mellitus.

    PubMed

    Dinckan, Ayhan; Aliosmanoglu, Ibrahim; Kocak, Huseyin; Mesci, Ayhan; Altunbas, Hasan; Gurkan, Alihan

    2015-01-01

    Patients who develop end-stage renal disease (ESRD) associated with Type I Diabetes Mellitus may receive kidney alone (KA) transplantation, simultaneous pancreas-kidney (SPK) transplantation, or a pancreas after kidney (PAK) transplantation. The goal of this study is to examine the long-term impact of pancreas transplantation on kidney graft and patient survival rates. A total of 85 transplantation cases, consisting of 30 that received living donor KA, 21 that received SPK, and 34 that received PAK, from 2003-2010 at Akdeniz University Organ Transplantation Institute were retrospectively screened. There was a graft loss in 4 cases from the KA group, and in 1 case from each of the SPK and PAK groups. The five-year kidney graft survival rates were 86.7% in KA, 95.2% in SPK, and 97.1% in PAK. There was a single patient loss in both KA and SPK. The kidney survival percentages were higher in SPK and PAK groups compared to the KA group. Therefore, SPK should be the primary preference in these patients; however, for the cases that have a living donor, pancreas transplantation should be considered after kidney transplantation, or the patients can be followed-up on with close blood sugar control.

  15. Interrogating the Aged Striatum: Robust Survival of Grafted Dopamine Neurons in Aging Rats Produces Inferior Behavioral Recovery and Evidence of Impaired Integration

    PubMed Central

    Collier, Timothy J.; O’Malley, Jennifer; Rademacher, David J.; Stancati, Jennifer A.; Sisson, Kellie A.; Sortwell, Caryl E.; Paumier, Katrina L.; Gebremedhin, Kibrom G.; Steece-Collier, Kathy

    2015-01-01

    Advanced age is the primary risk factor for Parkinson disease (PD). In PD patients and rodent models of PD, advanced age is associated with inferior symptomatic benefit following intrastriatal grafting of embryonic dopamine (DA) neurons, a pattern believed to result from decreased survival and reinnervation provided by grafted neurons in the aged host. To help understand the capacity of the aged, parkinsonian striatum to be remodeled with new DA terminals, we used a grafting model and examined whether increasing the number of grafted DA neurons in aged rats would translate to enhanced behavioral recovery. Young (3 mo), middle-aged (15 mo), and aged (22 mo) parkinsonian rats were grafted with proportionately increasing numbers of embryonic ventral mesencephalic (VM) cells to evaluate whether the limitations of the graft environment in subjects of advancing age can be offset by increased numbers of transplanted neurons. Despite robust survival of grafted neurons in aged rats, reinnervation of striatal neurons remained inferior and amelioration of levodopa-induced dyskinesias (LID) was delayed or absent. This study demonstrates that: 1) counter to previous evidence, under certain conditions the aged striatum can support robust survival of grafted DA neurons; and 2) unknown factors associated with the aged striatum result in inferior integration of graft and host, and continue to present obstacles to full therapeutic efficacy of DA cell-based therapy in this model of aging. PMID:25771169

  16. Immunosuppression of Allogenic Mesenchymal Stem Cells Transplantation after Spinal Cord Injury Improves Graft Survival and Beneficial Outcomes

    PubMed Central

    Torres-Espín, Abel; Redondo-Castro, Elena; Hernandez, Joaquim

    2015-01-01

    Abstract Cell therapy for spinal cord injury (SCI) is a promising strategy for clinical application. Mesenchymal stem cells (MSC) have demonstrated beneficial effects following transplantation in animal models of SCI. However, despite the immunoprivilege properties of the MSC, their survival in the injured spinal cord is reduced due to the detrimental milieu in the damaged tissue and immune rejection of the cells. The limited survival of the engrafted cells may determine the therapy success. Therefore, we compared two strategies to increase the presence of the cells in the injured spinal cord in rats: increasing the amount of MSC transplants and using immunosuppressive treatment with FK506 after transplantation. Functional outcomes for locomotion and electrophysiological responses were assessed. The grafted cells survival and the amount of cavity and spared tissue were studied. The findings indicate that immunosuppression improved grafted cells survival. A cell–dose effect was found regarding locomotion recovery and tissue protection independent of immunosuppression. Nevertheless, immunosuppression enhanced the electrophysiological outcomes and allowed filling of the cavity formed after injury by new regenerative tissue and axons. These results indicate that MSC transplantation combined with immunosuppression prolongs the survival of engrafted cells and improves functional and morphological outcomes after SCI. PMID:25203134

  17. Neuro-peptide treatment with Cerebrolysin improves the survival of neural stem cell grafts in an APP transgenic model of Alzheimer disease.

    PubMed

    Rockenstein, Edward; Desplats, Paula; Ubhi, Kiren; Mante, Michael; Florio, Jazmin; Adame, Anthony; Winter, Stefan; Brandstaetter, Hemma; Meier, Dieter; Masliah, Eliezer

    2015-07-01

    Neural stem cells (NSCs) have been considered as potential therapy in Alzheimer's disease (AD) but their use is hampered by the poor survival of grafted cells. Supply of neurotrophic factors to the grafted cells has been proposed as a way to augment survival of the stem cells. In this context, we investigated the utility of Cerebrolysin (CBL), a peptidergic mixture with neurotrophic-like properties, as an adjunct to stem cell therapy in an APP transgenic (tg) model of AD. We grafted murine NSCs into the hippocampus of non-tg and APP tg that were treated systemically with CBL and analyzed after 1, 3, 6 and 9months post grafting. Compared to vehicle-treated non-tg mice, in the vehicle-treated APP tg mice there was considerable reduction in the survival of the grafted NSCs. Whereas, CBL treatment enhanced the survival of NSCs in both non-tg and APP tg with the majority of the surviving NSCs remaining as neuroblasts. The NSCs of the CBL treated mice displayed reduced numbers of caspase-3 and TUNEL positive cells and increased brain derived neurotrophic factor (BDNF) and furin immunoreactivity. These results suggest that CBL might protect grafted NSCs and as such be a potential adjuvant therapy when combined with grafting.

  18. Graft-versus-host disease and survival after cord blood transplantation for acute leukemia: a comparison of Japanese versus White populations.

    PubMed

    Kuwatsuka, Yachiyo; Atsuta, Yoshiko; Horowitz, Mary M; Inagaki, Jiro; Kanda, Junya; Kato, Koji; Koh, Katsuyoshi; Zhang, Mei-Jie; Eapen, Mary

    2014-05-01

    An earlier report identified higher risks of acute and chronic graft-versus-host disease (GVHD) in White children compared with the Japanese after HLA-matched sibling transplantations. The current analysis explored whether racial differences are associated with GVHD risks after unrelated umbilical cord blood transplantation. Included are patients of Japanese descent (n = 257) and Whites (n = 260; 168 of 260 received antithymocyte globulin [ATG]). Transplants were performed in the United States or Japan between 2000 and 2009; patients were aged 16 years or younger, had acute leukemia, were in complete remission, and received a myeloablative conditioning regimen. The median ages of the Japanese and Whites who received ATG were younger at 5 years compared with 8 years for Whites who did not receive ATG. In all groups most transplants were mismatched at 1 or 2 HLA loci. Multivariate analysis found no differences in risks of acute GVHD between the Japanese and Whites. However, chronic GVHD was higher in Whites who did not receive ATG compared with the Japanese (hazard ratio, 2.16; P < .001), and treatment-related mortality was higher in Whites who received ATG compared with the Japanese (relative risk, 1.81; P = .01). Nevertheless, there were no significant differences in overall survival between the 3 groups.

  19. Survival of skin graft between transgenic cloned dogs and non-transgenic cloned dogs.

    PubMed

    Kim, Geon A; Oh, Hyun Ju; Kim, Min Jung; Jo, Young Kwang; Choi, Jin; Park, Jung Eun; Park, Eun Jung; Lim, Sang Hyun; Yoon, Byung Il; Kang, Sung Keun; Jang, Goo; Lee, Byeong Chun

    2014-01-01

    Whereas it has been assumed that genetically modified tissues or cells derived from somatic cell nuclear transfer (SCNT) should be accepted by a host of the same species, their immune compatibility has not been extensively explored. To identify acceptance of SCNT-derived cells or tissues, skin grafts were performed between cloned dogs that were identical except for their mitochondrial DNA (mtDNA) haplotypes and foreign gene. We showed here that differences in mtDNA haplotypes and genetic modification did not elicit immune responses in these dogs: 1) skin tissues from genetically-modified cloned dogs were successfully transplanted into genetically-modified cloned dogs with different mtDNA haplotype under three successive grafts over 63 days; and 2) non-transgenic cloned tissues were accepted into transgenic cloned syngeneic recipients with different mtDNA haplotypes and vice versa under two successive grafts over 63 days. In addition, expression of the inserted gene was maintained, being functional without eliciting graft rejection. In conclusion, these results show that transplanting genetically-modified tissues into normal, syngeneic or genetically-modified recipient dogs with different mtDNA haplotypes do not elicit skin graft rejection or affect expression of the inserted gene. Therefore, therapeutically valuable tissue derived from SCNT with genetic modification might be used safely in clinical applications for patients with diseased tissues.

  20. Validation of National Institutes of Health global scoring system for chronic graft-versus-host disease (GVHD) according to overall and GVHD-specific survival.

    PubMed

    Moon, Joon Ho; Sohn, Sang Kyun; Lambie, Anna; Ellis, Laura; Hamad, Nada; Uhm, Jieun; Gupta, Vikas; Lipton, Jeffrey H; Messner, Hans A; Kuruvilla, John; Kim, Dennis

    2014-04-01

    A new severity grading system for graft-versus-host disease (GVHD) was established by the National Institutes of Health (NIH) consensus criteria (NCC). However, its prognostic value still needs to be validated. Four hundred twenty-five consecutive patients who survived beyond 100 days after allogeneic stem cell transplantation were reviewed and reclassified using NCC. GVHD-specific survival (GSS) and cumulative incidence of relapse were compared according to the NIH global score at the onset and peak of chronic GVHD (cGVHD). Of 346 patients with cGVHD diagnosed by the Revised Seattle Criteria, 317 patients were reclassified according to the NCC as classic cGVHD (n = 144) and overlap syndrome (n = 173). The NIH global scores at onset were mild (43.2%), moderate (42.3%), and severe (14.5%), whereas more moderate (55.5%) and severe (31.6%) cGVHD was observed at the peak of cGVHD. With a median follow-up duration of 34 months, the 5-year GSS was significantly worse for the severe group than the moderate/mild groups at onset and at peak: 50.9% ± 7.8% versus 89.7% ± 3.2% versus 93.5% ± 2.4% at onset (P < .001) and 69.1% ± 5.2% versus 93.2% ± 2.1% versus 97.3% ± 2.7% at peak (P < .001). Severe NIH global score at onset and peak were confirmed as a poor prognostic factor for GSS in multivariate analysis. The cumulative incidence of relapse did not differ among the severity groups at onset or peak. In conclusion, the new NIH global scoring system was shown to differentiate a high-risk group of patients (with severe grade cGVHD) in terms of long-term transplant outcomes.

  1. Decreased graft survival in liver transplant recipients of donors with positive blood cultures: a review of the United Network for Organ Sharing dataset.

    PubMed

    Huaman, Moises A; Vilchez, Valery; Mei, Xiaonan; Shah, Malay B; Daily, Michael F; Berger, Jonathan; Gedaly, Roberto

    2016-11-29

    Liver transplantation using blood culture positive donors (BCPD) has allowed a significant expansion of the donor pool. We aimed to characterize BCPD and assess the outcomes of BCPD liver transplant recipients. We retrieved data from the United Network for Organ Sharing (UNOS) registry on all adults who underwent primary, single-organ deceased-donor liver transplantation in the USA between 2008 and 2013. Patients were classified into two cohorts: the BCPD cohort and the non-BCPD cohort. One-year graft and patient survival were compared between cohorts using Kaplan-Meier estimates and Cox models. A total of 28 961 patients were included. There were 2316 (8.0%) recipients of BCPD. BCPD were more likely to be older, female, black, diabetic, hypertensive, and obese compared to non-BCPD. Graft survival was significantly lower in BCPD recipients compared to non-BCPD recipients (Kaplan-Meier, 0.85 vs. 0.87; P = 0.009). Results remained significant in propensity-matched analysis (P = 0.038). BCPD was independently associated with decreased graft survival (adjusted HR; 1.10, 95% CI 1.01-1.20; P = 0.04). There were no significant differences in patient survival between study groups. BCPD was associated with decreased graft survival in liver transplant recipients. Studies are needed to identify subgroups of BCPD with the highest risk of graft failure and characterize the underlying pathogenic mechanisms.

  2. G-CSF and Exenatide Might Be Associated with Increased Long-Term Survival of Allogeneic Pancreatic Islet Grafts

    PubMed Central

    Peixoto, Eduardo; Messinger, Shari; Mantero, Alejandro; Padilla-Téllez, Nathalia D.; Baidal, David A.; Alejandro, Rodolfo; Ricordi, Camillo; Inverardi, Luca

    2016-01-01

    Background Allogeneic human islet transplantation is an effective therapy for the treatment of patients with Type 1 Diabetes (T1D). The low number of islet transplants performed worldwide and the different transplantation protocols used limit the identification of the most effective therapeutic options to improve the efficacy of this approach. Methods We present a retrospective analysis on the data collected from 44 patients with T1D who underwent islet transplantation at our institute between 2000 and 2007. Several variables were included: recipient demographics and immunological characteristics, donor and transplant characteristics, induction protocols, and additional medical treatment received. Immunosuppression was induced with anti-CD25 (Daclizumab), alone or in association with anti-tumor necrosis factor alpha (TNF-α) treatments (Etanercept or Infliximab), or with anti-CD52 (Alemtuzumab) in association with anti-TNF-α treatments (Etanercept or Infliximab). Subsets of patients were treated with Filgrastim for moderate/severe neutropenia and/or Exenatide for post prandial hyperglycemia. Results The analysis performed indicates a negative association between graft survival (c-peptide level ≥ 0.3 ng/ml) and islet infusion volume, with the caveat that, the progressive reduction of infusion volumes over the years has been paralleled by improved immunosuppressive protocols. A positive association is instead suggested between graft survival and administration of Exenatide and Filgrastim, alone or in combination. Conclusion This retrospective analysis may be of assistance to further improve long-term outcomes of protocols for transplant of islets and other organs. PMID:27285580

  3. Transplantation of allogeneic islets of Langerhans in the rat liver: effects of macrophage depletion on graft survival and microenvironment activation.

    PubMed

    Bottino, R; Fernandez, L A; Ricordi, C; Lehmann, R; Tsan, M F; Oliver, R; Inverardi, L

    1998-03-01

    Early impairment of islet function and graft loss limit the success of allogeneic islet transplantation. Nonspecific inflammatory events occurring at the transplant site immediately after grafting, involving the production of cytokines and free radicals and sinusoidal endothelial cell (SEC) activation, may contribute to islet cell damage. To evaluate whether Kupffer cell inactivation would result in prolonged allograft survival in a model system of intrahepatic islet transplantation in rats, we systemically administered either gadolinium chloride (GdCl3) or dichloromethylene diphosphonate (Cl2MDP) to assess the effects of macrophage inactivation on rejection and on the release of proinflammatory molecules, as well as to assess the functional profile of SEC. The results obtained were compared with those observed in untreated, sham-injected animals and in rats receiving intraportal infusions of microbeads. Transient macrophage inhibition, particularly in hepatic Kupffer cells, is associated with significant prolongation of graft survival after intraportal islet allotransplantation (ITx) in rats: 7.2 days in the control group versus 11.9 days in the GdCl3 group (P < 0.01) and 15.6 days in the Cl2MDP group (P < 0.0006), respectively. Although systemic release of inflammatory mediators was observed only when islet transplantations were performed and it could be inhibited by macrophage-targeting treatments, perturbation of the functional profile of endothelial cells was also observed when microembolization was induced by the use of microbeads and could not be prevented by macrophage inhibition. These experiments provide evidence to support the concept that macrophages play a key role in early inflammatory events known to adversely affect islet engraftment and suggest that manipulation of nonspecific immune activation by inhibition of macrophage function may facilitate hepatic engraftment of islet allografts. The mechanisms mediating this effect are likely to include

  4. Influence of Interleukin-1α and Tumor Necrosis Factor-α Production on Corneal Graft Survival

    PubMed Central

    Bosnar, Damir; Dekaris, Iva; Gabrić, Nikica; Markotić, Alemka; Lazić, Ratimir; Špoljarić, Ninoslav

    2006-01-01

    Aim To determine pro-inflammatory cytokine secretion from human corneas with different pathology and to establish whether cytokine profile influences corneal graft outcome. Method Secretion of both proinflammatory cytokine interleukin (IL)-1α and tumor necrosis factor (TNF)-α was measured after cultivation of 47 corneas collected from corneal graft recipients suffering from different corneal diseases. Non-inflammatory corneal diseases were keratoconus (n = 8), keratoglobus (n = 2), bullous keratopathy (n = 11), and Groenouw stromal dystrophy type II (n = 2), whereas inflammatory included vascularized corneal scar (n = 14), rejected graft (n = 6), and corneal ulcer (n = 4). Corneas were cultivated at 37°C for 24 hours and frozen until cytokine detection was measured by immunoassay. Donor corneas unsuitable for transplantation were used as controls (n = 7). Corneal graft recipients were followed at least 18 months and rejection rate was calculated for each group. Results The median concentration of IL-1α secreted from corneas of recipients with non-inflammatory diseases was 2.47 pg/mm3 (range, 0.13-9.95). In inflammatory corneal diseases, IL-1α concentration was significantly higher (median, 5.92 pg/mm3; range, 0.48-12.68; P = 0.005). IL-1α production in controls (median, 0.63 pg/mm3; range, 0.36-1.29 pg/mm3) was significantly lower than in inflammatory corneal diseases (P<0.001) and non-inflammatory diseases (P = 0.008). Low level of TNF-α was detected only in 5 cases of vascularized corneal scars, 3 cases of bullous keratopathy, and 3 cases of graft rejection. Rejection rate was significantly higher in inflammatory than in non-inflammatory group (46% vs <10%, respectively, P = 0.008). IL-1α and TNF-α were absent from all patient’s sera, confirming its local intra-ocular production. Conclusion Increased production of IL-1α in corneal recipients with inflammatory diseases suggests its role in corneal graft

  5. mTOR Inhibition and Alloantigen-Specific Regulatory T Cells Synergize to Promote Long-Term Graft Survival in Immunocompetent Recipients1

    PubMed Central

    Raimondi, Giorgio; Sumpter, Tina L.; Matta, Benjamin M.; Pillai, Mahesh; Corbitt, Natasha; Vodovotz, Yoram; Wang, Zhiliang; Thomson, Angus W.

    2010-01-01

    Minimization of immunosuppression and donor-specific tolerance to MHC-mismatched organ grafts are important clinical goals. The therapeutic potential of regulatory T cells (Treg) has been demonstrated, but conditions for optimizing their in vivo function post-transplant in nonlymphocyte-depleted hosts remain undefined. Herein, we address mechanisms through which inhibition of the mammalian target of rapamycin (Rapa) (mTOR) synergizes with alloAg-specific Treg (AAsTreg), to permit long-term, donor-specific heart graft survival in immunocompetent hosts. Crucially, immature allogeneic dendritic cells (DC) allowed AAsTreg selection in vitro, with minimal expansion of unwanted (TH17) cells. The rendered Treg potently inhibited T cell proliferation in an Ag-specific manner. However, these AAsTreg remained unable to control T cells stimulated by allogeneic mature DC, – a phenomenon dependent on the release of pro-inflammatory cytokines. In vivo, Rapa administration reduced danger-associated IL-6 production, T cell proliferation and graft infiltration. Based on these observation, AAsTreg were administered post-transplant (d7) in combination with a short course of Rapa and rendered >80% long-term (>150 d) graft survival, a result superior to that achieved with polyclonal Treg. Moreover, graft protection was alloAg-specific. Significantly, long-term graft survival was associated with alloreactive T cell anergy. These findings delineate combination of transient mTOR inhibition with appropriate AAsTreg selection as an effective approach to promote long-term organ graft survival. PMID:20007530

  6. Donor Age and Corneal Endothelial Cell Loss 5 Years after Successful Corneal Transplantation: Specular Microscopy Ancillary Study Results

    PubMed Central

    2010-01-01

    Objective To determine whether endothelial cell loss 5 years after successful corneal transplantation is related to the age of the donor. Design Multicenter, prospective, double-masked clinical trial. Participants Three hundred forty-seven subjects participating in the Cornea Donor Study who had not experienced graft failure 5 years after corneal transplantation for a moderate-risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema). Testing Specular microscopic images of donor corneas obtained before surgery and postoperatively at 6 months, 12 months, and then annually through 5 years were submitted to a central reading center to measure endothelial cell density (ECD). Main Outcome Measure Endothelial cell density at 5 years. Results At 5 years, there was a substantial decrease in ECD from baseline for all donor ages. Subjects who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 69% in the study eye, resulting in a 5-year median ECD of 824 cells/mm2 (interquartile range, 613–1342), whereas subjects who received a cornea from a donor 66 to 75 years old experienced a cell loss of 75%, resulting in a median 5-year ECD of 654 cells/mm2 (interquartile range, 538–986) (P [adjusted for baseline ECD] = 0.04). Statistically, there was a weak negative association between ECD and donor age analyzed as a continuous variable (r [adjusted for baseline ECD] = −0.19; 95% confidence interval, −0.29 to −0.08). Conclusions Endothelial cell loss is substantial in the 5 years after corneal transplantation. There is a slight association between cell loss and donor age. This finding emphasizes the importance of longer-term follow-up of this cohort to determine if this relationship affects graft survival. PMID:18387408

  7. Effect of FTY720 (fingolimod) on graft survival in renal transplant recipients: a systematic review protocol

    PubMed Central

    Gholamnezhadjafari, Reza; Falak, Reza; Aflatoonian, Reza; Ali Keshtkar, Abbas; Rezaei, Abbas

    2016-01-01

    Introduction Studies have shown that FTY720 has inconsistent effects in kidney transplant recipients. Several review articles on FTY720 have been published, but most have focused on the mechanism of action of FTY720. Therefore, this review aims to evaluate and determine the beneficial and harmful effects of FTY720 therapy in kidney transplant recipients. Methods and analysis We electronically searched the following databases: PubMed, Scopus, the Web of Sciences, EMBASE, Cochrane databases and the Cochrane Central Registry of Controlled Trials. Any clinical, randomised controlled trials relating to FTY720 for treating kidney transplant recipients were included without publication status or language restriction. Study selection, data extraction and assessment of study quality were performed independently by two researchers. Data were synthesised by either the fixed effects or the random effects model according to a heterogeneity test. If the extracted data were suitable for meta-analysis, STATA software was used to combine the relative risks for dichotomous outcomes, and the mean differences for continuous outcomes with 95% CIs were measured. Death, loss of function and incidence of acute kidney rejection were assessed as the primary outcomes. Renal graft function, malignancy, delayed graft function and infection were evaluated as secondary outcomes. Ethics/dissemination This review does not require formal ethics approval because the data are not individualised. The resulting review article will be submitted for publication in a peer-reviewed journal. Trial registration number CRD42015024648. PMID:27126975

  8. Operative strategies in aortic graft infections: is complete graft excision always necessary?

    PubMed

    Hart, Joseph P; Eginton, Mark T; Brown, Kellie R; Seabrook, Gary R; Lewis, Brian D; Edmiston, Charles E; Towne, Jonathan B; Cambria, Robert A

    2005-03-01

    The classic approach to aortic graft infections involves complete excision of the graft material with remote reconstruction of the distal circulation. Certain patients may not be well suited for this approach for physiologic or anatomic reasons. This study was undertaken to determine the outcome of partial graft excision in selected patients with aortic graft infection who were not felt to be candidates for complete graft excision. Retrospective analysis of 30 consecutive patients treated with infected grafts arising from the aorta over the past 10 years was performed. Mean interval between graft placement and infection was 5.5 years. Complete graft excision with bypass via clean tissue planes was achieved in 15 patients (group A), and partial or complete graft salvage or in situ graft replacement was performed at the discretion of the surgeon in 15 patients (group B). Perioperative mortality occurred in eight subjects (27%), including six in group A (40%) and two in group B (13%; p = NS). Six patients (20%) developed recurrent infection following graft excision, two (13%) in group A and four (27%) in group B (p = NS). Microorganisms were recovered from 24 of 30 (80%) graft cultures: 13 (43%) were gram positive, 4 (13%) were gram negative, and both gram-positive and gram-negative organisms were recovered from 7 (23%). Identification of culture isolates did not influence either perioperative mortality or the development of recurrent infection. Long-term survival was no different between the groups. We conclude that in certain high-risk patients who may not tolerate complete graft excision, local resection of infected graft segments may be preferable and leads to similar short- and long-term outcome.

  9. Coronary artery bypass grafting associated to aortic valve replacement in the elderly: survival and quality of life

    PubMed Central

    2012-01-01

    Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians. Between January 1991 and January 2010, 520 patients ageing > 70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed. Mean age was 74.2 ± 3.6 years (74.3 ± 3.6 in Group A, 74 ± 3.3 in Group B; p = 0.33). Hospital mortality was 9.5% (46 patients). Twenty-nine (7.8%) in Group A and 17 in Group B (15.2%)(p = 0.019). Actuarial survival was 88.5% ± 0.015 at 1 year, 81.9% ± 0.02 at 5 years, 76.6% ± 0.032 at 10 and 57.3 ± 0.1 at 15 years. Ten-year survival was 77% ± 0.034 in Group A and 77.8% ± 0.045 in Group B (p = 0.2). Multivariate analysis did not reveal associated CABG as a predictor of long term mortality. The scores obtained in the SF-36 test were similar in the two groups and significantly higher than those of the general population matched for country, age and sex (p < 0.001 in all domains). Associated CABG determines a significant increase of hospital mortality in the elderly undergoing aortic valve replacement. Survivors did not show differences in long-term outcome and quality of life according to the presence of associated CABG. PMID:22309837

  10. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival

    PubMed Central

    Hartwell, Matthew J.; Özbek, Umut; Holler, Ernst; Major-Monfried, Hannah; Reddy, Pavan; Aziz, Mina; Hogan, William J.; Ayuk, Francis; Efebera, Yvonne A.; Hexner, Elizabeth O.; Bunworasate, Udomsak; Qayed, Muna; Ordemann, Rainer; Wölfl, Matthias; Mielke, Stephan; Chen, Yi-Bin; Devine, Steven; Jagasia, Madan; Kitko, Carrie L.; Litzow, Mark R.; Kröger, Nicolaus; Locatelli, Franco; Morales, George; Nakamura, Ryotaro; Reshef, Ran; Rösler, Wolf; Weber, Daniela; Yanik, Gregory A.; Levine, John E.; Ferrara, James L.M.

    2017-01-01

    BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n = 309) and validation set (n = 358). RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P < 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P < 0.001) and the multicenter validation set (26% vs. 10%, P < 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P < 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P < 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset. CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM. FUNDING. The National Cancer Institute, American Cancer Society, and the Doris Duke Charitable Foundation. PMID:28194439

  11. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival.

    PubMed

    Hartwell, Matthew J; Özbek, Umut; Holler, Ernst; Renteria, Anne S; Major-Monfried, Hannah; Reddy, Pavan; Aziz, Mina; Hogan, William J; Ayuk, Francis; Efebera, Yvonne A; Hexner, Elizabeth O; Bunworasate, Udomsak; Qayed, Muna; Ordemann, Rainer; Wölfl, Matthias; Mielke, Stephan; Pawarode, Attaphol; Chen, Yi-Bin; Devine, Steven; Harris, Andrew C; Jagasia, Madan; Kitko, Carrie L; Litzow, Mark R; Kröger, Nicolaus; Locatelli, Franco; Morales, George; Nakamura, Ryotaro; Reshef, Ran; Rösler, Wolf; Weber, Daniela; Wudhikarn, Kitsada; Yanik, Gregory A; Levine, John E; Ferrara, James L M

    2017-02-09

    BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n = 309) and validation set (n = 358). RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P < 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P < 0.001) and the multicenter validation set (26% vs. 10%, P < 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P < 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P < 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset. CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM. FUNDING. The National Cancer Institute, American Cancer Society, and the Doris Duke Charitable Foundation.

  12. Long-Term Survival of Dental Implants Placed in the Grafted Maxillary Sinus: Systematic Review and Meta-Analysis of Treatment Modalities

    PubMed Central

    Duttenhoefer, Fabian; Souren, Cyriel; Menne, Dieter; Emmerich, Dominik; Schön, Ralf; Sauerbier, Sebastian

    2013-01-01

    Background A prevalent modality to increase the amount of available bone prior to implantation is grafting of the maxillary sinus. Multiple factors such as the surgical technique, moment of implant placement as well as grafting materials and membranes are known to affect implant survival. However, the role of different factor combinations and associated reciprocal effects remain unclear. Conventional statistical methods do not consider inconsistency of study designs and do not take covariables into account. Hence, a systematic research and meta-analysis was conducted to investigate the influence of various treatment modalities on implant survival in the grafted maxillary sinus. Materials and Methods A meta-analysis was conducted according to the PRISMA guidelines. Articles published from 1980 through January 2013 were electronically and manually searched in MEDLINE (Ovid), the Cochrane Register of Controlled Trials, the Database of Abstracts of Effects, and the Cochrane Database of Systematic Reviews. Clinical reports on single intervention sinus augmentation with root-form implants, a minimum of 10 patients and 6 months of loading were eligible for inclusion if implant survival was stated or calculable. Results were calculated by non-parametric univariate Kaplan-Meier analysis and Bayesian multivariate interval-censored Cox regression. Results A total of 122 publications on 16268 endosseous implants placed in grafted maxillary sinus were included. The treatment parameters surgical approach, grafting material and implant type showed no selective preference. However, application of membranes showed a significantly reduced hazard-ratio, independent of other co-factors. Conclusions The use of membranes is the most significant factor to achieve long-term implant survival in sinus augmentation procedures. More data exceeding 3 years follow-up are needed to address prospective confounding and improve clinical evidence. PMID:24058679

  13. Improvement of graft function and animal survival by fat emulsion in liver transplant rats.

    PubMed

    Ma, Zheng-Wei; Liu, Li-Dong; Li, Kun; Zhang, Yu-Jun; Dong, Jia-Hong

    2007-01-15

    Nutritional supports are required for liver transplant patients. However, no systematical assessment has been made of the optimal composition of energy yielding substrates in these patients. This study is to evaluate whether mixed energy system consisting of carbohydrate and lipid emulsions is more advantageous over single energy source of glucose for nutritional support in liver transplant recipients and whether structured lipid emulsion (STG) is superior to medium-chain triglyceride/long-chain triglycerides (MCT/LCT) and long-chain triglycerides (LCT) using a total parenteral nutrition model. Liver transplant rats were randomly divided to four groups according to the energy source, i.e. glucose (GLU), MCT/LCT, STG and LCT groups. Sham operated rats served as control. Hepatic function and lipid profile were determined to investigate the roles of lipid emulsion in hepatic function and lipid metabolism. Morphological changes of liver were observed, and nitrogen balance was determined. The results showed that infusion of lipid emulsion was well tolerated. The 1-week survival rate in the lipid emulsion groups was significantly higher than in the GLU group (100% versus 50%, P<0.05); compared with the GLU group, hepatic function recovered quickly and returned to normal level, and morphological alterations were less severer in the lipid emulsion groups, especially in the STG group; the lipid emulsions groups had normal serum TG and TC levels, especially STG and MCT/LCT groups; the lipid emulsions groups achieved a positive nitrogen balance on day 7 compared with the GLU group, and the STG group had the highest nitrogen balance. In conclusion, lipid emulsion is beneficial in improving hepatic function and the recipients' survival and does not influence the lipid metabolism. Mixed energy system consisting of carbohydrate and lipid is more advantageous over single energy source of glucose after liver transplantation, and STG is superior to MCT/LCT and LCT.

  14. Blockade of CCR7 leads to decreased dendritic cell migration to draining lymph nodes and promotes graft survival in low-risk corneal transplantation.

    PubMed

    Hos, D; Dörrie, J; Schaft, N; Bock, F; Notara, M; Kruse, F E; Krautwald, S; Cursiefen, C; Bachmann, B O

    2016-05-01

    The chemokine receptor CCR7 is essential for migration of mature dendritic cells (DCs) to the regional lymph nodes, and it has been shown that blocking of CCR7 improves graft survival after high-risk corneal transplantation in vascularized recipient corneas. However, it is so far unknown whether blocking of CCR7 reduces migration of DCs from the avascular cornea to the draining lymph nodes and whether this leads to improved graft survival also in the low-risk setting of corneal transplantation, which accounts for the majority of perforating transplantations performed. Therefore, in this study, pellets containing Freund's adjuvant and bovine serum albumin (BSA) conjugated to Alexa488 fluorescent dye were implanted into the corneal stroma of BALB/c mice to analyze antigen uptake by corneal DCs and their migration to the regional lymph nodes. After pellet implantation, mice were either treated by local administration of a CCR7 blocking fusion protein that consisted of CCL19 fused to the Fc part of human IgG1 or a control-IgG. In vivo fluorescence microscopy showed uptake of Alexa488-conjugated BSA by corneal DCs within 8 h. Furthermore, analysis of single cell suspensions of draining lymph nodes prepared after 48 h revealed that 2.1 ± 0.3% of CD11c(+) cells were also Alexa488(+). Importantly, DC migration was significantly reduced after topical administration of CCL19-IgG (1.2 ± 0.2%; p < 0.05). To test the effect of CCR7 blockade on graft rejection after allogeneic low-risk keratoplasty, corneal transplantations were performed using C57BL/6-mice as donors and BALB/c-mice as recipients. Treatment mice received two intraperitoneal loading doses of CCL19-IgG prior to transplantation, followed by local treatment with CCL19-IgG containing eye drops for the first two weeks after transplantation. Control mice received same amounts of control-IgG. Kaplan-Meier survival analysis showed that in the CCL19-IgG treated group, 76% of the grafts survived through the end

  15. Adipose-derived mesenchymal stem cells promote the survival of fat grafts via crosstalk between the Nrf2 and TLR4 pathways

    PubMed Central

    Chen, Xiaosong; Yan, Liu; Guo, Zhihui; Chen, Zhaohong; Chen, Ying; Li, Ming; Huang, Chushan; Zhang, Xiaoping; Chen, Liangwan

    2016-01-01

    Autologous fat grafting is an effective reconstructive surgery technique; however, its success is limited by inconsistent graft retention and an environment characterized by high oxidative stress and inflammation. Adipose-derived stem cells (ADSCs) increase the survival of fat grafts, although the underlying mechanisms remain unclear. Here, TLR4−/− and Nrf2−/− mice were used to explore the effects of oxidative stress and inflammation on the viability and function of ADSCs in vitro and in vivo. Enrichment of fat grafts with ADSCs inhibited inflammatory cytokine production, enhanced growth factor levels, increased fat graft survival, downregulated NADPH oxidase (NOX)1 and 4 expression, increased vascularization and reduced ROS production in a manner dependent on toll-like receptor (TLR)-4 and nuclear factor erythroid 2-related factor 2 (Nrf2) expression. Immunohistochemical analysis showed that exposure to hypoxia enhanced ADSC growth and promoted the differentiation of ADSCs into vascular endothelial cells. Hypoxia-induced inflammatory cytokine, growth factor and NOX1/4 upregulation, as well as increased ROS production and apoptosis in ADSCs were dependent on TLR4 and Nrf2, which also modulated the effect of ADSCs on promoting endothelial progenitor cell migration and angiogenesis. Western blot analyses showed that the effects of hypoxia on ADSCs were regulated by crosstalk between Nrf2 antioxidant responses and NF-κB- and TLR4-mediated inflammatory responses. Taken together, our results indicate that ADSCs can increase the survival of fat transplants through the modulation of inflammatory and oxidative responses via Nrf2 and TLR4, suggesting potential strategies to improve the use of ADSCs for cell therapy. PMID:27607584

  16. TNF-α promotes survival and migration of MSCs under oxidative stress via NF-κB pathway to attenuate intimal hyperplasia in vein grafts.

    PubMed

    Bai, Xiao; Xi, Jie; Bi, Yanwen; Zhao, Xin; Bing, Weidong; Meng, Xiangbin; Liu, Yimin; Zhu, Zhonglai; Song, Guangmin

    2017-03-07

    The oxidative stress caused by endothelial injury is involved in intimal hyperplasia (IH) in vein grafts. Mesenchymal stem cells (MSCs) can home to injured intima and promote endothelial repair. However, MSC apoptosis is increased accompanied by decreased functional activity under oxidative stress. Thus, we investigate whether tumour necrosis factor-α (TNF-α) can promote the survival and activity of MSCs under oxidative stress to reduce IH more effectively, and establish what role the NF-κB pathway plays in this. In this study, we preconditioned MSCs with TNF-α ((TNF)(-α-PC) MSCs) for 24 hrs and measured the activation of the IKK/NF-κB pathway. EdU and transwell assays were performed to assess proliferation and migration of (TNF)(-α-PC) MSCs. Apoptosis and migration of (TNF)(-α-)(PC) MSCs were evaluated in conditions of oxidative stress by analysis of the expression of Bcl-2 and CXCR4 proteins. (TNF)(-α-)(PC) MSCs were transplanted into a vein graft model, so that cell homing could be tracked, and endothelial apoptosis and IH of vein grafts were measured. The results demonstrated that TNF-α promotes proliferation and migration of MSCs. Furthermore, survival and migration of (TNF)(-α-)(PC) MSCs under oxidative stress were both enhanced. A greater number of MSCs migrated to the intima of vein grafts after preconditioning with TNF-α, and the formation of neointima was significantly reduced. These effects could be partially abolished by IKK XII (NF-κB inhibitor). All these results indicate that preconditioning with TNF-α can promote survival and migration of MSCs under oxidative stress via the NF-κB pathway and thus attenuate IH of vein grafts.

  17. Mesenchymal stem cells increase skin graft survival time and up-regulate PD-L1 expression in splenocytes of mice.

    PubMed

    Moravej, Ali; Geramizadeh, Bita; Azarpira, Negar; Zarnani, Amir-Hassan; Yaghobi, Ramin; Kalani, Mehdi; Khosravi, Maryam; Kouhpayeh, Amin; Karimi, Mohammad-Hossein

    2017-02-01

    Recently, mesenchymal stem cells (MSCs) have gained considerable interests as hopeful therapeutic cells in transplantation due to their immunoregulatory functions. But exact mechanisms underlying MSCs immunoregulatory function is not fully understood. Herein, in addition to investigate the ability of MSCs to prolong graft survival time, the effects of them on the expression of PD-L1 and IDO immunomodulatory molecules in splenocytes of skin graft recipient mice was clarified. To achieve this goal, full-thickness skins were transplanted from C57BL/6 to BALB/c mice. MSCs were isolated from bone marrow of BALB/c mice and injected to the recipient mice. Skin graft survival was monitored daily to determine graft rejection time. On days 2, 5 and 10 post skin transplantation, serum cytokine levels and expression of PD-L1 and IDO mRNA and protein in the splenocytes of recipient mice were evaluated. The results showed that administration of MSCs prolonged skin graft survival time from 11 to 14 days. On days 2 and 5 post transplantation, splenocytes PD-L1 expression and IL-10 serum level in MSCs treated mice were higher than those in the controls, while IL-2 and IFN-γ levels were lower. Rejection in MSCs treated mice was accompanied by an increase in IL-2 and IFN-γ, and decrease in PD-L1 expression and IL-10 level. No difference in the expression of IDO between MSCs treated mice and controls was observed. In conclusion, we found that one of the mechanisms underlying MSCs immunomodulatory function could be up-regulating PD-L1 expression.

  18. Neuropeptide Treatment with Cerebrolysin Enhances the Survival of Grafted Neural Stem Cell in an α-Synuclein Transgenic Model of Parkinson’s Disease

    PubMed Central

    Rockenstein, Edward; Desplats, Paula; Ubhi, Kiren; Mante, Michael; Florio, Jazmin; Adame, Anthony; Winter, Stefan; Brandstaetter, Hemma; Meier, Dieter; Moessler, Herbert; Masliah, Eliezer

    2015-01-01

    Neuronal stem cell (NSC) grafts have been investigated as a potential neuro-restorative therapy in Parkinson’s disease (PD) but their use is compromised by the death of grafted cells. We investigated the use of Cerebrolysin (CBL), a neurotrophic peptide mixture, as an adjunct to NSC therapy in the α-synuclein (α-syn) transgenic (tg) model of PD. In vehicle-treated α-syn tg mice, there was decreased survival of NSCs. In contrast, CBL treatment enhanced the survival of NSCs in α-syn tg groups and ameliorated behavioral deficits. The grafted NSCs showed lower levels of terminal deoxynucleotidyl transferase dUTP nick end labeling positive cells in the CBL-treated mice when compared with vehicle-treated α-syn tg mice. No evidence of tumor growth was detected. Levels of α-syn were similar in the vehicle in CBL-treated tg mice. In conclusion, CBL treatment might be a potential adjuvant for therapeutic NSC grafting in PD. PMID:27429559

  19. Efficient long-term survival of cell grafts after myocardial infarction with thick viable cardiac tissue entirely from pluripotent stem cells

    PubMed Central

    Matsuo, Takehiko; Masumoto, Hidetoshi; Tajima, Shuhei; Ikuno, Takeshi; Katayama, Shiori; Minakata, Kenji; Ikeda, Tadashi; Yamamizu, Kohei; Tabata, Yasuhiko; Sakata, Ryuzo; Yamashita, Jun K.

    2015-01-01

    Poor engraftment of cells after transplantation to the heart is a common and unresolved problem in the cardiac cell therapies. We previously generated cardiovascular cell sheets entirely from pluripotent stem cells with cardiomyocytes, endothelial cells and vascular mural cells. Though sheet transplantation showed a better engraftment and improved cardiac function after myocardial infarction, stacking limitation (up to 3 sheets) by hypoxia hampered larger structure formation and long-term survival of the grafts. Here we report an efficient method to overcome the stacking limitation. Insertion of gelatin hydrogel microspheres (GHMs) between each cardiovascular cell sheet broke the viable limitation via appropriate spacing and fluid impregnation with GHMs. Fifteen sheets with GHMs (15-GHM construct; >1 mm thickness) were stacked within several hours and viable after 1 week in vitro. Transplantation of 5-GHM constructs (≈2 × 106 of total cells) to a rat myocardial infarction model showed rapid and sustained functional improvements. The grafts were efficiently engrafted as multiple layered cardiovascular cells accompanied by functional capillary networks. Large engrafted cardiac tissues (0.8 mm thickness with 40 cell layers) successfully survived 3 months after TX. We developed an efficient method to generate thicker viable tissue structures and achieve long-term survival of the cell graft to the heart. PMID:26585309

  20. Efficient long-term survival of cell grafts after myocardial infarction with thick viable cardiac tissue entirely from pluripotent stem cells.

    PubMed

    Matsuo, Takehiko; Masumoto, Hidetoshi; Tajima, Shuhei; Ikuno, Takeshi; Katayama, Shiori; Minakata, Kenji; Ikeda, Tadashi; Yamamizu, Kohei; Tabata, Yasuhiko; Sakata, Ryuzo; Yamashita, Jun K

    2015-11-20

    Poor engraftment of cells after transplantation to the heart is a common and unresolved problem in the cardiac cell therapies. We previously generated cardiovascular cell sheets entirely from pluripotent stem cells with cardiomyocytes, endothelial cells and vascular mural cells. Though sheet transplantation showed a better engraftment and improved cardiac function after myocardial infarction, stacking limitation (up to 3 sheets) by hypoxia hampered larger structure formation and long-term survival of the grafts. Here we report an efficient method to overcome the stacking limitation. Insertion of gelatin hydrogel microspheres (GHMs) between each cardiovascular cell sheet broke the viable limitation via appropriate spacing and fluid impregnation with GHMs. Fifteen sheets with GHMs (15-GHM construct; >1 mm thickness) were stacked within several hours and viable after 1 week in vitro. Transplantation of 5-GHM constructs (≈2 × 10(6) of total cells) to a rat myocardial infarction model showed rapid and sustained functional improvements. The grafts were efficiently engrafted as multiple layered cardiovascular cells accompanied by functional capillary networks. Large engrafted cardiac tissues (0.8 mm thickness with 40 cell layers) successfully survived 3 months after TX. We developed an efficient method to generate thicker viable tissue structures and achieve long-term survival of the cell graft to the heart.

  1. Fetal hippocampal CA3 cell grafts enriched with FGF-2 and BDNF exhibit robust long-term survival and integration and suppress aberrant mossy fiber sprouting in the injured middle-aged hippocampus.

    PubMed

    Rao, Muddanna S; Hattiangady, Bharathi; Shetty, Ashok K

    2006-02-01

    Cell transplants that successfully replace the lost neurons and facilitate the reconstruction of the disrupted circuitry in the injured aging hippocampus are invaluable for treating acute head injury, stroke and status epilepticus in the elderly. This is because apt graft integration has the potential to prevent the progression of the acute injury into chronic epilepsy in the elderly. However, neural transplants into the injured middle-aged or aged hippocampus exhibit poor cell survival, suggesting that apt graft augmentation strategies are critical for robust integration of grafted cells into the injured aging hippocampus. We examined the efficacy of pre-treatment and grafting of donor fetal CA3 cells with a blend of fibroblast growth factor-2 (FGF-2) and brain-derived neurotrophic factor (BDNF) for lasting survival and integration of grafted cells in the injured middle-aged (12 months old) hippocampus of F344 rats. Grafts were placed at 4 days after the kainic-acid-induced hippocampal injury and were analyzed at 6 months post-grafting. We demonstrate that 80% of grafted cells exhibit prolonged survival and 71% of grafted cells differentiate into CA3 pyramidal neurons. Grafts also receive a robust afferent input from the host mossy fibers and project efferent axons into the denervated zones of the dentate gyrus and the CA1 subfield. Consequently, the aberrant sprouting of the dentate mossy fibers, an epileptogenic change that typically ensues after the hippocampal injury, was suppressed. Thus, grafts of fetal CA3 cells enriched with FGF-2 and BDNF exhibit robust integration and dampen the abnormal mossy fiber sprouting in the injured middle-aged hippocampus. Because the aberrantly sprouted mossy fibers contribute to the generation of seizures, the results suggest that the grafting intervention using FGF-2 and BDNF is efficacious for suppressing epileptogenesis in the injured middle-aged hippocampus.

  2. Reduced intensity haplo plus single cord transplant compared to double cord transplant: improved engraftment and graft-versus-host disease-free, relapse-free survival.

    PubMed

    van Besien, Koen; Hari, Parameswaran; Zhang, Mei-Jie; Liu, Hong-Tao; Stock, Wendy; Godley, Lucy; Odenike, Olatoyosi; Larson, Richard; Bishop, Michael; Wickrema, Amittha; Gergis, Usama; Mayer, Sebastian; Shore, Tsiporah; Tsai, Stephanie; Rhodes, Joanna; Cushing, Melissa M; Korman, Sandra; Artz, Andrew

    2016-05-01

    Umbilical cord blood stem cell transplants are commonly used in adults lacking HLA-identical donors. Delays in hematopoietic recovery contribute to mortality and morbidity. To hasten recovery, we used co-infusion of progenitor cells from a partially matched related donor and from an umbilical cord blood graft (haplo-cord transplant). Here we compared the outcomes of haplo-cord and double-cord transplants. A total of 97 adults underwent reduced intensity conditioning followed by haplo-cord transplant and 193 patients received reduced intensity conditioning followed by double umbilical cord blood transplantation. Patients in the haplo-cord group were more often from minority groups and had more advanced malignancy. Haplo-cord recipients received fludarabine-melphalan-anti-thymocyte globulin. Double umbilical cord blood recipients received fludarabine-cyclophosphamide and low-dose total body irradiation. In a multivariate analysis, haplo-cord had faster neutrophil (HR=1.42, P=0.007) and platelet (HR=2.54, P<0.0001) recovery, lower risk of grade II-IV acute graft-versus-host disease (HR=0.26, P<0.0001) and chronic graft-versus-host disease (HR=0.06, P<0.0001). Haplo-cord was associated with decreased risk of relapse (HR 0.48, P=0.001). Graft-versus-host disease-free, relapse-free survival was superior with haplo-cord (HR 0.63, P=0.002) but not overall survival (HR=0.97, P=0.85). Haplo-cord transplantation using fludarabine-melphalan-thymoglobulin conditioning hastens hematopoietic recovery with a lower risk of relapse relative to double umbilical cord blood transplantation using the commonly used fludarabine-cyclophosphamide-low-dose total body irradiation conditioning. Graft-versus-host disease-free and relapse-free survival is significantly improved. Haplo-cord is a readily available graft source that improves outcomes and access to transplant for those lacking HLA-matched donors. Trials registered at clinicaltrials.gov identifiers 00943800 and 01810588.

  3. Effect of acute and chronic graft-versus-host disease on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma

    PubMed Central

    Ringdén, Olle; Shrestha, Smriti; da Silva, Gisela Tunes; Zhang, Mei-Jie; Dispenzieri, Angela; Remberger, Mats; Kamble, Rammurti; Freytes, Cesar O.; Gale, Robert Peter; Gibson, John; Gupta, Vikas; Holmberg, Leona; Lazarus, Hillard; McCarthy, Philip; Meehan, Kenneth; Schouten, Harry; Milone, Gustavo A.; Lonial, Sagar; Hari, Parameswaran N

    2011-01-01

    We evaluated the effect of acute and chronic graft-versus-host disease (GVHD) on relapse and survival after allogeneic haematopoietic stem cell transplantation (HSCT) for multiple myeloma (MM) using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005 following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (grades I–IV) was 42% (95% confidence interval (CI) 35 – 49%) and of chronic GVHD at five years was 59% (95% CI 49 – 69%), with 70% developing extensive chronic GVHD. In multivariate analysis, acute GVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42; p=0.016), whereas limited chronic GVHD significantly decreased the risk of myeloma relapse (RR=0.35, p=0.035) and was associated with superior event-free survival (RR=0.40, p=0.027). Acute GVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52; p=0.001). The reduction in relapse risk associated with chronic GVHD is consistent with a beneficial graft-versus-myeloma effect, but this did not translate into a survival advantage. PMID:21946381

  4. Recombinant IL-33 prolongs leflunomide-mediated graft survival by reducing IFN-γ and expanding CD4(+)Foxp3(+) T cells in concordant heart transplantation.

    PubMed

    Dai, Chen; Lu, Fang-Na; Jin, Ning; Yang, Bo; Gao, Chang; Zhao, Bin; Fu, Jia-Zhao; Hong, Shi-Fu; Liang, Han-Ting; Chen, Li-Hong; Chen, Zhi-Shui; Chen, Jie; Qi, Zhong-Quan

    2016-08-01

    Interleukin (IL)-33 is a novel IL-1 family member, and its administration has been associated with promotion of T helper type-2 (Th2) cell activity and cytokines, particularly IL-4 and IL-5 in vivo. Recently, IL-33 was shown to increase CD4(+)Foxp3(+) regulatory T cells (Tregs) and to suppress levels of the Th1-type cytokine IFN-γ in allogeneic heart transplantation in mice. Therefore, we hypothesized that IL-33 and leflunomide (Lef) could prolong graft survival in the concordant mouse-to-rat heart transplantation model. In this model, xenografts undergo acute humoral xenograft rejection (AHXR) typically on day 3 or cell-mediated rejection approximately on day 7 if AHXR is inhibited by Lef treatment. Recipients were treated with Lef (n=6), IL-33 (n=6), IL-33 combined with Lef (n=6), or left untreated (n=6) for survival studies. Heart grafts were monitored until they stopped beating. Mouse heterotopic grafts were performed, and recipients were sacrificed on days 2 and 7 for histological and flow cytometric analyses. The combination of IL-33 and Lef significantly prolonged the grafts from 17.3±2.3 to 2.8±0.4 days, compared to untreated controls. IL-33 administration with Lef, while facilitating Th2-associated cytokines (IL-4 on day 2 but not day 7), also decreased IFN-γ on day 2 and day 7, compared with Lef treatment only. Furthermore, IL-33 with Lef administration caused an expansion of suppressive CD4(+)Foxp3(+) Tregs in rats. The IL-33 and Lef combination therapy resulted in significantly prolonged graft survival, associated with markedly decreased Th1 cells and increased IL-10 levels. In addition, the combination therapy significantly decreased the percentage of CD-45(+) B cells on days 2 and 7, compared with monotherapy. These findings reveal a new immunoregulatory property of IL-33. Specifically, it facilitates regulatory cells, particularly functional CD4(+)Foxp3(+) Tregs that underlie IL-33-mediated cardiac xenograft survival. Moreover, it can decrease Th

  5. Plasma Neutrophil Gelatinase-Associated Lipocalin as a Marker for Prediction of 3-Month Graft Survival after Kidney Transplantation

    PubMed Central

    Jafari, A.; Khatami, M. R.; Dashti-Khavidaki, S.; Lessan-Pezeshki, M.; Abdollahi, A.

    2017-01-01

    Background: Ischemic injury during organ transplantation increases the risk of acute and chronic rejections by promoting alloimmune responses. Measurement of neutrophil gelatinase-associated lipocalin (NGAL) immediately after kidney transplantation may be promising for early detection of ischemic injuries to allograft. Objective: This study assessed possible predictive values of plasma NGAL levels during first hours after kidney transplantation for graft loss within the first 3 months after transplantation. Methods: 45 kidney transplant recipients were classified into those without graft loss or with graft loss during 3 months after transplantation. Plasma NGAL levels were measured before and at 2, 6, 12, 24 and 96 hours after transplantation. Serum creatinine concentration was assessed daily during hospitalization and at 1, 2, and 3 months post-transplantation. Results: Serum creatinine and plasma NGAL levels were consistently higher in patients with graft loss compared with those without graft loss. At 2, 24, and 96 hours after transplantation, plasma NGAL concentration was significantly higher in patients who developed allograft loss within 3 months post-transplantation. The cutoff point of plasma NGAL at 2, 24, and 96 hours after transplantation for prediction of graft loss was 304.5 ng/mL (sensitivity of 71.4%, and specificity of 73.7%), 207.8 ng/mL(sensitivity of 85.7%, and specificity of 60.5%), and 184 ng/mL (sensitivity of 85.7%, and specificity of 71.1%), respectively. Conclusion: Plasma NGAL levels at 2, 24, and 96 hours after transplantation can predict 3-month graft loss with fair sensitivity and specificity. PMID:28299024

  6. [Short-term use of rapamycin combined with Tregs prolongs mouse cardiac graft survival but attenuates recipient's anti-tumor immunity].

    PubMed

    Yan, Ting; Luo, Chen; Yang, Xianmo; Ji, Lei; Luo, Shiqiao

    2017-02-01

    Objective To study the effect of short-term use of rapamycin(Rap) combined with regulatory T cells (Tregs) on the long-time survival of allogeneic mouse cardiac transplant, and its impact on the anti-tumor immunity of recipient. MethodsMouse Tregs were purified from recipients' spleen by magnetic activated cell sorting (MACS), and expanded by CD3/CD28 monoclonal antibody immunomagnetic beads and 2000 U/mL recombinant mouse IL-2 (rmIL-2) ex vivo. The purity was tested by fluorescence-activated cell sorting (FACS). Allogeneic mouse cardiac transplanted models were established (H-2(b) to H-2(d)), and the mice were divided into three groups: control group (transplant only), Rap group, and Rap combined with Tregs group. In the Rap group, the mice were treated with Rap [1 mg/(kg.d), ip] for 14 consecutive days, and the mice in the Rap plus Tregs group received the same treatment, and 1×10(7) Tregs were adoptively transferred through the tail vein on the day of transplantion. Meanwhile, the syngeneic transplanted group was set up (H-2(d) to H-2(d)). Allograft survival was monitored daily and the graft was harvested on the indicated day and histologically evaluated. In the experiment of recipient's anti-tumor immunity, the similar three groups of allogeneic cardiac transplanted models were established (H-2(b) to H-2(d)), and B16-F10 cells (recipient derived ) were transferred through the tail vein, another three groups of allogeneic cardiac transplanted mice (H-2(d) to H-2(b)) were also transferred with B16-F10 cells (donor derived). Two weeks later, the tumor nodules of the lung were compared. Results The median survival time (MST) of the graft was 7 days in the control group, 15 days in the Rap group, and 93 days in the Rap combined with Tregs group. Histologic analysis of long-time survival grafts showed lymphocyte infiltration and chronic vasculopathy. For donor-derived tumor, there was no tumor nodule in the control group, and tumor nodules significantly increased to

  7. Bone-Grafting in Polyostotic Fibrous Dysplasia

    PubMed Central

    Leet, Arabella I.; Boyce, Alison M.; Ibrahim, Khalda A.; Wientroub, Shlomo; Kushner, Harvey; Collins, Michael T.

    2016-01-01

    Background: Polyostotic fibrous dysplasia is a skeletal disease that results from somatic activating mutations in the gene GNAS in skeletal stem cells, leading to proliferation of immature osteogenic cells with replacement of normal marrow and bone with fibro-osseous tissue. Lesions may cause bone deformity or fracture. In the surgical care of polyostotic fibrous dysplasia, the role of grafting and the optimal grafting material are not clear. The purpose of this study was to evaluate the long-term survival of bone-grafting procedures in subjects with polyostotic fibrous dysplasia over time. Methods: The operative reports and radiographs of a cohort of subjects with polyostotic fibrous dysplasia followed in a natural history study were reviewed. Twenty-three subjects (mean age at the time of enrollment, thirteen years [range, two to forty years]) with fifty-two bone-grafting procedures had a mean follow-up time of 19.6 years (range, twenty-nine months to forty-seven years). Kaplan-Meier life table estimates, Cox proportional hazard models, and t tests comparing means were performed to assess various aspects of graft survival. Results: Kaplan-Meier curves showed a 50% estimate of survival of 14.5 years. Cox proportional hazards models showed no advantage comparing allograft with autograft or structural with nonstructural graft materials. The mean age of the patients was significantly greater (p < 0.001) in the subgroup of subjects in whom grafts were maintained over time (20.9 years) compared with the subgroup of patients whose grafts were resorbed over time (9.8 years). Conclusions: Bone-grafting, including both allograft and autograft, is of limited value in ablating the lesions of fibrous dysplasia. The expectations of patients and surgeons should include the high probability of graft resorption over time with return of bone characteristics of fibrous dysplasia, particularly in younger patients. This suggests the maintenance of normal bone mechanics with implant

  8. Renal transplantation in children less than 5 years of age.

    PubMed Central

    Rizzoni, G; Malekzadeh, M H; Pennisi, A J; Ettenger, R B; Uittenbogaart, C H; Fine, R N

    1980-01-01

    19 young children (less than 5 years old) have received 31 renal transplants from 4 live relatives and 27 cadaver donors. The 2-year allograft survival rate for the patients receiving their 1st allograft from the 4 live donors was 75 +/- 22% while for the patients receiving their 1st allograft from 15 cadaver donors was 26 +/- 11%. 10 children are currently surviving with functioning allographs (7 cadavers and 3 live relatives); 4 have died and 5 are undergoing dialysis after the loss of at least one allograft. Despite the poor allograft survival rate the fact that 7 children are surviving with cadaver allografts indicates that the lack of a living related donor should not prevent transplants in young children. PMID:7002060

  9. A glial cell line-derived neurotrophic factor-secreting clone of the Schwann cell line SCTM41 enhances survival and fiber outgrowth from embryonic nigral neurons grafted to the striatum and to the lesioned substantia nigra.

    PubMed

    Wilby, M J; Sinclair, S R; Muir, E M; Zietlow, R; Adcock, K H; Horellou, P; Rogers, J H; Dunnett, S B; Fawcett, J W

    1999-03-15

    We have developed a novel Schwann cell line, SCTM41, derived from postnatal sciatic nerve cultures and have stably transfected a clone with a rat glial cell line-derived neurotrophic factor (GDNF) construct. Coculture with this GDNF-secreting clone enhances in vitro survival and fiber growth of embryonic dopaminergic neurons. In the rat unilateral 6-OHDA lesion model of Parkinson's disease, we have therefore made cografts of these cells with embryonic day 14 ventral mesencephalic grafts and assayed for effects on dopaminergic cell survival and process outgrowth. We show that cografts of GDNF-secreting Schwann cell lines improve the survival of intrastriatal embryonic dopaminergic neuronal grafts and improve neurite outgrowth into the host neuropil but have no additional effect on amphetamine-induced rotation. We next looked to see whether bridge grafts of GDNF-secreting SCTM41 cells would promote the growth of axons to their striatal targets from dopaminergic neurons implanted orthotopically into the 6-OHDA-lesioned substantia nigra. We show that such bridge grafts increase the survival of implanted embryonic dopaminergic neurons and promote the growth of axons through the grafts to the striatum.

  10. Factors affecting graft survival within 1-year post-transplantation in heart and lung transplant: an analysis of the OPTN/UNOS registry.

    PubMed

    Ohe, Hidenori

    2012-01-01

    Today, a main focus of the transplant community is the long-term outcomes of lung and heart allograft recipients. However, even early post-transplant survival (within the first post-transplant year) needs improvement, as early graft failure still accounts for many allograft losses. In this chapter, we review the experience of heart and lung transplantation as reported to the Organ Procurement Transplant Network/United Network of Organ Sharing registry and investigate the factors responsible for causing failure in the first post-transplant year. Trends indicate that sicker patients are increasingly being transplanted, thereby limiting improvements in early post-transplant survival. More lung and heart transplant patients are coming to transplant on dialysis. In heart transplant, there is an increase in the number of heart retransplant patients and an increase in patients on extracorporeal membrane oxygenation. For lung transplant, more patients are on a ventilator prior to transplant than in the past 25 years. Given that sicker/riskier patients are now receiving more heart and lung transplants, future studies need to take place to better understand these patients so that they can have the same survival as patients entering transplant with less severe illnesses.

  11. Coencapsulation of Target Effector Cells With Mesenchymal Stem Cells Reduces Pericapsular Fibrosis and Improves Graft Survival in a Xenotransplanted Animal Model.

    PubMed

    Vaithilingam, Vijayaganapathy; Evans, Margaret D M; Rowe, Anthony; Bean, Penelope A; Tuch, Bernard E

    2016-01-01

    Pericapsular fibrotic overgrowth (PFO) is a problem that thwarts full implementation of cellular replacement therapies involving encapsulation in an immunoprotective material, such as for the treatment of diabetes. Mesenchymal stem cells (MSCs) have inherent anti-inflammatory properties. We postulated that coencapsulation of MSCs with the target cells would reduce PFO. A hepatoinsulinoma cell line (HUH7) was used to model human target cells and was coencapsulated with either human or mouse MSCs at different ratios in alginate microcapsules. Viability of encapsulated cells was assessed in vitro and xenografted either intraperitoneally or subcutaneously into C57BL/6 mice. Graft retrieval was performed at 3 weeks posttransplantation and assessed for PFO. Coencapsulation of human MSCs (hMSCs) or mouse MSCs (mMSCs) with HUH7 at different ratios did not alter cell viability in vitro. In vivo data from intraperitoneal infusions showed that PFO for HUH7 cells coencapsulated with hMSCs and mMSCs in a ratio of 1:1 was significantly reduced by ∼30% and ∼35%, respectively, compared to HUH7 encapsulated alone. PFO for HUH7 cells was reduced by ∼51% when the ratio of mMSC/HUH7 was increased to 2:1. Implanting the microcapsules subcutaneously rather than intraperitoneally substantially reduced PFO in all treatment groups, which was most significant in the mMSC/HUH7 2:1 group with a ∼53% reduction in PFO compared with HUH7 alone. Despite the reduced PFO reaction to the individual microcapsules implanted subcutaneously, all microcapsule treatment groups were contained in a vascularized fibrotic pouch at 3 weeks. The presence of MSCs in microcapsules retrieved from these fibrotic pouches improved graft survival with significantly higher cell viabilities of 83.1 ± 0.6% and 79.1 ± 0.8% seen with microcapsules containing mMSC/HUH7 at 2:1 and 1:1 ratios, respectively, compared to HUH7 alone (51.5 ± 0.7%) transplanted subcutaneously. This study showed that

  12. Soviet business chaos seen lasting 5 years

    SciTech Connect

    Not Available

    1991-12-16

    This paper reports that companies seeking work in the collapsing Soviet Union can expect political uncertainty for another 5 years. PW discussed changes in the Soviet Union and offered advice on dealing with officials of the central government and Soviet republics at a recent meeting in Houston with executives of oil field service companies. That meeting preceded reports of the Russian federation, Ukraine, and Byelorussia agreeing to form a Slavic commonwealth.

  13. Pulmonary symptoms measured by the national institutes of health lung score predict overall survival, nonrelapse mortality, and patient-reported outcomes in chronic graft-versus-host disease.

    PubMed

    Palmer, Jeanne; Williams, Kirsten; Inamoto, Yoshihiro; Chai, Xiaoyu; Martin, Paul J; Tomas, Linus Santo; Cutler, Corey; Weisdorf, Daniel; Kurland, Brenda F; Carpenter, Paul A; Pidala, Joseph; Pavletic, Steven Z; Wood, William; Jacobsohn, David; Arai, Sally; Arora, Mukta; Jagasia, Madan; Vogelsang, Georgia B; Lee, Stephanie J

    2014-03-01

    The 2005 National Institutes of Health (NIH) Consensus Conference recommended assessment of lung function in patients with chronic graft-versus-host disease (GVHD) by both pulmonary function tests (PFTs) and assessment of pulmonary symptoms. We tested whether pulmonary measures were associated with nonrelapse mortality (NRM), overall survival (OS), and patient-reported outcomes (PRO). Clinician and patient-reported data were collected serially in a prospective, multicenter, observational study. Available PFT data were abstracted. Cox regression models were fit for outcomes using a time-varying covariate model for lung function measures and adjusting for patient and transplantation characteristics and nonlung chronic GVHD severity. A total of 1591 visits (496 patients) were used in this analysis. The NIH symptom-based lung score was associated with NRM (P = .02), OS (P = .02), patient-reported symptoms (P < .001) and functional status (P < .001). Worsening of NIH symptom-based lung score over time was associated with higher NRM and lower survival. All other measures were not associated with OS or NRM; although, some were associated with patient-reported lung symptoms. In conclusion, the NIH symptom-based lung symptom score of 0 to 3 is associated with NRM, OS, and PRO measures in patients with chronic GVHD. Worsening of the NIH symptom-based lung score was associated with increased mortality.

  14. [Fissure sealants--5 years of use].

    PubMed

    Azul, A M

    1990-01-01

    This study assesses the caries prevalence, retention and cost-effectiveness of a pit and fissure sealant in a children population with 622 cases, 5 years after a single application of an auto-polymerized sealant to permanent molars. The status of the sealant and the presence of caries or restaurations on the sealed teeth was assessed. In a self-controlled group of children, the prevalence of disease (caries and restaurations) was also assessed in non-sealed teeth, for comparison. The sealant application was compared with Class I-restauration with amalgam for cost-effectiveness analysis.

  15. Outcomes utilizing imported liver grafts for recipients with hepatocellular carcinoma.

    PubMed

    Battula, Narendra; Reichman, Trevor W; Amiri, Yamah; Carmody, Ian C; Galliano, Gretchen; Seal, John; Bugeaud, Emily; Bohorquez, Humberto; Bruce, David; Cohen, Ari; Loss, George E

    2017-03-01

    Liver transplantation (LT) offers the best chance of survival in selected patients with hepatocellular carcinoma (HCC). Wait-list mortality or dropout due to tumor progression can be significant, and therefore, timely transplantation is critical. Liver grafts discarded by outside organ procurement organizations are a potential source of grafts for low Model for End-Stage Liver Disease tumor patients. The primary aim of this study was to assess the disease-free and overall survival of patients with HCC transplanted with imported liver grafts (ILGs). Review of all patients transplanted for HCC between June 2005 and December 2014 was performed. Data on demographics, survival, and HCC recurrence were analyzed. During this time period, 59 out of 190 (31%) recipients with HCC received ILG. Of these 59 grafts, 54 were imported from within the region and 5 were from national offers (outside the region). The mean cold ischemia time for local liver grafts (LLGs) was 4.1 ± 1.5 hours versus 5.1 ± 1.4 hours for ILG (P < 0.001). The 1-, 3-, and 5-year patient survival was 90%, 85%, and 83% and 85%, 80%, and 79% for LLG and ILG (P = 0.08), respectively. The observed disease recurrence rate for both LLG and ILG recipients was equivalent. The median wait-list time for HCC recipients was 43 days (range, 2-1167 days). In conclusion, with careful graft assessment, the use of ILGs results in comparable outcomes following LT and no increased risk of HCC recurrence. Use of ILGs maximizes the donor pool and results in a higher rate of transplantation for HCC recipients. Liver Transplantation 23 299-304 2017 AASLD.

  16. Vitamin D levels and their associations with survival and major disease outcomes in a large cohort of patients with chronic graft-vs-host disease

    PubMed Central

    Katić, Mašenjka; Pirsl, Filip; Steinberg, Seth M.; Dobbin, Marnie; Curtis, Lauren M.; Pulanić, Dražen; Desnica, Lana; Titarenko, Irina; Pavletic, Steven Z.

    2016-01-01

    Aim To identify the factors associated with vitamin D status in patients with chronic graft-vs-host disease (cGVHD) and evaluate the association between serum vitamin D (25(OH)D) levels and cGVHD characteristics and clinical outcomes defined by the National Institutes of Health (NIH) criteria. Methods 310 cGVHD patients enrolled in the NIH cGVHD natural history study (clinicaltrials.gov: NCT00092235) were analyzed. Univariate analysis and multiple logistic regression were used to determine the associations between various parameters and 25(OH)D levels, dichotomized into categorical variables: ≤20 and >20 ng/mL, and as a continuous parameter. Multiple logistic regression was used to develop a predictive model for low vitamin D. Survival analysis and association between cGVHD outcomes and 25(OH)D as a continuous as well as categorical variable: ≤20 and >20 ng/mL; <50 and ≥50 ng/mL, and among three ordered categories: ≤20, 20-50, and ≥50 ng/mL, was performed. PMID:27374829

  17. Total lymphoid irradiation in kidney and liver transplantation in the baboon: prolonged graft survival and alterations in T cell subsets with low cumulative dose regimens

    SciTech Connect

    Myburgh, J.A.; Smith, J.A.; Stark, J.H.; Browde, S.

    1984-02-01

    Prolonged kidney and liver allograft survival was produced in baboons by low cumulative doses (500 to 1200 rad) of total lymphoid irradiation (TLI). Continuing normal graft function for more than 1 year after transplantation was seen in 10 animals in this series. The longest survivor (> 4 years) rejected a third party kidney allograft in typically acute fashion 1 yr after the original transplantation. The dose-response effect was parabolic, with a cumulative dose of 800 rad given as twice weekly fractions of 100 rad each being the most effective. With smaller cumulative doses (500 or 600 rad) results were improved if TLI was administered as a large number of smaller fractions. These regimens are free of the radiation related mortality observed in earlier studies with larger cumulative doses. Alterations in T cell subpopulations were studied in these baboons with the use of the anti-human monoclonal antibodies OKT11 (anti-total T cells), OKT4 (anti-T helper cells; Th), and OKT8 (anti-T suppressor/cytotoxic cells, Tsc), which cross-react with baboon lymphocytes. After completion of TLI but before transplantation, the relative percentage of Tsc cells fell and the percentage of Th and the Th/Tsc ratio rose. Transplantation was followed by an inversion of this ratio due to reciprocal changes in the percentages of Th and Tsc cells. This pattern persisted and increased until 6 mo after transplantation, when it reverted to that seen in untreated control animals.

  18. Inhibition of nuclear factor-κB activation in pancreatic β-cells has a protective effect on allogeneic pancreatic islet graft survival.

    PubMed

    Eldor, Roy; Abel, Roy; Sever, Dror; Sadoun, Gad; Peled, Amnon; Sionov, Ronit; Melloul, Danielle

    2013-01-01

    Pancreatic islet transplantation, a treatment for type 1 diabetes, has met significant challenges, as a substantial fraction of the islet mass fails to engraft, partly due to death by apoptosis in the peri- and post-transplantation periods. Previous evidence has suggested that NF-κB activation is involved in cytokine-mediated β-cell apoptosis and regulates the expression of pro-inflammatory and chemokine genes. We therefore sought to explore the effects of β-cell-specific inhibition of NF-κB activation as a means of cytoprotection in an allogeneic model of islet transplantation. To this end, we used islets isolated from the ToI-β transgenic mouse, where NF-κB signalling can specifically and conditionally be inhibited in β-cells by expressing an inducible and non-degradable form of IκBα regulated by the tet-on system. Our results show that β-cell-specific blockade of NF-κB led to a prolonged islet graft survival, with a relative higher preservation of the engrafted endocrine tissue and reduced inflammation. Importantly, a longer delay in allograft rejection was achieved when mice were systemically treated with the proteasome inhibitor, Bortezomib. Our findings emphasize the contribution of NF-κB activation in the allograft rejection process, and suggest an involvement of the CXCL10/IP-10 chemokine. Furthermore, we suggest a potential, readily available therapeutic agent that may temper this process.

  19. Surgical Outcomes of Forearm Loop Arteriovenous Fistula Formation Using Tapered versus Non-Tapered Polytetrafluoroethylene Grafts

    PubMed Central

    Han, Sun; Seo, Pil Won; Ryu, Jae-Wook

    2017-01-01

    Background Tapered grafts, which have a smaller diameter on the arterial side, have been increasingly used for arteriovenous fistula (AVF) formation. We compared the outcomes of 4–6-mm tapered and 6-mm straight forearm loop arteriovenous grafts. Methods A total of 103 patients receiving forearm loop arteriovenous grafts between March 2005 and March 2015 were retrospectively analyzed and separated into 2 groups (group A, 4- to 6-mm tapered grafts, n=78; group B, 6-mm straight grafts, n=25). In each group, complications and patency rates after surgery were assessed. Results Clinical characteristics and laboratory results, except for cerebrovascular disease history (group A, 7.7%; group B, 28.0%; p=0.014), were similar between the groups. No significant differences were found for individual complications. Kaplan-Meier survival analysis revealed no significant differences in 1-year, 3-year, and 5-year patency rates between groups (61.8%, 44.9%, and 38.5% vs. 62.7%, 41.1%, and 35.3%, respectively). Conclusion We found no significant differences in complication and patency rates between the tapered and straight graft groups. If there are no differences in complication and patency between the two graft types, tapered grafts may be a valuable option for AVF formation in light of their other advantages. PMID:28180100

  20. Bone graft

    MedlinePlus

    Autograft - bone; Allograft - bone; Fracture - bone graft; Surgery - bone graft; Autologous bone graft ... Fuse joints to prevent movement Repair broken bones (fractures) that have bone loss Repair injured bone that ...

  1. Off-pump versus on-pump coronary artery bypass grafting in octogenarians: comparison of short-term outcomes and long-term survival.

    PubMed

    Lee, Daniel C; Ramirez, Sergio A; Bacchetta, Matthew; Borer, Jeffrey S; Ko, Wilson

    2013-01-01

    Off-pump coronary artery bypass (OPCAB) has gained increasing acceptance with potential benefits for high-risk elderly patients. We report a surgeon's operative outcomes in octogenarians with an OPCAB program. Retrospective, intention-to-treat analysis of 97 consecutive octogenarians who underwent coronary bypass by a single surgeon between 1997 and 2001 before and after initiation of a multi-vessel OPCAB program was performed. OPCAB was attempted in all octogenarians. The OPCAB cohort had higher serum creatinine (OPCAB vs. pre-OPCAB: 1.30 ± 0.79 mg/dl vs. 1.08 ± 0.27, p = 0.04) and ejection fractions (52 ± 14% vs. 45 ± 11%, p = 0.02) than the pre-OPCAB cohort. The OPCAB group was more likely to require urgent/emergency surgery (63 vs. 40%, p = 0.04) and to have chronic renal insufficiency (18 vs. 3%, p = 0.05). After programmatic change to OPCAB, significant postoperative improvements were observed in the length of hospital stay (17 ± 19 vs. 8 ± 4 days, p < 0.01), duration of inotropic requirement (47 ± 70 vs. 18 ± 39 h, p < 0.04), duration of ventilator support (51 ± 54 vs. 16 ± 27 h, p < 0.01) and incidence of tracheostomy (16 vs. 3%, p < 0.02). In-hospital mortalities (3.2 vs. 2.7%), strokes (3 per group) and 5-year survival did not differ significantly (57 vs. 67%, p = 0.50, NS). Despite some higher preoperative risks, the OPCAB program demonstrated clinical benefits in octogenarians but no advantage in hospital-mortality or long-term survival.

  2. Single vs dual (en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience

    PubMed Central

    Al-Shraideh, Yousef; Farooq, Umar; El-Hennawy, Hany; Farney, Alan C; Palanisamy, Amudha; Rogers, Jeffrey; Orlando, Giuseppe; Khan, Muhammad; Reeves-Daniel, Amber; Doares, William; Kaczmorski, Scott; Gautreaux, Michael D; Iskandar, Samy S; Hairston, Gloria; Brim, Elizabeth; Mangus, Margaret; Stratta, Robert J

    2016-01-01

    AIM: To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors. METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to the inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted. Post-transplant management strategies were standardized in all patients. RESULTS: From 2002-2015, 59 KTs were performed including 34 dual EB and 25 single KTs. Mean age of donors (17 mo vs 38 mo, P < 0.001), mean weight (11.0 kg vs 17.4 kg, P = 0.046) and male donors (50% vs 84%, P = 0.01) were lower in the dual EB compared to the single KT group, respectively. Mean cold ischemia time (21 h), kidney donor profile index (KDPI; 73% vs 62%) and levels of serum creatinine (SCr, 0.37 mg/dL vs 0.49 mg/dL, all P = NS) were comparable in the dual EB and single KT groups, respectively. Actuarial graft and patient survival rates at 5-years follow-up were comparable. There was one case of thrombosis resulting in graft loss in each group. Delayed graft function incidence (12% dual EB vs 20% single KT, P = NS) was slightly lower in dual EB KT recipients. Initial duration of hospital stay (mean 5.4 d vs 5.6 d) and the one-year incidences of acute rejection (6% vs 16%), operative complications (3% vs 4%), and major infection were comparable in the dual EB and single KT groups, respectively (all P = NS). Mean 12 mo SCr and abbreviated MDRD levels were 1.17 mg/dL vs 1.35 mg/dL and 72.5 mL/min per 1.73 m2 vs 60.5 mL/min per 1.73 m2 (both P = NS) in the dual EB and single KT groups, respectively. CONCLUSION: By transplanting kidneys from young pediatric donors into adult recipients, one can

  3. Circulating Angiogenic Factors Associated with Response and Survival in Patients with Acute Graft-Versus-Host Disease: Results from BMT CTN 0302 and 0802

    PubMed Central

    Holtan, Shernan G.; Verneris, Michael R.; Schultz, Kirk R.; Newell, Laura F.; Meyers, Gabrielle; He, Fiona; DeFor, Todd E.; Vercellotti, Gregory M.; Slungaard, Arne; MacMillan, Margaret L.; Cooley, Sarah A.; Blazar, Bruce R.; Panoskaltsis-Mortari, Angela; Weisdorf, Daniel J.

    2015-01-01

    Circulating angiogenic factors (AF) reflect tissue healing capacity, although some AF can also contribute to inflammation and are indicative of endothelial dysfunction. The AF milieu in acute graft-versus-host disease (aGVHD) has not been broadly characterized. We hypothesized that patients with abundant AF involved in repair/regeneration vs. those mediating damage/inflammation would have improved outcomes. Circulating AF known predominantly for repair/regeneration (epidermal growth factor [EGF], fibroblast growth factor-1 and -2, heparin binding-EGF-like growth factor, vascular endothelial growth factor-A, -C, and -D) and for damage/inflammation (angiopoietin-2, endothelin-1, soluble endoglin [sEng], follistatin [FS], leptin, placental growth factor [PlGF]) were measured in a discovery set of HCT recipients with grade III/IV aGVHD versus controls, then validated in two aGVHD cohorts enrolled in Blood and Marrow Transplant Clinical Trials Network (BMT CTN) trials 0302 (N=105, serum) and 0802 (N=158, plasma) versus controls without aGVHD (N=53, serum). Levels of EGF and VEGF-A were lower than controls at the onset of aGVHD in both trials and higher with complete response to first-line aGVHD therapy in CTN 0802. FS and PlGF were elevated in aGVHD measured in either serum or plasma. At day 28 after initial aGVHD therapy, elevated FS was an independent negative prognostic factor for survival in both cohorts (hazard ratio 9.3 in CTN 0302, 2.8 in CTN 0802). These data suggest that circulating AF are associated with clinical outcomes after aGVHD and thus may contribute to both pathogenesis and recovery. PMID:25759146

  4. The lung function score and its components as predictors of overall survival and chronic graft-vs-host disease after allogeneic stem cell transplantation

    PubMed Central

    Ditz, Diana; Rabanus, Robert; Schulz, Christian; Wolff, Daniel; Holler, Barbara; Holler, Ernst; Hildebrandt, Gerhard Carl

    2016-01-01

    Aim To retrospectively assess if the modified lung function score (LFS) and/or its components, forced expiratory volume within the first second (FEV1) and diffusion capacity for carbon monoxide corrected for hemoglobin level (cDLCO), predict overall survival (OS) and chronic graft-vs-host-disease (cGvHD). Methods We evaluated 241 patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the University of Regensburg Transplant Center between June 1998 and July 2005 in relation to their LFS, FEV1 and cDLCO, before and after HSCT. Results Decreased OS after allo-HSCT was related to decreased pre-transplantation values of FEV1<60% (P = 0.040), cDLCO<50% of predicted value (P = 0.025), and LFS≥III (P = 0.037). It was also related to decreased FEV1 at 3 and 12 months after HSCT (P < 0.001 and P = 0.001, respectively) and increased LFS at 3 and 12 months after HSCT (P = 0.028 and P = 0.002, respectively), but not to changes of cDLCO. A higher incidence of cGvHD was related to decreased FEV1 at 6, 12, and 18 months (P = 0.069, P = 0.054, and P = 0.009, respectively) and increased LFS at 12 months (P = 0.002), but not to changes in cDLCO. Conclusions OS was related to both LFS and FEV1, but cGvHD had a stronger relation to FEV1 than to cDLCO or LFS. FEV1 alone offered more information on the outcome after allo-HSCT than LFS or cDLCO, suggesting limited value of LFS for the patients’ assessment after allo-HSCT. PMID:26935611

  5. Prognosis of adult patients transplanted with liver grafts < 35% of their standard liver volume.

    PubMed

    Ikegami, Toshihiko; Masuda, Yuichi; Ohno, Yasunari; Mita, Atsushi; Kobayashi, Akira; Urata, Koichi; Nakazawa, Yuichi; Miwa, Shirou; Hashikura, Yasuhiko; Miyagawa, Shinichi

    2009-11-01

    We have previously reported that a graft volume (GV) > 30% of the recipient's standard liver volume (SLV) can meet the recipient's metabolic demands. Here we report our experience with adult-to-adult living donor liver transplantation using left side grafts < 35% of the recipient's SLV. Of 143 adult living donor liver transplants, 13 auxiliary partial orthotopic liver transplants, 8 right side grafts, and 2 retransplantation cases were excluded. The resulting 120 cases were divided into 2 groups: group S consisted of 33 patients who received liver grafts < 35% of their SLV, and group L consisted of 87 patients who received liver grafts > or = 35% of their SLV. Patient characteristics, postoperative liver function, duration of hospital stay, and recipient survival rates were compared between the 2 groups. There were no significant differences between groups in recipient or donor background characteristics. The mean GV/SLV ratio of group S was 31.8%, whereas that of group L was 42.5%. There were no significant differences in the postoperative serum total bilirubin levels, prothrombin time international normalized ratio, daily ascites volume, or duration of postoperative hospital stay between the groups. The 1- and 5-year survival rates in group S were 80.7% and 64.2%, respectively, whereas those of group L were 90.8% and 84.9%, respectively, with no significant difference between groups. In conclusion, graft size was not considered to be the only cause of so-called small-for-size graft syndrome, and left side grafting appears to be the procedure of choice for adult-to-adult living donor liver transplantation because of the lower risk to donors in comparison with right lobe grafting.

  6. [Grafting of carotid arteries].

    PubMed

    Belov, Iu V; Stepanenko, A B; Gens, A P; Bazylev, V V; Seleznev, M N; Savichev, D D

    2005-01-01

    Over 5-years, 167 reconstructive surgeries for stenosis of internal carotid arteries (ICA) were performed in 124 patients. Mean age of the patients was 63.5 years. One hundred and twenty-nine carotid endarterectomies (CEAE) in 86 patients and 38 reconstructive operations of ICA in 38 patients were performed. There were no lethal outcomes in short- and long-term postoperative period. In short-term period after prosthesis of ICA restenosis was revealed in 3% patients, after eversion CEAE in 3% patients the embolism was seen, after standard CEAE restenosis were diagnosed in 8% patients and thrombosis -- in 3%. In long-term period after grafting of ICA the strokes were seen in 3%, stenosis -- in 6% patients, after eversion endarterectomy -- in 0 and 3% patients, and after standard CEAE -- in 3 and 24% patients, respectively. It is concluded that grafting of ICA is adequate surgical method of reconstruction and stroke prevention in specific variants of carotid atherosclerosis.

  7. "Blame it on the Comorbidities": A 5-Year Follow-Up of 53 Chronic Dialysis-Dependent Patients Who Underwent Cardiac Surgery.

    PubMed

    Deutsch, Oliver; Rippinger, Nathalie; Spiliopoulos, Kyriakos; Eichinger, Walter; Gansera, Brigitte

    2016-10-01

    Objectives This study evaluates midterm survival rates and risk factors for mortality of chronic dialysis-dependent patients undergoing cardiac surgery. Methods Fifty-three dialysis-dependent patients (34 males, aged 67 ± 12 years) with end-stage renal disease operated within March 2007 and May 2012 were analyzed retrospectively. Survival rates were calculated using Kaplan-Meier methods. Predictors of midterm survival were identified with multivariate Cox-regression analysis. Results Twenty-three patients received isolated coronary artery bypass graft surgery, 17 received isolated valve replacement, and 13 received combined procedures. Thirty-day mortality was 24.5% (n = 13). Follow-up was complete for 94.3% (n = 50). Survival rates at 1, 3, and 5 years were: 82, 50, and 17%, respectively. Neither age, gender, poor ejection fraction, emergency, ECC/X-clamp (cross-clamp) time, nor use of left internal thoracic artery or right internal thoracic artery had any influence on midterm survival. Causes of death within midterm follow-up period were related to cardiac events in 16% and neurological events in 16%. In the majority (47%), cause of death was associated with peripheral arterial disease (PAD).The only comorbidity, which could be identified as a significant risk factor, was PAD (p = 0.035). Five patients underwent successful renal transplantation within the follow-up period. Conclusion Although 30-day mortality in this high-risk patient population was increased, midterm survival rates were comparable to the results described in the literature. Cause of death within midterm follow-up period was mostly noncardiac related. Given the limited number of patients, predictors for enhanced 30-day mortality, such as preoperative myocardial infarction, prolonged extracorporeal circulation, operation time, and diabetes mellitus, did not have an influence on midterm survival.

  8. Your Child's Development: 2.5 Years (30 Months)

    MedlinePlus

    ... Old Your Child’s Development: 2.5 Years (30 Months) KidsHealth > For Parents > Your Child’s Development: 2.5 Years (30 Months) A A A Are you amazed by the ... TOPIC Your Child's Checkup: 2.5 Years (30 Months) Home and Away: How to Keep Toddlers Active ...

  9. Kidney graft loss in children: implications for program development

    PubMed Central

    Crocker, J F; Wade, A W; McDonald, A T; McLellan, D H; Lawen, J G; Bitter-Suermann, H; Acott, P D

    1998-01-01

    BACKGROUND: Graft survival in children who undergo kidney transplantation is lower than that in adults. The objective of the study was to review the experience of the first 22 years of operation of the regional pediatric kidney transplantation unit for Atlantic Canada, based at the IWK-Grace Health Centre, Halifax, and to use the results to improve graft survival. METHODS: All cases of kidney transplantation performed at the centre from 1971 to 1992 were reviewed and the data compiled with the use of a predetermined database outline. Data for first transplants were analysed and compared with those in North American databases. Of the 40 graft failures, 19 (48%) occurred within the first 3 months after transplantation, a rate similar to that at other centres. The overall survival rates tended to be slightly lower than those of international databases. The introduction of cyclosporine A as an immunosuppressant, in 1985, did not provide the expected marked improvement in survival. Infection frequently accompanied acute rejection, and there was a delay in treatment of infections and rejection after discharge home. On the basis of these preliminary findings, several program changes were made: 1) a sequential immunosuppression protocol was implemented, 2) the intensity of the medical surveillance was increased for the first 3 months after transplantation, with aggressive treatment of infections and rejections, 3) a dedicated pediatric transplantation team was established as a subset of the adult team and 4) pediatric-specific selection criteria for cadaver donors were formulated. After these changes were implemented, data were collected and analysed up to June 30, 1997. RESULTS: Graft survival rates at 1, 2 and 5 years improved dramatically. After the beginning of 1993, there were only 2 graft losses among 22 transplants. Only one of these occurred in the first 3 months, and it was due to recurrent disease. Twenty-four rejection episodes occurred (10 in the first 3 months

  10. Increased survival of human free fat grafts with varying densities of human adipose-derived stem cells and platelet-rich plasma.

    PubMed

    Li, Kun; Li, Feng; Li, Jie; Wang, Hang; Zheng, Xiaohui; Long, Jie; Guo, Weihua; Tian, Weidong

    2017-01-01

    The high absorption rate of transplanted fat has limited the application of autogenous fat grafts in the clinical setting. Therefore, this study aimed to evaluate the effects of platelet-rich plasma (PRP) and adipose-derived stem cells (ASCs) on fat regeneration by investigating the impact of PRP and conditioned medium on the biological characteristics of ASCs. Fat grafts were prepared with ASCs at densities of 10(7) /ml, 10(6) /ml, 10(5) /ml, 10(4) /ml and 0/ml with and without PRP and injected subcutaneously into nude mice. Liquid overflow method, haematoxylin and eosin staining, and immunohistochemical analyses were used to examine the fat grafts. The residual fat volume of the 10(5) /ml ASC + PRP group was significantly higher than that of other treatment conditions after 90 days. Furthermore, histological examination revealed that in 10(5) /ml ASCs-treated grafts normal adipocyte area and capillary formation were increased dramatically compared with other treatment conditions. It is concluded that fat grafts consisting of PRP and 10(5) /ml ASCs constitute an ideal transplant strategy, which may result in decreased absorption and accelerated fat regeneration. This simple and reliable method could provide a valuable and needed tool in plastic and reconstructive surgery. Copyright © 2014 John Wiley & Sons, Ltd.

  11. Craniofacial Bone Grafting: Wolff's Law Revisited

    PubMed Central

    Oppenheimer, Adam J.; Tong, Lawrence; Buchman, Steven R.

    2008-01-01

    Bone grafts are used for the reconstruction of congenital and acquired deformities of the facial skeleton and, as such, comprise a vital component of the craniofacial surgeon's armamentarium. A thorough understanding of bone graft physiology and the factors that affect graft behavior is therefore essential in developing a more intelligent use of bone grafts in clinical practice. This article presents a review of the basic physiology of bone grafting along with a survey of pertinent concepts and current research. The factors responsible for bone graft survival are emphasized. PMID:22110789

  12. Angiomyolipoma of donor kidney: Successful transplantation and 5-year follow-up

    PubMed Central

    Gopalakrishnan, N.; Dhanapriya, J.; Sakthirajan, R.; Dineshkumar, T.; Balasubramaniyan, T.; Haris, Md.

    2016-01-01

    Angiomyolipomas (AML) of the kidney are non-encapsulated benign neoplasms with the incidence of 45-80% in patients with tuberous sclerosis and 1-3% in sporadic cases. There are very few case reports in the literature in which kidneys with AML have been used for transplantation. We report here a 27-year-old female patient who received a live related renal transplant from her mother with isolated angiomyolipoma in donor kidney and on follow-up after 5 years, has stable graft function and tumor size. PMID:27051138

  13. Improvement of grafted watermelon transplant survival as a result of size and starch increases over time caused by rootstock fatty alcohol treatment Part II

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fatty alcohol treatments can be used to eliminate the meristem of cucurbit (Family Cucurbitaceae) rootstocks which prevents regrowth when grafting, but the effects of the treatment on the rootstock have not been documented. Two rootstock types, ‘Emphasis’ bottle gourd (Lagenaria siceraria) and ‘Car...

  14. Study of psychosocial parameters related to the survival rate of renal transplantation in children.

    PubMed

    Mongeau, J G; Clermont, M J; Robitaille, P; Plante, A; Jéquier, J C; Godbout, C; Guertin, M C; Beaulieu, M A; Sarrazin, F

    1997-10-01

    The purpose of the present study was to assess the effect of intelligence, schooling, psychomotor, emotional, and social status on renal graft survival in children. Sixty-two cadaver renal transplant recipients were evaluated retrospectively and the influence of sex, age, weight, and the use of cyclosporin A (CyA) on the success rate of the graft from 1 to 5 years later was analyzed. Psychological and social scores were devised and included as factors predictive of survival of the graft. Univariate analysis showed that the following variables predicted renal graft survival: the use of CyA (P = 0.0002), pre-transplant dialysis (P = 0.04), weight at the time of transplantation (P = 0.072), and psychological scores (P = 0.064). Association analysis demonstrated that pre-transplantation dialysis was only a chance association and therefore the parameter was discarded. Multivariate analysis showed that the predictive parameters were the use of CyA, sex, weight in kilograms, and the psychological score. An equation was then derived from variables that predict the probability that a specific patient's graft will survive more than t months. This equation is the estimated survival distribution function and is as follow: S (t) = Exp {-Exp[-(0.8882x1 - 1.827x2 + 0.037x3 - 0.1746x4) + ln t - 4.7862]} where S (t) = the survival at t months post transplantation, x1 = sex (male 1, female 2), x2 = CyA (yes 1, no 2), x3 = weight in kilograms, and x4 = psychological score. The major impact of psychological factors on renal graft survival was surprising.

  15. A single-center analysis of chronic graft-versus-host disease-free, relapse-free survival after alternative donor stem cell transplantation in children with hematological malignancies.

    PubMed

    Inagaki, Jiro; Fukano, Reiji; Noguchi, Maiko; Okamura, Jun

    2017-02-15

    We assessed the clinical outcomes of allogeneic hematopoietic stem cell transplantation (SCT) from alternative donors for pediatric patients with hematological malignancies, defining graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) as a composite endpoint. We also defined chronic GVHD-free, relapse-free survival (cGRFS) as survival without severe chronic GVHD, relapse, or death. The probabilities of 2-year disease-free survival from a human leukocyte antigen (HLA) matched unrelated donor (n = 57), related donor with HLA-1 antigen mismatch in the graft-versus-host direction (1Ag-GvH-MMRD, n = 28), and unrelated umbilical cord blood (n = 35) were 52.2, 38.5, and 40.4%, respectively (P = 0.14), and for 2-year GRFS were 26.2, 13.4, and 30.4%, respectively (P = 0.089), and for 2-year cGRFS were 36.2, 16.7, and 40.4%, respectively (P = 0.015). Of the three groups, the 1Ag-GvH-MMRD group showed a significantly higher cumulative incidence of severe cGVHD, and was identified as a significant risk factor for worse cGRFS. These results suggest that intensification of GVHD prophylaxis may be needed for SCT from 1Ag-GvH-MMRD. As with GRFS, cGRFS should be used as an endpoint of the clinical study to predict long-term morbidity and mortality for patients who need longer follow-up such as pediatric SCT recipients.

  16. Five-year results of coronary bypass grafting for patients older than 70 years: role of internal mammary artery.

    PubMed

    Azariades, M; Fessler, C L; Floten, H S; Starr, A

    1990-12-01

    Despite numerous references to the superiority of the internal mammary artery (IMA) over the saphenous vein for myocardial revascularization, its role in the elderly is still in question. From January 1984 through December 1988, 1,081 patients older than 70 years (mean age, 74.9 years) underwent bypass grafting, 354 (33%) receiving left IMA grafts based on the surgeon's preference and 727 (67%) receiving vein grafts only. Selection bias resulted in a higher incidence of known risk factors (such as cardiomegaly, arrhythmias, left ventricular failure, wall motion abnormalities, and preoperative combined New York Heart Association/Canadian Cardiovascular Association functional class IV) in patients in whom the IMA was not used. However, unstable angina, acute myocardial infarction, left ventricular dysfunction, and left main disease were not contraindications for using IMA grafts. The operative mortality rate was significantly lower in IMA patients (2.8% versus 7.6%). The actuarial 5-year survival rate (standard error) was higher in patients with IMA grafts, 89% (3%) versus 78% (2%), and postoperative functional class improved to a greater extent in IMA patients (87% of patients were in classes I and II). Arrhythmias and myocardial infarction were significant causes of late death only in patients with vein grafts. When patients are older than 70 years, patient selection factors clearly play an important role in the differential results between patients in whom the IMA is used and patients in whom vein grafts are used. As in younger patients, excellent results can be achieved in the elderly.

  17. Bone grafts.

    PubMed

    Hubble, Matthew J W

    2002-09-01

    Bone grafts are used in musculoskeletal surgery to restore structural integrity and enhance osteogenic potential. The demand for bone graft for skeletal reconstruction in bone tumor, revision arthroplasty, and trauma surgery, couple with recent advances in understanding and application of the biology of bone transplantation, has resulted in an exponential increase in the number of bone-grafting procedures performed over the last decade. It is estimated that 1.5 million bone-grafting procedures are currently performed worldwide each year, compared to a fraction of that number 20 years ago. Major developments also have resulted in the harvesting, storage, and use of bone grafts and production of graft derivatives, substitutes, and bone-inducing agents.

  18. Plant grafting: new mechanisms, evolutionary implications

    PubMed Central

    Goldschmidt, Eliezer E.

    2014-01-01

    Grafting, an old plant propagation practice, is still widely used with fruit trees and in recent decades also with vegetables. Taxonomic proximity is a general prerequisite for successful graft-take and long-term survival of the grafted, composite plant. However, the mechanisms underlying interspecific graft incompatibility are as yet insufficiently understood. Hormonal signals, auxin in particular, are believed to play an important role in the wound healing and vascular regeneration within the graft union zone. Incomplete and convoluted vascular connections impede the vital upward and downward whole plant transfer routes. Long-distance protein, mRNA and small RNA graft-transmissible signals currently emerge as novel mechanisms which regulate nutritional and developmental root/top relations and may play a pivotal role in grafting physiology. Grafting also has significant pathogenic projections. On one hand, stock to scion mechanical contact enables the spread of diseases, even without a complete graft union. But, on the other hand, grafting onto resistant rootstocks serves as a principal tool in the management of fruit tree plagues and vegetable soil-borne diseases. The ‘graft hybrid’ historic controversy has not yet been resolved. Recent evidence suggests that epigenetic modification of DNA-methylation patterns may account for certain graft-transformation phenomena. Root grafting is a wide spread natural phenomenon; both intraspecific and interspecific root grafts have been recorded. Root grafts have an evolutionary role in the survival of storm-hit forest stands as well as in the spread of devastating diseases. A more fundamental evolutionary role is hinted by recent findings that demonstrate plastid and nuclear genome transfer between distinct Nicotiana species in the graft union zone, within a tissue culture system. This has led to the formation of alloploid cells that, under laboratory conditions, gave rise to a novel, alloploid Nicotiana species

  19. Latino Children's Body Mass Index at 2–3.5 Years Predicts Sympathetic Nervous System Activity at 5 Years

    PubMed Central

    Harley, Kim G.; Neilands, Torsten B.; Tambellini, Katelyn; Lustig, Robert H.; Boyce, W. Thomas; Eskenazi, Brenda

    2014-01-01

    Abstract Background: To understand whether the relationship between young children's autonomic nervous system (ANS) responses predicted their BMI, or vice versa, the association between standardized BMI (zBMI) at 2, 3.5, and 5 years of age and ANS reactivity at 3.5–5 years of age, and whether zBMI predicts later ANS reactivity or whether early ANS reactivity predicts later zBMI, was studied. Methods: Low-income, primarily Latino children (n=112) were part of a larger cohort study of mothers recruited during early pregnancy. Study measures included maternal prenatal weight, children's health behaviors (i.e., time watching television, fast food consumption, and time playing outdoors), children's height and weight at 2, 3.5, and 5 years, and children's ANS reactivity at 3.5 and 5 years. ANS measures of sympathetic nervous system (i.e., pre-ejection period) and parasympathetic nervous system (i.e., respiratory sinus arrhythmia) activity were monitored during rest and four challenges. Reactivity was calculated as the difference between mean challenge response and rest. Structural equation models analyzed the relationship between children's zBMI at 2, 3.5, and 5 years and ANS reactivity at 3.5 and 5 years, adjusting for mother's BMI, children's behaviors, and changes in height. Results: There was no association between zBMI and ANS cross-sectionally. Children with high zBMI at 2 or 3.5 years or large zBMI increases from 2 to 3.5 years of age had decreased sympathetic activity at 5 years. Neither sympathetic nor parasympathetic reactivity at 3.5 years predicted later zBMI. Conclusions: Increased zBMI early in childhood may dampen young children's SNS responses later in life. PMID:24745554

  20. [The PTFE plastic prosthesis as an arterial replacement: experiences over a 5-year period].

    PubMed

    Polterauer, P; Contreras, F; Kretschmer, G; Wagner, O; Piza, F; Waneck, R; Lechner, G; Schemper, M

    1984-03-30

    Unilateral iliac femoral reconstructions with PTFE are yielding good results-similar to those with Dacron, with patency rates of 75, 67, and 65% at 1, 2 and 3 years, respectively (Kaplan-Meier). PTFE has additional advantages compared with other materials: a) no need of preclotting; b) smooth inner surface-easy thrombectomy in case of thrombosis and c) good handling characteristics. In view of the above-mentioned facts PTFE can be recommended without restriction for unilateral pelvic reconstructions. The functional early results of bilateral aorto-femoral Goretex-Y bifurcation grafts in 50 cases after 2 years are encouraging. Long-term results are still pending. Reports of other groups using this material as aorto-bifemoral substitute are not yet available. The functional results with PTFE for femoro-popliteal grafts are not satisfactory: 35% after 2.5 years. Extra-anatomical bypasses yielded 70% one-year functioning rate. Especially the ring-or spiral-armoured PTFE grafts seem to be suitable for these reconstruction procedures.

  1. Your Child's Development: 1.5 Years (18 Months)

    MedlinePlus

    ... Your 1- to 2-Year-Old Your Child's Development: 1.5 Years (18 Months) KidsHealth > For Parents > ... parts ("Where is your nose?") Movement and Physical Development runs walks up stairs with hand held throws ...

  2. Fitness and Your 4-to 5-Year Old

    MedlinePlus

    ... Old Feeding Your 1- to 2-Year-Old Fitness and Your 4- to 5-Year-Old KidsHealth > ... the risk of serious illnesses later in life. Fitness for Preschoolers Physical activity guidelines for preschoolers recommend ...

  3. General Principles for 5-year Regional Haze Progress Reports

    EPA Pesticide Factsheets

    This guidance document was developed by the U.S. EPA for EPA Regional Offices and states in preparing and reviewing the 5-year progress reports for the initial regional haze state implementation plans.

  4. Medical Care and Your 4- to 5-Year-Old

    MedlinePlus

    ... compared with other kids the same age and gender. The doctor will take a medical and family ... cooperatively with other kids understand the concept of gender identify colors Developmental milestones for 5-year-olds ...

  5. The Amphibian Research and Monitoring Initiative (ARMI): 5-year report

    USGS Publications Warehouse

    Muths, Erin; Gallant, Alisa L.; Campbell Grant, Evan H.; Battaglin, William A.; Green, David E.; Staiger, Jennifer S.; Walls, Susan C.; Gunzburger, Margaret S.; Kearney, Rick F.

    2006-01-01

    This report is a 5-year retrospective of the structure, methodology, progress, and contributions to the broader scientific community that have resulted from this national USGS program. We evaluate ARMI’s success to date, with regard to the challenges faced by the program and the strengths that have emerged. We chart objectives for the next 5 years that build on current accomplishments, highlight areas meriting further research, and direct efforts to overcome existing weaknesses.

  6. 5-Year Update Environmental Assessment for CV-22 Beddown

    DTIC Science & Technology

    2007-02-01

    Final 5-Year Update Environmental Assessment for CV-22 Beddown Hurlburt Field , Florida...SIGNIFICANT IMPACT 5-YEAR UPDATE CV-22 BEDDOWN HURLBURT FIELD , FL Agencies: The United States Air Force (USAF) and the United States Navy (Navy...the CV-22 Osprey at Hurlburt Field , Florida. The purpose of the Proposed Action is to: • Conduct IOT&E by testing the operation of the CV-22 in as

  7. Bilateral internal thoracic artery grafting

    PubMed Central

    2013-01-01

    The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years. PMID:23977627

  8. Trabecular metal tibia still stable at 5 years

    PubMed Central

    Henricson, Anders; Rösmark, Dan; Nilsson, Kjell G

    2013-01-01

    Background and purpose Clinical results of total knee replacement (TKR) are inferior in younger patients, mainly due to aseptic loosening. Coating of components with trabecular metal (TM) is a new way of enhancing fixation to bone. We have previously reported stabilization of TM tibial components at 2 years. We now report the 5-year follow-up of these patients, including RSA of their TM tibial components. Patients and methods 22 patients (26 knees) received an uncemented TM cruciate-retaining tibial component and 19 patients (21 knees) a cemented NexGen Option cruciate-retaining tibial component. Follow-up with RSA, and clinical and radiographic examinations were done at 5 years. In bilaterally operated patients, the statistical analyses included only the first-operated knee. Results Both groups had most migration within the first 3 months, the TM implants to a greater extent than the cemented implants. After 3 months, both groups stabilized and remained stable up to the 5-year follow-up. Interpretation After a high initial degree of migration, the TM tibia stabilized. This stabilization lasted for at least 5 years, which suggests a good long-term performance regarding fixation. The cemented NexGen CR tibial components showed some migration in the first 3 months and then stabilized up to the 5-year follow-up. This has not been reported previously. PMID:23992142

  9. Skin graft

    MedlinePlus

    ... that need skin grafts to heal Venous ulcers, pressure ulcers , or diabetic ulcers that do not heal Very ... chap 17. Read More Burns Patient Instructions Preventing pressure ulcers Surgical wound care - open Review Date 3/13/ ...

  10. Interventions in Infrainguinal Bypass Grafts

    SciTech Connect

    Mueller-Huelsbeck, S. Order, B.-M.; Jahnke, T.

    2006-02-15

    The interventional radiologist plays an important role in the detection and prevention of infrainguinal bypass failure. Early detection and evaluation of flow-limiting lesions effectively preserve graft (venous bypass and polyester or expanded polytetrafluoroethylene bypass) patency by identifying stenoses before occlusion occurs. Delay in treatment of the at-risk graft may result in graft failure and a reduced chance of successful revascularization. For this reason, surveillance protocols form an important part of follow-up after infrainguinal bypass surgery. As well as having an understanding of the application of imaging techniques including ultrasound, MR angiography, CT angiography and digital subtraction angiography, the interventional radiologist should have detailed knowledge of the minimally invasive therapeutic options. Percutaneous transluminal angioplasty (PTA), or alternatively cutting balloon angioplasty, is the interventional treatment of choice in prevention of graft failure and occlusion. Further alternatives include metallic stent placement, fibrinolysis, and mechanical thrombectomy. Primary assisted patency rates following PTA can be up to 65% at 5 years. When the endovascular approach is unsuccessful, these therapeutic options are complemented by surgical procedures including vein patch revision, jump grafting, or placement of a new graft.

  11. Rhinoscleroma in a 5-year-old Portuguese Child.

    PubMed

    Simão, Inês; Gaspar, Iuri; Faustino, Rosário; Brito, Maria João Rocha

    2014-07-01

    Rhinoscleroma is a chronic granulomatous infectious disease that is rare in Western Europe. We report the case of a 5-year-old Portuguese boy diagnosed with rhinoscleroma in the context of recurrent epistaxis. He had a 6-month course of antibiotic (amoxicillin plus clavulanate) therapy with full recovery.

  12. True or False: Do 5-Year-Olds Understand Belief?

    ERIC Educational Resources Information Center

    Fabricius, William V.; Boyer, Ty W.; Weimer, Amy A.; Carroll, Kathleen

    2010-01-01

    In 3 studies (N = 188) we tested the hypothesis that children use a perceptual access approach to reason about mental states before they understand beliefs. The perceptual access hypothesis predicts a U-shaped developmental pattern of performance in true belief tasks, in which 3-year-olds who reason about reality should succeed, 4- to 5-year-olds…

  13. Subconjunctival injection of in vitro transforming growth factor-β-induced regulatory T cells prolongs allogeneic corneal graft survival in mice

    PubMed Central

    Xu, Qing; Tan, Xiaobo; Zhang, Yingnan; Jie, Ying; Pan, Zhiqiang

    2015-01-01

    This study is to investigate the effect of subconjunctival injection of in vitro induced regulatory T cells (iTregs) on the survival of corneal allografts. iTregs were expanded by culturing CD4+T cells with TGF-β in vitro. Foxp3, LAP and GARP were analyzed and the suppression ability of iTregs was assayed by co-culturing with effective T cells. Allogeneic transplantations in mice were modeled and randomly classified into PBS control, iTregs and TA groups. The allografts were observed for 60 days. CD25, Foxp3, LAP and GARP in CD4+T cells were analyzed on day 21 after the surgery. Inflammatory cells infiltrated in allografts were detected by flow cytometry and histopathological examination. Expressions of Foxp3, GARP and LAP in iTregs were high. iTregs suppressed the proliferation of effective T cells in vitro. The corneal allograft survival time for PBS, iTregs and TA groups was (18 ± 1.73) days, (38.6 ± 1.14) days and (60 ± 0) days, respectively. The corneal allograft survival time in iTregs group was significantly prolonged compared with PBS group (P < 0.05), but shorter than that in TA group (P < 0.05). No significant difference was observed in expressions of CD25, Foxp3, LAP or GARP in CD4+T cells (P > 0.05). Finally, CD3+CD4+T cell infiltration and fewer inflammatory cells were reduced in allografts in iTregs and TA groups compared with PBS group. The survival time of allografts were prolonged in mice after subconjunctival injection of iTregs. Local immune modulation might be involved in the mechanism. PMID:26884940

  14. Survival of host mast cells after establishment of hematopoietic chimerism by graft-versus-host reaction in nonirradiated F1 hybrid mice

    SciTech Connect

    Tsuyama, K.; Sonoda, T.; Kitamura, Y.; Inoue, R.; Ochi, T.; Ono, K.

    1982-10-01

    Since the tissue mast cell has been shown to be progeny of the multipotential hematopoietic stem cell (CFU-S), and the CFU-S is a sensitive target of graft-versus-host (GVH) reaction, we examined whether or not the mast cell is also the target of GVH reaction. Giant granules of C57BL/6-bgJ/bgJ mice were used as a marker of donor cells. When 10(8) spleen cells of C57BL/6-bgJ/bgJ mice were injected into nonirradiated (C57BL/6 X CBA)F1 hybrid mice, erythrocytes and neutrophils became of donor type in about one-half of the recipient mice. In the bone marrow and spleen of the chimeric mice, the CFU-S was of donor type as well. In contrast, mast cells of host type remained in many tissues of the chimeras. Moreover, mast cell precursors with capabilities of proliferation and differentiation were preserved in the skin of chimeras. The present results suggest that the effect of systemic GVH reaction on mature mast cells and the mast cell precursor fixed in the skin is significantly less severe than that on the CFU-S itself.

  15. Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity-matched cohort.

    PubMed

    Croome, Kristopher P; Lee, David D; Perry, Dana K; Burns, Justin M; Nguyen, Justin H; Keaveny, Andrew P; Taner, C Burcin

    2017-03-01

    The use of liver grafts from donation after cardiac death (DCD) has been limited due to the increased rate of graft failure, mostly related to ischemic cholangiopathy (IC). It is our hypothesis that longterm outcomes and quality of life (QOL) similar to patients undergoing liver transplantation (LT) with donation after brain death (DBD) can be achieved. Clinical outcomes of all patients undergoing DCD LT (n = 300) between 1998 and 2015 were compared with a propensity score-matched cohort of patients undergoing DBD LT (n = 300). Patients were contacted for a follow-up questionnaire and short-form (SF)-12 QOL Survey administration. Median follow-up was >5 years. Graft survival at 1-, 3-, and 5-years was 83.8%, 75.5%, and 70.1% in the DCD LT group and 88.4%, 80.3%, and 73.9% in the DBD LT group (P = 0.27). Patient survival at 1-, 3-, and 5-years was 92.3%, 86.1%, and 80.3% in the DCD LT group and 92.3%, 85.1%, and 79.5% in the DBD LT group (P = 0.81). IC developed in 11.7% and 2% of patients in the DCD LT group and DBD LT group, respectively (P < 0.001). DCD LT recipients who developed IC had inferior graft survival compared with both the DCD non-IC group (P < 0.001) and the DBD LT group (P < 0.001); no difference in graft survival was observed between the DCD non-IC group and the DBD LT group (P = 0.50). Physical and Mental Composite Scores on the SF-12 QOL questionnaire were similar between the DCD LT and DBD LT groups (44.0 versus 45.4; P = 0.34 and 51.9 versus 52.2; P = 0.83), respectively. Similar longterm survival and QOL scores can be achieved between DCD LT and DBD LT. Prevention of IC in DCD LT yields excellent graft and patient survival with virtually no difference compared with DBD LT. Liver Transplantation 23 342-351 2017 AASLD.

  16. General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital

    PubMed Central

    Gordon, AC

    2016-01-01

    Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals. PMID:27269243

  17. Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cw vs anti-A and/or -B antibodies

    PubMed Central

    Santos, Sofia; Malheiro, Jorge; Tafulo, Sandra; Dias, Leonídio; Carmo, Rute; Sampaio, Susana; Costa, Marta; Campos, Andreia; Pedroso, Sofia; Almeida, Manuela; Martins, La Salete; Henriques, Castro; Cabrita, António

    2016-01-01

    AIM To analyze the clinical impact of preformed antiHLA-Cw vs antiHLA-A and/or -B donor-specific antibodies (DSA) in kidney transplantation. METHODS Retrospective study, comparing 12 patients transplanted with DSA exclusively antiHLA-Cw with 23 patients with preformed DSA antiHLA-A and/or B. RESULTS One year after transplantation there were no differences in terms of acute rejection between the two groups (3 and 6 cases, respectively in the DSA-Cw and the DSA-A-B groups; P = 1). At one year, eGFR was not significantly different between groups (median 59 mL/min in DSA-Cw group, compared to median 51 mL/min in DSA-A-B group, P = 0.192). Moreover, kidney graft survival was similar between groups at 5-years (100% in DSA-Cw group vs 91% in DSA-A-B group, P = 0.528). The sole independent predictor of antibody mediated rejection (AMR) incidence was DSA strength (HR = 1.07 per 1000 increase in MFI, P = 0.034). AMR was associated with shortened graft survival at 5-years, with 75% and 100% grafts surviving in patients with or without AMR, respectively (Log-rank P = 0.005). CONCLUSION Our data indicate that DSA-Cw are associated with an identical risk of AMR and impact on graft function in comparison with “classical” class I DSA. PMID:28058219

  18. Onychomatricoma: A Case Report with 5-year Follow-up

    PubMed Central

    Ishida, Cleide Eiko; Gouveia, Bruna Melhoranse; Cuzzi, Tullia; Ramos-e-Silva, Marcia

    2016-01-01

    The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented. PMID:28163462

  19. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    SciTech Connect

    Osa, Etin-Osa O.; DeWyngaert, Keith; Roses, Daniel; Speyer, James; Guth, Amber; Axelrod, Deborah; Fenton Kerimian, Maria; Goldberg, Judith D.; Formenti, Silvia C.

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  20. Onlay Bone Grafts in Head and Neck Reconstruction

    PubMed Central

    Yazar, Sukru

    2010-01-01

    Bone grafts are used in a variety of clinical situations and can be divided into two categories: treatment of bone gaps (inlay bone grafting) and bone projection (onlay bone grafting). Cortical grafts are useful in situations requiring immediate mechanical strength. These grafts can survive with or without complete revascularization or resorption and are primarily used by plastic surgeons in the treatment of bone volume deficiency. Cancellous grafts, in contrast, have no mechanical strength and therefore require additional support to bridge bone defects. Thus, they are used primarily for the treatment of bone gaps and in general revascularize quickly, resorb completely, and stimulate significant new bone formation. PMID:22550447

  1. Olfactory Dysfunction Predicts 5-Year Mortality in Older Adults

    PubMed Central

    Pinto, Jayant M.; Wroblewski, Kristen E.; Kern, David W.; Schumm, L. Philip; McClintock, Martha K.

    2014-01-01

    Prediction of mortality has focused on disease and frailty, although antecedent biomarkers may herald broad physiological decline. Olfaction, an ancestral chemical system, is a strong candidate biomarker because it is linked to diverse physiological processes. We sought to determine if olfactory dysfunction is a harbinger of 5-year mortality in the National Social Life, Health and Aging Project [NSHAP], a nationally representative sample of older U.S. adults. 3,005 community-dwelling adults aged 57–85 were studied in 2005–6 (Wave 1) and their mortality determined in 2010–11 (Wave 2). Olfactory dysfunction, determined objectively at Wave 1, was used to estimate the odds of 5-year, all cause mortality via logistic regression, controlling for demographics and health factors. Mortality for anosmic older adults was four times that of normosmic individuals while hyposmic individuals had intermediate mortality (p<0.001), a “dose-dependent” effect present across the age range. In a comprehensive model that included potential confounding factors, anosmic older adults had over three times the odds of death compared to normosmic individuals (OR, 3.37 [95%CI 2.04, 5.57]), higher than and independent of known leading causes of death, and did not result from the following mechanisms: nutrition, cognitive function, mental health, smoking and alcohol abuse or frailty. Olfactory function is thus one of the strongest predictors of 5-year mortality and may serve as a bellwether for slowed cellular regeneration or as a marker of cumulative toxic environmental exposures. This finding provides clues for pinpointing an underlying mechanism related to a fundamental component of the aging process. PMID:25271633

  2. Olfactory dysfunction predicts 5-year mortality in older adults.

    PubMed

    Pinto, Jayant M; Wroblewski, Kristen E; Kern, David W; Schumm, L Philip; McClintock, Martha K

    2014-01-01

    Prediction of mortality has focused on disease and frailty, although antecedent biomarkers may herald broad physiological decline. Olfaction, an ancestral chemical system, is a strong candidate biomarker because it is linked to diverse physiological processes. We sought to determine if olfactory dysfunction is a harbinger of 5-year mortality in the National Social Life, Health and Aging Project [NSHAP], a nationally representative sample of older U.S. adults. 3,005 community-dwelling adults aged 57-85 were studied in 2005-6 (Wave 1) and their mortality determined in 2010-11 (Wave 2). Olfactory dysfunction, determined objectively at Wave 1, was used to estimate the odds of 5-year, all cause mortality via logistic regression, controlling for demographics and health factors. Mortality for anosmic older adults was four times that of normosmic individuals while hyposmic individuals had intermediate mortality (p<0.001), a "dose-dependent" effect present across the age range. In a comprehensive model that included potential confounding factors, anosmic older adults had over three times the odds of death compared to normosmic individuals (OR, 3.37 [95%CI 2.04, 5.57]), higher than and independent of known leading causes of death, and did not result from the following mechanisms: nutrition, cognitive function, mental health, smoking and alcohol abuse or frailty. Olfactory function is thus one of the strongest predictors of 5-year mortality and may serve as a bellwether for slowed cellular regeneration or as a marker of cumulative toxic environmental exposures. This finding provides clues for pinpointing an underlying mechanism related to a fundamental component of the aging process.

  3. Prediction of delayed graft function by means of a novel web-based calculator: a single-center experience.

    PubMed

    Rodrigo, E; Miñambres, E; Ruiz, J C; Ballesteros, A; Piñera, C; Quintanar, J; Fernández-Fresnedo, G; Palomar, R; Gómez-Alamillo, C; Arias, M

    2012-01-01

    Renal failure persisting after renal transplant is known as delayed graft function (DGF). DGF predisposes the graft to acute rejection and increases the risk of graft loss. In 2010, Irish et al. developed a new model designed to predict DGF risk. This model was used to program a web-based DGF risk calculator, which can be accessed via http://www.transplantcalculator.com . The predictive performance of this score has not been tested in a different population. We analyzed 342 deceased-donor adult renal transplants performed in our hospital. Individual and population DGF risk was assessed using the web-based calculator. The area under the ROC curve to predict DGF was 0.710 (95% CI 0.653-0.767, p < 0.001). The "goodness-of-fit" test demonstrates that the DGF risk was well calibrated (p = 0.309). Graft survival was significantly better for patients with a lower DGF risk (5-year survival 71.1% vs. 60.1%, log rank p = 0.036). The model performed well with good discrimination ability and good calibration to predict DGF in a single transplant center. Using the web-based DGF calculator, we can predict the risk of developing DGF with a moderate to high degree of certainty only by using information available at the time of transplantation.

  4. Results of Wagner SL revision stem with impaction bone grafting in revision total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: As the number of total hip arthroplasties (THAs) performed increases, so do the number of required revisions. Impaction bone grafting with Wagner SL Revision stem is a good option for managing bone deficiencies arising from aseptic osteolysis. We studied the results of cementless diaphyseal fixation in femoral revision after total hip arthroplasty and whether there was spontaneous regeneration of bone stock in the proximal femur after the use of Wagner SL Revision stem (Zimmer, Warsaw, IN, USA) with impaction bone grafting. Materials and Methods: We performed 53 hip revisions using impaction bone grafting and Wagner SL Revision stems in 48 patients; (5 cases were bilateral) for variety of indications ranging from aseptic osteolysis to preiprosthetic fractures. The average age was 59 years (range 44-68 years). There were 42 male and 6 female patients. Four patients died after surgery for reasons unrelated to surgery. 44 patients were available for complete analysis. Results: The mean Harris Hip Score was 42 before surgery and improved to 86 by the final followup evaluation at a mean point of 5.5 years. Of the 44 patients, 87% (n=39) had excellent results and 10% (n=5) had good results. The stem survival rate was 98% (n=43). Conclusion: Short term results for revision THA with impaction bone grafting and Wagner SL revision stems are encouraging. However, it is necessary to obtain long term results through periodic followup evaluation, as rate of complications may increase in future. PMID:23960279

  5. The acquired cardiac disease domain: the next 5 years.

    PubMed

    Pepper, John R

    2013-01-01

    At a recent in-house meeting at the European Association for Cardiothoracic Surgery (EACTS) headquarters in Windsor, the Chairs of the four domains were asked by the President to present their perception of the next 5 years in their respective domains. This review represents a distillation of our discussions on adult cardiac surgery. Advances in technology and imaging are having a radical effect on the working lives of surgeons. In clinical practice, the growth of heart teams and the breaking down of artificial barriers between specialities are altering the way we practice for the better. We see the development of hybrid approaches to many areas such as coronary artery surgery and operations on the thoracic aorta. These changes require careful analysis to ensure that they produce better outcomes that are also cost-effective. All health-care systems are at breaking point, and it is our responsibility to harness new technology to benefit our patients. This is all part of placing the patient at the centre of our activities. Hence, we see the involvement of patients in the design and analysis of clinical trials, which also require great mutual trust and cooperation between surgeons in different countries. Because of the dramatic changes in the pattern of working, we have had to alter our patterns of training and education, and we will continue to make significant innovations in the future. These are exciting challenges that will keep us all busy for the next 5 years at least.

  6. Costal Grafting in Mandibular Reconstruction

    PubMed Central

    Bourlet, Jerôme; Château, Joseph; Jacquemart, Mathieu; Dufour, Clémence; Mojallal, Ali; Gleizal, Arnaud

    2015-01-01

    Background: Reconstruction of mandibular bone defect is a common indication in craniomaxillofacial surgery, and free fibular flap is the gold standard for this indication. However, there are alternatives; nonvascular bone grafting is one of them, and we present the costal grafting for mandibular reconstruction, a classic technique that is reliable, efficient, and produced less morbidity than the technique of using composite free flaps. Method: A 9-year retrospective review of 54 patients treated surgically for mandibular reconstruction was performed. The criterion mainly analyzed was graft survival. The surgical technique was described in detail. Results: A total of 54 patients with mandibular bone defect were identified. Five symphysis, 46 corpus, and 20 ramus defects were considered. These patients underwent reconstruction by costal grafting, and the engrafting was successful in 92.6% of cases. Dental rehabilitation with dental implants was realized in 70% of cases. Conclusions: The approach described in this article allowed the authors to obtain good results with costal grafting for mandibular reconstruction and dental rehabilitation. Costal grafting is a good alternative for fibula free flap in specific indications. Reconstruction of mandibular bone defect is a common indication in craniomaxillofacial surgery. Since the 1980s, the gold standard for these defects is the use of free fibular flap.1 In some cases, this technique is contradicted; the surgeon then has several possibilities for the use of free osteomyocutaneous flaps (iliac crest, scapula, and serrato-costal flaps).2–8 PMID:26893990

  7. Why Do Grafts Clot Despite Access Blood Flow Surveillance?

    SciTech Connect

    Arbabzadeh, Massoud; Mepani, Bhupendra; Murray, Brian M.

    2002-12-15

    Purpose: To look in more detail at those grafts that clot despite access blood flow (ABF) surveillance and the outcome of radiological thrombectomy in those grafts. Methods: Retrospective review was carried out of all polytetrafluoroethylene grafts that clotted from September 1, 1998 to October 30, 2000. During this period, each graft had ABF measured monthly and was referred for prophylactic angioplasty if flow fell below 600 ml/min or by 25%. Results: Thirty-one of 62 monitored grafts clotted (0.44 episodes per patient per month). Five were surgically thrombectomized and 19 were radiologically thrombectomized. The last available ABF prior to graft thrombosis averaged 804 {+-} 108 ml/min and ranged from 215 to 2497 ml/min.Nine of the 23 grafts failed to trigger either of the ABF criteria prior to initial thrombosis. All but one of the 17 grafts throbolysedradiologically showed evidence of significant (>50%) venous stenoses,though additional lesions were found in nine. Thrombolysis was successful in 14 grafts, with ABF rising from 693 {+-} 96 to 941 {+-} 135 ml/min (p <0.05). Six additional grafts reclotted and were lost (6-month graft survival 37%). Conclusion: (1) A significant proportion (40%)of graft thromboses that occur despite ABF surveillance occur in grafts with preserved ABF (>600 ml/min); (2) over 70% can be successfully thrombectomized /angioplastied with about 35% long-term (6 months)survival.

  8. Renal amyloidosis followed more than 5 years: report of 12 cases.

    PubMed

    Kaaroud, H; Boubaker, K; Béji, S; Abderrahim, E; Moussa, F Ben; Turki, S; Goucha, R; Hedri, H; El Younsi, F; Kheder, A; Maiz, H Ben

    2004-01-01

    Renal involvement with amyloidosis is common but causes patient survival to be poor, rarely reaching 5 years. In this study, we retrospectively reviewed clinical and biological characteristics as well as treatments and outcomes of patients with renal amyloidosis followed for more than 5 years. Between 1975 and 2003, 485 patients were diagnosed with renal amyloidosis including only 12 patients who were followed more than 5 years. The six men and six women of mean age 42.4 years (range 18 to 66 years) displayed renal signs of lower limb edema in all cases; hypertension in four cases, proteinuria on urinalysis in all cases with microscopic hematuria in five cases. Biological tests showed nephrotic syndrome in 11 patients, normal renal function in nine patients, and renal failure in three patients whose mean creatinine was 481.6 micromol/L (range 294 to 726). The amyloidosis was AA type in 11 cases and non-AA in one case. An etiologic survey revealed spondylarthropathy in one patient, pulmonary tuberculosis in two patients, chronic bronchitis in three patients, hepatic hydatic cyst in one patient, Mediterranean familial fever in two patients, Crohn's disease in one patient, Hodgkin's lymphoma in one patient, and multiple myeloma in one patient. Specific treatment was initiated with colchicine in seven patients. At a 110-month mean follow-up (range 53 to 153 months), remission of nephrotic syndrome was observed in four cases, progression to chronic renal failure in two patients, and to end-stage renal failure in five cases (range 53 to 196 months), with stabilization of renal function in seven patients. In conclusion, primary amyloid disease should be optimally suppressed in patients with renal involvement. The role of this treatment in remission of renal amyloidosis is not well established. This efficacy of the treatment has been demonstrated in some patients with improved survival.

  9. [Kidney grafts from elderly donors].

    PubMed

    Hiesse, Christian; Pessione, Fabienne; Cohen, Sophie

    2003-06-07

    FROM AN EPIDEMIOLOGICAL POINT OF VIEW: The epidemiology of renal transplantation had greatly changed over the past 10 years. The increasing number of patients with renal failure and candidates for transplantation increases the demand for grafts, whereas the sampling rate of organs remains stable. The mean age of the donors is rising, hence underlining the question of the use of organs of so-called "borderline" quality. THE WEAK POINTS OF ELDERLY GRAFTS: Aging of the kidneys affects the structure of the parenchyma and renal function, which decreases, notably in hypertensive persons. The elderly graft exhibits a critical mass of nephrons that is insufficient to fulfil the functional requirements of a poorly equipped recipient. The recipient is more sensitive to the added agressions: prolonged ischemia and immunological and medicinal agressions. THE RESULTS OF RENAL GRAFT FROM ELDERLY DONORS: They are quantitatively and qualitatively inferior to those of renal transplants from "ideal" donors. The donor's age is a significant factor influencing negatively influences the survival of the transplanted kidney, but dependent on past vascular history. Good results regarding the maintenance of dialysis are obtained by selecting the donors and by avoiding added risk factors. THE ASSESSMENT OF A GRAFT FROM AN ELDERLY DONOR: This, basically, relies on clinical criteria: donor's history, cause of death and accurate measurement of the renal function. A biopsy of the graft, at the time of sampling, provides useful information. TRANSPLANTATION STRATEGY OF A GRAFT FROM AN ELDERLY DONOR: Donor-recipient matching by age is a common approach. Grafting of both kidneys in the same recipient is a method presently under assessment. The episode of ischemia must be reduced and the immunosuppressive therapy adapted.

  10. Sudden and unexpected death between 1 and 5 years.

    PubMed Central

    Southall, D P; Stebbens, V; Shinebourne, E A

    1987-01-01

    Of a population of 9856 children followed up from birth, 9251 of whom underwent 24 hour tape recordings of electrocardiograms and abdominal wall breathing movements during early infancy, five died suddenly and unexpectedly at home at ages ranging from 16 months to 4 years. Postmortem examination, including full histological and microbiological investigations. failed to identify abnormalities ordinarily associated with death in all five cases. Two of the children were known to have had frequent cyanotic episodes and died during these events. In the three remaining cases there was no previous history of cyanotic or apnoeic episodes. The death of one of these three children was seen by his parents and the clinical features suggested that apnoea rather than a cardiac arrhythmia was the primary mechanism for his death. As in infancy, sudden and unexpected death for which no adequate cause is found at necropsy seems to constitute a major component of mortality between 1 and 5 years. PMID:3632016

  11. Pyomyositis in a 5-year-old child.

    PubMed

    Romeo, S; Sunshine, S

    2000-07-01

    We present a case of pyomyositis in an otherwise healthy 5-year-old child that underscores the potential for serious, life-threatening complications. Pyomyositis of the gluteal, psoas, and iliacus muscles was associated with osteomyelitis, septic arthritis, a large inferior vena cava thrombus, septic pulmonary emboli, and eventual pneumonia. Primary pyomyositis is a purulent infection of striated muscle thought to be caused by seeding from a transient bacteremia. The focal infection typically forms an abscess that generally responds to intravenous antibiotics and occasionally requires adjunctive computed tomography-guided aspiration and drainage. This localized infectious process rarely produces further sequelae unless treatment is delayed. Pyomyositis is rare in healthy individuals and requires a high clinical suspicion in patients who present with fever, leukocytosis, and localized pain.

  12. Statistical analyses for NANOGrav 5-year timing residuals

    NASA Astrophysics Data System (ADS)

    Wang, Yan; Cordes, James M.; Jenet, Fredrick A.; Chatterjee, Shami; Demorest, Paul B.; Dolch, Timothy; Ellis, Justin A.; Lam, Michael T.; Madison, Dustin R.; McLaughlin, Maura A.; Perrodin, Delphine; Rankin, Joanna; Siemens, Xavier; Vallisneri, Michele

    2017-02-01

    In pulsar timing, timing residuals are the differences between the observed times of arrival and predictions from the timing model. A comprehensive timing model will produce featureless residuals, which are presumably composed of dominating noise and weak physical effects excluded from the timing model (e.g. gravitational waves). In order to apply optimal statistical methods for detecting weak gravitational wave signals, we need to know the statistical properties of noise components in the residuals. In this paper we utilize a variety of non-parametric statistical tests to analyze the whiteness and Gaussianity of the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) 5-year timing data, which are obtained from Arecibo Observatory and Green Bank Telescope from 2005 to 2010. We find that most of the data are consistent with white noise; many data deviate from Gaussianity at different levels, nevertheless, removing outliers in some pulsars will mitigate the deviations.

  13. Modifiable diarrhoea risk factors in Egyptian children aged <5 years.

    PubMed

    Mansour, A M; Mohammady, H El; Shabrawi, M El; Shabaan, S Y; Zekri, M Abou; Nassar, M; Salem, M E; Mostafa, M; Riddle, M S; Klena, J D; Messih, I A Abdel; Levin, S; Young, S Y N

    2013-12-01

    By conducting a case-control study in two university hospitals, we explored the association between modifiable risk behaviours and diarrhoea. Children aged <5 years attending outpatient clinics for diarrhoea were matched by age and sex with controls. Data were collected on family demographics, socioeconomic indicators, and risk behaviour practices. Two rectal swabs and a stool specimen were collected from cases and controls. Samples were cultured for bacterial pathogens using standard techniques and tested by ELISA to detect rotavirus and Cryptosporidium spp. Four hundred cases and controls were enrolled between 2007 and 2009. The strongest independent risk factors for diarrhoea were: presence of another household member with diarrhoea [matched odds ratio (mOR) 4.9, 95% CI 2.8-8.4] in the week preceding the survey, introduction to a new kind of food (mOR 3, 95% CI 1.7-5.4), and the child being cared for outside home (mOR 2.6, 95% CI 1.3-5.2). While these risk factors are not identifiable, in some age groups more easily modifiable risk factors were identified including: having no soap for handwashing (mOR 6.3, 95% CI 1.2-33.9) for children aged 7-12 months, and pacifier use (mOR 1.9, 95% CI 1.0-3.5) in children aged 0-6 months. In total, the findings of this study suggest that community-based interventions to improve practices related to sanitation and hygiene, handwashing and food could be utilized to reduce the burden of diarrhoea in Egyptian children aged <5 years.

  14. Proximal Tibial Bone Graft

    MedlinePlus

    ... All Site Content AOFAS / FootCareMD / Treatments Proximal Tibial Bone Graft Page Content What is a bone graft? Bone grafts may be needed for various ... the proximal tibia. What is a proximal tibial bone graft? Proximal tibial bone graft (PTBG) is a ...

  15. Coronary Artery Bypass Grafting

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  16. Circulating angiogenic factors associated with response and survival in patients with acute graft-versus-host disease: results from Blood and Marrow Transplant Clinical Trials Network 0302 and 0802.

    PubMed

    Holtan, Shernan G; Verneris, Michael R; Schultz, Kirk R; Newell, Laura F; Meyers, Gabrielle; He, Fiona; DeFor, Todd E; Vercellotti, Gregory M; Slungaard, Arne; MacMillan, Margaret L; Cooley, Sarah A; Blazar, Bruce R; Panoskaltsis-Mortari, Angela; Weisdorf, Daniel J

    2015-06-01

    Circulating angiogenic factors (AF) reflect tissue healing capacity, although some AF can also contribute to inflammation and are indicative of endothelial dysfunction. The AF milieu in acute graft-versus-host disease (aGVHD) has not been broadly characterized. We hypothesized that patients with abundant AF involved in repair/regeneration versus those mediating damage/inflammation would have improved outcomes. Circulating AF known predominantly for repair/regeneration (epidermal growth factor [EGF], fibroblast growth factor-1 and -2, heparin binding-EGF-like growth factor, and vascular endothelial growth factor-A [VEGF-A], -C, and -D) and for damage/inflammation (angiopoietin-2, endothelin-1, soluble endoglin [sEng], follistatin [FS], leptin, and placental growth factor [PlGF]) were measured in a discovery set of hematopoietic cell recipients with grade III and IV aGVHD and compared with controls, then validated in 2 aGVHD cohorts enrolled in Blood and Marrow Transplant Clinical Trials Network (BMT CTN) trials 0302 (n = 105, serum) and 0802 (n = 158, plasma) versus controls without aGVHD (n = 53, serum). Levels of EGF and VEGF-A were lower than in controls at the onset of aGVHD in both trials and higher with complete response to first-line aGVHD therapy in CTN 0802. FS and PlGF were elevated in aGVHD measured in either serum or plasma. At day 28 after initial aGVHD therapy, elevated FS was an independent negative prognostic factor for survival in both cohorts (hazard ratio, 9.3 in CTN 0302; 2.8 in CTN 0802). These data suggest that circulating AF are associated with clinical outcomes after aGVHD and, thus, may contribute to both pathogenesis and recovery.

  17. Minimal access surgery in children – 5 years institutional experience

    PubMed Central

    Oak, S N; Parelkar, S V; Akhtar, T; Joshi, M; Pathak, R; Viswanath, N; V, K Satish Kumar; Ravikiran, K; Manjunath, L; Ahmed, A

    2005-01-01

    Context: Minimal access surgery (MAS) in children are common place and performed worldwide with gratifying results as the learning curve of the surgeon attains plateau. We share our experience of this technically evolving modality of surgery, performed at our setup over a period of 5 years. We also review and individually compare the data for commonly performed procedures with other available series. Author also briefly discuss potential advantages of MAS in certain debatable conditions performed quickly and with cosmesis as open procedure. Materials and methods: We performed 677 MAS in children aged between 7 days and 12 years. Five hundred and sixty-eight of these were Laparoscopic procedures and 109 were Video assisted thoracoscopic surgeries (VATS). In all laparoscopic procedures, the primary port placement was by the Hasson's open technique. We have used 5, 3 and 2 mm instruments. Our study include 259 inguinal hernia, 161 Appendectomies, 95 VATS for empyema, 51 orchiopexies, 49 diagnostic laparoscopy, 29 cholecystectomies, 22 adhesionlysis and other uncommonly performed procedures. Results: The ultimate outcome of all the performed procedures showed gratifying trend, the data of which are discussed in detail in the article. Conclusion: As we gained experience the operating time showed a decreasing trend, the complication rates and conversion rate also reduced. The advantages we came across were better postoperative appearances, less pain and early return to unrestricted activities. PMID:21188009

  18. Calcium supplements and cardiovascular risk: 5 years on.

    PubMed

    Bolland, Mark J; Grey, Andrew; Reid, Ian R

    2013-10-01

    Calcium supplements have been widely used by older men and women. However, in little more than a decade, authoritative recommendations have changed from encouraging the widespread use of calcium supplements to stating that they should not be used for primary prevention of fractures. This substantial shift in recommendations has occurred as a result of accumulated evidence of marginal antifracture efficacy, and important adverse effects from large randomized controlled trials of calcium or coadministered calcium and vitamin D supplements. In this review, we discuss this evidence, with a particular focus on increased cardiovascular risk with calcium supplements, which we first described 5 years ago. Calcium supplements with or without vitamin D marginally reduce total fractures but do not prevent hip fractures in community-dwelling individuals. They also cause kidney stones, acute gastrointestinal events, and increase the risk of myocardial infarction and stroke. Any benefit of calcium supplements on preventing fracture is outweighed by increased cardiovascular events. While there is little evidence to suggest that dietary calcium intake is associated with cardiovascular risk, there is also little evidence that it is associated with fracture risk. Therefore, for the majority of people, dietary calcium intake does not require close scrutiny. Because of the unfavorable risk/benefit profile, widespread prescribing of calcium supplements to prevent fractures should be abandoned. Patients at high risk of fracture should be encouraged to take agents with proven efficacy in preventing vertebral and nonvertebral fractures.

  19. Novel expansion techniques for skin grafts

    PubMed Central

    Kadam, Dinesh

    2016-01-01

    The quest for skin expansion is not restricted to cover a large area alone, but to produce acceptable uniform surfaces, robust engraftment to withstand mechanical shear and infection, with a minimal donor morbidity. Ease of the technique, shorter healing period and reproducible results are essential parameters to adopt novel techniques. Significant advances seen in four fronts of autologous grafting are: (1) Dermal–epidermal graft expansion techniques, (2) epidermal graft harvests technique, (3) melanocyte-rich basal cell therapy for vitiligo and (4) robust and faster autologous cell cultures. Meek's original concept that the sum of perimeter of smaller grafts is larger than the harvested graft, and smaller the graft size, the greater is the potential for regeneration is witnessed in newer modification. Further, as graft size becomes smaller or minced, these micrografts can survive on the wound bed exudate irrespective of their dermal orientation. Expansion produced by 4 mm × 4 mm sized Meek micrografts is 10-folds, similarly 0.8 mm × 0.8 mm size micrografts produce 100-fold expansion, which becomes 700-fold with pixel grafts of 0.3 mm × 0.3 mm size. Fractional skin harvest is another new technique with 700 μ size full thickness graft. These provide instant autologous non-cultured graft to cover extensive areas with similar quality of engraftment surface as split skin grafts. Newer tools for epidermal blister graft harvest quickly, with uniform size to produce 7-fold expansions with reproducible results. In addition, donor area heals faster with minimal scar. Melanocyte-rich cell suspension is utilised in vitiligo surgery tapping the potential of hair root melanocytes. Further advances in the cell culture to reduce the cultivation time and provide stronger epidermal sheets with dermal carrier are seen in trials. PMID:27274117

  20. The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution

    PubMed Central

    Pulitanó, Carlo; Crawford, Michael; Ho, Phong; Gallagher, James; Joseph, David; Stephen, Michael; Sandroussi, Charbel

    2013-01-01

    Background Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection. Methods Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed. Results A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively. Conclusions The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation. PMID:23458108

  1. Working with Workflows: Highlights from 5 years Building Scientific Workflows

    SciTech Connect

    Critchlow, Terence J.; Altintas, Ilkay; Chin, George; Crawl, Daniel; Iyer, H.; Khan, Ayla; Klasky, S.; Koehler, Sven; Ludaescher, Bertram T.; Mouallem, Pierre; Nagappan, Mie; Podhorszki, Norbert; Shoshani, Arie; Silva, C.; Tchoua, Roselynne; Vouk, M.

    2011-07-30

    In 2006, the SciDAC Scientific Data Management (SDM) Center proposed to continue its work deploying leading edge data management and analysis capabilities to scientific applications. One of three thrust areas within the proposed center was focused on Scientific Process Automation (SPA) using workflow technology. As a founding member of the Kepler consortium [LAB+09], the SDM Center team was well positioned to begin deploying workflows immediately. We were also keenly aware of some of the deficiencies in Kepler when applied to high performance computing workflows, which allowed us to focus our research and development efforts on critical new capabilities which were ultimately integrated into the Kepler open source distribution, benefiting the entire community. Significant work was required to ensure Kepler was capable of supporting large-scale production runs for SciDAC applications. Our work on generic actors and templates have improved the portability of workflows across machines and provided a higher level of abstraction for workflow developers. Fault tolerance and provenance tracking were obvious areas for improvement within Kepler given the longevity and complexity of our target workflows. To monitor workflow execution, we developed and deployed a web-based dashboard. We then generalized this interface and released it so it could be deployed at other locations. Outreach has always been a primary focus of our work and we had many successful deployments across a number of scientific domains while continually publishing and presenting our work. This short paper describes our most significant accomplishments over the past 5 years. Additional information about the SDM Center can be found in the companion paper: The Scientific Data Management Center: Available Technologies and Highlights.

  2. Graft irradiation abrogates graft-versus-host disease in combined pancreas-spleen transplantation

    SciTech Connect

    Schulak, J.A.; Sharp, W.J.

    1986-04-01

    A model of combined pancreas-spleen transplantation (PST) was studied in LBN F1 recipients of Lewis grafts in order to evaluate the efficacy of pretransplant graft irradiation in preventing lethal graft-versus-host disease (GVHD). Recipients of unmodified PST uniformly developed severe GVHD and died (MST = 16.7 +/- 3.8 days). Whole body donor irradiation with either 500 or 250 rad prevented lethal GVHD. Similarly, ex vivo graft irradiation with either 1000 or 500 rad also resulted in normal weight gain, graft function, and host survival for the 6-week study period. Conversely, delay of graft irradiation until 3 days after transplantation failed to prevent this complication (MST = 15.8 +/- 3.7 days). Recipients of irradiated grafts displayed glucose tolerance tests that were identical to those in the control group indicating that the doses of radiation employed in these experiments were not deleterious to islet function. Irradiated spleen grafts appeared histologically normal at 6 weeks after transplantation. Cells derived from these grafts failed to stimulate lymph node enlargement in a popliteal lymph node assay for GVHD, suggesting that these spleens may have become repopulated with host cells. These experiments confirm that PST has the potential to cause lethal GVHD and suggest that pretransplant graft irradiation may be used to prevent its occurrence.

  3. Derivation of a Predictive Model for Graft Loss Following Acute Kidney Injury in Kidney Transplant Recipients

    PubMed Central

    Molnar, Amber O.; van Walraven, Carl; Fergusson, Dean; Garg, Amit X.; Knoll, Greg

    2017-01-01

    Background: Acute kidney injury (AKI) is common in the kidney transplant population. Objective: To derive a multivariable survival model that predicts time to graft loss following AKI. Design: Retrospective cohort study using health care administrative and laboratory databases. Setting: Southwestern Ontario (1999-2013) and Ottawa, Ontario, Canada (1996-2013). Patients: We included first-time kidney only transplant recipients who had a hospitalization with AKI 6 months or greater following transplant. Measurements: AKI was defined using the Acute Kidney Injury Network criteria (stage 1 or greater). The first episode of AKI was included in the analysis. Graft loss was defined by return to dialysis or repeat kidney transplant. Methods: We performed a competing risk survival regression analysis using the Fine and Gray method and modified the model into a simple point system. Graft loss with death as a competing event was the primary outcome of interest. Results: A total of 315 kidney transplant recipients who had a hospitalization with AKI 6 months or greater following transplant were included. The median (interquartile range) follow-up time was 6.7 (3.3-10.3) years. Graft loss occurred in 27.6% of the cohort. The final model included 6 variables associated with an increased risk of graft loss: younger age, increased severity of AKI, failure to recover from AKI, lower baseline estimated glomerular filtration rate, increased time from kidney transplant to AKI admission, and receipt of a kidney from a deceased donor. The risk score had a concordance probability of 0.75 (95% confidence interval [CI], 0.69-0.82). The predicted 5-year risk of graft loss fell within the 95% CI of the observed risk more than 95% of the time. Limitations: The CIs of the estimates were wide, and model overfitting is possible due to the limited sample size; the risk score requires validation to determine its clinical utility. Conclusions: Our prognostic risk score uses commonly available

  4. Coral reefs in Saudi Arabia: 3.5 years after the Gulf War oil spill

    NASA Astrophysics Data System (ADS)

    Vogt, I. P.

    1995-11-01

    As a consequence of the 1991 Gulf War, 6-8 million barrels of oil were released into the marine environment and a total of 1.12 billion barrels were burned in the Kuwaiti oil fields. In order to detect delayed effects of the Gulf War pollution, six permanent transect lines were placed on Saudi Arabian offshore and inshore reefs. A comparison of three sets of video recordings taken between 1992 and 1994 indicated a significant increase in live coral cover. Therefore, it has been concluded that corals in Saudi Arabia survived the largest oil spill on record remarkably unscathed, with no visible signs of immediate or late effects up to 3.5 years after the Gulf War.

  5. A 5-year experience with an elective scholarly concentrations program

    PubMed Central

    George, Paul; Green, Emily P.; Park, Yoon S.; Gruppuso, Philip A.

    2015-01-01

    Problem Programs that encourage scholarly activities beyond the core curriculum and traditional biomedical research are now commonplace among US medical schools. Few studies have generated outcome data for these programs. The goal of the present study was to address this gap. Intervention The Scholarly Concentration (SC) Program, established in 2006 at the Warren Alpert Medical School of Brown University, is a 4-year elective program that not only encourages students to pursue scholarly work that may include traditional biomedical research but also seeks to broaden students’ focus to include less traditional areas. We compared characteristics and academic performance of SC students and non-SC students for the graduating classes of 2010–2014. Context Approximately one-third of our students opt to complete an SC during their 4-year undergraduate medical education. Because this program is additional to the regular MD curriculum, we sought to investigate whether SC students sustained the academic achievement of non-SC students while at the same time producing scholarly work as part of the program. Outcome Over 5 years, 35% of students elected to enter the program and approximately 81% of these students completed the program. The parameters that were similar for both SC and non-SC students were age at matriculation, admission route, proportion of undergraduate science majors, and number of undergraduate science courses. Most academic indicators, including United States Medical Licensing Examinations scores, were similar for the two groups; however, SC students achieved more honors in the six core clerkships and were more likely to be inducted into the medical school's two honor societies. Residency specialties selected by graduates in the two groups were similar. SC students published an average of 1.3 peer-reviewed manuscripts per student, higher than the 0.8 manuscripts per non-SC student (p=0.013). Conclusions An elective, interdisciplinary scholarly program with

  6. Incidence, risk factors, and long-term outcomes of sclerotic graft-versus-host disease after allogeneic hematopoietic cell transplantation.

    PubMed

    Uhm, Jieun; Hamad, Nada; Shin, Elizabeth M; Michelis, Fotios V; Shanavas, Mohamed; Gupta, Vikas; Kuruvilla, John; Lipton, Jeffrey H; Messner, Hans A; Seftel, Matthew; Kim, Dennis Dong Hwan

    2014-11-01

    Sclerotic chronic graft-versus-host disease (sclGVHD) is associated with significant morbidity and a poor quality of life. We reviewed 502 patients diagnosed with chronic GVHD and analyzed the incidence and risk factors of sclGVHD and long-term outcomes and immunosuppressive therapy (IST) cessation in patients with sclGVHD. With a median onset at 18 months the cumulative incidence of sclGVHD was estimated at 22.6% at 5 years (95% confidence interval, 18.6% to 26.8%). Univariate and multivariate analysis identified 2 risk factors for sclGVHD: non-T cell depletion (hazard ratio [HR] 9.09, P < .001) and peripheral blood stem cell (HR 3.87, P < .001). Overall survival (OS) at 5 years was significantly better in the sclGVHD group (88.1%) compared with the non-sclGVHD group (62.7%; P < .001), as were nonrelapse mortality (7.3% versus 21.5% at 5 years) and relapse rates (9.1% versus 19.3% at 5 years). There was no difference in the rate of IST cessation at 5 years (44.8% versus 49.9%, P = .312), but there was a trend of longer IST duration in the sclGVHD group compared with the non-sclGVHD group (median 71.6 months versus 62.9 months). In conclusion, T cell depletion and graft source affect the risk of sclGVHD. SclGVHD did not adversely affect long-term outcomes or IST duration.

  7. Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol

    PubMed Central

    Willicombe, Michelle; Rizzello, Anna; Goodall, Dawn; Papalois, Vassilios; McLean, Adam G; Taube, David

    2017-01-01

    AIM To analyse the risk factors and outcomes of delayed graft function (DGF) in patients receiving a steroid sparing protocol. METHODS Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135 (31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression protocol. RESULTS Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function (PGF) group respectively, P = 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively, P < 0.001. Overall rejection free survival was no different between the DGF and PGF groups with a 1 and 5 year rejection free survival in the DGF group of 77.7% and 67.8% compared with 81.3% and 75.3% in the PGF group, P = 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis vintage. CONCLUSION Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF. PMID:28280693

  8. 5-Year Downstream Outcomes Following Prostate-Specific Antigen (PSA) Screening in Older Men

    PubMed Central

    Walter, Louise C.; Fung, Kathy Z.; Kirby, Katharine A.; Shi, Ying; Espaldon, Roxanne; O'Brien, Sarah; Freedland, Stephen J.; Powell, Adam A.; Hoffman, Richard M.

    2013-01-01

    Background Despite ongoing controversies surrounding PSA screening, large numbers of men age 65+ undergo screening. However, there are few data quantifying the chain of events following screening in clinical practice to better inform decisions. The objective of this study is to quantify 5-year downstream outcomes following a PSA screening result > 4 ng/ml in older men. Methods Longitudinal cohort study of 295,645 men age 65+ who underwent PSA screening in the VA healthcare system in 2003 and were followed for 5 years using national VA and Medicare data. Among men whose index screening PSA was > 4 ng/ml we determined the number who underwent biopsy, were diagnosed with prostate cancer, were treated and survived 5-years, according to baseline characteristics. Biopsy and treatment complications were also assessed. Results 25,208 (8.5%) men had an index PSA > 4 ng/ml. During 5-year follow-up, 8,313 (33%) men underwent at least one biopsy, 5,220 (63%) of men biopsied were diagnosed with prostate cancer of whom 4,284 (82%) were treated. Receipt of biopsy decreased with advancing age and worsening comorbidity (P<0.001), whereas the percentage treated for biopsy-detected cancer exceeded 75% even among men age 85+, those with Charlson score 3+, and those with low-risk cancer. Among men with biopsy-detected cancer, the risk of dying of non-prostate cancer causes increased with advancing age and comorbidity (P<0.001). 468 (6%) of men had 7-day biopsy complications. Treatment complications included 584 (14%) men with new incontinence and 588 (14%) men with new erectile dysfunction. Conclusions Receipt of biopsy is low in older men with abnormal screening PSA and decreases with advancing age and comorbidity. However, once biopsy detects cancer most men undergo immediate treatment regardless of advancing age, comorbidity, or low-risk cancer. Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA

  9. WMAP 5-year constraints on α and me

    NASA Astrophysics Data System (ADS)

    Scóccola, Claudia G.; Landau, Susana J.; Vucetich, Héctor

    2010-11-01

    We have studied the role of fundamental constants in an updated recombination scenario. We focus on the time variation of the fine structure constant α, and the electron mass me in the early Universe. In the last years, helium recombination has been studied in great detail revealing the importance of taking new physical processes into account in the calculation of the recombination history. The equations to solve the detailed recombination scenario can be found for example in Wong et al. 2008. In the equation for helium recombination, a term which accounts for the semi-forbidden transition 23p-11s is added. Furthermore, the continuum opacity of HI is taken into account by a modification in the escape probability of the photons that excite helium atoms, with the fitting formulae proposed Kholupenko et al 2007. We have analized the dependences of the quantities involved in the detailed recombination scenario on α and me. We have performed a statistical analysis with COSMOMC to constrain the variation of α and me at the time of neutral hydrogen formation. The observational set used for the analysis was data from the WMAP 5-year temperature and temperature-polarization power spectrum and other CMB experiments such as CBI, ACBAR and BOOMERANG and the power spectrum of the 2dFGRS. Considering the joint variation of α and me we obtain the following bounds: -0.011 < {Δα}/{α_0} < 0.019 and -0.068 < {Δ m_e}/{(m_e)_0 < 0.030 (68% c.l.). When considering only the variation of one fundamental constant we obtain: -0.010 < {Δ α}/{α_0} < 0.008 and -0.04 < {Δ m_e}/{(m_e)_0} < 0.02 (68% c.l.). We compare these results with the ones presented in Landau et al 2008, which were obtained in the standard recombination scenario and using WMAP 3 year release data. The constraints are tighter in the current analysis, which is an expectable fact since we are working with more accurate data from WMAP. The bounds obtained are consistent with null variation, for both α and me, but

  10. [Graft or CVC? A prosthetic graft is the better choice].

    PubMed

    Cifarelli, M

    2009-01-01

    and circular sections, separate-lumen CVCs, split CVCs, and so on. Also the radiological and ultrasound techniques of insertion have improved, thereby reducing risks and disadvantages. The choice of graft system or CVC is often determined not by clinical factors but by the preference or experience of the operator, the presence of a vascular surgeon, or a radiological staff experienced in vascular accesses. The probability of steno-occlusion of central veins, which may occur as early as 2 weeks after the procedure, could affect any other ''traditional'' vascular access in the corresponding limb owing to the high risk of arm edema. In the surgical timing, the preparation of a graft access should therefore precede the placement of a CVC. The refinement of endovascular procedures has allowed to increase the secondary patency considerably, permitting excellent survival of graft accesses. Statistical studies performed on large samples of patients have reported a marked increase in the mortality connected to CVC access, not only as a result of infection. There are, however, according to my surgical experience, some conditions in which the use of the CVC is a priority, namely in patients with severe cardiopathy and reduced ejection fraction in whom volume overload caused by a graft access increases the risk of cardiac failure; in pediatric patients weighing less than 20 kg, in whom a graft vascular access could cause notable, even insuperable, difficulties of construction and management, as well as negative psychological implications for the small patient; in very elderly patients in poor clinical condition with a short life expectancy or suffering from cancer, in whom a CVC could be used also for the infusion of chemotherapeutic drugs; and in patients with peripheral arteriopathy in whom the alternative is a graft in a lower limb, because of the high risk of ischemia.

  11. Electrostrictive Graft Elastomers

    NASA Technical Reports Server (NTRS)

    Su, Ji (Inventor); Harrison, Joycelyn S. (Inventor); St.Clair, Terry L. (Inventor)

    2003-01-01

    An electrostrictive graft elastomer has a backbone molecule which is a non-crystallizable, flexible macromolecular chain and a grafted polymer forming polar graft moieties with backbone molecules. The polar graft moieties have been rotated by an applied electric field, e.g., into substantial polar alignment. The rotation is sustained until the electric field is removed. In another embodiment, a process for producing strain in an elastomer includes: (a) providing a graft elastomer having a backbone molecule which is a non-crystallizable, flexible macromolecular chain and a grafted polymer forming polar graft moieties with backbone molecules; and (b) applying an electric field to the graft elastomer to rotate the polar graft moieties, e.g., into substantial polar alignment.

  12. [Skin graft, smoking and diabetes mellitus type 2].

    PubMed

    Pérez-Guisado, Joaquín; Fidalgo-Rodríguez, Félix T; Gaston, Kate L; Rioja, Luis F; Thomas, Steven J

    2012-01-01

    Smoking and hyperglycemia decrease the success of skin graft survival in specific circumstances. It is well known that smoking and diabetes mellitus (DM) type 2 increase the oxidative and impair the endothelial function. The objective of this retrospective study was to determine if smoking and DM type 2 are factors associated with lower skin graft survival, in different etiologies of the injury associated to the skin loss. It was a bicentric, retrospective, cross sectional case control study, carried out on 2457 medical patients who met the inclusion criteria. It was carried out over a 10 years period between January 2000-December 2009, at Reina Sofía University Hospital (Córdoba, Spain) and UAB Hospital at Birmingham (Alabama, USA). The percentage of successful graft for each group and its control were analyzed by Chi-square test. The confidence interval chosen for statistical differences was 95%. Smoking and DM type 2 decreased the percentage of skin graft survival when compared with their control groups. DM type 2 was associated with greater negative success on skin graft survival than smoking when compared with their control groups. There was a statistically significant drop in skin graft of 18% in smoking group (range: 68-86%) and 25% in DM type 2 group (53-78%). The OR showed a clear association between the risk factors studied and the lower skin graft success, being stronger for DM type 2. In conclusion, DM type 2 and smoking are factors associated to lower skin graft take.

  13. PRFM enhance wound healing process in skin graft.

    PubMed

    Reksodiputro, Mirta; Widodo, Dini; Bashiruddin, Jenny; Siregar, Nurjati; Malik, Safarina

    2014-12-01

    Facial plastic and reconstructive surgery often used skin graft on defects that cannot be covered primarily by a local flap. However, wound healing using skin graft is slow, most of the time the graft is contractured and the take of graft is not optimal. Platelet rich fibrin matrix (PRFM) is a new generation of concentrated platelets that produce natural fibrin and reported to speed up the healing process. Application of PRFM in the skin graft implants is expected to increase the survival of the graft. We used porcine as animal models to elucidate the effect of autologous PRFM on wound healing in full-thickness (FTSG) and split-thickness (STSG) skin grafts. Survival level of the skin graft was determined by using ImageJ software based on the formation of collagen type 1 and graft take. We observed that the use of PRFM in FTSG and STSG increased type 1 collagen formation. We also found that PRFM addition in STSG gave the best skin graft take.

  14. Seven-year follow-up of expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts.

    PubMed Central

    McAuley, C E; Steed, D L; Webster, M W

    1984-01-01

    Expanded polytetrafluoroethylene (PTFE) grafts have proven to be an acceptable short-term alternative for femoropopliteal reconstruction in those patients without suitable autologous saphenous vein. One hundred and twenty-seven femoropopliteal arterial bypass operations utilizing PTFE grafts were performed in 105 patients. Seven-year follow-up is now available for 20 grafts, 6-year follow-up for 47 grafts, and 5-year follow-up for 62 grafts. Graft occlusion was determined by angiography, Doppler assessment, loss of previously palpable pulses, or return of symptoms. Thirty nonocclusive graft losses were due to death, infection, aneurysm, amputation, or proximal occlusive disease. Overall cumulative patency rate, according to occlusive criteria alone and calculated by the life-table method, was 74% at 6 months, 63% at 1 year, 48% at 3 years, 40% at 5 years, and 35% at 7 years. Excluding early bypass failures (less than 1 year patency), 75% of grafts were patent at 3 years, 63% at 5 years, and 55% patent 7 years following operation. Diabetes mellitus was associated with a significantly lower patency rate. Patency rates were not adversely affected by graft diameter, distal popliteal anastomotic site, number of patent runoff vessels, preoperative symptoms, or prior arterial reconstruction. In patients without suitable autologous saphenous vein, the PTFE graft has proven to be a durable and dependable long-term alternative for femoropopliteal reconstruction. PMID:6691731

  15. A 5-year follow-up study on one-stage implants inserted concomitantly with localized alveolar ridge augmentation.

    PubMed

    Juodzbalys, G; Raustia, A M; Kubilius, R

    2007-10-01

    The aim of this study was to evaluate the success of one-stage implants placed at the time of alveolar bone augmentation using simultaneous guided bone regeneration technique with a collagen barrier membrane in patients suffering from insufficient bone width. Seventeen patients were treated with 20 one-stage OSTEOFIX (Oulu, Finland) implants using simultaneous guided bone regeneration technique. Dehiscence defects were filled by bovine bone mineral Bio-Oss and covered with collagen membrane. Clinical and radiographic parameters of the peri-implant conditions were assessed at the moment of prosthesis placement and at 1- and 5-year follow-ups. Diagnostic dehiscence defect measurements after implant placement showed that the mean vertical defect varied from 3.8 mm to 10.0 mm. At the moment of prosthesis placement and at 1- and 5-year follow-ups all implants were stable, painless and without biological complications. Clinical and radiographic parameters of the peri-implant conditions remained stable during follow-up. The cumulative implant survival rate was 100% after the 5-year observation period and the success rate for all pooled implants was 90%. The present study showed predictable treatment outcomes recorded after 5 years of function for one-stage OSTEOFIX (Oulu, Finland) oral implants placed simultaneously with guided bone regeneration using collagen membrane and deproteinized bovine bone mineral.

  16. Osteoporosis and the risk of symptomatic nephrolithiasis: a population-based 5-year follow-up study in Taiwan.

    PubMed

    Chou, Ping-Song; Kuo, Chun-Nan; Hung, Kuo-Sheng; Chang, Wei-Chiao; Liao, Yu-Chien; Chi, Ying-Chen; Chou, Wei-Po; Tsai, Shih-Jen; Liu, Mu-En; Lai, Chiou-Lian; Chou, Yii-Her; Chang, Wei-Pin

    2014-10-01

    This study estimates the risk of symptomatic nephrolithiasis within 5 years of newly diagnosed osteoporosis in a Taiwan population. This cohort study consisted of patients with a diagnosis of osteoporosis between Jan. 2003 and Dec. 2005 (N = 1634). Four age- and gender- matched patients for every patient in the study cohort were selected using random sampling as the comparison cohort (N = 6536). All patients were tracked for 5 years from the date of cohort entry to identify whether they developed symptomatic nephrolithiasis. Cox proportional hazard regressions were performed to evaluate the 5-year nephrolithiasis-free survival rates. During the 5-year follow-up period, 60 osteoporosis patients (3.7%) and 165 non- osteoporosis patients (2.5%) developed symptomatic nephrolithiasis. The adjusted HR of symptomatic nephrolithiasis was 1.38 times greater risk for patients with osteoporosis than for the comparison cohort (95% confidence interval (CI) 1.03-1.86; P < .05). Osteoporosis is very likely to be an independent risk factor for subsequent diagnosis of symptomatic nephrolithiasis.

  17. Surgical treatment of cardiac tumors: a 5-year experience from a single cardiac center

    PubMed Central

    Yin, Liang; He, Dengke; Shen, Hua; Ling, Xinyu; Li, Wei; Xue, Qian

    2016-01-01

    Background Cardiac tumors are rare but manifested with various clinical presentations and often cause unexpected symptoms or sudden death. The objective is to review the clinical presentation, histopathological spectrum, mortality and follow-up data of patients with cardiac tumors following surgery treatment over a period of 5 years. Methods We retrospectively collected the medical records of all patients diagnosed of cardiac tumors in the period between January 2008 and December 2013 at the cardiac center of our university. Clinical histories, perioperative data, surgical findings, efficacy and follow-up data were reviewed in our study. Patients were divided into two groups according to site distribution of the tumors in the heart. Results A total of 131 patients underwent surgical treatment of cardiac tumors were enrolled in this study, with a mean age of 51.39±16.37. The result of analysis showed that 79.47% (n=104) of the primary intracardiac tumors were benign, while primary malignant neoplasms accounted for 16.03% (n=21) of all patients, with the remainder (n=6, 4.6%) metastatic tumors transferred from other organs. Among all patients there were 2 in-hospital deaths and the survival rate in all patients at 1-year, 3-year and 5-year follow up was 83.20%, 78.62% and 66.41% respectively. Both patients with tumors in the left and right heart had similar basic characteristics except sex gender (P=0.002), BSA (P=0.045) and weight (P=0.033). Compared with patients with tumors in the right heart, patients with tumors in the left heart had significant higher CPB time (P<0.001), cross clamp time (P<0.001) and time of mechanical ventilation (P<0.001), and they also had longer ICU stay (P<0.001) but not total hospital stay (P=0.434). Conclusions Surgical resection represents an effective protocol in treating cardiac tumors. Data in our study of cardiac tumors on frequency and allocation were consistent with previous reports which may provide useful clinical evidence on

  18. Partial Breast Radiation Therapy With Proton Beam: 5-Year Results With Cosmetic Outcomes

    SciTech Connect

    Bush, David A.; Do, Sharon; Lum, Sharon; Garberoglio, Carlos; Mirshahidi, Hamid; Patyal, Baldev; Grove, Roger; Slater, Jerry D.

    2014-11-01

    Purpose: We updated our previous report of a phase 2 trial using proton beam radiation therapy to deliver partial breast irradiation (PBI) in patients with early stage breast cancer. Methods and Materials: Eligible subjects had invasive nonlobular carcinoma with a maximal dimension of 3 cm. Patients underwent partial mastectomy with negative margins; axillary lymph nodes were negative on sampling. Subjects received postoperative proton beam radiation therapy to the surgical bed. The dose delivered was 40 Gy in 10 fractions, once daily over 2 weeks. Multiple fields were treated daily, and skin-sparing techniques were used. Following treatment, patients were evaluated with clinical assessments and annual mammograms to monitor toxicity, tumor recurrence, and cosmesis. Results: One hundred subjects were enrolled and treated. All patients completed the assigned treatment and were available for post-treatment analysis. The median follow-up was 60 months. Patients had a mean age of 63 years; 90% had ductal histology; the average tumor size was 1.3 cm. Actuarial data at 5 years included ipsilateral breast tumor recurrence-free survival of 97% (95% confidence interval: 100%-93%); disease-free survival of 94%; and overall survival of 95%. There were no cases of grade 3 or higher acute skin reactions, and late skin reactions included 7 cases of grade 1 telangiectasia. Patient- and physician-reported cosmesis was good to excellent in 90% of responses, was not changed from baseline measurements, and was well maintained throughout the entire 5-year follow-up period. Conclusions: Proton beam radiation therapy for PBI produced excellent ipsilateral breast recurrence-free survival with minimal toxicity. The treatment proved to be adaptable to all breast sizes and lumpectomy cavity configurations. Cosmetic results appear to be excellent and unchanged from baseline out to 5 years following treatment. Cosmetic results may be improved over those reported with photon

  19. Neonatal striatal grafts prevent lethal syndrome produced by bilateral intrastriatal injection of kainic acid.

    PubMed

    Tulipan, N; Huang, S; Whetsell, W O; Allen, G S

    1986-07-02

    It is reported that unilateral grafts of neonatal striatal tissue protect the recipient from the lethal aphagia and adipsia produced by bilateral intrastriatal injection of 10 nmol of kainic acid in rats. It is shown that neither adult striatum nor neonatal tissue from other sites have the same lifesaving effect and that the salutary effect of the graft is dependent upon graft survival. Grafts from a histoincompatible donor are apparently rejected, leading to the death of the recipient. Cyclosporine inhibits rejection thereby enabling recipient survival. It is postulated that the graft exerts a neurohumoral influence that protects the striatum from the toxic effect of kainate.

  20. A Reappraisal of Saphenous Vein Grafting

    PubMed Central

    Yuan, Shi-Min; Jing, Hua

    2011-01-01

    Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy. PMID:21245602

  1. Salvage HDR Brachytherapy for Recurrent Prostate Cancer After Previous Definitive Radiation Therapy: 5-Year Outcomes

    SciTech Connect

    Chen, Chien Peter; Weinberg, Vivian; Shinohara, Katsuto; Roach, Mack; Nash, Marc; Gottschalk, Alexander; Chang, Albert J.; Hsu, I-Chow

    2013-06-01

    Purpose: Evaluate efficacy and toxicity of salvage high-dose-rate brachytherapy (HDRB) for locally recurrent prostate cancer after definitive radiation therapy (RT). Methods and Materials: We retrospectively analyzed 52 consecutively accrued patients undergoing salvage HDRB between 1998 and 2009 for locally recurrent prostate cancer after previous definitive RT. After pathologic confirmation of locally recurrent disease, patients received 36 Gy in 6 fractions. Twenty-four patients received neoadjuvant hormonal therapy before salvage, and no patients received adjuvant hormonal therapy. Determination of biochemical failure after salvage HDRB was based on the Phoenix definition. Overall survival (OS) and bF distributions were calculated using the Kaplan-Meier method. Univariate analyses were performed to identify predictors of biochemical control. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities, based on Common Terminology Criteria for Adverse Events (version 4), were documented. Results: Median follow-up after salvage HDRB was 59.6 months. The 5-year OS estimate was 92% (95% confidence interval [CI]: 80%-97%) with median survival not yet reached. Five-year biochemical control after salvage was 51% (95% CI: 34%-66%). Median PSA nadir postsalvage was 0.1 (range: 0-7.2) reached at a median of 10.2 months after completing HDRB. As for complications, acute and late grade 3 GU toxicities were observed in only 2% and 2%, respectively. No grade 2 or higher acute GI events and 4% grade 2 GI late events were observed. On univariate analysis, disease-free interval after initial definitive RT (P=.07), percent of positive cores at the time of diagnosis (P=.08), interval from first recurrence to salvage HDRB (P=.09), and pre-HDRB prostate-specific antigen (P=.07) were each of borderline significance in predicting biochemical control after salvage HDRB. Conclusions: Prostate HDRB is an effective salvage modality with relatively few long-term toxicities. We

  2. A case of primary spinal atypical teratoid/rhabdoid tumor in a 5-year-old child

    PubMed Central

    Mankotia, Dipanker Singh; Tandon, Vivek; Sharma, Bhawani Shankar; Rajeshwari, Madhu; Sharma, Mehar Chand

    2016-01-01

    Atypical teratoid/rhabdoid tumor (AT/RT) is a rare central nervous system neoplasm affecting children, and isolated primary spinal involvement is extremely rare. Authors describe a case of spinal AT/RT in a 5-year-old male child presenting with rapidly progressing quadriparesis diagnosed and managed surgically and medically. Biopsy revealed large, rhabdoid cells with prominent nucleoli in nest and immunohistochemistry further showed loss of integrase integrator 1 expression considered to be gold standard for diagnosis. AT/RT has extremely poor prognosis with median survival being 6 months. PMID:27606020

  3. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5-year RCT and a 4.5-year follow-up.

    PubMed

    Lewis, Joshua R; Calver, Janine; Zhu, Kun; Flicker, Leon; Prince, Richard L

    2011-01-01

    Concern has been expressed that calcium supplementation, a key intervention for preventing osteoporotic fracture in older women, may increase the risk of atherosclerotic vascular disease. To evaluate the risk further, an examination of complete verified atherosclerotic vascular hospitalization and mortality data from a 5-year randomized, controlled trial (RCT) of calcium carbonate and 4.5 years of posttrial follow-up was undertaken. This study used data from a published 5-year randomized, double-blinded, placebo-controlled trial [Calcium Intake Fracture Outcome Study (CAIFOS)]. The participants were 1460 women aged 75.1 ± 2.7 years at baseline (1998) recruited from the general population and randomized to receive 1200 mg of calcium carbonate daily or an identical placebo. All hospital admission and deaths during the 5-year study and the 4.5-year follow-up were derived from the Western Australian Data Linkage Service (WADLS). Hazard ratios (HRs) for the combined endpoint of atherosclerotic vascular mortality or first hospitalization were calculated using prespecified intention-to-treat and per-protocol models. The intervention group that received calcium supplementation did not have a higher risk of death or first-time hospitalization from atherosclerotic vascular disease in either the 5-year RCT [multivariate-adjusted HR = 0.938, 95% confidence interval (CI) 0.690-1.275] or during the 9.5 years of observational study (multivariate-adjusted HR = 0.919, 95% CI 0.737-1.146). Further analysis suggested that calcium supplementation may reduce the risk of hospitalization and mortality in patients with preexisting atherosclerotic cardiovascular disease. This trial provides compelling evidence that calcium supplementation of 1200 mg daily does not significantly increase the risk of atherosclerotic vascular disease in elderly women.

  4. Serum alkaline phosphatase and bilirubin are early surrogate markers for ischemic cholangiopathy and graft failure in liver transplantation from donation after circulatory death.

    PubMed

    Halldorson, J B; Rayhill, S; Bakthavatsalam, R; Montenovo, M; Dick, A; Perkins, J; Reyes, J

    2015-03-01

    Liver transplantation with the use of donation after circulatory death (DCD) is associated with ischemic cholangiopathy (IC) often leading to graft loss. We hypothesized that serial postoperative analysis of alkaline phosphatase and bilirubin might identify patients who would later on develop ischemic cholangiopathy and/or graft loss, allowing early recognition and potentially retransplantation. The University of Washington DCD experience totals 89 DCD liver transplantations performed from 2003 to 2011 with Kaplan-Meier estimated 5-year patient and graft survival rates of 81.6% and 75.6%, respectively; 84/89 patients transplanted with DCD livers lived ≥ 60 days after transplantation and were analyzed. Serum bilirubin and alkaline phosphatase levels at 1 week, 2 week, 1 month, and 2 months after transplantation were analyzed. Two-month serum bilirubin and alkaline phosphatase proved to have the strongest associations with development of IC and graft failure. Two-month alkaline phosphatase of <100 U/L had a negative predictive value of 97% for development of IC. Two-month alkaline phosphatase demonstrated an inflection starting at >300 U/L strongly associated with development of IC (P < .0001). Serum bilirubin at 2 months was most strongly associated with graft failure within the 1st year with a strong inflection point at 2.5 mg/dL (P = .0001). All jaundiced recipients at 60 days after transplantation (bilirubin >2.5 mg/dL) developed graft failure within the 1st year (P < .0001). Use of these early surrogate markers could facilitate prioritization and early retransplantation for DCD liver recipients with allografts destined for failure.

  5. Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival

    PubMed Central

    Scoccianti, Guido; Frenos, Filippo; Bettini, Leonardo; Beltrami, Giovanni; Cuomo, Pierluigi; De Biase, Pietro; Capanna, Rodolfo

    2016-01-01

    The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1–167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure (p = 0.921), nor to the reconstruction site (p = 0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions (p = 0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease. PMID:28050552

  6. Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

    PubMed Central

    2012-01-01

    Objective To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy. Design A collaborative analysis of data from 12 cohorts in Europe and north America on 20 379 adults who started HAART between 1995 and 2003. Methods Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention-to-continue-treatment, ignoring treatment changes and interruptions. Results During 61 798 person-years of follow-up, 1005 patients died and an additional 1303 developed AIDS. A total of 10 046 (49%) patients started HAART either with a CD4 cell count of less than 200 cells/μl or with a diagnosis of AIDS. The 5-year risk of AIDS or death (death alone) from the start of HAART ranged from 5.6 to 77% (1.8–65%), depending on age, CD4 cell count, HIV-1-RNA level, clinical stage, and history of injection drug use. From 6 months the corresponding figures were 4.1–99% for AIDS or death and 1.3–96% for death alone. Conclusion On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org. PMID:17502729

  7. 5 Years Experience With Drug Eluting and Bare Metal Stents as Primary Intervention in Transplant Renal Artery Stenosis

    PubMed Central

    Estrada, Chelsea C.; Musani, Muzammil; Darras, Frank; Suh, Heesuck; Abate, Mersema T.; Mani, Anil; Nord, Edward P.

    2017-01-01

    Background Transplant renal artery stenosis (TRAS) is a common vascular complication after kidney transplantation and is associated with refractory hypertension, volume overload, and graft injury or loss. This article describes 5-year outcomes of endovascular intervention for TRAS with bare metal and drug eluting stents (DES). Methods We investigated, as a prospective cohort study, patient and graft outcomes after the targeted use of DES for vessel diameter less than 5 mm and bare metal stents (BMS) for vessel diameter greater than 5 mm as the primary management for TRAS. Results From March 2008 to November 2014, 57 patients were stented for hemodynamically significant TRAS; 29 received DES, 26 received BMS, and 2 patients received both stent types. They were followed up for a mean of 35.1 ± 22.8 months; a subset of these patients who all received DES were followed up for 61.7 ± 17.5 months. Mean serum creatinine declined from 2.87 ± 1.5 mg/dL at the time of intervention to 1.98 ± 0.76 mg/dL (P < 0.001) at one month follow-up and was 1.96 ±0.92 mg/dL (P < 0.001) at 35.1 ± 22.8 months. Mean systolic blood pressure declined from 159.05 ± 19.68 mm Hg at time of intervention to 135.65 ± 15.10 mm Hg (P < 0.001) at most recent visit. Clinically driven restenosis requiring repeat revascularization occurred in 15.7% of patients. Conclusions Primary stenting with DES and BMS is both successful in the initial treatment of TRAS and also produced an immediate and long-term reduction in serum creatinine and systolic blood pressure. PMID:28361112

  8. Clinical Study of Graft Selection in Malaysian Rhinoplasty Patients

    PubMed Central

    2013-01-01

    Graft selection remains the greatest challenge for surgeons performing rhinoplasty. The preferred choice thus far for nasal reconstruction would be autograft compared to allograft due to its lower rate of infection and extrusion as it does not induce an immune response. We have evaluated 26 patients who underwent open structured rhinoplasty at our center and compared our experience regarding the operative technique, graft availability, indications, and limitations. The racial distribution was 18 Indians, 5 Chinese, and 3 Malays with a mean age, hospitalization, and followup of 30.5 years, 16.9 months, and 4.4 days, respectively. Majority of the patients (57.6%) presented with twisted nose and 30.7% of the patients presented with history of nasal trauma. All the patients had deviated septum of varying severity. The most common graft used was quadrangular cartilage graft and the common complications noted were ala deformity and tip anaesthesia in 7.6% patients respectively. PMID:24078883

  9. 77 FR 64959 - Endangered and Threatened Species; Initiation of 5-Year Review for the Southern Distinct...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-24

    ...; Initiation of 5-Year Review for the Southern Distinct Population Segment of North American Green Sturgeon... 5-year review of the Southern Distinct Population Segment (DPS) of North American green sturgeon... of requested information include: (1) Species biology including, but not limited to,...

  10. 77 FR 5491 - Endangered and Threatened Species; Initiation of 5-Year Review for Sei Whales

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-03

    ...; Initiation of 5-Year Review for Sei Whales AGENCY: National Marine Fisheries Service (NMFS), National Oceanic...; request for information. SUMMARY: NMFS announces a 5-year review of sei whales (Balaenoptera borealis... of any such information on sei whales that has become available since that has become available...

  11. The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient.

    PubMed

    Fullerton, J K; Smith, C E; Milner, S M

    2000-10-01

    Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.

  12. Calcar bone graft

    SciTech Connect

    Bargar, W.L.; Paul, H.A.; Merritt, K.; Sharkey, N.

    1986-01-01

    A canine model was developed to investigate the use of an autogeneic iliac bone graft to treat the calcar deficiency commonly found at the time of revision surgery for femoral component loosening. Five large male mixed-breed dogs had bilateral total hip arthroplasty staged at three-month intervals, and were sacrificed at six months. Prior to cementing the femoral component, an experimental calcar defect was made, and a bicortical iliac bone graft was fashioned to fill the defect. Serial roentgenograms showed the grafts had united with no resorption. Technetium-99 bone scans showed more uptake at three months than at six months in the graft region. Disulfine blue injection indicated all grafts were perfused at both three and six months. Thin section histology, fluorochromes, and microradiographs confirmed graft viability in all dogs. Semiquantitative grading of the fluorochromes indicated new bone deposition in 20%-50% of each graft at three months and 50%-80% at six months. Although the calcar bone graft was uniformly successful in this canine study, the clinical application of this technique should be evaluated by long-term results in humans.

  13. Optimizing repeat liver transplant graft utility through strategic matching of donor and recipient characteristics.

    PubMed

    Hung, Kenneth; Gralla, Jane; Dodge, Jennifer L; Bambha, Kiran M; Dirchwolf, Melisa; Rosen, Hugo R; Biggins, Scott W

    2015-11-01

    Repeat liver transplantation (LT) is controversial because of inferior outcomes versus primary LT. A minimum 1-year expected post-re-LT survival of 50% has been proposed. We aimed to identify combinations of Model for End-Stage Liver Disease (MELD), donor risk index (DRI), and recipient characteristics achieving this graft survival threshold. We identified re-LT recipients listed in the United States from March 2002 to January 2010 with > 90 days between primary LT and listing for re-LT. Using Cox regression, we estimated the expected probability of 1-year graft survival and identified combinations of MELD, DRI, and recipient characteristics attaining >50% expected 1-year graft survival. Re-LT recipients (n = 1418) had a median MELD of 26 and median age of 52 years. Expected 1-year graft survival exceeded 50% regardless of MELD or DRI in Caucasian recipients who were not infected with hepatitis C virus (HCV) of all ages and Caucasian HCV-infected recipients <50 years old. As age increased in HCV-infected Caucasian and non-HCV-infected African American recipients, lower MELD scores or lower DRI grafts were needed to attain the graft survival threshold. As MELD scores increased in HCV-infected African American recipients, lower-DRI livers were required to achieve the graft survival threshold. Use of high-DRI livers (>1.44) in HCV-infected recipients with a MELD score > 26 at re-LT failed to achieve the graft survival threshold with recipient age ≥ 60 years (any race), as well as at age ≥ 50 years for Caucasians and at age < 50 years for African Americans. Strategic donor selection can achieve >50% expected 1-year graft survival even in high-risk re-LT recipients (HCV infected, older age, African American race, high MELD scores). Low-risk transplant recipients (age < 50 years, non-HCV-infected) can achieve the survival threshold with varying DRI and MELD scores.

  14. Grafts in "closed" rhinoplasty.

    PubMed

    Scattolin, A; D'Ascanio, L

    2013-06-01

    Rhinoplasty is a fascinating and complex surgical procedure aiming at attaining a well-functioning and aesthetically pleasant nose. The use of grafts is of the utmost importance for the nasal surgeon to achieve such results. However, the philosophy and technical use of nasal grafts are different in "closed" and "open" rhinoplasty. The aim of this paper is not detailed description of the numerous grafts reported in the literature; we will describe the main principles of grafts use in "closed" rhinoplasty derived from our experience, with special reference to the philosophical and technical differences in their employment between "closed" and "open" rhinoplasty. Some cases are reported as an example of graft use in "endonasal" approach rhinoplasty.

  15. Replacement of Vertebral Lamina (Laminoplasty) in Surgery for Lumbar Isthmic Spondylolisthesis: 5-Year Follow-Up Results

    PubMed Central

    2016-01-01

    Study Design A review of clinical and radiological outcomes of lumbar laminoplasty (LL) for the treatment of isthmic spondylolisthesis (ISL). Purpose The single session performance of posterior lumbar interbody fusion with allograft in the anterior column and providing the realignment of the vertebrae was presented as a preliminary report earlier. Overview of Literature Long-term surgical outcome of cervical laminoplasty in patients has been reported. But, outcome of LL in patients is unclear. Methods The long-term (5 years) year follow-up results of the LL technique are reported in this retrospective study. All patients underwent preoperative and postoperative direct X-ray, computed tomography, and magnetic resonance imaging. The patients that did not respond to conservative treatment were operated. Twenty-one (52.5%) female and 19 (47.5%) male patients were included. Results Mean age was 43,5 years (ranges, 22–57 years). The most common symptoms were low back pain (89%), pelvic and leg pain (69%) and reduction in walking distance (65%). A total of 180 pedicle screws were inserted in 40 patients; posterior lumbar interbody fusion and laminoplasty with reduction was performed in 20 patients for L4–L5, 12 patients for L5–S1, 4 patients for L3–L4–L5 and 4 patients for L4–L5-S1. Ten (25%) patients with ILL had accompanying spinal stenosis. The difference between preoperative and postoperative sagittal plane rotation and dislocation degrees and disc space heights were statistically significant in all patients (p<0.05). Solid grade 4 fusion was observed in 38 patients; in only 2 patients grade 2 pseudoarthrosis developed (5%), but these patients were asymptomatic. Visual analog scale, Prolo economical and functional scale was examined with an average follow-up 5.5 years. Conclusions LL technique has the advantages of shorter duration of operation, lack of graft donor site complications, protection of posterior column osseoligamentous structures and

  16. Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up.

    PubMed

    Bernabé, Pedro Felício Estrada; Azuma, Mariane Maffei; Ferreira, Luciana Louzada; Dezan-Júnior, Eloi; Gomes-Filho, João Eduardo; Cintra, Luciano Tavares Angelo

    2013-01-01

    Apical surgery should be considered as the last treatment option and employed when conventional endodontic treatment does not provide the expected result. In teeth undergoing apical surgery, the type of retrograde filling material is one of the factors interfering with the repair of periapical tissues. The material in intimate contact with the periapical tissues plays a fundamental role in the repair process. Several materials have been studied and indicated for use in apical surgery procedures, but the mineral trioxide aggregate (MTA) is still the most frequently used one. Guided tissue regeneration (GTR) techniques have been proposed as an adjunct to apical surgery to enhance bone healing. Here is reported a clinical case in which apical surgery was performed in conjunction with MTA-based root reconstruction of the maxillary right second incisor. After the apical surgery, a root-end cavity was prepared at the vestibular face of the involved tooth and filled with MTA. A bovine bone graft and a cortical collagen membrane were placed on the bone defect. After 5 years, clinical and radiographic assessments showed that the treatment was successful. It may be concluded that MTA presents favorable characteristics in adverse conditions and can be used in conjunction with GTR in cases involving root reconstruction.

  17. Juvenile Breast Hypertrophy: A Successful Breast Reduction of 14.9% Body Weight without Recurrence in a 5-Year Follow-Up

    PubMed Central

    Abd Latib, Marzida; Basiron, Normala

    2017-01-01

    Juvenile hypertrophy of the breast (JHB) is a rare and relentless disease affecting women in the peripubertal period. We present a 13-year-old girl with massive bilateral JHB, successfully treated with a breast reduction and free nipple graft technique. A total of 7300 grams of breast tissue had been removed, accounting for 14.9% of the patient's total body weight. Prophylactic hormonal therapy was not commenced. During the 5-year follow-up period, there was no recurrence and the patient remains satisfied with the aesthetic outcome. A recent meta-analysis study indicates that subcutaneous mastectomy is associated with reduced risk of recurrence, but it is more deforming and the aesthetic result is inferior to a reduction mammaplasty. In patients treated with the latter technique, some evidence exists suggesting that the use of a free nipple graft is associated with a less frequent risk of recurrence than a pedicle technique. This present case is unique as it demonstrates the clinical course of this patient at a considerably longer follow-up period than most reported studies. We adhered to the limited available evidence and highlight the long-term reliability of breast reduction with free nipple grafting as the first line surgical option in JHB, eliminating the need for repeated surgeries. PMID:28255494

  18. Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

    PubMed Central

    Kiekara, Tommi; Paakkala, Antti; Suomalainen, Piia; Huhtala, Heini; Järvelä, Timo

    2017-01-01

    Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results. PMID:28203605

  19. Sabril® registry 5-year results: Characteristics of adult patients treated with vigabatrin.

    PubMed

    Krauss, Gregory; Faught, Edward; Foroozan, Rod; Pellock, John M; Sergott, Robert C; Shields, W Donald; Ziemann, Adam; Dribinsky, Yekaterina; Lee, Deborah; Torri, Sarah; Othman, Feisal; Isojarvi, Jouko

    2016-03-01

    Vigabatrin (Sabril®), approved in the US in 2009, is currently indicated as adjunctive therapy for refractory complex partial seizures (rCPS) in patients ≥ 10 years old who have responded inadequately to several alternative treatments and as monotherapy for infantile spasms (IS) in patients 1 month to 2 years of age. Because of reports of vision loss following vigabatrin exposure, FDA approval required a risk evaluation mitigation strategy (REMS) program. Vigabatrin is only available in the US through Support, Help, And Resources for Epilepsy (SHARE), which includes a mandated registry. This article describes 5 years of demographic and treatment exposure data from adult patients (≥ 17 years old) in the US treated with vigabatrin and monitored in the ongoing Sabril® registry. Registry participation is mandatory for all US Sabril® prescribers and patients. A benefit-risk assessment must be documented by the physician for a patient to progress to maintenance therapy, defined as 1 month of vigabatrin treatment for patients with IS and 3 months for patients with rCPS. Ophthalmologic assessments must be documented during and after completion of therapy. As of August 26, 2014, a total of 6823 patients were enrolled in the registry, of which 1200 were adults at enrollment. Of these patients, 1031 (86%) were naïve to vigabatrin. The majority of adult patients (n=783, 65%) had previously been prescribed ≥ 4 AEDs, and 719 (60%) were receiving ≥ 3 concomitant AEDs at vigabatrin initiation. Prescribers submitted an initial ophthalmological assessment form for 863 patients; an ophthalmologic exam was not completed for 300 (35%) patients and thus, were considered exempted from vision testing. Of these patients, 128 (43%) were exempted for neurologic disabilities. Clinicians discontinued treatment in 8 patients because of visual field deficits (VFD) (5 patients naïve to vigabatrin and 3 patients previously exposed). Based on Kaplan-Meier survival estimates, it is

  20. Deferiprone versus deferoxamine in thalassemia intermedia: Results from a 5-year long-term Italian multicenter randomized clinical trial.

    PubMed

    Calvaruso, Giuseppina; Vitrano, Angela; Di Maggio, Rosario; Lai, Eliana; Colletta, Grazia; Quota, Alessandra; Gerardi, Calogera; Rigoli, Luciana Concetta; Sacco, Massimiliano; Pitrolo, Lorella; Maggio, Aurelio

    2015-07-01

    In patients with thalassemia intermedia (TI), such as beta-TI, alpha-thalassemia (mainly HbH disease and mild/moderate forms of HbE/beta-thalassemia), iron overload is an important challenge in terms of diagnosis, monitoring, and treatment. Moreover, to date, the only possible chelators available are deferoxamine, deferasirox, and deferiprone. Here, we report the first 5-year long-term randomized clinical trial comparing the effectiveness of deferiprone versus deferoxamine in patients with TI. Body iron burden, which was determined by measuring serum ferritin levels in the same patient over 5 years and analyzed according to the generalized linear mixed model (GLMM), showed a linear decrease over time in the mean serum ferritin levels in both treatment groups (P-value = 0.035). The overall period of observation was 235.2 person-years for the deferiprone patients compared with 214.3 person-years for the deferoxamine patients. The results of the log-rank test suggested that the deferiprone treatment did not affect survival compared with the deferoxamine treatment (P-value = 0.360). The major adverse events observed included gastrointestinal symptoms and joint pain or arthralgia. Neutropenia and agranulocytosis were also detected, suggesting needing of strict hematological control. In conclusion, long-term iron chelation therapy with deferiprone is associated with an efficacy and safety similar to that of deferoxamine, suggesting that this drug is an alternative option in cases in which deferoxamine and deferasirox are contraindicated.

  1. Effect of water content and temperature on seed longevity of seven Brassicaceae species after 5 years of storage.

    PubMed

    Mira, S; Estrelles, E; González-Benito, M E

    2015-01-01

    Maximising seed longevity is crucial for genetic resource preservation and longevity of orthodox seeds is determined by environmental conditions (water content and temperature). The effect of water content (down to 0.01 g·H₂O·g(-1) ) on seed viability was studied at different temperatures for a 5-year storage period in taxonomically related species. Seeds of seven Brassicaceae species (Brassica repanda, Eruca vesicaria, Malcolmia littorea, Moricandia arvensis, Rorippa nasturtium-aquaticum, Sinapis alba, Sisymbrium runcinatum) were stored at 48 environments comprising a combination of eight water contents, from 0.21 to 0.01 g·H₂O·g(-1) DW and six temperatures (45, 35, 20, 5, -25, -170 °C). Survival curves were modelled and P50 calculated for those conditions where germination was reduced over the 5-year assay period. Critical water content for storage of seeds of six species at 45 °C ranged from 0.02 to 0.03 g·H₂O·g(-1) . The effect of extreme desiccation at 45 °C showed variability among species: three species showed damaging effects of drying below the critical water content, while for three species it was neither detrimental nor beneficial to seed longevity. Lipid content could be related to longevity, depending on the storage conditions. A variable seed longevity response to water content among taxonomically related species was found. The relative position of some of the species as long- or short-lived at 45 °C varied depending on the humidity at which storage behaviour was evaluated. Therefore, predictions of survival under desiccated conditions based on results obtained at high humidity might be problematic for some species.

  2. Bone graft substitutes.

    PubMed

    Bhatt, Reena A; Rozental, Tamara D

    2012-11-01

    Replacement of missing bone stock is a reconstructive challenge to upper extremity surgeons and decision-making with regards to available choices remains difficult. Preference is often given to autograft in the form of cancellous, cortical, or corticocancellous grafts from donor sites. However, the available volume from such donor sites is limited and fraught with potential complications. Advances in surgical management and medical research have produced a wide array of potential substances that can be used for bone graft substitute. Considerations in selecting bone grafts and substitutes include characteristic capabilities, availability, patient morbidity, immunogenicity, potential disease transmission, and cost variability.

  3. Composite graft including bone tissue: a case report of successful reattachment of multiple fingertip oblique amputation.

    PubMed

    Lee, Kyung Suk; Lim, Yun sub; Choi, Jaehoon; Kim, Nam Gyun; Kim, Jun Sik

    2013-02-01

    A composite graft for reattachment of an amputated fingertip is a very controversial and challenging procedure. An osteocutaneous composite graft is rarely conducted and has a low success rate following fingertip amputation. A 21-year-old male patient was referred to our emergency clinic with dorsal oblique amputation of the middle, ring and small fingers of the left hand through the distal interphalangeal joint and middle phalanx. The amputated parts of the middle and ring fingers were reattached with osteocutaneous composite grafts. The amputated part of the small finger was revascularised to the ulnar palmar digital artery of the small finger. The composite grafts of the middle and ring fingers and the revascularised small finger survived completely. We suggest that careful patient selection will allow an osteocutaneous composite graft to become an acceptable method for the treatment of fingertip amputation. A large-scale study of osteocutaneous graft of amputated fingertips is required to improve the survival rate.

  4. Endothelial Cell Density to Predict Endothelial Graft Failure After Penetrating Keratoplasty

    PubMed Central

    Lass, Jonathan H.; Sugar, Alan; Benetz, Beth Ann; Beck, Roy W.; Dontchev, Mariya; Gal, Robin L.; Kollman, Craig; Gross, Robert; Heck, Ellen; Holland, Edward J.; Mannis, Mark J.; Raber, Irving; Stark, Walter; Stulting, R. Doyle

    2010-01-01

    Objective To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema. Methods In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail. Results Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (±95% confidence interval) of failure was 13% (±12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm2 vs 2%(±3%) for the 137 participants with a 6-monthECDof 2500 cells/mm2 or higher. After 5 years’ follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm2. Conclusions Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm2. PMID:20065219

  5. Visual function and car driving: longitudinal results 5 years after cataract surgery in a population

    PubMed Central

    Mönestam, E; Lundquist, B; Wachtmeister, L

    2005-01-01

    Aims: To determine visual function in drivers who had cataract surgery 5 years previously, and to analyse longitudinal data, by comparing preoperative and postoperative changes in subjective driving ability and objective visual function. Methods: All patients (810) who underwent cataract surgery, during a 1 year period, were prospectively studied. Data regarding present driving status were collected from self administered questionnaires and visual acuity (VA) data were measured before and after surgery. All patients who were alive 5 years later were invited to participate with a new eye examination and questionnaire. Results: Before surgery 36 active drivers (16%) did not fulfil the visual requirements for driving; with improved glasses this number could be reduced to 24 (11%). 5 years after surgery, the corresponding figures were 5% and 3% (5/174), respectively. Before surgery 50% stated visual difficulties while driving in daylight and 79% in darkness. A few months and 5 years after surgery the corresponding figures were 6% and 5%, respectively, for daytime driving and 34% and 44%, respectively, for night-time driving. Conclusions: Long term results regarding cataract surgery in car drivers are beneficial. 5 years after surgery only a few patients drove not fulfilling the requirements, but there were a larger proportion of patients with problems driving in darkness compared with a few months after surgery. PMID:15774924

  6. The effects of oil pollution on Antarctic benthic diatom communities over 5 years.

    PubMed

    Polmear, R; Stark, J S; Roberts, D; McMinn, A

    2015-01-15

    Although considered pristine, Antarctica has not been impervious to hydrocarbon pollution. Antarctica's history is peppered with oil spills and numerous abandoned waste disposal sites. Both spill events and constant leakages contribute to previous and current sources of pollution into marine sediments. Here we compare the response of the benthic diatom communities over 5 years to exposure to a commonly used standard synthetic lubricant oil, an alternative lubricant marketed as more biodegradable, in comparison to a control treatment. Community composition varied significantly over time and between treatments with some high variability within contaminated treatments suggesting community stress. Both lubricants showed evidence of significant effects on community composition after 5 years even though total petroleum hydrocarbon reduction reached approximately 80% over this time period. It appears that even after 5 years toxicity remains high for both the standard and biodegradable lubricants revealing the temporal scale at which pollutants persist in Antarctica.

  7. Outcomes and long-term survival of coronary artery surgery: The controversial role of opium as risk marker

    PubMed Central

    Najafi, Mahdi; Jahangiry, Leila; Mortazavi, Seyedeh Hamideh; Jalali, Arash; Karimi, Abbasali; Bozorgi, Ali

    2016-01-01

    AIM To study survival in isolated coronary artery bypass graft (CABG) patients and to evaluate the impact of preoperative chronic opium consumption on long-term outcome. METHODS Cohort of 566 isolated CABG patients as Tehran Heart Center cardiac output measurement was conducted. Daily evaluation until discharge as well as 4- and 12-mo and 6.5-year follow-up information for survival status were fulfilled for all patients. Long-term 6.5-year overall and opium-stratified survival, adjusted survival curves based on opium consumption as well as possible predictors of all-cause mortality using multiple cox regression were determined by statistical analysis. RESULTS Six point five-year overall survival was 91.8%; 86.6% in opium consumers and 92.7% in non-opium consumers (P = 0.035). Patients with positive history of opium consumption significantly tended to have lower ejection fraction (EF), higher creatinine level and higher prevalence of myocardial infarction. Multiple predictors of all-cause mortality included age, body mass index, EF, diabetes mellitus and cerebrovascular accident. The hazard ratio (HR) of 2.09 for the risk of mortality in opium addicted patients with a borderline P value (P = 0.052) was calculated in this model. Further adjustment with stratification based on smoking and opium addiction reduced the HR to 1.20 (P = 0.355). CONCLUSION Simultaneous impact of smoking as a confounding variable in most of the patients prevents from definitive judgment on the role of opium as an independent contributing factor in worse long-term survival of CABG patients in addition to advanced age, low EF, diabetes mellitus and cerebrovascular accident. Meanwhile, our findings do not confirm any cardio protective role for opium to improve outcome in coronary patients with the history of smoking. Further studies are needed to clarify pure effect of opium and warrant the aforementioned findings. PMID:27957254

  8. Graft failure following reduced-intensity cord blood transplantation for adult patients.

    PubMed

    Narimatsu, Hiroto; Kami, Masahiro; Miyakoshi, Shigesaburo; Murashige, Naoko; Yuji, Koichiro; Hamaki, Tamae; Masuoka, Kazuhiro; Kusumi, Eiji; Kishi, Yukiko; Matsumura, Tomoko; Wake, Atsushi; Morinaga, Shinichi; Kanda, Yoshinobu; Taniguchi, Shuichi

    2006-01-01

    We reviewed the medical records of 123 adult reduced-intensity cord blood transplantation (RI-CBT) recipients to investigate the clinical features of graft failure after RI-CBT. Nine (7.3%) had graft failure, and were classified as graft rejection rather than primary graft failure; they showed peripheral cytopenia with complete loss of donor-type haematopoiesis, implying destruction of donor cells by immunological mechanisms rather than poor graft function. Three of them died of bacterial or fungal infection during neutropenia. Two recovered autologous haematopoiesis. The remaining four patients underwent a second RI-CBT and developed severe regimen-related toxicities. One died of pneumonia on day 8, and the other three achieved engraftment. Two of them died of transplant-related mortality, and the other survived without disease progression for 9.0 months after the second RI-CBT. In total, seven of the nine patients with graft failure died. The median survival of those with graft failure was 3.8 months (range, 0.9-15.4). Graft failure is a serious complication of RI-CBT. As host T cells cannot completely be eliminated by reduced-intensity preparative regimens, we need to be aware of the difficulty in differentiating graft rejection from other causes of graft failure following RI-CBT. Further studies are warranted to establish optimal diagnostic and treatment strategies.

  9. Deficiency of Endothelial Progenitor Cells Associates with Graft Thrombosis in Patients Undergoing Endovascular Therapy of Dysfunctional Dialysis Grafts

    PubMed Central

    Chen, Tsung-Yan; Lin, Lin; Hsieh, Mu-Yang; Kuo, Jui-Cheng; Wang, Chia-Ling; Wang, Ren-Huei; Lai, Chao-Lun; Huang, Po-Hsun; Wu, Chih-Cheng

    2017-01-01

    Background The deficiency of endothelial progenitor cells has been demonstrated to be associated with cardiovascular events in patients undergoing dialysis. However, their correlation with dialysis graft outcomes remains unknown. The objective of this study was to investigate the relationship between circulating endothelial progenitor cells and dialysis graft outcomes. Methods After excluding 14 patients with acute coronary syndrome, decompensated heart failure or graft thrombosis in the prior three months, a total of 120 patients undergoing dialysis who underwent endovascular therapy of dysfunctional dialysis grafts were prospectively enrolled. Blood was sampled from study subjects in the morning of a mid-week non-dialysis day. Surface makers of CD34, KDR, and CD133 were used in combination to determine the number of circulating endothelial progenitor cells. All participants were prospectively followed until June 2013. Results The median follow-up duration was 13 months, within which 62 patients experienced at least one episode of graft thrombosis. Patients with graft thrombosis had lower CD34+KDR+ cell counts compared with patients without graft thrombosis (median 4.5 vs. 8 per 105 mononuclear cells, p = 0.02). Kaplan-Meier analysis demonstrated thrombosis-free survival was lower in the low CD34+KDR+ cell count group (30%) than in the high CD34+KDR+ cell count group (61%; p = 0.007). Univariate analysis showed diabetes, high sensitive C-reactive protein, lesion length and CD34+KDR+ cell counts associated with graft thrombosis. Multivariate analyses confirmed an independent association between low CD34+KDR+ cell counts and graft thrombosis (hazard ratio, 2.52; confidence interval, 1.43-4.44; p = 0.001). Conclusions Our study demonstrated an independent association between low circulating endothelial progenitor cell counts and dialysis graft thrombosis. PMID:28115811

  10. Grafting in revision rhinoplasty.

    PubMed

    Bussi, M; Palonta, F; Toma, S

    2013-06-01

    Rhinoplasty is one of the most difficult aesthetic surgery procedures with a high rate of revision. In revision rhinoplasty the surgeon should explore the patient's concerns and then verify the possibility to satisfy expectations after complete internal and external examination of the nose. For the vast majority of complex secondaries, an open approach is the only reasonable method. In fact, in secondary nasal surgery, because of the scarring process following the primary operation, dissection is tedious, and landmarks are lost. One of the main objectives for the surgeon who approaches secondary rhinoplasty is to restore the structural support of the nose and to replace the lost volume of soft tissues. To achieve this purpose, the surgeon must often rely on grafts. An ideal grafting material must be easy to sculpt, resistant to trauma, infection and extrusion, mechanically stable, inert and readily available. For all these reasons, autogenous cartilage grafts harvested from septum, auricular concha and rib represent the first choice in rhinoplasty. In order to obtain a camouflage graft that provides natural contouring to the nose, temporalis fascia can be used. All these carefully trimmed grafts are useful in tip revision surgery, in secondary surgery of the dorsum and to resolve or reduce functional problems.

  11. Role of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation.

    PubMed

    Loforte, Antonio; Murana, Giacomo; Cefarelli, Mariano; Jafrancesco, Giuliano; Sabatino, Mario; Martin Suarez, Sofia; Pilato, Emanuele; Pacini, Davide; Grigioni, Francesco; Bartolomeo, Roberto Di; Marinelli, Giuseppe

    2016-08-01

    Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx). We investigated the predictive risk factors for moderate-to-severe EGF requiring an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) circulatory support as treatment after Htx. Between January 2000 and December 2014, 412 consecutive adult patients underwent isolated Htx at our institution. Moderate and severe EGF were defined as the need for IABP and ECMO support, respectively, within 24 h after Htx. All available recipient and donor variables were analyzed to assess the risk of EGF occurrence. Overall, moderate-to-severe EGF occurred in 46 (11.1%) patients. Twenty-nine (63.04%) patients required peripheral or central ECMO support in the treatment of severe EGF and 17 (36.9%) patients required IABP support for the treatment of moderate EGF. The predictive risk factors for moderate-to-severe EGF in recipients, as assessed by logistic regression analysis, were a preoperative transpulmonary gradient > 12 mm Hg (odds ratio [OR] 5.2; P = 0.023), a preoperative inotropic score > 10 (OR 8.5; P = 0.0001), and preoperative ECMO support (OR 4.2; P = 0.012). For donors, the predictive risk factor was a donor score ≥ 17 (OR 8.3; P = 0.006). The absence of EGF was correlated with improved long-term survival: 94% at 1 year and 81% at 5 years without EGF versus 76% and 36% at 1 year (P < 0.001), and 70% and 28% at 5 years (P < 0.001) with EGF requiring IABP and ECMO support, respectively. In-hospital weaned and survived patients after IABP or ECMO treatment for moderate-to-severe EGF had a similar 5-year conditional survival rate as transplant patients who had not suffered EGF: 88% without EGF versus 84% with EGF treated with mechanical circulatory support devices (P = 0.08). The occurrence of EGF is a multifactorial deleterious event that depends on donor and recipient profiles. IABP and ECMO support are reliable

  12. 24 CFR 903.6 - What information must a PHA provide in the 5-Year Plan?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false What information must a PHA provide in the 5-Year Plan? 903.6 Section 903.6 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN...

  13. Changes in Exercise Capacity of Cardiac Asymptomatic Hereditary Hemochromatosis Subjects over 5-Year Follow up

    PubMed Central

    Shizukuda, Yukitaka; Smith, Kevin P.; Tripodi, Dorothy J.; Arena, Ross; Yau, Yu-Ying; Bolan, Charles D.; Waclawiw, Myron A.; Leitman, Susan F.; Rosing, Douglas R.

    2012-01-01

    Objective A long-term effect of hereditary hemochromatosis (HH) on aerobic exercise capacity (AEC) has not been well described. Design Forty-three HH and 21 volunteer control (VC) subjects who were asymptomatic underwent cardiopulmonary exercise testing using the Bruce protocol. AEC was assessed with minute ventilation (VE), oxygen uptake (VO2), and carbon dioxide production (VCO2) at baseline (BL) at a 5-year follow up (5Y) assessment. A paired t-test was used for analyses of normality data; otherwise, a Wilcoxon singed rank sum test was used. Results Thirty-three HH subjects and 18 VC subjects returned for a repeat CPX at 5Y (80% overall return rate). At 5Y, AEC was not different between the two groups. As compared with BL measurements, exercise time, peak VO2, and the VE/VCO2 slope did not differ statistically at 5Y between both groups. Iron depletion by phlebotomy for 5 years did not significantly affect AEC in newly diagnosed HH subjects at baseline (n=14) and cardiac arrhythmias during exercise tended to decrease after 5 years of therapy in this group. Conclusions The AEC of asymptomatic HH subjects treated with conventional therapy is not statistically affected by the disease over a 5-year period. PMID:22311055

  14. Structural Priming as Learning: Evidence from Mandarin-Learning 5-Year-Olds

    ERIC Educational Resources Information Center

    Hsu, Dong-Bo

    2014-01-01

    Three experiments on structural priming in Mandarin-speaking 5-year-olds were conducted to test the priming as implicit learning hypothesis. It describes a learning mechanism that acts on a shared abstract syntactic representation in response to linguistic input using an equi-biased Mandarin SVO-"ba" alternation. The first two…

  15. Cognitive and Temperament Clusters in 3- to 5-Year-Old Children with Aggressive Behavior

    ERIC Educational Resources Information Center

    Sakimura, Jean N.; Dang, Michelle T.; Ballard, Kelley B.; Hansen, Robin L.

    2008-01-01

    Background: This study assessed the co-occurrence of cognitive problems and difficult temperament characteristics in children aged 3 to 5 years exhibiting aggressive behavior. Methods: Thirty-one children with high ratings on the Aggressive Behavior subscale of the Achenbach Child Behavior Checklist or Teacher Report Form were recruited from a…

  16. Introducing Engineering in Elementary Education: A 5-Year Study of Teachers and Students

    ERIC Educational Resources Information Center

    Diefes-Dux, Heidi A.

    2015-01-01

    Engineering, when integrated into K-12 education, may offer a number of potential student learning and future success benefits. In a 5-year study, four cohorts of elementary teachers of grades 2 to 4 in a single US school district were provided with teacher professional development with engineering education. Teachers were prepared to teach…

  17. Trauma Revisited: A 5-Year-Old's Journey from Experiences, to Thoughts, to Words, towards Hope

    ERIC Educational Resources Information Center

    Jackson, Emil

    2004-01-01

    In this paper, I describe the first 2 years of intensive psychotherapy of a multiply traumatized 5-year-old girl. I explore some of the ways in which violent and traumatic experiences were re-lived in the therapy and how they impacted on both patient and therapist. Within the discussion and illustrated by clinical vignettes, I consider the…

  18. The Development of Regulatory Functions from Birth to 5 Years: Insights from Premature Infants

    ERIC Educational Resources Information Center

    Feldman, Ruth

    2009-01-01

    This study examined physiological, emotional, and attentional regulatory functions as predictors of self-regulation in 125 infants followed 7 times from birth to 5 years. Physiological regulation was assessed by neonatal vagal tone and sleep-wake cyclicity; emotion regulation by response to stress at 3, 6, and 12 months; and attention regulation…

  19. Verbal Competence in Narrative Retelling in 5-Year-Olds with Unilateral Cleft Lip and Palate

    ERIC Educational Resources Information Center

    Klintö, Kristina; Salameh, Eva-Kristina; Lohmander, Anette

    2015-01-01

    Background: Research regarding expressive language performance in children born with cleft palate is sparse. The relationship between articulation/phonology and expressive language skills also needs to be further explored. Aims: To investigate verbal competence in narrative retelling in 5-year-old children born with unilateral cleft lip and palate…

  20. Developmental Norms of Children Aged 2 1/2-5 Years: A Pilot Study.

    ERIC Educational Resources Information Center

    Muralidharan, Rajalakshmi

    1969-01-01

    The purpose of this pilot study, aside from collection of developmental data on 38 nursery school children aged 2 1/2 to 5 years, was (1) to develop, modify and adapt the testing equipment used in Gesell's Developmental Schedule, in the field of motor, adaptive, language, and personal-social development; (2) to develop elaborate, exhaustive,…

  1. The Dynamics of an Online Knowledge Building Community: A 5-Year Longitudinal Study

    ERIC Educational Resources Information Center

    Myllari, Jarkko; Ahlberg, Mauri; Dillon, Patrick

    2010-01-01

    This paper reports a 5-year design experiment on cumulative knowledge building as part of an international project. Through a longitudinal study and analysis of cumulative research data, we sought to answer the question, "what happened and why in knowledge building?" Research data constitute messages which participants have written into a shared…

  2. Effectiveness of Multipurpose Unit Early Classroom Intervention Program for 4-5-Year-Old Children

    ERIC Educational Resources Information Center

    Celebioglu Morkoc, Ozlem; Aktan Acar, Ebru

    2014-01-01

    This research examined the effectiveness of Multipurpose Unit Early Classroom Intervention Program (MUECIP) prepared for 4-5-year-old (48-60 months) children whose development is at risk because of their families' socioeconomic conditions. The research adopted a preliminary test-final test control group trial model. The research participants were…

  3. Parental Strategies and Trajectories of Peer Victimization in 4 to 5 Year Olds

    ERIC Educational Resources Information Center

    Bonnet, Marielle; Goossens, Frits A.; Schuengel, Carlo

    2011-01-01

    This study was designed to examine how parental strategies contribute to explaining trajectories of peer victimization in young children. A total of 73 4 and 5 year old children identified as victims of peer aggression in the fall semester and their parents were recruited from 46 classrooms in 18 schools in the Netherlands. All children were…

  4. 75 FR 57254 - American Community Survey 5-Year Data Product Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-20

    ...' specific feedback on the following four dimensions: 1. Block Group Level Geography--The Census Bureau... block group geography level, (2) the types of data products to be included in the 5-year data products... response is below. 1. Block Group Level Geography The Census Bureau received six comments in response...

  5. 24 CFR 903.6 - What information must a PHA provide in the 5-Year Plan?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What information must a PHA provide in the 5-Year Plan? 903.6 Section 903.6 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN...

  6. 24 CFR 903.6 - What information must a PHA provide in the 5-Year Plan?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false What information must a PHA provide in the 5-Year Plan? 903.6 Section 903.6 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN...

  7. Early Book Stages, 0-5 Years [and] Creciendo con Libros (Growing [up] with Books). [Videotape.

    ERIC Educational Resources Information Center

    Holguin, Roxanna

    Using a lighthearted and simple approach, this 23-minute videotape in English and Spanish versions presents interactions between parents and children while reading books. The children in the videotape range in age from 0 to 5 years. The video is introduced by scenes of children enjoying books while narration discussing the impact of reading to…

  8. Episodic Memory and Episodic Foresight in 3- and 5-Year-Old Children

    ERIC Educational Resources Information Center

    Hayne, Harlene; Gross, Julien; McNamee, Stephanie; Fitzgibbon, Olivia; Tustin, Karen

    2011-01-01

    In the present study, we examined the development of episodic memory and episodic foresight. Three- and 5-year-olds were interviewed individually using a personalised timeline that included photographs of them at different points in their life. After constructing the timeline with the experimenter, each child was asked to discuss a number of…

  9. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  10. Low antibiotic resistance among anaerobic Gram-negative bacteria in periodontitis 5 years following metronidazole therapy.

    PubMed

    Dahlen, G; Preus, H R

    2017-02-01

    The objective of this study was to assess antibiotic susceptibility among predominant Gram-negative anaerobic bacteria isolated from periodontitis patients who 5 years prior had been subject to mechanical therapy with or without adjunctive metronidazole. One pooled sample was taken from the 5 deepest sites of each of 161 patients that completed the 5 year follow-up after therapy. The samples were analyzed by culture. A total number of 85 anaerobic strains were isolated from the predominant subgingival flora of 65/161 patient samples, identified, and tested for antibiotic susceptibility by MIC determination. E-tests against metronidazole, penicillin, amoxicillin, amoxicillin + clavulanic acid and clindamycin were employed. The 73/85 strains were Gram-negative rods (21 Porphyromonas spp., 22 Prevotella/Bacteroides spp., 23 Fusobacterium/Filifactor spp., 3 Campylobacter spp. and 4 Tannerella forsythia). These were all isolated from the treated patients irrespective of therapy procedures (+/-metronidazole) 5 years prior. Three strains (Bifidobacterium spp., Propionibacterium propionicum, Parvimonas micra) showed MIC values for metronidazole over the European Committee on Antimicrobial Susceptibility Testing break point of >4 μg/mL. All Porphyromonas and Tannerella strains were highly susceptible. Metronidazole resistant Gram-negative strains were not found, while a few showed resistance against beta-lactam antibiotics. In this population of 161 patients who had been subject to mechanical periodontal therapy with or without adjunct metronidazole 5 years prior, no cultivable antibiotic resistant anaerobes were found in the predominant subgingival microbiota.

  11. Influence of Emotional Facial Expressions on 3-5-Year-Olds' Face Recognition

    ERIC Educational Resources Information Center

    Freitag, Claudia; Schwarzer, Gudrun

    2011-01-01

    Three experiments examined 3- and 5-year-olds' recognition of faces in constant and varied emotional expressions. Children were asked to identify repeatedly presented target faces, distinguishing them from distractor faces, during an immediate recognition test and during delayed assessments after 10 min and one week. Emotional facial expression…

  12. Hands as Companions of the Mind: Essential Practical Life for the 5-Year-Old

    ERIC Educational Resources Information Center

    Gilder, Sharon Allen

    2012-01-01

    Numerous observations in Montessori classrooms led veteran Montessorians Pamela W. Trumble and Eleni Bokas to the conclusion that a universal need exists to bring integrity back to Practical Life, especially for 5-year-olds. Maria Montessori's observations over a century ago revealed the importance of Practical Life and its relationship to the…

  13. Wakefulness (Not Sleep) Promotes Generalization of Word Learning in 2.5-Year-Old Children

    ERIC Educational Resources Information Center

    Werchan, Denise M.; Gómez, Rebecca L.

    2014-01-01

    Sleep enhances generalization in adults, but this has not been examined in toddlers. This study examined the impact of napping versus wakefulness on the generalization of word learning in toddlers when the contextual background changes during learning. Thirty 2.5-year-old children (M = 32.94, SE = 0.46) learned labels for novel categories of…

  14. Children Born to Women with Intellectual Disabilities--5-Year Incidence in a Swedish County

    ERIC Educational Resources Information Center

    Weiber, I.; Berglund, J.; Tengland, P.-A.; Eklund, M.

    2011-01-01

    Background: Families with parental intellectual disabilities (ID) are likely to need support in achieving a decent family life. In order to accurately plan for such support services, society needs data regarding the occurrence of those parents and their children. The aim of this study was to investigate the 5-year incidence of children born to…

  15. Plastic bronchitis developing 5 years after Fontan procedure in a girl with Kartagener's syndrome.

    PubMed

    Nawa, Tomohiro; Yokozawa, Masato; Takamuro, Motoki; Kasuga, Ai

    2012-06-01

    Although rare, plastic bronchitis (PB) is an important early complication after Fontan procedure. Kartagener's syndrome is characterized by mucociliary dysfunction of the respiratory tract and has a triad of features, including situs inversus totalis, chronic sinusitis, and bronchiectasia. We experienced PB in a patient with Kartagener's syndrome 5 years after Fontan procedure.

  16. Predictors of ADHD Persistence in Girls at 5-Year Follow-Up

    ERIC Educational Resources Information Center

    Mick, Eric; Byrne, Deirdre; Fried, Ronna; Monuteaux, Michael; Faraone, Stephen V.; Biederman, Joseph

    2011-01-01

    Objective: The main aim of this study was to examine the age-dependent remission from ADHD in girls transitioning through childhood into adolescence and early adulthood. Method: We conducted a 5-year prospective follow-up study of 123 girls with ADHD and 106 non-ADHD control girls aged between 6 and 17 years at ascertainment. ADHD was considered…

  17. How Do 5-Year-Olds Understand Questions? Differences in Languages across Europe

    ERIC Educational Resources Information Center

    Sauerland, Uli; Grohmann, Kleanthes K.; Guasti, Maria Teresa; Andelkovic, Darinka; Argus, Reili; Armon-Lotem, Sharon; Arosio, Fabrizio; Avram, Larisa; Costa, João; Dabašinskiene, Ineta; de López, Kristine; Gatt, Daniela; Grech, Helen; Haman, Ewa; van Hout, Angeliek; Hrzica, Gordana; Kainhofer, Judith; Kamandulyte-Merfeldiene, Laura; Kunnari, Sari; Kovacevic, Melita; Kuvac Kraljevic, Jelena; Lipowska, Katarzyna; Mejias, Sandrine; Popovic, Maša; Ruzaite, Jurate; Savic, Maja; Sevcenco, Anca; Varlokosta, Spyridoula; Varnava, Marina; Yatsushiro, Kazuko

    2016-01-01

    The comprehension of constituent questions is an important topic for language acquisition research and for applications in the diagnosis of language impairment. This article presents the results of a study investigating the comprehension of different types of questions by 5-year-old, typically developing children across 19 European countries, 18…

  18. Behavior Problems at 5 Years of Age and Maternal Mental Health in Autism and Intellectual Disability

    ERIC Educational Resources Information Center

    Totsika, Vasiliki; Hastings, Richard P.; Emerson, Eric; Berridge, Damon M.; Lancaster, Gillian A.

    2011-01-01

    We examined child behavior problems and maternal mental health in a British population-representative sample of 5 year-old children with an autism spectrum disorder (ASD), controlling for the presence of an intellectual disability (ID). Behavior problems were significantly higher in children with ASD with/out ID compared to typically developing…

  19. Ready, Set, Grow! Health Education for 3-5 Year Olds.

    ERIC Educational Resources Information Center

    Peterson, Paula J.

    Intended for use in family day care, preschool centers, professional preparation institutions, and in homes, this comprehensive health education curriculum for 3- through 5-year-old children contains units designed to sequentially teach concepts about physical health, mental health, family living, and safety. Contents include the following…

  20. Guidelines for Health Assessment and Intervention Techniques for 3, 4, and 5 Year Old Children.

    ERIC Educational Resources Information Center

    Bentley, Judy K.

    These guidelines were developed to help registered nurses identify preschoolers with potential handicaps in the course of health assessments. Contents include guidelines on 3-, 4-, and 5-year-olds. Contents are organized within age levels in terms of functioning levels and anticipatory guidance. Functional areas covered include physical,…

  1. Ensemble Perception of Size in 4-5-Year-Old Children

    ERIC Educational Resources Information Center

    Sweeny, Timothy D.; Wurnitsch, Nicole; Gopnik, Alison; Whitney, David

    2015-01-01

    Groups of objects are nearly everywhere we look. Adults can perceive and understand the "gist" of multiple objects at once, engaging ensemble-coding mechanisms that summarize a group's overall appearance. Are these group-perception mechanisms in place early in childhood? Here, we provide the first evidence that 4-5-year-old children use…

  2. Therapeutic Community in a California Prison: Treatment Outcomes after 5 Years

    ERIC Educational Resources Information Center

    Zhang, Sheldon X.; Roberts, Robert E. L.; McCollister, Kathryn E.

    2011-01-01

    Therapeutic communities have become increasingly popular among correctional agencies with drug-involved offenders. This quasi-experimental study followed a group of inmates who participated in a prison-based therapeutic community in a California state prison, with a comparison group of matched offenders, for more than 5 years after their initial…

  3. Effect of blood transfusions on canine renal allograft survival

    SciTech Connect

    van der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

    1982-04-01

    In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Furthermore, no improvement in graft survival has been found after a peroperative transfusion of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion or irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

  4. Effect of blood transfusions on canine renal allograft survival

    SciTech Connect

    Van Der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

    1982-04-01

    In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Futhermore, no improvement in graft survival has been found after a peroperative transfuson of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion of irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

  5. Deferiprone versus deferoxamine in sickle cell disease: results from a 5-year long-term Italian multi-center randomized clinical trial.

    PubMed

    Calvaruso, Giusi; Vitrano, Angela; Di Maggio, Rosario; Ballas, Samir; Steinberg, Martin H; Rigano, Paolo; Sacco, Massimiliano; Telfer, Paul; Renda, Disma; Barone, Rita; Maggio, Aurelio

    2014-12-01

    Blood transfusion and iron chelation currently represent a supportive therapy to manage anemia, vasculopathy and vaso-occlusion crises in Sickle-Cell-Disease. Here we describe the first 5-year long-term randomized clinical trial comparing Deferiprone versus Deferoxamine in patients with Sickle-Cell-Disease. The results of this study show that Deferiprone has the same effectiveness as Deferoxamine in decreasing body iron burden, measured as repeated measurements of serum ferritin concentrations on the same patient over 5-years and analyzed according to the linear mixed-effects model (LMM) (p=0.822). Both chelators are able to decrease, significantly, serum ferritin concentrations, during 5-years, without any effect on safety (p=0.005). Moreover, although the basal serum ferritin levels were higher in transfused compared with non-transfused group (p=0.031), the changes over time in serum ferritin levels were not statistically significantly different between transfused and non-transfused cohort of patients (p=0.389). Kaplan-Meier curve, during 5-years of study, suggests that Deferiprone does not alter survival in comparison with Deferoxamine (p=0.38). In conclusion, long-term iron chelation therapy with Deferiprone was associated with efficacy and safety similar to that of Deferoxamine. Therefore, in patients with Sickle-Cell-Disease, Deferiprone may represent an effective long-term treatment option.

  6. Extended Long-Term (5 Years) Outcomes of Triangle Tilt Surgery in Obstetric Brachial Plexus Injury

    PubMed Central

    Nath, Rahul K; Somasundaram, Chandra

    2013-01-01

    Objective: We evaluated the "extended" long-term (5 years) functional outcomes in obstetric brachial plexus injury (OBPI) patients, who underwent triangle tilt surgery between February 2005 and January 2008. Methods: Twenty two children (9 girls and 13 boys, mean age at surgery was 5.8 years; ranging 2.1-11.8 years old), who initially presented with medial rotation contracture and scapula deformity secondary to obstetric brachial plexus injury were included in this study. Functional movements were evaluated pre-operatively, and 5 years following triangle tilt surgery by modified Mallet scale. Results: Here, we report long-term (5 years) follow-up of triangle tilt surgery for 22 OBPI patients. Upper extremity functional movements such as, external rotation (2.5±0.6 to 4.1±0.8, p<0.0001), hand-to-spine (2.6±0.6 to 3.4±1.1, p<0.005), hand-to-neck (2.7±0.7 to 4.3±0.7, p<0.0001), hand-to-mouth (2.3±0.9 (92º±33) to 4.2±0.5 (21º±16), p<0.0001), and supination (2.6±1.1 (-8.2º ±51) to 4.1±0.7 (61±32)) were significantly improved (p<0.0001), and maintained over the extended long-term (5 years). Total modified Mallet functional score was also shown to improve from 14.1±2.7 to 20.3±2.5. Conclusions: The triangle tilt surgery improved all shoulder functions significantly, and maintained over the extended long-term (5 years) in these patients. PMID:23730369

  7. Dopaminergic therapy and subthalamic stimulation in Parkinson's disease: a review of 5-year reports.

    PubMed

    Romito, Luigi M; Albanese, Alberto

    2010-11-01

    The long-term efficacy and safety of deep brain stimulation (DBS) implant for Parkinson's disease (PD) is described in several recent papers. This procedure has been reported to permit a stable reduction of dopaminergic therapy requirements for up to 5 years, although some expectation of deterioration in non-dopaminergic signs has been recently stated. Our aim is to perform a literature-based review of papers available describing long-term post-operative follow-up after a bilateral implant for subthalamic DBS (STN-DBS). Only peer-reviewed published papers with a post-operative follow-up of at least 5 years were considered. Clinical outcome, disease progression and side effects were assessed at baseline and 2 (or 3 years) and 5 years after surgery. Seven papers were included in the review. A total of 238 patients were analyzed. STN-DBS was confirmed to be an effective treatment for selected patients with PD. In all studies, off-related motor symptoms improved dramatically, compared with pre-implant, at 2 (or 3, according to the study) years and this result persisted at 5-year evaluations. Antiparkinsonian drug reductions, improvements in motor fluctuations and dyskinesias, functional measures and the progression of underlying PD were also reported in all series. Some axial scores, in particular postural stability and speech, improved transiently. Persisting adverse effects included eyelid opening apraxia, weight gain, psychiatric disorders, depression, dysarthria, dyskinesias, and apathy. The present review of the 5-year observations confirms that STN-DBS is a powerful method in the management of PD, but its long-term effects must be thoroughly assessed.

  8. Post-transplant donor-specific antibody production and graft outcome in kidney transplantation: results of sixteen-year monitoring by flow cytometry.

    PubMed

    Piazza, Antonina; Poggi, Elvira; Ozzella, Giuseppina; Borrelli, Laura; Scornajenghi, Alessandra; Iaria, Giuseppe; Tisone, Giuseppe; Adorno, Domenico

    2006-01-01

    Our data show that monitoring by sensitive flow cytometric techniques of the de novo production of anti-HLA antibodies in patients receiving kidney transplantation is a useful and noninvasive tool to identify the onset of an immune response towards the graft before any clinical manifestation of antibody-mediated graft injury. Consequently prospective posttransplant monitoring of anti-HLA donor-directed antibodies may offer the chance to realize an effective clinical intervention in order to prevent graft dysfunction and to prolong graft survival. The long follow-up period of the study allowed us to demonstrate a very low graft survival rate in patients who developed donor-specific HLA antibodies in comparison with patients who did not have antibodies, thus confirming the "humoral theory of transplantation". The posttransplant production of anti-HLA antibodies can predict not only graft failure but also chronic dysfunction of the graft. Moreover, our findings suggest that graft survival is influenced by the epitope- and locus-specificity of anti-HLA donor-directed antibodies. The interval between antibody appearance and loss of graft function was short in some patients but reached several years in others. Moreover, some patients showed consistent production of antibodies for many years and an uneventful clinical status. These findings suggest a mechanism of graft "accommodation" or the production of "harmless" antibodies. Immunosuppressive drug combinations able to inhibit T and B cell activation are useful tools to prevent the humoral immune response against graft and consequently to prolong graft survival.

  9. Grafts for Ridge Preservation

    PubMed Central

    Jamjoom, Amal; Cohen, Robert E.

    2015-01-01

    Alveolar ridge bone resorption is a biologic phenomenon that occurs following tooth extraction and cannot be prevented. This paper reviews the vertical and horizontal ridge dimensional changes that are associated with tooth extraction. It also provides an overview of the advantages of ridge preservation as well as grafting materials. A Medline search among English language papers was performed in March 2015 using alveolar ridge preservation, ridge augmentation, and various graft types as search terms. Additional papers were considered following the preliminary review of the initial search that were relevant to alveolar ridge preservation. The literature suggests that ridge preservation methods and augmentation techniques are available to minimize and restore available bone. Numerous grafting materials, such as autografts, allografts, xenografts, and alloplasts, currently are used for ridge preservation. Other materials, such as growth factors, also can be used to enhance biologic outcome. PMID:26262646

  10. Impact of donor-specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation: a Eurocord, Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI) and Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) analysis.

    PubMed

    Ruggeri, Annalisa; Rocha, Vanderson; Masson, Emeline; Labopin, Myriam; Cunha, Renato; Absi, Lena; Boudifa, Ali; Coeffic, Brigitte; Devys, Anne; De Matteis, Muriel; Dubois, Valérie; Hanau, Daniel; Hau, Françoise; Jollet, Isabelle; Masson, Dominique; Pedron, Beatrice; Perrier, Pascale; Picard, Christophe; Ramouneau-Pigot, Annie; Volt, Fernanda; Charron, Dominique; Gluckman, Eliane; Loiseau, Pascale

    2013-07-01

    Graft failure is a major complication after unrelated cord blood transplantation. Presence of HLA-antibodies before cord blood transplantation may impact graft failure. To analyze the effect of anti-HLA antibodies on unrelated cord blood transplantation outcomes, we analyzed 294 unrelated cord blood transplant recipients after reduced intensity conditioning regimen. The majority of the patients (82%) were transplanted for malignancies, 60% with double-unrelated cord blood transplant, 63% were HLA mismatched. Retrospectively, pre-unrelated cord blood transplant serum was tested for HLA-Ab using Luminex™ platform. Results were interpreted as mean fluorescence intensity (MFI) against donor-specific mismatch. Among 62 recipients (23%) who had anti-HLA antibodies before unrelated cord blood transplant, 14 patients had donor specific anti-HLA antibodies (DSA) (7 were donor-specific anti-HLA antibodies for single unrelated cord blood transplant and 7 for double unrelated cord blood transplant). Donor specific anti-HLA antibodies threshold ranged from 1620-17629 of mean fluorescence intensity (MFI). Cumulative incidence of Day-60 neutrophil engraftment was 76%: 44% for recipients with donor specific anti-HLA antibodies and 81% in those without donor specific anti-HLA antibodies (P=0.006). The cumulative incidence of 1-year transplant related mortality was 46% in patients with donor specific anti-HLA antibodies and 32% in those without antibodies (P=0.06). The presence of donor specific anti-HLA antibodies was associated with a trend for decreased survival rate (42% vs. 29%; P=0.07). Donor specific anti-HLA antibody in recipients of unrelated cord blood transplant is associated with graft failure and decreased survival. Patient's screening for donor specific anti-HLA antibodies before unrelated cord blood transplantation is recommended before choosing an HLA mismatched cord blood unit. Whenever possible it is important to avoid selecting a unit for which the patient has

  11. Graft-versus-host disease

    MedlinePlus

    GVHD; Bone marrow transplant - graft-versus-host disease; Stem cell transplant - graft-versus-host disease; Allogeneic transplant - ... GVHD may occur after a bone marrow, or stem cell, transplant in which someone receives bone marrow ...

  12. Ten Years of Experience with the GORE EXCLUDER{sup Registered-Sign} Stent-Graft for the Treatment of Aortic and Iliac Aneurysms: Outcomes from a Single Center Study

    SciTech Connect

    Maleux, G. Claes, H.; Van Holsbeeck, A.; Janssen, R.; Laenen, A.; Heye, S.; Houthoofd, S.; Fourneau, I.

    2012-06-15

    Purpose: This study was designed to assess the long-term outcome of selected patients with aortic, aortoiliac, and isolated common iliac aneurysms treated with the GORE EXCLUDER{sup Registered-Sign} stent-graft. Methods: Between December 1998 and June 2010, 121 nonconsecutive patients underwent insertion of a GORE EXCLUDER{sup Registered-Sign} stent-graft to treat an aortic (n = 80; 66%), aortoiliac (n = 25; 21%), or isolated common iliac (n = 16; 13%) aneurysm. Procedural and follow-up data were collected prospectively. Primary endpoints are overall survival, intervention-free survival, and freedom from aneurysm rupture. Secondary endpoints are device- and procedure-related complications, including all types of endoleaks or endotension, and reintervention. Results: The mean follow-up is 4.98 years (standard deviation, 3.18; median follow-up, 4.05 years). The estimated percentage overall survival (with 95% confidence interval) after respectively 5 and 10 years of follow-up is 74.5% (65.8; 81.3) and 57.8% (47.7; 66.7). The estimated intervention-free survival after respectively 5 and 10 years is 90% (84.3; 96.1) and 77.7% (67; 88.4). There was no aneurysm rupture during follow-up. Early postoperative complications occurred in 16 patients (13%); none were fatal. Late reinterventions were performed in 18 patients (15%). Finally, throughout the follow-up period, endoleaks were identified: type I (n = 4; 3%); type II (n = 39; 32%); type III (n = 0; 0%); endotension was seen in 11 patients (9%). Conclusions: Aneurysm exclusion with use of the GORE EXCLUDER{sup Registered-Sign} stent-graft is durable through a mean follow-up of nearly 5 years. There was no postprocedural aneurysm rupture. Complications occurred throughout the follow-up period, requiring continued clinical and radiological surveillance.

  13. The vascular pattern and viability of microvascularized rib grafts based on periosteal circulation--an experimental study

    SciTech Connect

    Papanastasiou, V.W.; Lalonde, D.H.; Williams, H.B.

    1984-11-01

    Previous reports have stressed the importance of the nutrient blood supply in rib grafts transferred by microvascular anastomoses. In the present experimental study, we have demonstrated that a rib graft transferred by microvascular anastomoses based on periosteal vessels can survive; vascular clearing studies demonstrated that the vascularity of these grafts extends not only into the cortex but the medulla as well. The relative facility of harvesting these grafts (compared with those based on nutrient vessels) should make them the favored choice. Technetium bone scintigraphy proved accurate in the assessment of both vascular pattern and microanastomotic patency. Tetracycline labeling did not correlate well with the patency of a rib graft's pedicle blood supply.

  14. Situational analysis and future directions of AYUSH: An assessment through 5-year plans of India.

    PubMed

    Samal, Janmejaya

    2015-01-01

    AYUSH is an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. These are the six indigenous systems of medicine practiced in India. A department called Department of Indian System of medicine was created in March 1995 and renamed to AYUSH in November 2003 with a focus to provide increased attention for the development of these systems. Very recently, in 2014, a separate ministry was created under the union Government of India, which is headed by a minister of state. Planning regarding these systems of medicine was a part of 5-year planning process since 1951. Since then many developments have happened in this sector albeit the system was struggling with a great degree of uncertainty at the time of 1(st)5-year plan. A progressive path of development could be observed since the first to the 12(th)5-year plan. It was up to the 7(th)plan the growth was little sluggish and from 8(th)plan onward the growth took its pace and several innovative development processes could be observed thereafter. The system is gradually progressing ahead with a vision to be a globally accepted system, as envisaged in 11(th)5-year plan. Currently, AYUSH system is a part of mainstream health system implemented under National Rural Health Mission (NRHM). NRHM came into play in 2005 but implemented at ground level in 2006 and introduced the scheme of "Mainstreaming of AYUSH and revitalization of local health traditions" to strengthen public health services. This scheme is currently in operation in its second phase, since 1(st)April 2012, with the 12(th)5-year plan. The scheme was primarily brought in to operation with three important objectives; choice of treatment system to the patients, strengthen facility functionally and strengthen the implementation of national health programmes, however, in some places it seems to be a forced medical pluralism owing to a top-down approach by the union government without considerable involvement of the concerned community. In this

  15. Situational analysis and future directions of AYUSH: An assessment through 5-year plans of India

    PubMed Central

    Samal, Janmejaya

    2015-01-01

    AYUSH is an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. These are the six indigenous systems of medicine practiced in India. A department called Department of Indian System of medicine was created in March 1995 and renamed to AYUSH in November 2003 with a focus to provide increased attention for the development of these systems. Very recently, in 2014, a separate ministry was created under the union Government of India, which is headed by a minister of state. Planning regarding these systems of medicine was a part of 5-year planning process since 1951. Since then many developments have happened in this sector albeit the system was struggling with a great degree of uncertainty at the time of 1st5-year plan. A progressive path of development could be observed since the first to the 12th5-year plan. It was up to the 7thplan the growth was little sluggish and from 8thplan onward the growth took its pace and several innovative development processes could be observed thereafter. The system is gradually progressing ahead with a vision to be a globally accepted system, as envisaged in 11th5-year plan. Currently, AYUSH system is a part of mainstream health system implemented under National Rural Health Mission (NRHM). NRHM came into play in 2005 but implemented at ground level in 2006 and introduced the scheme of “Mainstreaming of AYUSH and revitalization of local health traditions” to strengthen public health services. This scheme is currently in operation in its second phase, since 1stApril 2012, with the 12th5-year plan. The scheme was primarily brought in to operation with three important objectives; choice of treatment system to the patients, strengthen facility functionally and strengthen the implementation of national health programmes, however, in some places it seems to be a forced medical pluralism owing to a top-down approach by the union government without considerable involvement of the concerned community. In this study, the

  16. Bone Grafts in Craniofacial Surgery

    PubMed Central

    Elsalanty, Mohammed E.; Genecov, David G.

    2009-01-01

    Reconstruction of cranial and maxillofacial defects is a challenging task. The standard reconstruction method has been bone grafting. In this review, we shall describe the biological principles of bone graft healing, as pertinent to craniofacial reconstruction. Different types and sources of bone grafts will be discussed, as well as new methods of bone defect reconstruction. PMID:22110806

  17. Grafting effects on vegetable quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In the United States, vegetable grafting is rare and few experiments have been done to determine optimal grafting procedures and production practices for different geographical and climatic regions in America. Grafting vegetables to control soilborne disease is a common practice in Asia, parts of E...

  18. 75 FR 53272 - Endangered and Threatened Species; Initiation of 5-Year Review of the Eastern Distinct Population...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-31

    ... of 5-Year Review of the Eastern Distinct Population Segment of the Steller Sea Lion AGENCY: National..., 2010, announcing the initiation of a 5-year review of the eastern Distinct Population Segment (DPS) of..., announcing the initiation of a 5-year review of the eastern Distinct Population Segment (DPS) of the...

  19. Resting Energy Expenditure and Systolic Blood Pressure Relationships in Women Across 4.5 Years

    PubMed Central

    Sriram, Neeraj; Hunter, Gary R.; Fisher, Gordon; Brock, David W.

    2014-01-01

    Recent studies have reported a strong association between blood pressure (BP) and resting energy expenditure (REE). However, it is not known if this relationship persists over time. Therefore, we examined the temporal relationship between REE and systolic BP. Additionally, we examined the impact of sympathetic tone and anthropometric variables on this relationship. All testing was performed on healthy, overweight African American and European American women aged 25 – 45 years over 4.5 years in the UAB General Clinical Research Center. Repeated measures mixed-models revealed REE as a significant determinant of systolic BP (β=0.0155, P<0.0001), independent of catecholamines, leg fat, visceral fat, fat free mass, fat mass, height, RSMI, and resting heart rate. Observations that REE is predictive of systolic BP across 4.5 years support previous findings that REE may potentially mediate resting BP, independent of anthropometric variables and a marker for sympathetic tone. PMID:24548382

  20. Screw fixation for atlantoaxial dislocation related to Down syndrome in children younger than 5 years.

    PubMed

    Ito, Kenyu; Imagama, Shiro; Ito, Zenya; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ishikawa, Yoshimoto; Ishiguro, Naoki

    2017-01-01

    The aim of this study was to present cases of upper cervical fixation in Down syndrome patients younger than 5 years. In two cases, C1 lateral mass screws were installed. However, owing to the irreducible atlantoaxial dislocation, the screw backed out and fractured. Therefore, O-C2 fusion was performed. Furthermore, C2 bilateral lamina screws were added to the C2 pedicle screw for reinforcement. C1-C2 fusion is an option for Down syndrome patients younger than 5 years with atlantoaxial dislocation, when the dislocation is reducible. If the dislocation is irreducible, or the implant cannot be firmly secured, the fixation range should be expanded to O-C2 or below.

  1. [Tibial valgization osteotomy in gonarthrosis with or without chondrocalcinosis. Results after 5 years].

    PubMed

    Job-Deslandre, C; Languepin, A; Benvenuto, M; Menkès, C J

    1991-01-01

    The authors compare the results of valgisation tibial osteotomies in osteoarthrosis of the knee (146 cases) and osteoarthrosis of the knee with chondrocalcinosis (94 cases). The two groups were identical in terms of age, but differed by sex ratio (female predominance in CCA) and the initial radiological stage (more advanced forms in the CCA group). Results differed after the second year and reached significantly different values at 5 years (73% in knee osteoarthrosis as against 34% good clinical results in chondrocalcinosis). Study of two groups of patients paired for age, sex, weight and radiological stage showed that results at 5 years were significantly less good in the CCA group. These results are discussed and compared with those in the 1990 literature.

  2. Residual gentamicin-release from antibiotic-loaded polymethylmethacrylate beads after 5 years of implantation.

    PubMed

    Neut, Daniëlle; van de Belt, Hilbrand; van Horn, Jim R; van der Mei, Henny C; Busscher, Henk J

    2003-05-01

    In infected joint arthroplasty, high local levels of antibiotics are achieved through temporary implantation of non-biodegradable gentamicin-loaded polymethylmethacrylate beads. Despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferentially adhere, grow and potentially develop antibiotic resistance. In routine clinical practice, these beads are removed after 14 days, but for a variety of reasons, we were confronted with a patient in which these beads were left in situ for 5 years. Retrieval of gentamicin-loaded beads from this patient constituted an exceptional case to study the effects of long-term implantation on potentially colonizing microflora and gentamicin release. Gentamicin-release test revealed residual antibiotic release after being 5 years in situ and extensive microbiological sampling resulted in recovery of a gentamicin-resistant staphylococcal strain from the bead surface. This case emphasizes the importance of developing biodegradable antibiotic-loaded beads as an antibiotic delivery system.

  3. Successful management of peri-implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3- to 7.5-year follow-up.

    PubMed

    Froum, Stuart J; Froum, Scott H; Rosen, Paul S

    2012-02-01

    The results of a case series of 51 consecutively treated, peri-implantitis-affected implants in 38 patients with follow-up measurements from 3 to 7.5 years are presented. Each implant displayed bleeding on probing, probing depths ≥ 6 mm, and bone loss ≥ 4 mm prior to surgery. A successful regenerative approach including surface decontamination, use of enamel matrix derivative, a combination of platelet-derived growth factor with anorganic bovine bone or mineralized freeze-dried bone, and coverage with a collagen membrane or a subepithelial connective tissue graft was employed in all cases. Patients were divided into two groups. Group 1 included patients in which the greatest defect depth was visible on radiographs; group 2 included patients in which the greatest loss of bone was on the facial or oral aspect of the implant. Bone level changes in patients in group 2 were determined by probe sounding under local anesthesia. Probing depth reductions at 3 to 7.5 years of follow-up were 5.4 and 5.1 mm in groups 1 and 2, respectively. Concomitant bone level gain was 3.75 mm in group 1 and 3.0 mm in group 2. No implant in either group lost bone throughout the duration of the study. The results to date with this regenerative approach for the treatment of peri-implantitis appear to be encouraging.

  4. A 5-year Journey with Cutis Laxa in an Indian Child: The De Barsy Syndrome Revisited

    PubMed Central

    Dutta, Abhijit; Ghosh, Sudip Kumar; Ghosh, Arghyaprasun; Roy, Sutirtha

    2016-01-01

    De Barsy syndrome (DBS), synonymously known as autosomal recessive cutis laxa type III, is an extremely rare condition clinically characterized by cutis laxa, a progeroid appearance, and ophthalmologic abnormalities. We present here an account of 5-year follow-up since the birth of an Indian boy with DBS, who had a few rare and unusual manifestations. In addition, our case probably represents the first reported case of DBS from India. PMID:26955101

  5. Equatorial Annual Oscillation with QBO-driven 5-year Modulation in NCEP Data

    NASA Technical Reports Server (NTRS)

    Mayr, H. G.; Mengel, J. G.; Huang, F. T.; Nash, E. R.

    2007-01-01

    An analysis is presented of the zonal wind and temperature variations supplied by the National Center for Environmental Prediction (NCEP), which have been assimilated in the Reanalysis and the Climate Prediction Center (CCP) data sets. The derived zonal-mean variations are employed. Stimulated by modeling studies, the data are separated into the hemispherically symmetric and anti-symmetric components, and spectral analysis is applied to study the annual 12-month oscillation and Quasi-biennial Oscillation (QBO). For data samples that cover as much as 40 years, the results reveal a pronounced 5-year modulation of the symmetric AO in the lower stratosphere, which is confined to equatorial latitudes. This modulation is also inferred for the temperature variations but extends to high latitudes, qualitatively consistent with published model results. A comparison between different data samples indicates that the signature of the 5-year oscillation is larger when the QBO of 30 months is more pronounced. Thus there is circumstantial evidence that this periodicity of the QBO is involved in generating the oscillation. The spectral analysis shows that there is a weak anti-symmetric 5-year oscillation in the zonal winds, which could interact with the large antisymmetric A0 to produce the modulation of the symmetric AO as was shown in earlier modeling studies. According to these studies, the 30-month QBO tends to be synchronized by the equatorial Semi-annual Oscillation (SAO), and this would explain why the inferred 5-year modulation is observed to persist and is phase locked over several cycles.

  6. Increased risk of cancer after Bell's palsy: a 5-year follow-up study.

    PubMed

    Sheu, Jau-Jiuan; Keller, Joseph J; Lin, Herng-Ching

    2012-11-01

    Reactivation of latent herpes simplex virus (HSV) type I or varicella-zoster virus (VZV) has been recognized as the most common pathomechanism underlying Bell's palsy. There is also increased reactivation of HSV or VZV in patients with immunosuppressed states and in cancer patients. The purpose of this study was to investigate the risk for cancer during a 5-year follow-up period after diagnosis of Bell's palsy by using a population-based dataset in Taiwan. We used data from the "Longitudinal Health Insurance Database". We identified 2,618 patients with Bell's palsy as the study cohort and randomly selected 13,090 patients to be used as a comparison cohort. Cox proportional hazards regression was performed to compare the 5-year risk of subsequent cancer between the study and comparison cohorts. We found that the incidence of cancer was 1.55 (95 % CI 1.35-1.78) per 100 person-years for patients with Bell's palsy and 1.09 (95 % CI 1.02-1.18) per 100 person-years for comparison patients. After censoring cases that died from non-cancer causes during the follow-up period and adjusting for urbanization, monthly income, geographic region, and diabetes, the hazard ratio (HR) for cancer during the 5-year follow-up period for patients with Bell's palsy was 1.43 times that for comparison patients (95 % CI 1.22-1.73). There was a particularly increased risk of oral cancer (HR = 2.49; 95 % CI 1.54-4.03) for patients with Bell's palsy compared with the other patients. We conclude that patients with Bell's palsy were at significant risk of cancer during a 5-year follow-up period after diagnosis.

  7. Childhood leukaemia incidence below the age of 5 years near French nuclear power plants.

    PubMed

    Laurier, D; Hémon, D; Clavel, J

    2008-09-01

    A recent study indicated an excess risk of leukaemia among children under the age of 5 years living in the vicinity of nuclear power plants in Germany. We present results relating to the incidence of childhood leukaemia in the vicinity of nuclear power plants in France for the same age range. These results do not indicate an excess risk of leukaemia in young children living near French nuclear power plants.

  8. Relief of membranous obstruction of the inferior vena cava in a 5-year-old child.

    PubMed

    Amodeo, A; Di Donato, R; Dessanti, A; Caccia, G; Zaltron, D; Alberti, D; Callea, F; Marcelletti, C

    1986-12-01

    Membranous obstruction of the inferior vena cava is a rare congenital anomaly that may present clinical features of Budd-Chiari syndrome caused by chronic obstruction of the hepatic drainage. We report membranous obstruction of the inferior vena cava in a 5-year-old boy. Surgical repair was prompted by signs and symptoms of hepatic venous obstruction. To our knowledge, this is the youngest patient successfully operated on for this anomaly.

  9. Prenatal Lead Exposure and Weight of 0- to 5-Year-Old Children in Mexico City

    PubMed Central

    Peterson, Karen E.; Sánchez, Brisa N.; Cantonwine, David; Lamadrid-Figueroa, Héctor; Schnaas, Lourdes; Ettinger, Adrienne S.; Hernández-Avila, Mauricio; Hu, Howard; Téllez-Rojo, Martha M.

    2011-01-01

    Background: Cumulative prenatal lead exposure, as measured by maternal bone lead burden, has been associated with smaller weight of offspring at birth and 1 month of age, but no study has examined whether this effect persists into early childhood. Objective: We investigated the association of perinatal maternal bone lead, a biomarker of cumulative prenatal lead exposure, with children’s attained weight over time from birth to 5 years of age. Methods: Children were weighed at birth and at several intervals up until 60 months. Maternal tibia and patella lead were measured at 1 month postpartum using in vivo K-shell X-ray fluorescence. We used varying coefficient models with random effects to assess the association of maternal bone lead with weight trajectories of 522 boys and 477 girls born between 1994 and 2005 in Mexico City. Results: After controlling for breast-feeding duration, maternal anthropometry, and sociodemographic characteristics, a 1-SD increase in maternal patella lead (micrograms per gram) was associated with a 130.9-g decrease in weight [95% confidence interval (CI), –227.4 to –34.4 g] among females and a 13.0-g nonsignificant increase in weight among males (95% CI, –73.7 to 99.9 g) at 5 years of age. These associations were similar after controlling for concurrent blood lead levels between birth and 5 years. Conclusions: Maternal bone lead was associated with lower weight over time among female but not male children up to 5 years of age. Given that the association was evident for patellar but not tibial lead levels, and was limited to females, results need to be confirmed in other studies. PMID:21715242

  10. The prevalence of dental erosion in 5-year-old preschoolers in Sharjah, United Arab Emirates

    PubMed Central

    Gopinath, Vellore Kannan

    2016-01-01

    Objective: The aim of this study was to determine the percentage of 5-year-old preschoolers in Sharjah, affected by dental erosion and to assess the predictors. Materials and Methods: A total of 403 5-year-old children were examined of which 48.14% (n = 194) were boys and 51.86% (n = 209) were girls; 31.27% (n = 126) were Emirati and 68.73% (n = 277) were non-Emirati Arabs. Examination of dental erosion was confined to palatal surfaces of maxillary incisors using the erosion index described in the UK National Survey of Children's Dental Health, 1993. Dental caries was charted using the World Health Organization 1997 criteria. Results: In the sample of 403 5-year-old preschoolers examined, dental erosion was apparent in 237 (58.80%) children, with 55.09% showing the dissolution of enamel and 3.72% exhibiting exposed dentin. Predictors of dental erosion as determined by logistic regression concluded that compared to Emirati citizens other Arab nationalities have 0.27 times the odds (95% confidence interval [CI] =0.18–0.42) of having tooth erosion (P < 0.05). Children with caries experience have 0.28 times the odds (95% CI = 0.16–0.51) of having tooth erosion compared to children with no caries experience (P < 0.05). Children who drink sugary or carbonated beverages have 0.30 times the odds (95% CI = 0.19–0.41) of having dental erosion compared to children who drink water (P < 0.05). Conclusions: The findings of this study indicate that 58.80% of 5-year-old preschoolers in Sharjah, United Arab Emirates, were affected by dental erosion. Caries experience and consumption of acidic drinks were associated with dental erosion. PMID:27095899

  11. Development and verification of child observation sheet for 5-year-old children.

    PubMed

    Fujimoto, Keiko; Nagai, Toshisaburo; Okazaki, Shin; Kawajiri, Mie; Tomiwa, Kiyotaka

    2014-02-01

    The aim of the study was to develop a newly devised child observation sheet (COS-5) as a scoring sheet, based on the Childhood Autism Rating Scale (CARS), for use in the developmental evaluation of 5-year-old children, especially focusing on children with autistic features, and to verify its validity. Seventy-six children were studied. The children were recruited among participants of the Japan Children's Cohort Study, a research program implemented by the Research Institute of Science and Technology for Society (RISTEX) from 2004 to 2009. The developmental evaluation procedure was performed by doctors, clinical psychologists, and public health nurses. The COS-5 was also partly based on the Kyoto Scale of Psychological Development 2001 (Kyoto Scale 2001). Further, the Developmental Disorders Screening Questionnaire for 5-Years-Olds, PDD-Autism Society Japan Rating Scale (PARS), doctor interview questions and neurological examination for 5-year-old children, and the Draw-a-Man Test (DAM) were used as evaluation scales. Eighteen (25.4%) children were rated as Suspected, including Suspected PDD, Suspected ADHD and Suspected MR. The COS-5 was suggested to be valid with favorable reliability (α=0.89) and correlation with other evaluation scales. The COS-5 may be useful, with the following advantages: it can be performed within a shorter time frame; it facilitates the maintenance of observation quality; it facilitates sharing information with other professions; and it is reliable to identify the autistic features of 5-year-old children. In order to verify its wider applications including the screening of infants (18months to 3years old) by adjusting the items of younger age, additional study is needed.

  12. Esthetic restorations: observations and insights gained over a 5-year period demonstrated with three case reports.

    PubMed

    Obama, Tadakazu

    2007-01-01

    This article presents two prosthodontically treated patient cases that were observed over a period of at least 5 years after treatment. The evaluation, diagnosis, treatment planning, and treatment stages were critically reviewed and reassessed from different perspectives. The conclusions drawn from this evaluation were subsequently implemented in a third clinical case. To ensure the long-term success of a restoration, certain biologic and mechanical principles must be observed, and the appropriate prosthodontic treatment must be chosen accordingly.

  13. Skin graft - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100100.htm Skin graft - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  14. Acrylonitrile grafted to PVDF

    SciTech Connect

    Yang, Jin; Eitouni, Hany Basam

    2015-03-31

    PVDF-g-PAN has been synthesized by grafting polyacrylonitrile onto polyvinylidene fluoride using an ATRP/AGET method. The novel polymer is ionically conducive and has much more flexibility than PVDF alone, making it especially useful either as a binder in battery cell electrodes or as a polymer electrolyte in a battery cell.

  15. Grafting for disease resistance

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The primary purpose of grafting vegetables worldwide has been to provide resistance to soilborne diseases. The potential loss of methyl bromide as a soil fumigant combined with pathogen resistance to commonly used pesticides will make resistance to soil born pathogens even more important in the futu...

  16. Grafting for disease resistance

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The primary purpose of grafting vegetables worldwide has been to provide resistance to soil-borne diseases. The potential loss of methyl bromide as a soil fumigant combined with pathogen resistance to commonly used pesticides will make resistance to soil-borne pathogens even more important in the fu...

  17. Genetic therapy for vein bypass graft disease: current perspectives.

    PubMed

    Simosa, Hector F; Conte, Michael S

    2004-01-01

    Although continued progress in endovascular technology holds promise for less invasive approaches to arterial diseases, surgical bypass grafting remains the mainstay of therapy for patients with advanced coronary and peripheral ischemia. In the United States, nearly 400,000 coronary and 100,000 lower extremity bypass procedures are performed annually. The autogenous vein, particularly the greater saphenous vein, has proven to be a durable and versatile arterial substitute, with secondary patency rates at 5 years of 70 to 80% in the extremity. However, vein graft failure is a common occurrence that incurs significant morbidity and mortality, and, to date, pharmacologic approaches to prolong vein graft patency have produced limited results. Dramatic advances in genetics, coupled with a rapidly expanding knowledge of the molecular basis of vascular diseases, have set the stage for genetic interventions. The attraction of a genetic approach to vein graft failure is based on the notion that the tissue at risk is readily accessible to the clinician prior to the onset of the pathologic process and the premise that genetic reprogramming of cells in the wall of the vein can lead to an improved healing response. Although the pathophysiology of vein graft failure is incompletely understood, numerous relevant molecular targets have been elucidated. Interventions designed to influence cell proliferation, thrombosis, inflammation, and matrix remodeling at the genetic level have been described, and many have been tested in animal models. Both gene delivery and gene blockade strategies have been investigated, with the latter reaching the stage of advanced clinical trials.

  18. Prevalence and Factors Associated with Anemia among Children under 5 Years of Age—Uganda, 2009

    PubMed Central

    Menon, Manoj P.; Yoon, Steven S.

    2015-01-01

    Anemia in children under 5 years of age, defined by the World Health Organization as a hemoglobin concentration < 11 g/dL, is a global public health problem. According to the 2006 Demographic Health Survey, the prevalence of anemia among children under five in Uganda was 72% in 2006. The 2009 Uganda Malaria Indicator Survey was conducted in late 2009 and revealed that over 60% of children less than 5 years of age were anemic and that over half of children tested positive for malaria via a rapid diagnostic test. Children with concomitant malaria infection, and in households without any type of mosquito net were more likely to be anemic, confirming that children under 5 years, are vulnerable to both the threat of malaria and anemia and the beneficial effect of malaria prevention tools. However, prevention and treatment of other factors associated with the etiology of anemia (e.g., iron deficiency) are likely necessary to combat the toll of anemia in Uganda. PMID:26055748

  19. Psychological distress and the development of hypertension over 5 years in black South Africans.

    PubMed

    Schutte, Aletta E; Ware, Lisa J; Huisman, Hugo W; Fourie, Carla M T; Greeff, Minrie; Khumalo, Tumi; Wissing, Marie P

    2015-02-01

    Alarming increases in the incidence of hypertension in many low- and middle-income countries are related to alcohol overuse. It is unclear whether alcohol overuse is a symptom of psychological distress. The authors assessed psychological distress in Africans and its relationship with a 5-year change in blood pressure (BP), independent of alcohol intake. The authors followed 107 Africans with optimal BP (≤120/80 mm Hg) (aged 35-75 years) over 5 years. Alcohol intake (self-report and serum γ-glutamyl transferase) and nonspecific psychological distress (Kessler Screening Scale for Psychological Distress [K6]) were assessed. The K6 predicted hypertension development (P=.019), and its individual component "nervous" increased a participant's risk two-fold to become hypertensive (hazard ratio, 2.00 [1.23-3.26]). By entering K6 and γ-glutamyl transferase into multivariable-adjusted regression models for change in systolic BP, both were independently associated with change in systolic BP. Psychological distress and scoring high on being nervous predicted the development of hypertension over 5 years, independent of alcohol intake.

  20. Hypoadiponectinemia As an Independent Predictor for the Progression of Carotid Atherosclerosis: A 5-Year Prospective Study

    PubMed Central

    Hui, Elaine; Xu, Aimin; Chow, Wing-Sun; Lee, Paul C.H.; Fong, Carol H.Y.; Cheung, Stephen C.W.; Tse, Hung Fat; Chau, Ming-Tak; Cheung, Bernard M.Y.

    2014-01-01

    Abstract Background: Hypoadiponectinemia predicts the development of diabetes and hypertension, both being potent atherosclerotic risk factors. Whether adiponectin predicts the progression of early atherosclerosis remains unclear. In this 5-year prospective study, we examined the relationship between serum adiponectin and carotid intima media thickness (CIMT), a marker of subclinical atherosclerosis. Methods: A total of 265 subjects from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study, with no known cardiovascular disease, underwent CIMT measurement at baseline and at 5 years. Results: In all, 129 men and 136 women, aged 54.6±12.3 years, were studied. Median CIMT at baseline was 0.63 mm (interquartile range 0.52–0.73 mm) and increased to 0.67 mm (0.56–0.78 mm) after 5 years (P<0.001). CIMT increment correlated with baseline adiponectin, age, and smoking (all P<0.05) and baseline CIMT (P<0.001), but not with sex, fasting glucose, lipid profiles, hypertension, or diabetes. In multiple linear regression analysis, baseline serum adiponectin level was an independent predictor of CIMT increment β (standardized beta)=−0.17, P=0.015], after adjusting for age, smoking, baseline CIMT, hypertension, body mass index, fasting glucose, low-density lipoprotein cholesterol, and triglycerides. Conclusion: Hypoadiponectinemia predicted CIMT progression, independent of known predictive factors such as age, smoking, hyperlipidemia, and hypertension. PMID:25211296

  1. Immunologic memory 5 years after meningococcal A/C conjugate vaccination in infancy.

    PubMed

    MacLennan, J; Obaro, S; Deeks, J; Lake, D; Elie, C; Carlone, G; Moxon, E R; Greenwood, B

    2001-01-01

    Infant vaccination with meningococcal conjugates may provide long-term protection against disease. Antibody levels and immunologic memory were assessed in 5-year-old Gambian children who received meningococcal A/C conjugate vaccination (MenA/C) in infancy. At 2 years, they were randomized to receive a booster of MenA/C (conjugate group), meningococcal A/C polysaccharide (MPS group), or inactivated polio vaccine (IPV group). All groups were revaccinated with 10 microg MPS at 5 years of age, as were 39 previously unvaccinated age-matched control subjects. Before revaccination, titers were higher in the conjugate and MPS groups than in control subjects (P<.001); titers for the IPV group were similar to those for control subjects. Ten days after revaccination, the conjugate and IPV groups had similar serogroup C serum bactericidal antibody titers (3421 vs. 2790, respectively). These levels were significantly higher than those in the MPS (426) and control (485) groups (P<.001). Thus, immunologic memory was sustained for > or =5 years; however, MPS challenge at 2 years interfered with a subsequent memory response.

  2. Endocrine dysfunction following traumatic brain injury: a 5-year follow-up nationwide-based study

    PubMed Central

    Yang, Wei-Hsun; Chen, Pau-Chung; Wang, Ting-Chung; Kuo, Ting-Yu; Cheng, Chun-Yu; Yang, Yao-Hsu

    2016-01-01

    Post-traumatic endocrine dysfunction is a complication of traumatic brain injury (TBI). However, there is lack of long-term follow-up and large sample size studies. This study included patients suffering from TBI registered in the Health Insurance Database. Endocrine disorders were identified using the ICD codes: 244 (acquired hypothyroidism), 253 (pituitary dysfunction), 255 (disorders of the adrenal glands), 258 (polyglandular dysfunction), and 259 (other endocrine disorders) with at least three outpatient visits within 1 year or one admission diagnosis. Overall, 156,945 insured subjects were included in the final analysis. The 1- and 5-year incidence rates of post-traumatic endocrinopathies were 0.4% and 2%, respectively. The risks of developing a common endocrinopathy (p < 0.001) or pituitary dysfunction (P < 0.001) were significantly higher in patients with a TBI history. Patients with a skull bone fracture had a higher risk of developing pituitary dysfunction at the 1-year follow up (p value < 0.001). At the 5-year follow up, the association between intracranial hemorrhage and pituitary dysfunction (p value: 0.002) was significant. The risk of developing endocrine dysfunction after TBI increased during the entire 5-year follow-up period. Skull bone fracture and intracranial hemorrhage may be associated with short and long-term post-traumatic pituitary dysfunction, respectively. PMID:27608606

  3. Profiling the ethnic characteristics of domestic injuries in children younger than age 5 years.

    PubMed

    Oyetunji, Tolulope A; Stevenson, Adrienne A; Oyetunji, Aderonke O; Onguti, Sharon K; Ames, Sarah A; Haider, Adil H; Nwomeh, Benedict C

    2012-04-01

    The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per cent. Among whites, blacks, Hispanics, Asians, and Native Americans, intentional injuries accounted for 6.5, 12.8, 10.2, 5.2, and 19.0 per cent of all injuries by intent, respectively (P < 0.003). Burn injury was disproportionately higher in blacks (24.1%) followed by Native Americans and Asians (15.3 and 11.5%, P = 0.008). On multivariate analysis, black ethnicity was associated with increased length of stay. Intentional injuries were significantly higher in blacks and Native Americans with black patients sustaining a disproportionately higher proportion of burn injury. Therefore, greater attention is needed to provide more effective home safety interventions to children among high-risk ethnic groups.

  4. Minimum 5-year Follow-up Results of Minimally Invasive Total Knee Arthroplasty Using Mini-Keel Modular Tibial Implant

    PubMed Central

    Yoo, Ju-Hyung; Park, Byoung-Kyu; Han, Chang-Dong; Oh, Hyun-Cheol

    2014-01-01

    Purpose To evaluate the minimum 5-year mid-term clinical and radiological results of minimally invasive surgery total knee arthroplasty (MIS-TKA) using a mini-keel modular tibia component. Materials and Methods We retrospectively evaluated 254 patients (361 cases) who underwent MIS-TKA between 2005 and 2006. The latest clinical and radiological assessments were done in 168 cases that had been followed on an outpatient basis for more than 5 postoperative years. Clinical results were assessed using the Hospital for Special Surgery (HSS) score and Knee Society score. Radiological evaluation included measurements of knee alignment. Results The average postoperative knee range of motion and HSS score were 134.3°±12.4° and 92.7°±7.0°, respectively. The average postoperative femorotibial angle and tibial component alignment angle were 5.2°±1.7° valgus and 90.2°±1.6°, respectively. The average tibial component posterior inclination was 4.8°±2.1°. The percentage of cases with tibial component alignment angle of 90°±3° was 96.1%, and that with the femorotibial angle of 6°±3° valgus was 94.0%. Radiolucent lines were observed in 20 cases (12.0%): around the femur, tibia, and patella in 14 cases, 10 cases, and 1 case, respectively. However, they were less than 2 mm and non-progressive in all cases. The survival rate was 99.4% and there was no implant-related revision. Conclusions MIS-TKA using a mini-keel modular tibial plate showed satisfactory results, a high survival rate, and excellent clinical and radiological results in the mid-term follow-up. PMID:25229044

  5. Bioabsorbable Bypass Grafts Biofunctionalised with RGD Have Enhanced Biophysical Properties and Endothelialisation Tested In vivo

    PubMed Central

    Antonova, Larisa V.; Seifalian, Alexander M.; Kutikhin, Anton G.; Sevostyanova, Victoria V.; Krivkina, Evgeniya O.; Mironov, Andrey V.; Burago, Andrey Y.; Velikanova, Elena A.; Matveeva, Vera G.; Glushkova, Tatiana V.; Sergeeva, Evgeniya A.; Vasyukov, Georgiy Y.; Kudryavtseva, Yuliya A.; Barbarash, Olga L.; Barbarash, Leonid S.

    2016-01-01

    Small diameter arterial bypass grafts are considered as unmet clinical need since the current grafts have poor patency of 25% within 5 years. We have developed a 3D scaffold manufactured from natural and synthetic biodegradable polymers, poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and poly(𝜀-caprolactone) (PCL), respectively. Further to improve the biophysical properties as well as endothelialisation, the grafts were covalently conjugated with arginine-glycine-aspartic acid (RGD) bioactive peptides. The biophysical properties as well as endothelialisation of PHBV/PCL and PCL 2 mm diameter bypass grafts were assessed with and without biofunctionalisation with RGD peptides in vitro and in vivo. Morphology of the grafts was assessed by scanning electron microscopy, whereas physico-mechanical properties were evaluated using a physiological circulating system equipped with a state of art ultrasound vascular wall tracking system. Endothelialisation of the grafts in vitro and in vivo were assessed using a cell viability assay and rat abdominal aorta replacement model, respectively. The biofunctionalisation with RGD bioactive peptides decreased mean fiber diameter and mean pore area in PHBV/PCL grafts; however, this was not the case for PCL grafts. Both PHBV/PCL and PCL grafts with RGD peptides had lower durability compared to those without; these durability values were similar to those of internal mammary artery. Modification of PHBV/PCL and PCL grafts with RGD peptides increased endothelial cell viability in vitro by a factor of eight and enhanced the formation of an endothelial cell monolayer in vivo 1 month postimplantation. In conclusion, PHBV/PCL small-caliber graft can be a suitable 3D scaffold for the development of a tissue engineering arterial bypass graft. PMID:27252652

  6. Development of the Intrinsic Language Network in Preschool Children from Ages 3 to 5 Years

    PubMed Central

    Xiao, Yaqiong; Brauer, Jens; Lauckner, Mark; Zhai, Hongchang; Jia, Fucang; Margulies, Daniel S.; Friederici, Angela D.

    2016-01-01

    Resting state studies of spontaneous fluctuations in the functional magnetic resonance imaging (fMRI) blood oxygen level dependent signal have shown great potential in mapping the intrinsic functional connectivity of the human brain underlying cognitive functions. The aim of the present study was to explore the developmental changes in functional networks of the developing human brain exemplified with the language network in typically developing preschool children. To this end, resting-sate fMRI data were obtained from native Chinese children at ages of 3 and 5 years, 15 in each age group. Resting-state functional connectivity (RSFC) was analyzed for four regions of interest; these are the left and right anterior superior temporal gyrus (aSTG), left posterior superior temporal gyrus (pSTG), and left inferior frontal gyrus (IFG). The comparison of these RSFC maps between 3- and 5-year-olds revealed that RSFC decreases in the right aSTG and increases in the left hemisphere between aSTG seed and IFG, between pSTG seed and IFG, as well as between IFG seed and posterior superior temporal sulcus. In a subsequent analysis, functional asymmetry of the language network seeding in aSTG, pSTG and IFG was further investigated. The results showed an increase of left lateralization in both RSFC of pSTG and of IFG from ages 3 to 5 years. The IFG showed a leftward lateralized trend in 3-year-olds, while pSTG demonstrated rightward asymmetry in 5-year-olds. These findings suggest clear developmental trajectories of the language network between 3- and 5-year-olds revealed as a function of age, characterized by increasing long-range connections and dynamic hemispheric lateralization with age. Our study provides new insights into the developmental changes of a well-established functional network in young children and also offers a basis for future cross-culture and cross-age studies of the resting-state language network. PMID:27812160

  7. Development of the Intrinsic Language Network in Preschool Children from Ages 3 to 5 Years.

    PubMed

    Xiao, Yaqiong; Brauer, Jens; Lauckner, Mark; Zhai, Hongchang; Jia, Fucang; Margulies, Daniel S; Friederici, Angela D

    2016-01-01

    Resting state studies of spontaneous fluctuations in the functional magnetic resonance imaging (fMRI) blood oxygen level dependent signal have shown great potential in mapping the intrinsic functional connectivity of the human brain underlying cognitive functions. The aim of the present study was to explore the developmental changes in functional networks of the developing human brain exemplified with the language network in typically developing preschool children. To this end, resting-sate fMRI data were obtained from native Chinese children at ages of 3 and 5 years, 15 in each age group. Resting-state functional connectivity (RSFC) was analyzed for four regions of interest; these are the left and right anterior superior temporal gyrus (aSTG), left posterior superior temporal gyrus (pSTG), and left inferior frontal gyrus (IFG). The comparison of these RSFC maps between 3- and 5-year-olds revealed that RSFC decreases in the right aSTG and increases in the left hemisphere between aSTG seed and IFG, between pSTG seed and IFG, as well as between IFG seed and posterior superior temporal sulcus. In a subsequent analysis, functional asymmetry of the language network seeding in aSTG, pSTG and IFG was further investigated. The results showed an increase of left lateralization in both RSFC of pSTG and of IFG from ages 3 to 5 years. The IFG showed a leftward lateralized trend in 3-year-olds, while pSTG demonstrated rightward asymmetry in 5-year-olds. These findings suggest clear developmental trajectories of the language network between 3- and 5-year-olds revealed as a function of age, characterized by increasing long-range connections and dynamic hemispheric lateralization with age. Our study provides new insights into the developmental changes of a well-established functional network in young children and also offers a basis for future cross-culture and cross-age studies of the resting-state language network.

  8. Evaluation of acute pyelonephritis with DMSA scans in children presenting after the age of 5 years.

    PubMed

    Ataei, Neamatollah; Madani, Abbas; Habibi, Reza; Khorasani, Mosa

    2005-10-01

    It is generally believed that infants are more susceptible to development of renal scarring after pyelonephritis than children over 5 years old. This view has led to differences in investigations and treatment according to age. The aim of this prospective study was to assess the occurrence of renal parenchymal lesion in children over 5 years admitted with a first-time symptomatic urinary tract infection (UTI). Between October 2000 and April 2002, 52 children aged over 5 years who were admitted to our department with probable acute pyelonephritis (APN) and a positive urine culture were included in this study. All children received antibiotics for 14 days. During the acute phase of infection, scintigraphy with technetium-99m-labeled dimercaptosuccinic acid (DMSA) and ultrasonography (US) were done. Voiding cystourethrography (VCUG) was performed in all children early in the course of the illness, generally within 5-7 days of hospitalization. When scintigraphy showed renal parenchymal changes, repeat scintigraphy was done after at least 3 months to assess the progression of renal abnormalities. Of the 52 children with a first-time documented pyelonephritis, cortical scintigraphy showed renal lesion in 41 children (78.8%). US was normal in all children with normal renal scintigraphy, while it detected renal abnormalities in 16 of the 41 (39 %) with abnormal scintigraphy (p <0.0001). Topographic analysis of the 165 focal lesions showed that 42.4% were localized to the upper poles, 17.5% to the middle third, and 40% to the lower poles of the kidneys. Repeat scintigraphy showed persistent lesions corresponding to those on the initial scan in nine (28.2%) of the 32 children. Renal lesions had partly regressed in 23 (71.8%) of the patients who underwent repeat scintigraphy. Vesicoureteral reflux was observed in 13.4% of kidneys and renal parenchymal abnormalities were identified in 71.4% and 72.2% of renal units, respectively, with and without reflux ( p >0.05). In

  9. The versatile autogenous rib graft in septorhinoplasty.

    PubMed

    Sherris, D A; Kern, E B

    1998-01-01

    In the graft depleted revision rhinoplasty patient and the patient with major tissue needs, alternatives to septal and conchal cartilage grafts are needed. The costal cartilage graft and rib bone/costal cartilage combination graft are excellent alternatives. In this study 14 patients received 40 grafts from 20 autogenous ribs harvested during septorhinoplasty. Materials were harvested for use as septal replacement grafts, cantilevered grafts, dorsal onlay grafts, columellar struts, and tip grafts. Patient followup was 6 to 31 months, and no evidence of graft resorption or warpage was evident during that period. Complications of harvest were minimal, and harvest techniques are detailed.

  10. [Choice of an optimal free graft for replacement urethroplasty in extensive urethral strictures].

    PubMed

    Loran, O B; Veliev, E I; Kotov, S V; Belomyttsev, S V

    2011-01-01

    Irrespective of the type and properties of a free graft in urethroplasty, survival of the graft depends on blood circulation in the nutrient bed. We made an experimental trial to study engraftment of free grafts of buccal and lingual mucosa on different types of the nutrient bed. Free flaps (78 buccal and 86 lingual mucosa samples) were taken from 52 male Wistar rats (300 to 470 body mass). Grafting was made on different types of nutrient bed - skeletal muscle, subcutaneous fat and penile tunica albuginea. Histological examination of the grafts was made 2, 4, 7 and 14 days after transplantation. The process of engraftment followed all the stages of nonspecific inflammation. The alteration stage (48 hours) is characterized by marked epithelial atrophy, necrosis of most of the cross-striate muscular fibers of the graft, necrotic alterations of the nutrient bed, primarily in the suture area. Excudation and emigration (2-4 days)--by continued necrotic changes with infiltration of the graft with neutrophilic leukocytes, edema of the upper layer stroma and infiltrate extention on the nutrient bed. Proliferation (day 7)--by attenuation of necroinflammatory processes, decline of leukocyte infiltration, formation of blood vessels in the subepithelial base of the graft. Regeneration (day7-14)--by recovery of the epithelial graft layer, development of granulation tissue in the submucosal base. The best engraftment was registered on transplantation on penile tunica albuginea (buccal graft--93.4%, lingual one--88.9%). Successful implantation on the muscle occurred in 90.7% for buccal and 87.9% for lingual grafts. On fat tissue buccal transplant failed in 19, lingua--in 23.89% transplantations. Thus, staging in interaction between different grafts and types of nutrient bed do not depend on characteristics of the bed and graft. Necroinflammatory changes in the buccal graft change for proliferative processes earlier than in the lingual one. Proliferative and regenerative processes

  11. Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950-2000).

    PubMed Central

    Garenne, Michel; Gakusi, Enéas

    2006-01-01

    OBJECTIVE: To reconstruct and analyse mortality trends in children younger than 5 years in sub-Saharan Africa between 1950 and 2000. METHODS: We selected 66 Demographic and Health Surveys and World Fertility Surveys from 32 African countries for analysis. Death rates were calculated by yearly periods for each survey. When several surveys were available for the same country, overlapping years were combined. Country-specific time series were analysed to identify periods of monotonic trends, whether declining, steady or increasing. We tested changes in trends using a linear logistic model. FINDINGS: A quarter of the countries studied had monotonic declining mortality trends: i.e. a smooth health transition. Another quarter had long-term declines with some minor rises over short periods of time. Eight countries had periods of major increases in mortality due to political or economic crises, and in seven countries mortality stopped declining for several years. In eight other countries mortality has risen in recent years as a result of paediatric AIDS. Reconstructed levels and trends were compared with other estimates made by international organizations, usually based on indirect methods. CONCLUSION: Overall, major progress in child survival was achieved in sub-Saharan Africa during the second half of the twentieth century. However, transition has occurred more slowly than expected, with an average decline of 1.8% per year. Additionally, transition was chaotic in many countries. The main causes of mortality increase were political instability, serious economic downturns, and emerging diseases. PMID:16799731

  12. Bone Graft Substitution and Augmentation.

    PubMed

    Nauth, Aaron; Lane, Joseph; Watson, J Tracy; Giannoudis, Peter

    2015-12-01

    Selection of appropriate bone graft or bone graft substitute requires careful recognition of the bone healing needs of the patient's specific clinical problem and a thorough understanding of the different properties possessed by the available bone grafts and substitutes. Although autogenous iliac crest bone graft remains the gold standard of treatment for delayed unions, nonunions, and bone defects, there are a number of promising alternatives available, and emerging evidence suggests that they can be very effective when used in the proper setting. Among these, reamer-irrigator-aspirator bone graft, bone marrow concentrate, bone morphogenetic proteins, and calcium phosphate cements have received a great deal of attention in the literature. This review describes these grafts in detail along with the evidence for their use. In addition, a framework is provided for selecting the appropriate graft or substitute based on their provided properties.

  13. Novel technologies to engineer graft for tolerance induction

    PubMed Central

    Woodward, Kyle B.; Wang, Feng; Zhao, Hong; Yolcu, Esma S.; Shirwan, Haval

    2015-01-01

    Purpose of review Conquering allograft rejection remains an elusive goal in spite of recent breakthroughs in the field of immunosuppression. Much of the problem lies in the toxicity and side effects of long-term use of systemic immunosuppressant drugs, which are sometimes ineffective in controlling rejection, but also hinder establishment of transplant tolerance. In this review, we discuss novel technologies that use grafts engineered with immunomodulatory molecules as a means of inducing tolerance. Recent findings Several recent studies have demonstrated the feasibility of engineering cells, tissues, or solid organ grafts with immunoregulatory biologics to achieve long termgraft survival without the use of chronic immunosuppression. This approach was shown to primarily change the ratio of T effector versus CD4+CD25+FoxP3+ T regulatory cells within the graft microenvironment in favor of attaining localized tolerance induction and maintenance. Summary Localized immunomodulation using biologic-engineered allografts represent a new paradigm for achieving long term graft survival in the absence of chronic use of immunosuppression. The manipulation of the graft, rather than the recipient, not only ensures short and long-term safety by minimizing the adverse effects of immunosuppression, but also allows retention of immune competency critical for the ability of the recipient to fight infections and cancer. PMID:26626421

  14. Utilization of the scrotum as a full thickness skin graft in a dog

    PubMed Central

    Wells, Sean; Gottfried, Sharon D.

    2010-01-01

    A 1.5-year-old, intact, male dog was presented for degloving wounds to the distal pelvic limbs due to vehicular trauma. Treatment involved serial debridement of the wounds and use of the scrotal skin as a full thickness, meshed skin graft applied to the dorsal aspect of the left pes with a successful outcome. PMID:21286329

  15. Noninvasive imaging of islet grafts using positron-emission tomography

    NASA Astrophysics Data System (ADS)

    Lu, Yuxin; Dang, Hoa; Middleton, Blake; Zhang, Zesong; Washburn, Lorraine; Stout, David B.; Campbell-Thompson, Martha; Atkinson, Mark A.; Phelps, Michael; Gambhir, Sanjiv Sam; Tian, Jide; Kaufman, Daniel L.

    2006-07-01

    Islet transplantation offers a potential therapy to restore glucose homeostasis in type 1 diabetes patients. However, islet transplantation is not routinely successful because most islet recipients gradually lose graft function. Furthermore, serological markers of islet function are insensitive to islet loss until the latter stages of islet graft rejection. A noninvasive method of monitoring islet grafts would aid in the assessment of islet graft survival and the evaluation of interventions designed to prolong graft survival. Here, we show that recombinant adenovirus can engineer isolated islets to express a positron-emission tomography (PET) reporter gene and that these islets can be repeatedly imaged by using microPET after transplantation into mice. The magnitude of signal from engineered islets implanted into the axillary cavity was directly related to the implanted islet mass. PET signals attenuated over the following weeks because of the transient nature of adenovirus-mediated gene expression. Because the liver is the preferred site for islet implantation in humans, we also tested whether islets could be imaged after transfusion into the mouse liver. Control studies revealed that both intrahepatic islet transplantation and hyperglycemia altered the biodistribution kinetics of the PET probe systemically. Although transplanted islets were dispersed throughout the liver, clear signals from the liver region of mice receiving PET reporter-expressing islets were detectable for several weeks. Viral transduction, PET reporter expression, and repeated microPET imaging had no apparent deleterious effects on islet function after implantation. These studies lay a foundation for noninvasive quantitative assessments of islet graft survival using PET. diabetes | transplantation

  16. Pranlukast reduces asthma exacerbations during autumn especially in 1- to 5-year-old boys

    PubMed Central

    Campos Alberto, Eduardo; Suzuki, Shuichi; Sato, Yoshinori; Hoshioka, Akira; Abe, Hiroki; Saito, Kimiyuki; Tsubaki, Toshikazu; Haraki, Mana; Sawa, Akiko; Nakayama, Yoshio; Kojima, Hiroyuki; Shigeta, Midori; Yamaide, Fumiya; Kohno, Yoichi; Shimojo, Naoki

    2017-01-01

    Background Leukotriene receptor antagonists have been used to prevent virus-induced asthma exacerbations in autumn. Its efficacy, however, might differ with age and sex. Objective This study aimed to investigate whether pranlukast added to usual asthma therapy in Japanese children during autumn, season associated with the peak of asthma, reduces asthma exacerbations. It was also evaluated the effect of age and sex on pranlukast's efficacy. Methods A total of 121 asthmatic children aged 1 to 14 years were randomly assigned to receive regular pranlukast or not according to sex, and were divided in 2 age groups, 1–5 years and 6–14 years. The primary outcome was total asthma score calculated during 8 weeks by using a sticker calendar related to the days in which a child experienced a worsening of asthma symptoms. This open study lasted 60 days from September 15 to November 14, 2007. Results Significant differences in pranlukast efficacy were observed between sex and age groups. Boys aged 1 to 5 years had the lower total asthma score at 8 weeks (p = 0.002), and experienced fewer cold episodes (p = 0.007). There were no significant differences between pranlukast and control group in total asthma score at 8 weeks (p = 0.35), and in the days in which a child experienced a worsening of asthma symptoms (p = 0.67). Conclusion There was a substantial benefit of adding pranlukast to usual therapy in asthmatic children, especially in boys aged 1 to 5 years, during autumn season. PMID:28154801

  17. 5-Year Longitudinal Follow-up after Retropubic and Transobturator Midurethral Slings

    PubMed Central

    Kenton, Kimberly; Stoddard, Anne M.; Zyczynski, Halina; Albo, Michael; Rickey, Leslie; Norton, Peggy; Wai, Clifford; Kraus, Stephen R.; Sirls, Larry T.; Kusek, John W.; Litman, Heather J.; Chang, Robert P.; Richter, Holly E.

    2014-01-01

    Background Few studies have characterized longer-term outcomes after retropubic and transobturator midurethral slings. Methods Women completing 2-year participation in a randomized equivalence trial who had not received surgical retreatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no retreatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events. Results 404 of 597 (68%) women from the original trial enrolled. Five-years after surgical treatment, success was 7.9% greater in women assigned to retropubic-sling compared to transobturator-sling (51.3% vs 43.4%, 95% CI −1.4%, 17.2%) not meeting pre-specified criteria for equivalence. Satisfaction decreased over 5-years, but remained high and similar between arms (79%, retropubic-sling vs 85%, transobturator-sling groups, p=0.15). Urinary symptoms and quality of life worsened over time (p<0.001), and women with retropubic-sling reported greater urinary urgency (P=0.001), more negative quality of life impact (p=0.02), and worse sexual function (P=0.001). There was no difference in proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic-sling-3, transobturator-sling-4). Conclusion Treatment success declined over 5-years for retropubic and transobturator-slings and did not meet pre-specified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing transobturator-sling reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate. PMID:25158274

  18. Intrauterine Adiposity and BMI in 4- to 5-Year-Old Offspring from Diabetic Pregnancies

    PubMed Central

    Hammoud, Nurah M.; de Valk, Harold W.; Biesma, Douwe H.; Visser, Gerhard H.A.

    2016-01-01

    Background Pregnancies complicated by maternal diabetes are associated with disproportionate intrauterine growth that subsequently may lead to pediatric adiposity. Objectives We investigated whether disproportionate intrauterine growth leads to differences in BMI in 4- to 5-year-old offspring from pregnancies complicated by type 1 (ODM1), type 2 (ODM2), or gestational diabetes (OGDM). Methods Ultrasound data of fetal head-to-abdominal circumference (HC/AC) ratio obtained between 32 and 36 weeks of gestational age were related to offspring anthropometrics that were retrieved from infant welfare centers. Results Data from 27 ODM1, 22 ODM2, and 24 OGDM were obtained. Ultrasound measurements for the HC/AC ratio were performed at a mean of 33-34 weeks, with a mean Z-score of the HC/AC ratio of -0.801, -0.879, and 0.017 in ODM1, ODM2, and OGDM. Mean BMI SDS was highest in ODM2 as compared to ODM1 and OGDM. In ODM1 there was a negative correlation between HC/AC ratio and BMI SDS at the ages of 4 and 5 years, but not in ODM2 or OGDM. The birth weight Z-score was positively correlated to BMI SDS in ODM2 and OGDM. Conclusion Disproportionate intrauterine growth, expressed as the HC/AC ratio, was inversely related with BMI SDS in ODM1 at the ages of 4-5 years, but not in ODM2 or OGDM. Weight and maybe obesity in ODM1 offspring are likely to be related to intrauterine adiposity, whereas overweight in ODM2 and OGDM offspring seems more related to other factors such as birth weight centile, maternal obesity, and altered lifestyle factors during childhood. PMID:27788515

  19. Association between depression in carers and malnutrition in children aged 6 months to 5 years

    PubMed Central

    Ganiyu, Adewale B.; Firth, Jacqueline A.

    2017-01-01

    Background Childhood malnutrition is an important risk factor for child mortality and underlies close to 50% of child deaths worldwide. Previous studies have found an association between maternal depression and child malnutrition, but it is not known whether this association exists in Botswana. In addition, previous studies excluded non-maternal primary caregivers (PCGs). It is unclear whether the association between primary caregiver depression and child malnutrition remains when non-maternal PCGs are included. Aim The aim of this study was to determine if there is an association between PCG depression and malnutrition in children aged between 6 months and 5 years in Mahalapye, Botswana. Setting The study was conducted in the child welfare clinics of Xhosa and Airstrip clinics, two primary health care facilities in Mahalapye, Botswana. Methods This was a case control study. Cases were malnourished children aged between 6 months and 5 years, and controls were non-malnourished children matched for age and gender. The outcome of interest was depression in the PCGs of the cases and controls, which was assessed using the Patient Health Questionnaire 9 (PHQ 9), a depression screening tool. Results From a sample of 171 children, 84 of whom were malnourished, we found that the malnourished children were significantly more likely to have depressed PCGs (odds ratio = 4.33; 95% CI: 1.89, 9.89) than non-malnourished children in the 6-month to 5-year age group; the PCGs of malnourished children also had lower educational status. Conclusion This study found a significant association between PCG depression and child malnutrition. PMID:28155288

  20. Gross Motor Development in Children Aged 3-5 Years, United States 2012.

    PubMed

    Kit, Brian K; Akinbami, Lara J; Isfahani, Neda Sarafrazi; Ulrich, Dale A

    2017-02-14

    Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p < 0.05). However, the mean locomotor standardized scores for both boys and girls fell into the range categorized as "average." There were no other differences by age, race/Hispanic origin, weight status, or income in either of the subtest standardized scores (p > 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status.

  1. Global strategy for the diagnosis and management of asthma in children 5 years and younger.

    PubMed

    Pedersen, Soren Erik; Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan; Zar, Heather J; Sly, Peter D; Soto-Quiroz, Manuel; Wong, Gary; Bateman, Eric D

    2011-01-01

    Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information. In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in

  2. Development of allocentric spatial memory abilities in children from 18 months to 5 years of age.

    PubMed

    Ribordy, Farfalla; Jabès, Adeline; Banta Lavenex, Pamela; Lavenex, Pierre

    2013-02-01

    Episodic memories for autobiographical events that happen in unique spatiotemporal contexts are central to defining who we are. Yet, before 2 years of age, children are unable to form or store episodic memories for recall later in life, a phenomenon known as infantile amnesia. Here, we studied the development of allocentric spatial memory, a fundamental component of episodic memory, in two versions of a real-world memory task requiring 18 month- to 5-year-old children to search for rewards hidden beneath cups distributed in an open-field arena. Whereas children 25-42-months-old were not capable of discriminating three reward locations among 18 possible locations in absence of local cues marking these locations, children older than 43 months found the reward locations reliably. These results support previous findings suggesting that allocentric spatial memory, if present, is only rudimentary in children under 3.5 years of age. However, when tested with only one reward location among four possible locations, children 25-39-months-old found the reward reliably in absence of local cues, whereas 18-23-month-olds did not. Our findings thus show that the ability to form a basic allocentric representation of the environment is present by 2 years of age, and its emergence coincides temporally with the offset of infantile amnesia. However, the ability of children to distinguish and remember closely related spatial locations improves from 2 to 3.5 years of age, a developmental period marked by persistent deficits in long-term episodic memory known as childhood amnesia. These findings support the hypothesis that the differential maturation of distinct hippocampal circuits contributes to the emergence of specific memory processes during early childhood.

  3. Development of aerobic and anaerobic power in adolescent rowers: a 5-year follow-up study.

    PubMed

    Mikulic, P

    2011-12-01

    We aimed to determine whether the physical and physiological superiority of early-maturing rowing athletes, observed at ages 12-13 years, over that of their late-maturing counterparts observed at the same ages, still persists at 17-18 years of age, when all adolescent athletes are expected to have completed pubertal development. We hypothesized that this superiority of early maturers would not be observed at reassessment, as late maturers would have likely "caught up" with their early-maturing peers. Twenty-one male rowers were assessed at age 12.8 ± 0.5 years and again at 17.5 ± 0.5 years (mean ± SD). They were divided into groups of early-maturing and late-maturing rowing athletes based on Tanner's sexual maturity ratings. A two-way repeated-measures MANOVA followed by a series of ANOVAs with one within-subject factor (time) and one between-subject factor (group) indicated significant (P≤0.003) within-subject and between-subjects main effects for lean body mass (LBM), maximal oxygen uptake (VO2max), and mean power (MP). The group × time interaction effects were significant for LBM (P=0.003), VO2max (P=0.004), but not for MP (P=0.171). Over 5 years, early-maturers' advantage dwindled in terms of LBM (+38% to +9%), VO2max (+47% to +9%), and MP (+76% to +15%); however, these differences may still be considered practically relevant. The proposed hypothesis was not supported.

  4. A Patient with Recurrent Arteriovenous Graft Thrombosis

    PubMed Central

    2015-01-01

    Arteriovenous grafts (AVGs) are prone to frequent thrombosis that is superimposed on underlying hemodynamically significant stenosis, most commonly at the graft-vein anastomosis. There has been great interest in detecting AVG stenosis in a timely fashion and performing preemptive angioplasty, in the belief that this will prevent AVG thrombosis. Three surveillance methods (static dialysis venous pressure, flow monitoring, and duplex ultrasound) can detect AVG stenosis. Whereas observational studies have reported that surveillance with preemptive angioplasty substantially reduces AVG thrombosis, randomized clinical trials have failed to confirm such a benefit. There is a high frequency of early AVG restenosis after angioplasty caused by aggressive neointimal hyperplasia resulting from vascular injury. Stent grafts prevent AVG restenosis better than balloon angioplasty, but they do not prevent AVG thrombosis. Several pharmacologic interventions to prevent AVG failure have been evaluated in randomized clinical trials. Anticoagulation or aspirin plus clopidogrel do not prevent AVG thrombosis, but increase hemorrhagic events. Treatment of hyperhomocysteinemia does not prevent AVG thrombosis. Dipyridamole plus aspirin modestly decreases AVG stenosis or thrombosis. Fish oil substantially decreases the frequency of AVG stenosis and thrombosis. In patients who have exhausted all options for vascular access in the upper extremities, thigh AVGs are a superior option to tunneled internal jugular vein central vein catheters (CVCs). An immediate-use AVG is a reasonable option in patients with recurrent CVC dysfunction or infection. Tunneled femoral CVCs have much worse survival than internal jugular CVCs. PMID:25883073

  5. Grafting of genetically manipulated cells into adult brain: toward graft-gene therapy.

    PubMed

    Uchida, K; Toya, S

    1996-06-01

    Accumulating evidence has shown that functional recoveries in various kinds of animal models of neurodegenerative diseases can be achieved by grafting fetal neurons into the brain. On the basis of these successful results, clinical trials are under way to determine whether human fetal mesencephalic tissue can ameliorate motor functions in patients with Parkinson's disease. Recent autopsy findings of parkinsonian patient implanted with human fetal mesencephalic tissue clearly revealed that the fetal neuronal graft can survive for extended period of time in the human brain and densely reinnervate the surrounding host striatal tissue. It is, however, still important to obtain more practical, effective and ethically justifiable donor material for the future clinical application of the procedures. Desirable properties for the donor cells include long-term survival in the host brain, neuronal cell type for the reconstruction of damaged neural circuits, and susceptibility to genetic manipulation for the practical use. With the development of molecular biology techniques, genetic modification and transplantation of the donor neuronal cells might be a feasible way to cure many kinds of central nervous system diseases toward a "graft-gene therapy".

  6. Full term delivery following cryopreservation of human embryos for 7. 5 years.

    PubMed

    Ben-Ozer, S; Vermesh, M

    1999-06-01

    Successful pregnancy in a 44 year old woman is described following the transfer of embryos which were cryopreserved for 7.5 years. The embryos were obtained during a gamete intra-Fallopian transfer (GIFT) procedure in 1989. To our knowledge this is one of the longest published periods of cryopreservation of embryos which has resulted in a healthy baby. This report illustrates the previously presumed viability and normality of human embryos undergoing long-term cryopreservation. Additionally, it emphasizes the importance for advanced reproductive technique programmes and patients to review and update their embryo status.

  7. Clinical treatment of a ruptured temporomandibular joint disc: morphological changes at 5-year follow-up.

    PubMed

    Cardinal, Lucas; Porto, Felipe; Agarwal, Sachin; Grossman, Eduardo

    2014-01-01

    Osteoarthrosis is a disease that affects the temporomandibular joint (TMJ). This case report chronicles the diagnosis and treatment of a patient for whom this pathological condition was accompanied by a rupture of the articular disc. The patient presented with loud sounds in the left TMJ and an irregular mandibular occlusal plane due to condylar intrusion in the glenoid fossa on the ipsilateral side. A noninvasive treatment was selected. A 4-month follow-up revealed remission of the articular sounds, and tissue regeneration was noted. These improvements remained visible at 5-year follow-up.

  8. Socioeconomic status and changes in body mass from 3 to 5 years

    PubMed Central

    De Spiegelaere, M; Dramaix, M; Hennart, P

    1998-01-01

    The influence of social status on the development of body mass was analysed in a retrospective cohort study of 675 Belgian children monitored between the ages of 3 and 5 years by the preventive medical services in Brussels. At age 3, no association between excess weight and social status was observed. Adiposity rebound before age 5 was inversely related to body mass at age 3 and was independent of social status. The social influences on obesity observed in adolescence cannot be explained by a higher frequency of early adiposity rebound in children of low socioeconomic status.

 PMID:9659099

  9. Giant pericardial cyst in a 5-year-old child: A rare anomaly

    PubMed Central

    Kumar, Sanjay; Jain, Promil; Sen, Rajeev; Rattan, KN; Agarwal, Ruchi; Garg, Shilpa

    2011-01-01

    Pericardial cysts are uncommon congenital abnormalities that occur in the middle mediastinum. Most of these are found incidentally on chest x-rays. The occurrence of pericardial cyst in children is quite rare. It needs to be differentiated from other cystic mediastinal masses. A rare case of pericardial cyst in a 5 year old male child is reported. The child presented with chest pain, cough and fever. The preoperative diagnosis of pericardial cyst was suggestive on echocardiography and CT scan. It was confirmed on histopathology after successful surgical excision. The rarity of this benign mediastinal lesion in children prompted us to report this case. PMID:21677811

  10. Complex venous anomalies: magnetic resonance imaging findings in a 5-year-old boy.

    PubMed

    Hazirolan, Tuncay; Ozkan, Efe; Haliloglu, Mithat; Celiker, Alpay; Balkanci, Ferhun

    2006-10-01

    We report magnetic resonance imaging (MRI) findings of a very unusual venous anomaly case. A 5-year-old boy who had surgical repair of coarctation of the thoracic aorta was referred to our department for evaluation of an enlarged venous structure anterior to the aorta, which had been noted during the surgery. Contrast enhanced dynamic MRI revealed partial anomalous pulmonary venous return to the left azygos vein, double inferior and superior vena cava with the left azygos continuation of the left superior vena cava. The recognition of venous anomalies allows correct planning of surgical and interventional procedures. MRI is a valuable imaging tool providing detailed anatomical information.

  11. Malnutrition among children younger than 5 years-old in conflict zones of Chiapas, Mexico.

    PubMed

    Sánchez-Pérez, Héctor Javier; Hernán, Miguel A; Ríos-González, Adriana; Arana-Cedeño, Marcos; Navarro, Albert; Ford, Douglas; Micek, Mark A; Brentlinger, Paula

    2007-02-01

    We performed a cross-sectional, community-based survey, supplemented by interviews with community leaders in Chiapas, Mexico, to examine the prevalence and predictors of child malnutrition in regions affected by the Zapatista conflict. The prevalence rates of stunting, wasting, and underweight were 54.1%, 2.9%, and 20.3%, respectively, in 2666 children aged younger than 5 years. Stunting was associated with indigenous ethnicity, poverty, region of residence, and intracommunity division. The results indicate that malnutrition is a serious public health problem in the studied regions.

  12. [Acute cerebellar ataxia in a 5-year-old boy. Clinical warnings].

    PubMed

    Mrozińska, M; Horwath, A; Ostoja-Chrzastowski, W

    1998-01-01

    A case of acute cerebellar ataxia caused by ECHO virus 30.5-year-old boy admitted to the Clinic of Gastroenterology and Nutrition in Warsaw, in September, 1996, complaining of headache, dizziness, weakness, somnolence, dysarthria and an unsteady walk. On neurological examination he had imparied coordination, rombergism, generalized hypotonia. There was no history of exposure to contagious diseases, ear discharge, convulsions, trauma. Parents suggested that the child could have swallowed an unidentified pill--toxicological tests ruled out poisoning. The diagnosis is based on the clinical examination and amplification ECHO virus from CSF.

  13. Drifter-based estimate of the 5 year dispersal of Fukushima-derived radionuclides

    NASA Astrophysics Data System (ADS)

    Rypina, I. I.; Jayne, S. R.; Yoshida, S.; Macdonald, A. M.; Buesseler, K.

    2014-11-01

    Employing some 40 years of North Pacific drifter-track observations from the Global Drifter Program database, statistics defining the horizontal spread of radionuclides from Fukushima nuclear power plant into the Pacific Ocean are investigated over a time scale of 5 years. A novel two-iteration method is employed to make the best use of the available drifter data. Drifter-based predictions of the temporal progression of the leading edge of the radionuclide distribution are compared to observed radionuclide concentrations from research surveys occupied in 2012 and 2013. Good agreement between the drifter-based predictions and the observations is found.

  14. Malnutrition Among Children Younger Than 5 Years-Old in Conflict Zones of Chiapas, Mexico

    PubMed Central

    Sánchez-Pérez, Héctor Javier; Hernán, Miguel A.; Ríos-González, Adriana; Arana-Cedeño, Marcos; Navarro, Albert; Ford, Douglas; Micek, Mark A.; Brentlinger, Paula

    2007-01-01

    We performed a cross-sectional, community-based survey, supplemented by interviews with community leaders in Chiapas, Mexico, to examine the prevalence and predictors of child malnutrition in regions affected by the Zapatista conflict. The prevalence rates of stunting, wasting, and underweight were 54.1%, 2.9%, and 20.3%, respectively, in 2666 children aged younger than 5 years. Stunting was associated with indigenous ethnicity, poverty, region of residence, and intracommunity division. The results indicate that malnutrition is a serious public health problem in the studied regions. PMID:17194868

  15. Stage I carcinoma of the endometrium: a 5-year experience utilizing preoperative cesium

    SciTech Connect

    Belinson, J.L.; Spirou, B.; McClure, M.; Badger, G.; Pretorius, R.G.; Roland, T.A.

    1985-03-01

    A treatment protocol for the management of stage I endometrial carcinoma utilizing preoperative cesium is evaluated. One hundred and twelve consecutive patients were treated according to this protocol over a 5-year period. Based on this experience and a literature review a new protocol is recommended. The significant changes include primary surgery without preoperative cesium, primary treatment based on grade without regard to uterine size, modified radical hysterectomy for G3 tumors, pelvic radiotherapy for clear cell carcinoma confined to the pelvis regardless of depth of invasion, cytoxan, adriamycin, and cis-platinum for papillary serous tumors, and postoperative vaginal cuff cesium for G2 and G3 tumors not requiring pelvic radiotherapy.

  16. Infantile fibrosarcoma of ethmoid sinus, misdiagnosed as an adenoid in a 5-year-old child

    PubMed Central

    Geramizadeh, Bita; Khademi, Bijan; Karimi, Mehran; Shekarkhar, Golsa

    2015-01-01

    Infantile fibrosarcoma of head and neck is rare and the presence of this tumor in ethmoid sinus is even more uncommon. To the best of our knowledge, <5 cases have been reported in the last 20 years in the English literature, so far, only one of which has been infantile type in a 15 months old girl. In this case report, we will explain our experience with a rare case of infantile fibrosarcoma originating from ethmoid sinus in a 5-year-old boy who presented with dyspnea and epistaxis. After biopsy, it was diagnosed as fibrosarcoma of sinus origin. PMID:26604519

  17. Corneal grafting and banking.

    PubMed

    Ehlers, Niels; Hjortdal, Jesper; Nielsen, Kim

    2009-01-01

    Corneal transplantation was conceptualized at the end of the 18th century, but it took more than 100 years before human corneal grafting was introduced. The greatest step forward was the demonstration by Filatov that corneal tissue can be collected and used post mortem. The history of eye banking includes the development of preservation techniques. Storage in cold to minimize microbial growth and tissue disintegration was first choice but during the last 30 years this has been taken over by warm storage (organ culture) where the donor cornea proves its sterility and vitality before being transferred to the recipient. The long-term organ culture storage makes exchange between centres possible and allows for histocompatibility matching. The internationalization led to the establishing of the European Eye Bank Association but also to an increasing number of governmental regulations. Developments in years to come may lead to control of graft biomechanics and optics. This technical development tends to favour a centralization.

  18. A Computational Model of Optimal Vein Graft Adaptation in an Arterial Environment

    NASA Astrophysics Data System (ADS)

    Ramachandra, Abhay B.; Sankaran, Sethuraman; Humphrey, Jay; Marsden, Alison

    2012-11-01

    In coronary artery disease, surgical revascularization using venous bypass grafts is performed to relieve symptoms and prolong life. Coronary bypass graft surgery is performed on approximately 500,000 people every year in the United States, with graft failure rates as high as 50% within 5 years. When a vein graft is implanted in the arterial system it adapts to the high flow rate and high pressure of the arterial environment by changing composition and geometry, and thus stiffness. Hemodynamic loads, resulting in altered wall shear and intramural stresses, are major factors impacting vein graft remodeling. Here, a constrained mixture theory of growth and remodeling for arteries is extended to model the evolution of a vein graft subjected to arterial flow and pressure conditions. A derivative-free optimization method is used to estimate the optimal set of constitutive parameters that best match passive biaxial mouse inferior vena cava data from experiments. Optimization is performed using surrogate management framework, a pattern search method with established convergence theory. The resulting parameter set is used to predict optimal vein adaptation in an arterial environment for two illustrative cases: a) Step change b) Gradual change in loading. Results are compared against vein graft data from the literature and a possible set of mechanisms for sub-optimal vein graft remodeling is suggested.

  19. Pediatric burn wound impetigo after grafting.

    PubMed

    Aikins, Kimberly; Prasad, Narayan; Menon, Seema; Harvey, John G; Holland, Andrew J A

    2015-01-01

    Modern burn care techniques have reduced the risk of infection of the acute burn wound, resulting in more rapid healing and a lower incidence of graft loss. Secondary breakdown may still occur. The loss of epithelium in association with multifocal superficial abscesses and ulceration has been termed burns impetigo. This may result in considerable morbidity and require prolonged treatment. The events preceding development, the impact on the patient, and the ideal treatment appear unclear and poorly reported. In 5 years, between 2006 and 2011, 406 pediatric burns were treated with skin grafts, with 7% developing burns impetigo. Time to resolution ranged from 5 to 241 days: the mean time to complete healing was greatest with conservative management (96 days), followed by antibacterial dressings (37 days), oral antibiotics (36 days), topical steroids (16 days), and oral antibiotics in combination with topical steroids (13.5 days). Burns impetigo resulted in significant morbidity, requiring multiple visits to the treatment center and prolonged symptoms. Delay in diagnosis and treatment resulted in worse outcomes. Prompt consideration of burns impetigo should occur when postgraft patients present with suggestive clinical signs and treatment with oral antibiotics plus topical steroids should be considered.

  20. Acellular dermal graft reinforcement at the hiatus.

    PubMed

    Freedman, Bruce

    2012-11-01

    The ideal technique to repair large hiatal and diaphragmatic defects remains controversial. Due to high recurrence rates with primary repair alone, attempts at crural reinforcement with various products has been investigated. Initial evaluation of synthetic mesh at the hiatus in retrospective studies led to the conclusion that there were too many serious complications with these products. The next step was to see how biologic grafts fared in this location. Beginning with porcine intestine submucosa in a laminated array and progressing through human and porcine acellular dermal matrices, multiple, retrospective studies looked at the efficacy and safety of these products. Unfortunately, most of these studies evaluated a small sample size with a relatively short follow-up period. The one study followed out to 5 years failed to show any benefit using the biologic (porcine intestinal submucosa) compared with the primary repair alone. Additional, prospective, randomized studies with ample numbers carried out for years will be necessary to see which biologic graft is not only safe but also successful in preventing recurrent herniations.

  1. Exemestane Following Tamoxifen Reduces Breast Cancer Recurrences and Prolongs Survival

    Cancer.gov

    Postmenopausal women with early-stage hormone receptor-positive breast cancer had delayed disease recurrence and longer survival after taking 2-3 years of tamoxifen followed by exemestane for a total of 5 years compared to taking tamoxifen for 5 years.

  2. Dacron Graft Aneurysm Treated by Endovascular Stent-Graft

    SciTech Connect

    Ofer, Amos; Nitecki, Samy; Hoffman, Aaron; Engel, Ahuva

    2001-01-15

    A 72-year old man who underwent aorto-bifemoral bypass with insertion of a Dacron graft 18 years previously presented with an aneurysm in the left limb of his graft. Angiography also demonstrated a bilateral occlusion of the popliteal arteries. Computed tomography (CT) angiography was performed and showed a localized dilation of 3 cm in the left limb of the graft, which had a diameter of 14 mm throughout. In view of the technical difficulties of a surgical procedure, an endovascular stent was considered. Through a left femoral arteriotomy, a stent graft was inserted and deployed in the left limb of the graft. This resulted in total exclusion of the Dacron graft aneurysm. To the best of our knowledge, this is the first report of such a procedure.

  3. Siloxane-grafted membranes

    DOEpatents

    Friesen, D.T.; Obligin, A.S.

    1989-10-31

    Composite cellulosic semipermeable membranes are disclosed which are the covalently bonded reaction product of an asymmetric cellulosic semipermeable membrane and a polysiloxane containing reactive functional group. The two reactants chemically bond by ether, ester, amide or acrylate linkages to form a siloxane-grafted cellulosic membrane having superior selectivity and flux stability. Selectivity may be enhanced by wetting the surface with a swelling agent such as water.

  4. Siloxane-grafted membranes

    DOEpatents

    Friesen, Dwayne T.; Obligin, Alan S.

    1989-01-01

    Composite cellulosic semipermeable membranes are disclosed which are the covalently bonded reaction product of an asymmetric cellulosic semipermeable membrane and a polysiloxane containing reactive functional groups. The two reactants chemically bond by ether, ester, amide or acrylate linkages to form a siloxane-grafted cellulosic membrane having superior selectivity and flux stability. Selectivity may be enhanced by wetting the surface with a swelling agent such as water.

  5. Anti-Donor HLA Antibody Response After Pancreatic Islet Grafting: Characteristics, Risk Factors, and Impact on Graft Function.

    PubMed

    Pouliquen, E; Baltzinger, P; Lemle, A; Chen, C-C; Parissiadis, A; Borot, S; Frimat, L; Girerd, S; Berney, T; Lablanche, S; Benhamou, P Y; Morelon, E; Badet, L; Dubois, V; Kessler, L; Thaunat, O

    2017-02-01

    Pancreatic islet grafting restores endogenous insulin production in type 1 diabetic patients, but long-term outcomes remain disappointing as a result of immunological destruction of allogeneic islets. In solid organ transplantation, donor-specific anti-HLA antibodies (DSA) are the first cause of organ failure. This retrospective multicentric study aimed at providing in-depth characterization of DSA response after pancreatic islet grafting, identifying the risk factor for DSA generation and determining the impact of DSA on graft function. Forty-two pancreatic islet graft recipients from the Groupe Rhin-Rhône-Alpes-Genève pour la Greffe d'Ilots de Langerhans consortium were enrolled. Pre- and postgrafting sera were screened for the presence of DSA and their ability to activate complement. Prevalence of DSA was 25% at 3 years postgrafting. The risk of sensitization increased steeply after immunosuppressive drug withdrawal. DSA repertoire diversity correlated with the number of HLA and eplet mismatches. DSA titer was significantly lower from that observed in solid organ transplantation. No detected DSA bound the complement fraction C3d. Finally, in contrast with solid organ transplantation, DSA did not seem to negatively affect pancreatic islet graft survival. This might be due to the low DSA titers, specific features of IgG limiting their ability to activate the complement and/or the lack of allogenic endothelial targets in pancreatic islet grafts.

  6. Tamoxifen beyond 5 years--patients' decisions regarding entry to the aTTom trial.

    PubMed

    Ferguson, M J; Dewar, J A

    2002-09-01

    The aim of this study was to assess among a population of women who had taken adjuvant tamoxifen for 5 years, how many were prepared to enter a randomised trial looking at the duration of tamoxifen treatment and what was the preference of those who declined trial entry. There is uncertainty as to the optimum duration of adjuvant tamoxifen and this is the subject of the aTTom (adjuvant Tamoxifen Treatment offer more?) trial in which patients are randomised to continue or stop tamoxifen after 5 years. Patients have been recruited to the aTTom trial in Dundee since 1996 and a record has been kept of all the patients with whom the trial was discussed. Patients who declined trial entry were allowed to choose whether to electively stop or continue tamoxifen. 306 patients were eligible for trial entry of whom 171 (56%) consented to randomisation (82 to continue and 89 to stop). Amongst the 135 (44%) who declined randomisation, 28 (21%) elected to stop tamoxifen treatment, 90 (67%) elected to continue and in 17 (13%) their decision was unclear. These results illustrate that patients eligible for the aTTom trial share our clinical equipoise. A majority (56%) of patients were agreeable to randomisation, but among those who declined, some (67%) preferred to continue, some (21%) to stop tamoxifen. This trial is unusual in that the patients have already experienced the treatment options, so the patients' preferences reflect a truly informed choice.

  7. Body composition during fetal development and infancy through the age of 5 years

    PubMed Central

    Toro-Ramos, T; Paley, C; Pi-Sunyer, FX; Gallagher, D

    2015-01-01

    Fetal body composition is an important determinant of body composition at birth, and it is likely to be an important determinant at later stages in life. The purpose of this work is to provide a comprehensive overview by presenting data from previously published studies that report on body composition during fetal development in newborns and the infant/child through 5 years of age. Understanding the changes in body composition that occur both in utero and during infancy and childhood, and how they may be related, may help inform evidence-based practice during pregnancy and childhood. We describe body composition measurement techniques from the in utero period to 5 years of age, and identify gaps in knowledge to direct future research efforts. Available literature on chemical and cadaver analyses of fetal studies during gestation is presented to show the timing and accretion rates of adipose and lean tissues. Quantitative and qualitative aspects of fetal lean and fat mass accretion could be especially useful in the clinical setting for diagnostic purposes. The practicality of different pediatric body composition measurement methods in the clinical setting is discussed by presenting the assumptions and limitations associated with each method that may assist the clinician in characterizing the health and nutritional status of the fetus, infant and child. It is our hope that this review will help guide future research efforts directed at increasing the understanding of how body composition in early development may be associated with chronic diseases in later life. PMID:26242725

  8. Separable Sustained and Selective Attention Factors Are Apparent in 5-Year-Old Children

    PubMed Central

    Underbjerg, Mette; George, Melanie S.; Thorsen, Poul; Kesmodel, Ulrik S.; Mortensen, Erik L.; Manly, Tom

    2013-01-01

    In adults and older children, evidence consistent with relative separation between selective and sustained attention, superimposed upon generally positive inter-test correlations, has been reported. Here we examine whether this pattern is detectable in 5-year-old children from the healthy population. A new test battery (TEA-ChJ) was adapted from measures previously used with adults and older children and administered to 172 5-year-olds. Test-retest reliability was assessed in 60 children. Ninety-eight percent of the children managed to complete all measures. Discrimination of visual and auditory stimuli were good. In a factor analysis, the two TEA-ChJ selective attention tasks (one visual, one auditory) loaded onto a common factor and diverged from the two sustained attention tasks (one auditory, one motor), which shared a common loading on the second factor. This pattern, which suggests that the tests are indeed sensitive to underlying attentional capacities, was supported by the relationships between the TEA-ChJ factors and Test of Everyday Attention for Children subtests in the older children in the sample. It is possible to gain convincing performance-based estimates of attention at the age of 5 with the results reflecting a similar factor structure to that obtained in older children and adults. The results are discussed in light of contemporary models of attention function. Given the potential advantages of early intervention for attention difficulties, the findings are of clinical as well as theoretical interest. PMID:24376591

  9. Fasting increases risk for onset of binge eating and bulimic pathology: a 5-year prospective study.

    PubMed

    Stice, Eric; Davis, Kendra; Miller, Nicole P; Marti, C Nathan

    2008-11-01

    Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. The authors tested the hypothesis that fasting (going without eating for 24 hr for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5 years. Results confirmed that only 23% of participants with elevated dietary restraint scores reported fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting.

  10. Aetiology and clinical features of dysentery in children aged <5 years in rural Bangladesh.

    PubMed

    Ferdous, F; Ahmed, S; DAS, S K; Farzana, F D; Latham, J R; Chisti, M J; Faruque, A S G

    2014-01-01

    The study identified the common aetiological agents and prominent clinical features of dysentery cases in children aged <5 years and compared this to non-dysentery diarrhoeal cases from the same population. From January 2010 to December 2011, 2324 children aged <5 years received treatment at Kumudini Hospital, of which 682 (29%) presented with dysentery. Of the dysenteric children, aetiology could not be determined for over half (61%). Shigella spp. accounted for 32% of dysentery cases. Significant associations were found between presence of blood in stool and: child age (24-59 months) [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.49-3.27], no treatment of drinking water at home (OR 2.00, 95% CI 1.09-3.67), vomiting (OR 0.19, 95% CI 0.14-0.25), abdominal pain (OR 4.68, 95% CI 3.24-6.77), straining (OR 16.45, 95% CI 11.92-22.69), wasting (OR 1.66, 95% CI 1.15-2.41), and presence of Shigella in stool (OR 6.25, 95% CI 4.20-9.29) after controlling for confounders. This study makes it clear that appropriate public health strategies are needed to reduce the burden of dysentery in Bangladesh.

  11. The Thermal State of KS 1731-260 after 14.5 years in Quiescence

    NASA Astrophysics Data System (ADS)

    Merritt, Rachael L.; Cackett, Edward M.; Brown, Edward F.; Page, Dany; Cumming, Andrew; Degenaar, Nathalie; Deibel, Alex; Homan, Jeroen; Miller, Jon M.; Wijnands, Rudy

    2016-12-01

    Crustal cooling of accretion-heated neutron stars provides insight into the stellar interior of neutron stars. The neutron star X-ray transient, KS 1731-260, was in outburst for 12.5 years before returning to quiescence in 2001. We have monitored the cooling of this source since then through Chandra and XMM-Newton observations. Here we present a 150 ks Chandra observation of KS 1731-260 taken in 2015 August, about 14.5 years into quiescence and 6 years after the previous observation. We find that the neutron star surface temperature is consistent with the previous observation, suggesting that crustal cooling has likely stopped and the crust has reached thermal equilibrium with the core. Using a theoretical crust thermal evolution code, we fit the observed cooling curves and constrain the core temperature (T c = 9.35 ± 0.25 × 107 K), composition (Q {}{imp}={4.4}-0.5+2.2), and level of extra shallow heating required (Q sh = 1.36 ± 0.18 MeV/nucleon). We find that the presence of a low thermal conductivity layer, as expected from nuclear pasta, is not required to fit the cooling curve well, but cannot be excluded either.

  12. Family meal frequency and weight status among adolescents: cross-sectional and 5-year longitudinal associations.

    PubMed

    Fulkerson, Jayne A; Neumark-Sztainer, Dianne; Hannan, Peter J; Story, Mary

    2008-11-01

    This study examined cross-sectional and 5-year longitudinal associations between the frequency of family meals and overweight status (>85th percentile for age and gender) in a large, diverse population of adolescents (n = 2,516). The population included two cohorts (midadolescence to young adulthood, n = 1,710, and early adolescence to midadolescence, n = 806). Logistic regression models tested cross-sectional and longitudinal (1999-2004) associations between family meal frequency and overweight status. Two sets of models are presented: (i) models adjusted only for baseline demographic characteristics and (ii) models also adjusted for physical activity, sedentary behaviors, and energy intake. Longitudinal models adjusted for baseline overweight status. Although significant inverse associations between family meal frequency and overweight status were observed for early adolescent females in all cross-sectional models (P < 0.001), longitudinal associations were not significant. Neither cross-sectional nor longitudinal associations were significant for males of either cohort and older females in any models. Young adolescent females who do not eat meals with their families may be at risk for overweight; however, the increased risk may not persist over a 5-year period. Eating family meals during high school may not protect against overweight during young adulthood. Although previous longitudinal research has suggested significant dietary and psychosocial benefits related to family meal frequency, the weight-related benefits of family meals may be more complex and deserving of further study, including an examination of the quality and quantity of food consumed at family meals.

  13. Factors associated with vaccination coverage in children < 5 years in Angola.

    PubMed

    Oliveira, Manuel Falcão Saturnino de; Martinez, Edson Zangiacomi; Rocha, Juan Stuardo Yazlle

    2014-12-01

    OBJECTIVE To analyze vaccination coverage and factors associated with a complete immunization scheme in children < 5 years old. METHODS This cross-sectional household census survey evaluated 1,209 children < 5 years old living in Bom Jesus, Angola, in 2010. Data were obtained from interviews, questionnaires, child immunization histories, and maternal health histories. The statistical analysis used generalized linear models, in which the dependent variable followed a binary distribution (vaccinated, unvaccinated) and the association function was logarithmic and had the children's individual, familial, and socioeconomic factors as independent variables. RESULTS Vaccination coverage was 37.0%, higher in children < 1 year (55.0%) and heterogeneous across neighborhoods; 52.0% of children of both sexes had no immunization records. The prevalence rate of vaccination significantly varied according to child age, mother's level of education, family size, ownership of household appliances, and destination of domestic waste. CONCLUSIONS Vulnerable groups with vaccination coverage below recommended levels continue to be present. Some factors indicate inequalities that represent barriers to full immunization, indicating the need to implement more equitable policies. The knowledge of these factors contributes to planning immunization promotion measures that focus on the most vulnerable groups.

  14. An implantable neuroprosthesis for standing and walking in paraplegia: 5-year patient follow-up

    NASA Astrophysics Data System (ADS)

    Guiraud, David; Stieglitz, Thomas; Koch, Klaus Peter; Divoux, Jean-Louis; Rabischong, Pierre

    2006-12-01

    We present the results of a 5-year patient follow-up after implantation of an original neuroprosthesis. The system is able to stimulate both epimysial and neural electrodes in such a way that the complete flexor-extensor chain of the lower limb can be activated without using the withdrawal reflex. We demonstrate that standing and assisted walking are possible, and the results have remained stable for 5 years. Nevertheless, some problems were noted, particularly regarding the muscle response on the epimysial channels. Analysis of the electrical behaviour and thresholds indicated that the surgical phase is crucial because of the sensitivity of the functional responses to electrode placement. Neural stimulation proved to be more efficient and more stable over time. This mode requires less energy and provides more selective stimulation. This FES system can be improved to enable balanced standing and less fatiguing gait, but this will require feedback on event detection to trigger transitions between stimulation sequences, as well as feedback to the patient about the state of his lower limbs.

  15. HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.

    PubMed

    Knapp, Herschel; Hagedorn, Hildi; Anaya, Henry D

    2014-08-01

    Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). The purpose of this work was to use a mixed methodology approach to evaluate the 5-year sustainability of an intervention that implemented HIV RT in a VA emergency department setting in a large, urban VA medical center to reduce missed diagnostic and treatment opportunities in this vulnerable patient population. In-person semistructured interviews were conducted with providers and stakeholders. Interview notes were qualitatively coded for emerging themes. Quarterly testing rates were evaluated for a 5-year time span starting from the launch in July 2008. Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts.

  16. [Bocavirus in infants under 5 years with acute respiratory infection. Chaco Province, Argentina, 2014].

    PubMed

    Deluca, Gerardo D; Urquijo, María Cecilia; Passarella, Carolina; Picón, César; Picón, Dimas; Acosta, María; Rovira, Carina; Marín, Héctor M

    2016-01-01

    Acute respiratory infection (ARI) is the most frequent pathology along human life, being the most common cause of morbidity and mortality in children under 5 years. The aim of this study was to determine the frequency of bocavirus (BoV) in infants under 5 years with symptoms of ARI from north Argentina (Chaco province). The study was performed on nasopharyngeal aspirates from 488 patients, in the period of January-December 2014. The samples were tested by real time PCR and 36 positive BoV cases (7.4%) were detected. The period with the highest detection rate was June-September with 28 cases (77.8%), of which 26 (72.2%) were infants between 6-18 moths of life. In half of BoV positive cases this virus was detected as single infection of the upper respiratory tract, and in the remaining 50%, as concomitant infection with other microorganisms. To our knowledge, this would be the first study on molecular epidemiology of BoV in northern Argentina. We emphasize the importance of investigating these new viruses capable of generating acute respiratory disease and also to disseminate awareness on their circulation within the community.

  17. Gender Differences in Appraisal of Stress and Coping 5 Years after Heart Transplantation

    PubMed Central

    Grady, Kathleen L; Andrei, Adin-Cristian; Li, Zhi; Rybarczyk, Bruce; White-Williams, Connie; Gordon, Robert; McGee, Edwin C.

    2015-01-01

    OBJECTIVES We examined whether gender differences exist regarding stress, symptom distress, coping, adherence, and social support 5 years after heart transplantation. BACKGROUND Differences exist in health-related quality of life outcomes by gender after heart transplantation; women report poorer outcomes. METHODS Patients (n=210, female=42), were from a prospective, multi-site, study of health-related quality of life long-term after heart transplantation. Patients completed self-report instruments 5 years after heart transplantation (mean=4.98±0.17 years after transplant). Statistical analyses included two-sample t-tests, Chi-square or Fisher’s exact test, and multivariable modeling. RESULTS Women did not report more overall stress or symptom distress, but reported more difficulty adhering to the transplant regimen, yet more actual adherence than men. Women reported using more negative coping styles, but reported more satisfaction with social support. CONCLUSIONS Gender differences exist regarding appraisal of stress, coping styles, and coping resources long-term after heart transplantation. These differences may guide tailoring therapy regarding stress, poor coping, and lack of resources. PMID:26514074

  18. Discourse prominence effects on 2.5-year-old children’s interpretation of pronouns

    PubMed Central

    Song, Hyun-joo; Fisher, Cynthia

    2007-01-01

    Three experiments examined 2.5-year-olds’ sensitivity to discourse structure in pronoun interpretation. Children heard simple two-character stories illustrated by pictures on two video screens. In Experiments 1 and 2, one character in each story was established as more prominent than the other in several context sentences because it was mentioned first, appeared in subject position, was mentioned more often, and was pronominalized once. In Experiment 3, one character was singled out as more prominent only by being mentioned first and placed in subject position. In all three experiments, after hearing a pronoun subject in the final (test) sentence of each story, children looked longer at the character established as more prominent in the preceding sentences. These experiments show that 2.5-year-olds, like older children and adults, interpret pronouns relative to a discourse representation in which referents are ranked in prominence, and that the prominence of discourse referents is influenced by some of the same factors that guide pronoun interpretation in adulthood. PMID:18978930

  19. A 5-Year Investigation of Children's Adaptive Functioning Following Conformal Radiation Therapy for Localized Ependymoma

    SciTech Connect

    Netson, Kelli L.; Conklin, Heather M.; Wu Shengjie; Xiong Xiaoping; Merchant, Thomas E.

    2012-09-01

    Purpose: Conformal and intensity modulated radiation therapies have the potential to preserve cognitive outcomes in children with ependymoma; however, functional behavior remains uninvestigated. This longitudinal investigation prospectively examined intelligence quotient (IQ) and adaptive functioning during the first 5 years after irradiation in children diagnosed with ependymoma. Methods and Materials: The study cohort consisted of 123 children with intracranial ependymoma. Mean age at irradiation was 4.60 years (95% confidence interval [CI], 3.85-5.35). Serial neurocognitive evaluations, including an age-appropriate IQ measure and the Vineland Adaptive Behavior Scales (VABS), were completed before irradiation, 6 months after treatment, and annually for 5 years. A total of 579 neurocognitive evaluations were included in these analyses. Results: Baseline IQ and VABS were below normative means (P<.05), although within the average range. Linear mixed models revealed stable IQ and VABS across the follow-up period, except for the VABS Communication Index, which declined significantly (P=.015). Annual change in IQ (-.04 points) did not correlate with annual change in VABS (-.90 to +.44 points). Clinical factors associated with poorer baseline performance (P<.05) included preirradiation chemotherapy, cerebrospinal fluid shunt placement, number and extent of surgical resections, and younger age at treatment. No clinical factors significantly affected the rate of change in scores. Conclusions: Conformal and intensity modulated radiation therapies provided relative sparing of functional outcomes including IQ and adaptive behaviors, even in very young children. Communication skills remained vulnerable and should be the target of preventive and rehabilitative interventions.

  20. EXPOSE-E: an ESA astrobiology mission 1.5 years in space.

    PubMed

    Rabbow, Elke; Rettberg, Petra; Barczyk, Simon; Bohmeier, Maria; Parpart, André; Panitz, Corinna; Horneck, Gerda; von Heise-Rotenburg, Ralf; Hoppenbrouwers, Tom; Willnecker, Rainer; Baglioni, Pietro; Demets, René; Dettmann, Jan; Reitz, Guenther

    2012-05-01

    The multi-user facility EXPOSE-E was designed by the European Space Agency to enable astrobiology research in space (low-Earth orbit). On 7 February 2008, EXPOSE-E was carried to the International Space Station (ISS) on the European Technology Exposure Facility (EuTEF) platform in the cargo bay of Space Shuttle STS-122 Atlantis. The facility was installed at the starboard cone of the Columbus module by extravehicular activity, where it remained in space for 1.5 years. EXPOSE-E was returned to Earth with STS-128 Discovery on 12 September 2009 for subsequent sample analysis. EXPOSE-E provided accommodation in three exposure trays for a variety of astrobiological test samples that were exposed to selected space conditions: either to space vacuum, solar electromagnetic radiation at >110 nm and cosmic radiation (trays 1 and 3) or to simulated martian surface conditions (tray 2). Data on UV radiation, cosmic radiation, and temperature were measured every 10 s and downlinked by telemetry. A parallel mission ground reference (MGR) experiment was performed on ground with a parallel set of hardware and samples under simulated space conditions. EXPOSE-E performed a successful 1.5-year mission in space.

  1. [The Octabaix study. Baseline assessment and 5 years of follow-up].

    PubMed

    Ferrer, Assumpta; Formiga, Francesc; Padrós, Gloria; Badia, Teresa; Almeda, Jesús; Octabaix, Grupo Estudio

    This is a review of a prospective, community-based study with a follow-up period of 5years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijón test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group.

  2. Lateralization of tongue movements during eating in children 2 to 5 years old.

    PubMed

    Gisel, E G; Schwaab, L; Lange-Stemmler, L; Niman, C W; Schwartz, J L

    1986-04-01

    Normative data on skills of the tongue used in eating are presented. Normal children 2 to 5 years old were studied regarding their preference of placing food either on the right or left side when eating, and they were compared with age-matched Down's syndrome children. In addition, the ability to move food from the right to the left side of the mouth was studied. Normal children underwent a transition from predominantly placing food on the right side at 2 years of age to predominantly placing it on the left side at 4 years of age. Among Down's syndrome children females preferred the right side, and males preferred the left side. The ability to move food from right to left (lateralizing) undergoes a developmental progression from tilting the head to rolling, followed by slow and eventually by smooth movement from one side to the other. Only 15% of the 5-year-olds were able to move food smoothly from side to side. These data provide a baseline against which children with eating problems can be compared.

  3. Separable sustained and selective attention factors are apparent in 5-year-old children.

    PubMed

    Underbjerg, Mette; George, Melanie S; Thorsen, Poul; Kesmodel, Ulrik S; Mortensen, Erik L; Manly, Tom

    2013-01-01

    In adults and older children, evidence consistent with relative separation between selective and sustained attention, superimposed upon generally positive inter-test correlations, has been reported. Here we examine whether this pattern is detectable in 5-year-old children from the healthy population. A new test battery (TEA-Ch(J)) was adapted from measures previously used with adults and older children and administered to 172 5-year-olds. Test-retest reliability was assessed in 60 children. Ninety-eight percent of the children managed to complete all measures. Discrimination of visual and auditory stimuli were good. In a factor analysis, the two TEA-Ch(J) selective attention tasks (one visual, one auditory) loaded onto a common factor and diverged from the two sustained attention tasks (one auditory, one motor), which shared a common loading on the second factor. This pattern, which suggests that the tests are indeed sensitive to underlying attentional capacities, was supported by the relationships between the TEA-Ch(J) factors and Test of Everyday Attention for Children subtests in the older children in the sample. It is possible to gain convincing performance-based estimates of attention at the age of 5 with the results reflecting a similar factor structure to that obtained in older children and adults. The results are discussed in light of contemporary models of attention function. Given the potential advantages of early intervention for attention difficulties, the findings are of clinical as well as theoretical interest.

  4. Radiometric calibration stability of the EO-1 advanced land imager: 5 years on-orbit

    USGS Publications Warehouse

    Markham, B.L.; Ong, L.; Barsi, J.A.; Mendenhall, J.A.; Lencioni, D.E.; Helder, D.L.; Hollaren, D.M.; Morfitt, R.

    2006-01-01

    The Advanced Land Imager (ALI) was developed as a prototype sensor for follow on missions to Landsat-7. It was launched in November 2000 on the Earth Observing One (EO-1) satellite as a nominal one-year technology demonstration mission. As of this writing, the sensor has continued to operate in excess of 5 years. Six of the ALl's nine multi-spectral (MS) bands and the panchromatic band have similar spectral coverage as those on the Landsat-7 ETM+. In addition to on-board lamps, which have been significantly more stable than the lamps on ETM+, the ALI has a solar diffuser and has imaged the moon monthly since launch. This combined calibration dataset allows understanding of the radiometric stability of the ALI system, its calibrators and some differentiation of the sources of the changes with time. The solar dataset is limited as the mechanism controlling the aperture to the solar diffuser failed approximately 18 months after launch. Results over 5 years indicate that: the shortest wavelength band (443 nm) has degraded in response about 2%; the 482 nm and 565 nm bands decreased in response about 1%; the 660 nm, 790 nm and 868 nm bands each degraded about 5%; the 1250 nm and 1650 nm bands did not change significantly and the 2215 nm band increased in response about 2%.

  5. A 5-year study of adenoviruses causing conjunctivitis in Izmir, Turkey.

    PubMed

    Erdin, Begüm Nalça; Pas, Suzan D; Durak, İsmet; Schutten, Martin; Sayıner, A Arzu

    2015-03-01

    Adenoviruses are a common cause of conjunctivitis. Genotypes are diverse and differ according to population and geographical distribution of the virus. There is limited data regarding ocular adenoviral infections and genotype distribution in Turkey. This study aimed to determine the adenovirus genotypes and their epidemiological features among patients with conjunctivitis between 2006 and 2010, in Izmir, Turkey. Adenoviral DNA was detected by PCR in 213 of 488 (44%) of the ocular samples collected from patients with viral conjunctivitis during the 5-year study period. Of these, 101 (47%) were randomly chosen and genotyped by sequence analysis. Seven genotypes were identified, including 3, 4, 8, 11, 19, 37, and 53. Genotype 8 and 4 were the dominant types detected in 67 (66.3%) and 25 (24.7%) of the samples, respectively. Other five genotypes (3, 11, 19, 37, 53) were detected in 9 (8.9%) samples. Genotype and seasonal differences observed throughout the study. Human adenoviruse (HAdV)-8 was the most frequent type, except 2008. The prevalence of genotype 4 increased starting from 2006, became dominant in 2008 and decreased in the following years. The peak season was mostly spring months, although it was possible to detect positive samples throughout the year. In conclusion, genotype 8 followed by genotype 4 was the most frequent adenoviral types causing conjunctivitis during the 5-year study period. Findings suggest that there is a slow shift between genotypes throughout the years.

  6. Molecular characterization of cryptosporidium in children aged 0- 5 years with diarrhea in Jos, Nigeria

    PubMed Central

    Anejo-Okopi, Joseph Aje; Okojokwu, Julius Ocheme; Ebonyi, Augustine Odo; Ejeliogu, Emeka Uba; Isa, Samson Ejiji; Audu, Onyemocho; Akpakpan, Edoama Edet; Nwachukwu, Esther Ebere; Ifokwe, Christabel Kelechi; Ali, Murna; Lar, Patricia; Oguche, Stephen

    2016-01-01

    Introduction Cryptosporidium is an important cause of diarrhea in children and immune-compromised individuals. Recent advances in molecular diagnostics have led to the discovery of subtype families that are thought to be more commonly associated with diarrhea. We aimed to isolate and characterize Cryptosporidium spp among children with diarrhea in Jos, Nigeria. Methods Stool samples were collected from165 children aged 0-5 years with diarrhea. Cryptosporidium oocysts were examined by wet mount preparation, using formalin ether and a modified acid fast staining method. DNA was extracted from positive samples using QIAamp DNA stool mini kit and PCR-RFLP assay was carried out after quantification. Genotyping and phylogenetic analysis were done to determine the subtype families and their relatedness. Results From the 165 children studied, 8 (4.8%) were infected with Cryptosporidium. PCR-RFLP assay and genotype characterization found the following Cryptosporidium species: C. hominis 6 (75%) and C. parvum 2 (25.0%), with family subtypes Id-5, Ie-1 and IIa-1, IId-1 respectively.The most common species was C. hominis and the frequent subtype was C. hominis-Id 5 (62.5%). Conclusion Cryptosporidium is not an uncommon cause of diarrhea in children, with C. hominis being the dominant species. Also C. hominis Id is the commonest sub-family subtype. Put together, zoonotic species may be an important cause of diarrhea in children aged 0-5 years in Jos, Nigeria. PMID:28293369

  7. Factors associated with vaccination coverage in children < 5 years in Angola

    PubMed Central

    de Oliveira, Manuel Falcão Saturnino; Martinez, Edson Zangiacomi; Rocha, Juan Stuardo Yazlle

    2014-01-01

    OBJECTIVE To analyze vaccination coverage and factors associated with a complete immunization scheme in children < 5 years old. METHODS This cross-sectional household census survey evaluated 1,209 children < 5 years old living in Bom Jesus, Angola, in 2010. Data were obtained from interviews, questionnaires, child immunization histories, and maternal health histories. The statistical analysis used generalized linear models, in which the dependent variable followed a binary distribution (vaccinated, unvaccinated) and the association function was logarithmic and had the children’s individual, familial, and socioeconomic factors as independent variables. RESULTS Vaccination coverage was 37.0%, higher in children < 1 year (55.0%) and heterogeneous across neighborhoods; 52.0% of children of both sexes had no immunization records. The prevalence rate of vaccination significantly varied according to child age, mother’s level of education, family size, ownership of household appliances, and destination of domestic waste. CONCLUSIONS Vulnerable groups with vaccination coverage below recommended levels continue to be present. Some factors indicate inequalities that represent barriers to full immunization, indicating the need to implement more equitable policies. The knowledge of these factors contributes to planning immunization promotion measures that focus on the most vulnerable groups. PMID:26039393

  8. Prevalence of Malocclusion in 3- to 5-Year-Old Children in Shanghai, China

    PubMed Central

    Zhou, Xinhua; Zhang, Ying; Wang, Yan; Zhang, Hao; Chen, Li; Liu, Yuehua

    2017-01-01

    The aim of the present study was to obtain the prevalence of malocclusions in preschool children in Shanghai, China. A cross-sectional survey was conducted among 2335 children aged 3–5 years from kindergartens. Several occlusal parameters were clinically assessed, including second deciduous molar terminal plane, canine relationship, degree of overjet and overbite, anterior and posterior crossbite, and the presence or absence of physiologic spaces and crowding. All parents of subjects were asked to fill in the oral health knowledge questionnaires. The prevalence of malocclusion in primary dentition in Shanghai was 83.9%, and no significant differences were found in genders. Data showed that the prevalence of deep overbite (63.7%) was the highest in children with malocclusion, followed by deep overjet (33.9%), midline deviation (26.6%), anterior crossbite (8.0%) and anterior crowding (6.5%). The results revealed a high prevalence of malocclusion in primary dentition in children aged 3–5 years old of Shanghai, especially in vertical anomalies. The need for preventive orthodontic therapy is extremely desired and oral health education about malocclusion should be strengthened. PMID:28327525

  9. Do costochondral grafts have any growth potential in temporomandibular joint surgery? A systematic review

    PubMed Central

    Kumar, Praveen; Rattan, Vidya; Rai, Sachin

    2015-01-01

    Purpose of the study To assess the growth potential of costochondral graft in temporomandibular joint reconstruction in patients with temporomandibular ankylosis and hemifacial microsomia. Method Systematic review after inclusion of articles fulfilling the following criteria: (1) only human studies; (2) patients of temporomandibular joint ankylosis and hemifacial microsomia; and (3) studies with minimum of five cases and with a minimum follow-up for a period of 5 years. The primary outcome measure was the percentage of patients with optimum growth of costochondral graft. Secondary outcomes were any abnormal growth and restoration of function. Delphi's criteria were used for assessing the quality of the included studies. Result Only three studies satisfied all the inclusion criteria. A total of 96 costochondral grafts were placed in the included studies. Optimum growth was reported in 54 grafts, undergrowth in 1 graft, overgrowth in 7 grafts, lateral overgrowth in 1 graft and no growth in 1 graft. Graft resorption, reankylosis and sequestration were seen in 21, 8 and 3 cases, respectively. When the Delphi's criteria were applied to the case series for the assessment of quality, majority of the studies could be considered as satisfying at least 50% of the criteria. Conclusion There are no randomised clinical trials and the only evidence is in the form of case series that is considered as the lowest level of evidence for any study. No inference can be interpreted regarding growth potential of costochondral graft. Thus, on the basis of available evidence, it can be concluded that use of costochondral graft for temporomandibular joint reconstruction lacks scientific evidence. PMID:26605146

  10. Reduced Long-Term Relative Survival in Females and Younger Adults Undergoing Cardiac Surgery: A Prospective Cohort Study

    PubMed Central

    Enger, Tone Bull; Pleym, Hilde; Stenseth, Roar; Greiff, Guri; Wahba, Alexander; Videm, Vibeke

    2016-01-01

    Objectives To assess long-term survival and mortality in adult cardiac surgery patients. Methods 8,564 consecutive patients undergoing cardiac surgery in Trondheim, Norway from 2000 until censoring 31.12.2014 were prospectively followed. Observed long-term mortality following surgery was compared to the expected mortality in the Norwegian population, matched on gender, age and calendar year. This enabled assessment of relative survival (observed/expected survival rates) and relative mortality (observed/expected deaths). Long-term mortality was compared across gender, age and surgical procedure. Predictors of reduced survival were assessed with multivariate analyses of observed and relative mortality. Results During follow-up (median 6.4 years), 2,044 patients (23.9%) died. The observed 30-day, 1-, 3- and 5-year mortality rates were 2.2%, 4.4%, 8.2% and 13.8%, respectively, and remained constant throughout the study period. Comparing observed mortality to that expected in a matched sample from the general population, patients undergoing cardiac surgery showed excellent survival throughout the first seven years of follow-up (relative survival ≥ 1). Subsequently, survival decreased, which was more pronounced in females and patients undergoing other procedures than isolated coronary artery bypass grafting (CABG). Relative mortality was higher in younger age groups, females and patients undergoing aortic valve replacement (AVR). The female survival advantage in the general population was obliterated (relative mortality ratio (RMR) 1.35 (1.19–1.54), p<0.001). Increasing observed long-term mortality seen with ageing was due to population risk, and younger age was independently associated with increased relative mortality (RMR per 5 years 0.81 (0.79–0.84), p<0.001)). Conclusions Cardiac surgery patients showed comparable survival to that expected in the general Norwegian population, underlining the benefits of cardiac surgery in appropriately selected patients. The

  11. The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: A systematic review

    PubMed Central

    Aloy-Prósper, Amparo; Peñarrocha-Oltra, David; Peñarrocha-Diago, Maria A.

    2015-01-01

    Aim: The purpose of this study was to systematically review clinical studies examining the survival and success rates of implants placed with intraoral onlay autogenous bone grafts to answer the following question: do ridge augmentations procedures with intraoral onlay block bone grafts in conjunction with or prior to implant placement influence implant outcome when compared with a control group (guided bone regeneration, alveolar distraction, native bone or short dental implants.)? Material and Method: An electronic data banks and hand searching were used to find relevant articles on vertical and lateral augmentation procedures performed with intraoral onlay block bone grafts for dental implant therapy published up to October 2013. Publications in English, on human subjects, with a controlled study design –involving at least one group with defects treated with intraoral onlay block bone grafts, more than five patients and a minimum follow-up of 12 months after prosthetic loading were included. Two reviewers extracted the data. Results: A total of 6 studies met the inclusion criteria: 4 studies on horizontal augmentation and 2 studies on vertical augmentation. Intraoperative complications were not reported. Most common postsurgical complications included mainly mucosal dehiscences (4 studies), bone graft or membrane exposures (3 studies), complete failures of block grafts (2 studies) and neurosensory alterations (4 studies). For lateral augmentation procedures, implant survival rates ranged from 96.9% to 100%, while for vertical augmentation they ranged from 89.5% to 100%. None article studied the soft tissues healing. Conclusions: Survival and success rates of implants placed in horizontally and vertically resorbed edentulous ridges reconstructed with block bone grafts are similar to those of implants placed in native bone, in distracted sites or with guided bone regeneration. More surgical challenges and morbidity arise from vertical augmentations, thus short

  12. Aortic graft infection and mycotic aneurysm with Streptococcus equi zooepidemicus: two cases with favorable outcome of antibiotic treatment.

    PubMed

    Altreuther, Martin; Lange, Conrad; Myhre, Hans Olav; Hannula, Raisa

    2013-02-01

    Infections with Streptococcus equi zooepidemicus are rare and are associated with contact with animals or animal products. There are very few reports about infected vascular grafts or aneurysms with this etiology. We present two patients. The first is a 77-year-old man with an infected bifurcated graft four years after an open operation for an abdominal aortic aneurysm (AAA). The second is a 72-year-old man with a symptomatic mycotic AAA, treated with endovascular aneurysm repair. Both received prolonged treatment with bactericidal antibiotics and responded well. Follow-up time at present is 5.5 years for the first, and 4.5 years for the second, patient.

  13. 5-year Angiographic and Clinical Follow-up of Coil-embolised Intradural Saccular Aneurysms

    PubMed Central

    Batista, LL.; Mahadevan, J.; Sachet, M.; Alvarez, H.; Rodesch, G.; Lasjaunias, P.

    2002-01-01

    Summary The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a midterm (3 years) and 45 patients had a 5year or more angiographic FU (mean 67,7 months per patient). Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos-embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. No mortality related to the procedure was observed in the unruptured AA group. No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long

  14. [Edwards syndrome--most frequent indications for genetic amniocentesis. Analysis of the last 5 years].

    PubMed

    Chuchracki, Marek; Janiak, Justyna; Ziółkowska, Katarzyna; Sedziak, Anna; Opala, Tomasz

    2012-01-01

    Edwards syndrome (trisomy 18) occurs in 1: 8000 live births and is closely related to the mother's age. Most of the embryos and fetuses with trisomy of 18 chromosome pair undergo natural abortion. Change in number and structure of chromosomes usually takes place spontaneously. However, the incidence of chromosome mutations increases with the presence of mutagenic factors. One of the chemical mutagenic factors is benzopyrene - present in cigarette smoke. Prenatal cytogenetic diagnostic is used for detecting diseases and clinical syndromes conditioned by chromosome aberrations. To this date the "golden standard" of this diagnostic is the assessment of the fetus karyotype by means of analysis of chromosome banding pattern from amniotic fluid-derived cells. The aim of the study was the analysis of indications for genetic amniocenteses carried out in the last 5 years and in case of which trisomy of chromosome 18 (Edwards syndrome) was diagnosed. The analysis covered 1593 results of fetus karyotypes obtained from Cytogenetic Laboratory of the Central Gynecological-Obstetric Clinical Hospital in Poznań over the last 5 years. The study procedure consisted in producing cell culture from amniotic fluid, appliance of appropriate color techniques and thorough microscopic analysis of chromosome banding pattern. As a result of the analysis it was discovered that in 1538 cases the karyotype was normal, and in 55 cases trisomy 18 was diagnosed, which constituted 3% of all cytogenetic tests. The highest number of trisomy 18 cases was noted in 2009 - 19 cases, which constitutes 5% of all tests. In 2010 and 2011 the results included respectively 2% and 3% of diagnosed trisomy 18 (Edwards syndrome). In the last 5 years normal results for karyotypes constituted 87%, in 10% cases other aberrations were diagnosed through cystogenetic tests, whereas 3% of the results have shown trisomy 18 (Edwards syndrome The most frequent indications for performing genetic amniocentesis, as a result of

  15. Mycobacterium tuberculosis complex transmission is not associated with recent immigration (≤5 years) in Florida.

    PubMed

    Séraphin, Marie Nancy; Lauzardo, Michael

    2015-12-01

    As tuberculosis (TB) incidence decreases in the US, foreign-born persons continue to account for a larger proportion of the burden. In these cross-sectional analyses of 1149 culture-confirmed TB cases genotyped using spoligotyping and 24-locus MIRU, we show that over a quarter of cases among the foreign-born population in Florida resulted from recent transmission of the Mycobacterium tuberculosis complex. In addition, over a third of these cases occurred among persons who had immigrated 5 years or less prior to their diagnosis. Although recent immigration was not a significant predictor of TB transmission, younger age, birthplace in the Americas, homelessness, drug use and TB lineage are risk factors for TB transmission among the foreign-born population in Florida. These data provide actionable insights into TB transmission among the foreign-born population in Florida.

  16. Speaking a tone language enhances musical pitch perception in 3-5-year-olds.

    PubMed

    Creel, Sarah C; Weng, Mengxing; Fu, Genyue; Heyman, Gail D; Lee, Kang

    2017-01-16

    Young children learn multiple cognitive skills concurrently (e.g., language and music). Evidence is limited as to whether and how learning in one domain affects that in another during early development. Here we assessed whether exposure to a tone language benefits musical pitch processing among 3-5-year-old children. More specifically, we compared the pitch perception of Chinese children who spoke a tone language (i.e., Mandarin) with English-speaking American children. We found that Mandarin-speaking children were more advanced at pitch processing than English-speaking children but both groups performed similarly on a control music task (timbre discrimination). The findings support the Pitch Generalization Hypothesis that tone languages drive attention to pitch in nonlinguistic contexts, and suggest that language learning benefits aspects of music perception in early development. A video abstract of this article can be viewed at: https://youtu.be/UY0kpGpPNA0.

  17. ECG-based PICC tip verification system: an evaluation 5 years on.

    PubMed

    Oliver, Gemma; Jones, Matt

    2016-10-27

    In 2011, the vascular access team at East Kent Hospitals University NHS Foundation Trust safely and successfully incorporated the use of electrocardiogram (ECG) guidance technology for verification of peripherally inserted central catheters (PICC) tip placement into their practice. This study, 5 years on, compared the strengths and limitations of using this ECG method with the previous gold-standard of post-procedural chest X-ray. The study was undertaken using an embedded case study approach, and the cost, accuracy and efficiency of both systems were evaluated and compared. Using ECG to confirm PICC tip position was found to be cheaper, quicker and more accurate than post-procedural chest X-ray.

  18. Atlantoaxial rotatory subluxation as a cause of torticollis in a 5-year-old girl.

    PubMed

    Bagouri, Elmunzar; Deshmukh, Sandeep; Lakshmanan, Palaniappan

    2014-05-15

    Many patients present to the emergency department complaining of a sore or stiff neck and lateral flexion of the neck with contralateral rotation. Under the pressure of the breaching time and busy shifts some of the patients are discharged to the care of their general practitioners without adequate investigations. While most of the cases are due to benign causes, torticollis can be due to many congenital and acquired pathologies, some of which may need further investigation and urgent management. Atlantoaxial subluxation (AAS), tumours of the base of the skull and infections are among these causes. Delayed diagnosis may lead to worsening neurology and complicate the management. We report a case of a 5-year-old girl who presented to our fracture clinic with a fractured clavicle and torticollis; her subsequent investigations confirmed the diagnosis of AAS. Our patient responded to non-operative treatment and improved with no neurological complications.

  19. The thermoregulatory theory of yawning: what we know from over 5 years of research

    PubMed Central

    Gallup, Andrew C.; Eldakar, Omar T.

    2012-01-01

    Over the past 5 years numerous reports have confirmed and replicated the specific brain cooling and thermal window predictions derived from the thermoregulatory theory of yawning, and no study has found evidence contrary to these findings. Here we review the comparative research supporting this model of yawning among homeotherms, while highlighting a recent report showing how the expression of contagious yawning in humans is altered by seasonal climate variation. The fact that yawning is constrained to a thermal window of ambient temperature provides unique and compelling support in favor of this theory. Heretofore, no existing alternative hypothesis of yawning can explain these results, which have important implications for understanding the potential functional role of this behavior, both physiologically and socially, in humans and other animals. In discussion we stress the broader applications of this work in clinical settings, and counter the various criticisms of this theory. PMID:23293583

  20. Performance of the MIR Cooperative Solar Array After 2.5 Years in Orbit

    NASA Technical Reports Server (NTRS)

    Kerslake, Thomas W.; Hoffman, David J.

    1999-01-01

    The Mir Cooperative Solar Array (MCSA) was developed jointly by the United States and Russia to produce 6 kW of power for the Russian space station Mir. Four, multi-orbit test sequences were executed between June 1996 and December 1998 to measure MCSA electrical performance. A dedicated Fortran computer code was developed to analyze the detailed thermal-electrical performance of the MCSA. The computational performance results compared very favorably with the measured flight data in most cases. Minor performance degradation was detected in one current generating section of the MCSA. Yet overall, the flight data indicated the MCSA was meeting and exceeding performance expectations. There was no precipitous performance loss due to contamination or other causes after 2.5 years of operation. In this paper, we review the MCSA flight electrical performance tests, data and computational modeling and discuss findings from data comparisons with the computational results.

  1. Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital.

    PubMed

    Alrifai, S B; Alsaadi, A; Mahmood, Y A; Ali, A A; Al-Kaisi, L A

    2009-01-01

    A cross-sectional hospital-based study was carried out at Tikrit teaching hospital, Iraq, from October 2004 to September 2005, to identify the prevalence and etiology of nosocomial infectious diarrhoea among children under 5 years of age. Of 259 children admitted to the paediatric ward for reasons other than diarrhoea and hospitalized for more than 3 days, clinical and laboratory analysis of stool samples showed nosocomial diarrhoea in 84 children (32.4%). The most common causative agents were enteropathogenic Escherichia coli (25.9%), Clostridium difficile (21.0%) and rotavirus (18.5%). Single infectious agents caused 63.1% of the cases, while mixed infections were detected in 16.7%; in 20.2% of children the cause remained unknown.

  2. Salter-Harris type-IV displaced distal radius fracture in a 5-year-old.

    PubMed

    Huntley, Samuel R; Summers, Spencer H; Stricker, Stephen J

    2016-03-01

    Displaced Salter-Harris type-IV fractures are rare in young children and can result in articular incongruity or premature physeal arrest. We describe a 5-year-old boy who sustained a displaced left distal radial Salter-Harris type-IV fracture. The patient had normal wrist function and physeal growth at the 3-year postoperative follow-up. Our patient is by far the youngest reported child with a displaced Salter-Harris type-IV fracture of the distal radius. Prompt anatomic reduction and fixation of a displaced distal radial Salter-Harris type-IV fracture can result in excellent short-term wrist motion with maintenance of physeal function.

  3. Re-embodying eating: patients' experiences 5 years after bariatric surgery.

    PubMed

    Natvik, Eli; Gjengedal, Eva; Moltu, Christian; Råheim, Målfrid

    2014-12-01

    Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life-a part that is not necessarily healed by surgery. Empirical research on patients' experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery.

  4. Degradation assessment of LYRA after 5 years on orbit - Technology Demonstration -

    NASA Astrophysics Data System (ADS)

    BenMoussa, A.; Giordanengo, B.; Gissot, S.; Dammasch, I. E.; Dominique, M.; Hochedez, J.-F.; Soltani, A.; Bourzgui, N.; Saito, T.; Schühle, U.; Gottwald, A.; Kroth, U.; Jones, A. R.

    2015-03-01

    We present a long-term assessment of the radiometric calibration and degradation of the Large Yield Radiometer (LYRA), which has been on orbit since 2009. LYRA is an ultraviolet (UV) solar radiometer and is the first space experiment using aboard a pioneering diamond detector technology. We show that LYRA has degraded after the commissioning phase but is still exploitable scientifically after almost 5 years on orbit thanks to its redundancy design and calibration strategy correcting for instrument degradation. We focus on the inflight detector's calibration and show that diamond photodetectors have not degraded while silicon reference photodiodes that are even less exposed to the Sun show an increase of their dark current and a decrease of their photoresponse.

  5. Climatic factors associated with hospitalizations for rotavirus diarrhoea in children under 5 years of age

    PubMed Central

    D'SOUZA, R. M.; HALL, G.; BECKER, N. G.

    2008-01-01

    SUMMARY This study compares the seasonality of rotavirus diarrhoeal hospital admissions and its relationship to climatic factors across three Australian cities. Weekly admission of rotavirus diarrhoea (1993–2003) in children aged <5 years and weekly average temperature and relative humidity for each city were modelled using a log-linear model with a cubic trend and season. Interactions were included to test for differences in the effect of temperature and humidity between seasons and between cities. Admissions of rotavirus diarrhoea peaked in winter and spring and were lowest in summer. Higher temperature and humidity in the previous week were associated with a decrease in rotavirus diarrhoeal admissions in three cities. The effects of both temperature and humidity on rotavirus admissions in Brisbane differed across seasons. Strategies to combat outbreaks of rotavirus diarrhoea should take climatic factors and seasonal effects into consideration to plan for the excess seasonal hospital admissions. PMID:17352836

  6. A student-centred, problem-based curriculum: 5 years' experience.

    PubMed Central

    Des Marchais, J E

    1993-01-01

    In 1987, the University of Sherbrooke's school of medicine implemented a student-centred, problem-based learning (PBL) curriculum. The experience of the first 5 years is reviewed; program goals, the schedule of learning activities, the instructional format and assessment of student learning are described. The new program is more demanding of teachers and requires better faculty training in pedagogy. No new financial resources have been available. The preclinical reform has led to revision of the clerkship, where sessions on clinical reasoning are now based on the PBL philosophy. Student reactions to the program are reported. The Sherbrooke experience has demonstrated that it is both possible and feasible to shift from a traditional to a problem-based curriculum. PMID:8477383

  7. Large laryngeal vascular malformation in a 5-year-old child

    PubMed Central

    Danstrup, Christian Sander; Madsen, Mette Hjørringgaard; Bille, Jesper

    2015-01-01

    A 5-year-old boy was admitted with stridor, which was initially interpreted as subglottic laryngitis. He had a history of prolonged hoarseness and his voice was deep for his age. The stridor persisted despite treatment with epinephrine inhalations and intravenous glucocorticoids. A direct laryngoscopy and blood work up did not support the suspected diagnosis. A MRI was then carried out, followed by angiography. The latter revealed an arteriovenous malformation (AVM) involving the lingual and superior thyroid arteries bilaterally. Owing to the rareness and extent of such an AVM, the patient was referred to Paris for further treatment. This case presents the difficulties in diagnostics and emphasises the importance of diagnostics and multidisciplinary approaches with regard to treatment of AVMs. PMID:25795744

  8. Renal stone associated with the ketogenic diet in a 5-year old girl with intractable epilepsy.

    PubMed

    Choi, Ji Na; Song, Ji Eun; Shin, Jae Il; Kim, Heung Dong; Kim, Myung Joon; Lee, Jae Seung

    2010-05-01

    In this paper, we report on a 5-year-old girl who developed a renal stone while following the ketogenic diet to treat refractory seizure disorder. Three months after initiating the ketogenic diet, she developed severe abdominal pain and vomiting. The spot urine calcium-to-creatinine (Ca/Cr) ratio and 24-hour urine evaluation showed hypercalciuria. Computed tomography (CT) imaging revealed a stone in the right ureteropelvic junction, resulting in hydronephrosis of the right kidney. The renal stone disappeared 5 days after conservative treatment; the patient's microscopic hematuria resolved concurrently. In light of this case report, we recommend regularly monitoring the urine Ca/Cr ratio with ultrasonography for further development of renal stones in patients following the ketogenic diet. If these patients exhibit evidence of symptomatic hypercalciuria or cyristalluria, liberalization of fluid restriction and urine alkalization using oral potassium citrate should be considered.

  9. 5 years of experience with a large-scale mentoring program for medical students

    PubMed Central

    Pinilla, Severin; Pander, Tanja; von der Borch, Philip; Fischer, Martin R.; Dimitriadis, Konstantinos

    2015-01-01

    In this paper we present our 5-year-experience with a large-scale mentoring program for undergraduate medical students at the Ludwig Maximilians-Universität Munich (LMU). We implemented a two-tiered program with a peer-mentoring concept for preclinical students and a 1:1-mentoring concept for clinical students aided by a fully automated online-based matching algorithm. Approximately 20-30% of each student cohort participates in our voluntary mentoring program. Defining ideal program evaluation strategies, recruiting mentors from beyond the academic environment and accounting for the mentoring network reality remain challenging. We conclude that a two-tiered program is well accepted by students and faculty. In addition the online-based matching seems to be effective for large-scale mentoring programs. PMID:25699108

  10. Assessing the Performance of a Medical Intensive Care Unit: A 5-year single-center Experience

    PubMed Central

    Anushiravani, Amir; Masoompour, Seyed Masoom

    2017-01-01

    Patient care in the Intensive Care Unit (ICU) is complex and expensive, serving to provide optimal outcome as well as the adequate use of resources. Our objective was to determine variables associated with admission practices, processes of care, and clinical outcomes for critically ill patients. Admission records of a 10-bed ICU were gathered during a 5-year period. Variables such as average length of stay, bed turnover, bed occupancy rate, and turnover interval were evaluated. Of the 1719 patients evaluated, 54% were men. Mortality was highest between 10 pm and 2 am. There was no significant difference in ICU mortality during different days of the week. We showed that nonoffice hour admissions were not associated with poorer clinical outcomes, and significant differences in ICU mortality and ICU length of stay were not seen. Moreover, hospital mortality rates were not significantly higher for patients admitted to our ICU on weekends, at nights, or any day of the week.

  11. Imerslund-Grasbeck syndrome in a 5-year-old Iranian boy

    PubMed Central

    Goudarzipour, K.; Zavvar, N.; Behnam, B.; Ahmadi, M. A.

    2016-01-01

    Imerslund-Grasbeck syndrome (IGS) is a rare syndrome characterized by clinical symptoms and signs of Vitamin B12 deficiency and proteinuria. Our patient was a 5-year-old boy with pallor, lack of appetite, and low weight gain. Laboratory studies showed severe macrocytic anemia, normal reticulocyte count, negative direct coombs test, normal osmotic fragility, and autohemolysis test. He has had intermittent proteinuria since 3 years ago despite normal creatinine level and absence of hematuria or hypertension. Finally, based on low level of serum B12 vitamin and normal folate level accompanied by asymptomatic proteinuria, the diagnosis of IGS was made. Furthermore, his sister has had laboratory abnormalities without any symptoms. IGS responded to B12 replacement therapy dramatically but intermittent proteinuria persisted even after appropriate therapy. PMID:27942180

  12. 5 years of experience with a large-scale mentoring program for medical students.

    PubMed

    Pinilla, Severin; Pander, Tanja; von der Borch, Philip; Fischer, Martin R; Dimitriadis, Konstantinos

    2015-01-01

    In this paper we present our 5-year-experience with a large-scale mentoring program for undergraduate medical students at the Ludwig Maximilians-Universität Munich (LMU). We implemented a two-tiered program with a peer-mentoring concept for preclinical students and a 1:1-mentoring concept for clinical students aided by a fully automated online-based matching algorithm. Approximately 20-30% of each student cohort participates in our voluntary mentoring program. Defining ideal program evaluation strategies, recruiting mentors from beyond the academic environment and accounting for the mentoring network reality remain challenging. We conclude that a two-tiered program is well accepted by students and faculty. In addition the online-based matching seems to be effective for large-scale mentoring programs.

  13. Full-mouth rehabilitation of Class II deep-bite patient: A 5-year clinical report

    PubMed Central

    Ergun, Gulfem; Bozkaya, Erdal

    2016-01-01

    This case report demonstrates the full-mouth rehabilitation of a 45-year-old male patient with severe deep-bite by increasing vertical dimension. The technique of anterior maxillary osteotomy performed in the present situation has been found to be effective, requiring anterior and inferior repositioning of the anterior maxilla to provide an esthetic and functional implant supported fixed prosthesis. Four months after surgery, the fixation system was removed, and 6 dental implants were placed. The anterior and inferior movements of the segment allowed for natural tooth anatomy and size in the definitive implant supported partial fixed prosthesis. A satisfactory functional and esthetic result was obtained after 5 years of follow-up. PMID:27403066

  14. The impact patient-specific instrumentation has had on my practice in the last 5 years.

    PubMed

    Collins, Michael J

    2014-03-01

    I have performed total knee arthroplasty (TKA) using patient- specific instrumentation (PSI) (TRUMATCH® Personalized Solutions, DePuy Synthes Joint Reconstruction, Warsaw, Indiana) since July 2009. Since that time, I have performed over 600 of these procedures, all at the same hospital and all using the same personnel I worked with before I began using PSI. I do not have a physician assistant, but I do have a surgical assistant who scrubs with and assists me on all TKAs. There are a number of reasons why a surgeon may decide to use PSI. This paper discusses the effect PSI has had on my practice in the last 5 years, including my experiences and conclusions.

  15. Endoscopic removal of foreign bodies from the upper gastrointestinal tract: 5-year experience

    PubMed Central

    Emara, Mohamed H; Darwiesh, Ehab M; Refaey, Mohamed M; Galal, Sherif M

    2014-01-01

    Background Foreign bodies (FBs) in the upper gastrointestinal tract are produced chiefly by accidental swallowing but rarely produce symptoms. Removal of FBs is not an infrequent challenge for upper gastrointestinal endoscopy. The aim of this study is to elicit our experience in a 5-year period in dealing with FBs in the upper gastrointestinal tract using upper endoscopy. Methods This retrospective study was conducted at Zagazig University Hospitals, Egypt, over a 5-year period. We reviewed all patients’ files with full notations on age, sex, type of FB and its anatomical location, treatments, and outcomes (complications, success rates, and mortalities). Patients with incomplete files and those with FBs not identified at the endoscopic examination were excluded. Results A total of 45 patients were identified. Their ages ranged from 6 months to 102 years. Slight male predominance was noticed (53.3%). The most frequent presentation was a history of FB ingestion without any associated manifestations (44.4%). Coins were the most commonly encountered FBs (14/45). Esophagus was the most common site of trapping (27/45). The overall success rate was 95.6% (43/45). Upper endoscopy successfully resolved the problem by either FB removal (41/43) or dislodgment of the impacted fleshy meat to the stomach (2/43). Two cases were referred for surgical removal. The rate of complications was 6.7%. Furthermore, no mortalities due to FB ingestion or removal had been reported throughout the study. Conclusion Our experience with FB removal emphasizes its importance and ease when performed by experienced hands, at well-equipped endoscopy units, and under conscious sedation in most cases, with high success rates and minor complications. PMID:25053889

  16. Snoring, sleep disturbance, and behaviour in 4-5 year olds.

    PubMed Central

    Ali, N J; Pitson, D J; Stradling, J R

    1993-01-01

    Parents of 996 children aged 4-5 years identified consecutively from the Oxford health visitor register were asked to complete a questionnaire about breathing disorders during sleep. A total of 782 (78.5%) was returned. Ninety five (12.1%) children were reported to snore on most nights. Habitual snoring was significantly associated with daytime sleepiness, restless sleep, and hyperactivity. The questionnaire responses were used to select two subgroups, one at high risk of a sleep and breathing disorder and a control group. These children (132 in total) were monitored at home with overnight video recording and oximetry, and had formal behavioural assessment using the Conners scale. Seven (7/66) children from the high risk group and none from the control group had obvious sleep disturbance consequent on snoring and upper airway obstruction. Thus our estimate of the prevalence of sleep and breathing disorders in this age group is 7/996 or 0.7%. The high risk group had significantly higher nocturnal movement, oxygen saturation dip rates, and overnight pulse rates than the controls. Maternal but not paternal smoking was associated with the high risk group. Parents and teachers thought those in the high risk group were more hyperactive and inattentive than the controls, but only their parents thought them more aggressive. Significant sleep and breathing disorders occur in about 0.7% of 4-5 year olds. Children whose parents report snoring and sleep disturbance have objective evidence of sleep disruption and show more behaviour problems than controls. PMID:8280201

  17. Stereopsis Results at 4.5 Years of Age in the Infant Aphakia Treatment Study

    PubMed Central

    Hartmann, E. Eugenie; Stout, Ann U.; Lynn, Michael J.; Yen, Kimberly G.; Kruger, Stacey J.; Lambert, Scott R.

    2014-01-01

    Purpose To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used. Design Randomized prospective clinical trial Methods The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1 to 7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using three different tests: 1) Frisby; 2) Randot Preschool; and 3) Titmus fly. Results Twenty-eight patients (25%) had a positive response to at least one of the stereopsis tests. There was no statistically significant difference in stereopsis between the two treatment groups. Frisby (contact lens, 6 (11%); IOL, 7 (13%); p=0.99), Randot (contact lens, 3 (6%); IOL, 1 (2%); p=0.62) or Titmus: (contact lens, 8 (15%); IOL, 13 (23%); p=0.34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 versus 2.4 months; p=0.002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs. 20/252; p=0.0003). Conclusion The type of optical correction did not influence stereopsis outcomes. However, two other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis. PMID:25261241

  18. Food assistance programmes are indirectly associated with anaemia status in children <5 years old in Mexico.

    PubMed

    Shamah-Levy, Teresa; Méndez-Gómez-Humarán, Ignacio; Gaona-Pineda, Elsa B; Cuevas-Nasu, Lucia; Villalpando, Salvador

    2016-09-01

    Anaemia in children is a public health concern in Mexico; Federal food assistance programmes are being implemented to prevent it. We undertook this research to investigate the indirect association between food assistance programmes (FAP) and anaemia through dietary and socio-economic conditions of beneficiary children. A structural equation model (SEM) was constructed to assess associations among FAP, dietary and socio-economic conditions, as well as anaemia. A cross-sectional comparative study was conducted based on a sample of 1214 households with children <5 years old, beneficiaries of two FAP: Prospera and rescue from malnutrition with amaranth (RMA) and a comparison group in San Luis Potosí, Mexico. The SEM and a decomposition effect analysis revealed the existence of a significant indirect association of FAP on the prevalence of anaemia via dietary and socio-economic conditions in children under 5 years old. The Prospera assistance programme showed a significant indirect positive association with the prevalence of anaemia (standard coefficient=0·027, P<0·031), and the RMA programme showed a significant indirect negative association with the prevalence of anaemia (standard coefficient=-0·029, P=0·047). There was a direct association between FAP and dietary and socio-economic conditions. FAP could indirectly modify the prevalence of anaemia in young children with a direct improvement on dietary and socio-economic conditions. The unexpected finding of the association between RMA, dietary and socio-economic conditions and the prevalence of anaemia reflects differences in the focus of the programmes.

  19. Surgical Treatment for Adult Spinal Deformity: Projected Cost Effectiveness at 5-Year Follow-Up

    PubMed Central

    Terran, Jamie; McHugh, Brian J.; Fischer, Charla R.; Lonner, Baron; Warren, Daniel; Glassman, Steven; Bridwell, Keith; Schwab, Frank; Lafage, Virginie

    2014-01-01

    Background In the United States, expenditures related to spine care are estimated to account for $86 billion annually. Policy makers have set a cost-effectiveness benchmark of less than $100,000/quality adjusted life year (QALY), forcing surgeons to defend their choices economically. This study projects the cost/QALY for surgical treatment of adult spinal deformity at 5-year follow-up based on 2-year cost- and health-related quality-of-life (HRQOL) data. Methods In a review of 541 patients with adult spinal deformity, the patients who underwent revision or were likely to undergo revision were identified and cost of surgery was doubled to account for the second procedure; all other patients maintained the cost of the initial surgery. Oswestry Disability Index (ODI) was modeled by revision status based on literature findings. Total surgical cost was based on Medicare reimbursement. Chi square and student t tests were utilized to compare cost-effective and non–cost-effective patients. Results The average cost/QALY at 5-year follow-up was $120,311.73. A total of 40.7% of patients fell under the threshold of a cost/QALY <$100,000. Cost-effective patients had higher baseline ODI scores (45% vs 34% [P=0.001]), lower baseline total Scoliosis Research Society scores (2.89 vs 3.00 [P=0.04]), and shorter fusions (8.23 vs 9.87 [P=0.0001]). Conclusion We found 40.7% of patients to be below the threshold of cost effectiveness. Factors associated with reaching the threshold <$100,000/QALY were greater preoperative disability, diagnosis of idiopathic scoliosis, poor preoperative HRQOL scores, and fewer fusion levels. PMID:24688328

  20. Status of medical education reform at Saga Medical School 5 years after introducing PBL.

    PubMed

    Oda, Yasutomo; Koizumi, Shunzo

    2008-03-01

    In Japan, problem-based learning (PBL) is a relatively new method of educating medical students that is reforming the face of medical education throughout the world, including Asia. It shifts from teacher-centered learning strategies (for example, lectures in large auditoriums) to student-centered, self-directed learning methods (for example, active discussions and problem-solving by students in small groups under the guidance of faculty tutors). Upon a recommendation by the Japan Model Core Curriculum, Saga Medical School introduced a PBL curriculum 5 years ago. A full PBL curriculum was adopted from the McMaster model through Hawaii. A description of how PBL was implemented into the 3rd and 4th year (Phase III curriculum) is given. The overall result has been good. Students who experienced PBL had increased scores on the National Medical License Exam, and Saga increased its ranking from 56th to 19th of the 80 medical schools in Japan. A key step was introduction of the educational scaffolding in PBL Step 0. Students were allowed to see page one of the PBL case, containing the chief complaint, on the weekend before meeting in small groups. Despite a perceived overall benefit to student learning, symptoms of superficial discussions by students have been observed recently. How this may be caused by poor case design is discussed. Other problems, including "silent tutors" and increased faculty workload, are discussed. It is concluded that after 5 years, Saga's implementation of a PBL curriculum has been successful. However, many additional issues, including motivation of students and preparation for PBL in the first 2 years, must still be resolved in the future. This is the first description of the positive and negative outcomes associated with the reform of medical education and the introduction of PBL to a traditional medical school curriculum in Japan.

  1. Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study

    PubMed Central

    Geng, Zhi-Yu; Wang, Dong-Xin

    2017-01-01

    Background: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). Methods: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies. PMID:28218212

  2. POSTTRAUMATIC STRESS DISORDER AMONG INDONESIAN CHILDREN 5 YEARS AFTER THE TSUNAMI.

    PubMed

    Irwanto; Faisal; Zulfa, Hendra

    2015-09-01

    Children are at risk for developing posttraumatic stress disorder (PTSD) due to experiencing or living in a disaster area. The factors that increase the likelihood of a child developing PTSD need further clarification. We studied the factors associated with PTSD among children who experienced the tsunami in Sumatra, Indonesia. We conducted a cross sectional study in 2 subdistricts of Sumatra 5 years after experiencing a tsunami. Children aged 7-13 years were enrolled using stratified cluster sampling. A tsunami-modified version of The PsySTART Rapid Triage System was used to question children about their tsunami-specific traumatic experiences. Trauma symptoms were evaluated using the Trauma Symptom Checklist For Children (TSCC). The diagnosis of PTSD was made using the Child PTSD Symptom Scale (CPSS) and DSM-IV criteria. The data were analyzed with chi-square tests and multivariate logistic regression analysis with 95% confidence intervals (CI). A total of 262 children were enrolled in this study. The prevalence of PTSD in these children was 20.6%. On multivariate analysis, having experienced a delay in evacuation (PR = 4.5; 95% CI: 2.794-13.80; p < 0.001) and being unable to escape (PR = 13.07; 95% CI: 5.884-64; p < 0.001) were significantly associated with PTSD 5 years after the tsunami. Children who experienced a traumatic event in which they were unable to escape or when there is a delay in evacuation are at risk of developing PTSD and need appropriate treatment.

  3. Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up

    PubMed Central

    van Bommel, E F H; Elgersma, O E; Hendriksz, T R

    2014-01-01

    Objective: To determine prevalence, clinicoradiological characteristics and outcome of patients with mesenteric panniculitis (MP) in a large hospital-based population. Methods: Consecutive abdominal CT examinations of 3820 patients were evaluated for MP. Clinical characteristics, therapy and outcome of patients with MP were evaluated during a 5-year follow-up period. A matched pair analysis was performed to further investigate the relation between MP and malignancy. Results: 94 (2.5%) patients with MP were identified (mean age, 66.6 ± 11.2 years, 70.2% male). MP coexisted with malignancy (especially prostatic carcinoma) in 48.9% of patients, and this was slightly but significantly higher than in age- and sex-matched control patients (n = 188, 46.3%). In 48 patients, MP was presumed to be idiopathic. The most frequent presenting symptom was pain (54.3%). Laboratory findings revealed increased acute-phase reactants in half of the patients with MP. CT findings included increased density of mesenterial fat (mean, −56.8 ± 10.8 HU), fat ring sign, tumoural pseudocapsule and small soft-tissue nodules. Patients with MP (14.6%) developed significantly more malignancies during a 5-year follow-up than did the control group (6.9%). One patient was treated with prednisone without satisfactory response. Conclusion: The prevalence of MP in this study was 2.5%. In most patients, radiologic features included increased mesenteric fat density, fat ring sign and small soft-tissue nodules. MP was associated with a significant higher prevalence of coexisting malignancies and a higher prevalence of future cancer development. Advances in knowledge: A more accurate prevalence of MP on CT is demonstrated. An underlying malignancy may play a role. PMID:25271412

  4. A 5-year scientometric analysis of research centers affiliated to Tehran University of Medical Sciences

    PubMed Central

    Yazdani, Kamran; Rahimi-Movaghar, Afarin; Nedjat, Saharnaz; Ghalichi, Leila; Khalili, Malahat

    2015-01-01

    Background: Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced. Methods: This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers. Results: The medians of the numbers of papers and books during a 5-year period were 150.5 and 2.5 respectively. The median of the "articles per researcher" was 19.1. Based on multiple linear regression, younger age centers (p=0.001), having a separate budget line (p=0.016), and number of research personnel (p<0.001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0.004). Conclusion: The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers. PMID:26157724

  5. Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

    PubMed Central

    Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H.

    2011-01-01

    Background In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Methods and Findings Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0–100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3–84.5, p<0.0001); provider satisfaction (65.4–79.2, p<0.01); capacity for service provision (47.4–76.4, p<0.0001); quality of services (40.5–67.4, p<0.0001); and overall vision for pro-poor and pro-female health services (52.0–52.6). The financial domain also showed improvement until 2007 (84.4–95.7, p<0.01), after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. Conclusions The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary PMID:21814499

  6. The Use of Bone Graft Substitute in Hand Surgery

    PubMed Central

    Liodaki, Eirini; Kraemer, Robert; Mailaender, Peter; Stang, Felix

    2016-01-01

    Abstract Bone defects are a very common problem in hand surgery, occurring in bone tumor surgery, in complicated fractures, and in wrist surgery. Bone substitutes may be used instead of autologous bone graft to avoid donor site morbidity. In this article, we will review our experience with the use of Cerament bone void filler (Bonesupport, Lund, Sweden) in elective and trauma hand surgery. A prospective clinical study was conducted with 16 patients treated with this bone graft substitute in our department over a period of 3.5 years. Twelve patients (2 female, 10 male; with an average age of 42.42 years) with monostoic enchondroma of the phalanges were treated and 4 patients (1 female, 3 male; with an average age of 55.25 years) with complicated metacarpal fractures with bone defect. Data such as postoperative course with rating of pain, postoperative complications, functional outcome assessment at 1, 2, 3, 6 months, time to complete remodeling were registered. Postoperative redness and swelling after bone graft substitute use was noticed in 7 patients with enchondroma surgery due to the thin soft-tissue envelope of the fingers. Excellent total active motion of the involved digit was noticed in 10 of 12 enchondroma patients and in all 4 fracture patients at 2-month follow-up. In summary, satisfying results are described, making the use of injectable bone graft substitute in the surgical treatment of enchondromas, as well as in trauma hand surgery a good choice. PMID:27310946

  7. Femoral impaction grafting

    PubMed Central

    Scanelli, John A; Brown, Thomas E

    2013-01-01

    Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus is non-supportive. The available level of evidence is primarily derived from case series, which shows a mean survivorship of 90.5%, with revision or re-operation as the end-point, with an average follow-up of 11 years. The rate of femoral fracture requiring re-operation or revision of the component varies between several large case series, ranging from 2.5% to 9%, with an average of 5.4%. PMID:23362469

  8. Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery.

    PubMed

    He, Guo-Wei; Taggart, David P

    2016-03-01

    Spasm of arterial grafts in coronary artery bypass grafting surgery is still a clinical problem, and refractory spasm can occasionally be lethal. Perioperative spasm in bypass grafts and coronary arteries has been reported in 0.43% of all coronary artery bypass grafting surgery, but this may be an underestimate. Spasm can develop not only in the internal mammary artery but more frequently in the right gastroepiploic and radial artery. The mechanism of spasm can involve many pathways, particularly those involving regulation of the intracellular calcium concentration. Endothelial dysfunction also plays a role in spasm. Depending on the clinical scenario, the possibility of spasm during and after coronary artery bypass grafting should be confirmed by angiography. If present, immediate intraluminal injection of vasodilators is often effective, although other procedures such as an intraaortic balloon pump or extracorporeal membrane oxygenation may also become necessary to salvage the patient. Prevention of spasm involves many considerations, and the principles are discussed in this review article.

  9. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap

    PubMed Central

    Francis, Ashish; Baynosa, Richard C.

    2017-01-01

    Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia–reperfusion (IR). Traumatic avulsions and amputated composite tissues—compromised tissue—may fail from crush injury and excessively large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects. Recent Advances: Hyperbaric oxygen (HBO) has demonstrated utility in the salvage of compromised grafts/flaps. It can increase the likelihood and effective size of composite graft survival, improve skin graft outcomes, and enhance flap survival. Mechanisms underlying these beneficial effects include increased oxygenation, improved fibroblast function, neovascularization, and amelioration of IR injury. Critical Issues: Common strategies for the compromised graft or flap include local wound care, surgical debridement, and repeated reconstruction. These modalities are associated with added costs, time, need for reoperation, morbidity, and psychosocial effects. Preservation of the amputated/avulsed tissues minimizes morbidity and maximizes the reconstructive outcome by salvaging the compromised tissue and obviating additional surgery. HBO is often overlooked as a potential tool that can limit these issues. Future Directions: Animal studies demonstrate a benefit of HBO in the treatment of compromised tissues. Clinical studies support these findings, but are limited to case reports and series. Further research is needed to provide multicenter prospective clinical studies and cost analyses comparing HBO to other adjunctive therapies in the treatment of compromised grafts/flaps. PMID:28116225

  10. 38 CFR 8.26 - Renewal of National Service Life Insurance on the 5-year level premium term plan.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Service Life Insurance on the 5-year level premium term plan. 8.26 Section 8.26 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE Renewal of Term Insurance § 8.26 Renewal of National Service Life Insurance on the 5-year level premium term plan. (a)...

  11. 38 CFR 8.26 - Renewal of National Service Life Insurance on the 5-year level premium term plan.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Service Life Insurance on the 5-year level premium term plan. 8.26 Section 8.26 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE Renewal of Term Insurance § 8.26 Renewal of National Service Life Insurance on the 5-year level premium term plan. (a)...

  12. 76 FR 70156 - Proposed 5-Year Outer Continental Shelf (OCS) Oil and Gas Leasing Program for 2012-2017

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-10

    ... Bureau of Ocean Energy Management Proposed 5-Year Outer Continental Shelf (OCS) Oil and Gas Leasing... on the Proposed 5-Year OCS Oil and Gas Leasing Program for 2012-2017 (``Proposed Program''). This is part of a multi-step process required by law before the Secretary of the Interior may approve a new...

  13. 77 FR 26232 - Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for Waivers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... 447 RIN 0938-AO53 Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for... Federal Register entitled ``Medicaid Program; State Plan Home and Community-Based Services, 5- Year Period... read ``July 2, 2012''. (Catalog of Federal Domestic Assistance Program No. 93.778, Medical...

  14. 75 FR 53978 - Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews for Lomatium cookii (Cook's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-02

    ... Fish and Wildlife Service Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews for... Meadowfoam) AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of initiation of reviews; request for information. SUMMARY: We, the U.S. Fish and Wildlife Service, are initiating 5-year reviews for two...

  15. 38 CFR 8.26 - Renewal of National Service Life Insurance on the 5-year level premium term plan.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Effective June 25, 1970, a 5-year level premium term policy which lapsed for nonpayment of the premium due... Service Life Insurance on the 5-year level premium term plan. 8.26 Section 8.26 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE Renewal of Term...

  16. 38 CFR 8.26 - Renewal of National Service Life Insurance on the 5-year level premium term plan.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Effective June 25, 1970, a 5-year level premium term policy which lapsed for nonpayment of the premium due... Service Life Insurance on the 5-year level premium term plan. 8.26 Section 8.26 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE Renewal of Term...

  17. 38 CFR 8.26 - Renewal of National Service Life Insurance on the 5-year level premium term plan.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Effective June 25, 1970, a 5-year level premium term policy which lapsed for nonpayment of the premium due... Service Life Insurance on the 5-year level premium term plan. 8.26 Section 8.26 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE Renewal of Term...

  18. 75 FR 17377 - Endangered and Threatened Species; Initiation of 5-Year Review for Southern Resident Killer Whales

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-06

    ... of 5-Year Review for Southern Resident Killer Whales AGENCY: National Marine Fisheries Service (NMFS... whales (Orcinus orca) under the Endangered Species Act of 1973, as amended (ESA). A 5-year review is a..., we are requesting submission of any such information on Southern Resident killer whales that...

  19. Coverage Root after Removing Peripheral Ossifying Fibroma: 5-Year Follow-Up Case Report

    PubMed Central

    Okajima, Luciana S.; Nunes, Marcelo P.; Montalli, Victor A. M.

    2016-01-01

    When lesions in soft tissue reach the gingival margin, they can produce aesthetic defects during its permanence and after its removal. Periodontal plastic surgery allows the correction of the gingival contour using different techniques. This paper is a case report of a peripheral ossifying fibroma removal in the interproximal area of teeth 21 and 22 in addition to root coverage of the affected area through two surgical phases: keratinized gingival tissue augmentation surgery with free gingival graft concurrent with removal of the lesion and, in a second stage, root coverage by performing coronally advanced flap technique with a follow-up of five years. The initial results achieved, which were root coverage of 100% after 6 months, promoted an adequate gingival contour and prevented the development of a mucogingival defect or a root exposure with its functional and aesthetic consequences. After five years, the results showed long term success of the techniques, where the margin remained stable with complete root coverage and tissues were stable and harmonic in color. PMID:27891263

  20. 38 CFR 8.15 - Provision for paid-up insurance; other than 5-year level premium term or limited convertible 5...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... insurance; other than 5-year level premium term or limited convertible 5-year level premium term policies. 8... than 5-year level premium term or limited convertible 5-year level premium term policies. If a National Service Life Insurance policy on any plan other than 5-year level premium term or limited convertible...

  1. 38 CFR 8.15 - Provision for paid-up insurance; other than 5-year level premium term or limited convertible 5...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... insurance; other than 5-year level premium term or limited convertible 5-year level premium term policies. 8... than 5-year level premium term or limited convertible 5-year level premium term policies. If a National Service Life Insurance policy on any plan other than 5-year level premium term or limited convertible...

  2. 38 CFR 8.15 - Provision for paid-up insurance; other than 5-year level premium term or limited convertible 5...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... insurance; other than 5-year level premium term or limited convertible 5-year level premium term policies. 8... than 5-year level premium term or limited convertible 5-year level premium term policies. If a National Service Life Insurance policy on any plan other than 5-year level premium term or limited convertible...

  3. 38 CFR 8.15 - Provision for paid-up insurance; other than 5-year level premium term or limited convertible 5...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... insurance; other than 5-year level premium term or limited convertible 5-year level premium term policies. 8... than 5-year level premium term or limited convertible 5-year level premium term policies. If a National Service Life Insurance policy on any plan other than 5-year level premium term or limited convertible...

  4. Femoral impaction bone allografting with an Exeter cemented collarless, polished, tapered stem in revision hip replacement: a mean follow-up of 10.5 years.

    PubMed

    Wraighte, P J; Howard, P W

    2008-08-01

    Femoral impaction bone allografting has been developed as a means of restoring bone stock in revision total hip replacement. We report the results of 75 consecutive patients (75 hips) with a mean age of 68 years (35 to 87) who underwent impaction grafting using the Exeter collarless, polished, tapered femoral stem between 1992 and 1998. The mean follow-up period was 10.5 years (6.3 to 14.1). The median pre-operative bone defect score was 3 (interquartile range (IQR) 2 to 3) using the Endo-Klinik classification. The median subsidence at one year post-operatively was 2 mm (IQR 1 to 3). At the final review the median Harris hip score was 80.6 (IQR 67.6 to 88.9) and the median subsidence 2 mm (IQR 1 to 4). Incorporation of the allograft into trabecular bone and secondary remodelling were noted radiologically at the final follow-up in 87% (393 of 452 zones) and 40% (181 of 452 zones), respectively. Subsidence of the Exeter stem correlated with the pre-operative Endo-Klinik bone loss score (p = 0.037). The degree of subsidence at one year had a strong association with long-term subsidence (p < 0.001). There was a significant correlation between previous revision surgery and a poor Harris Hip score (p = 0.028), and those who had undergone previous revision surgery for infection had a higher risk of complications (p = 0.048). Survivorship at 10.5 years with any further femoral operation as the end-point was 92% (95% confidence interval 82 to 97).

  5. Application of Hydrogel in Reconstruction Surgery: Hydrogel/Fat Graft Complex Filler for Volume Reconstruction in Critical Sized Muscle Defects

    PubMed Central

    Ip, W. Y.

    2016-01-01

    Autogenic fat graft usually suffers from degeneration and volume shrinkage in volume reconstruction applications. How to maintain graft viability and graft volume is an essential consideration in reconstruction therapies. In this presented investigation, a new fat graft transplantation method was developed aiming to improve long term graft viability and volume reconstruction effect by incorporation of hydrogel. The harvested fat graft is dissociated into small fragments and incorporated into a collagen based hydrogel to form a hydrogel/fat graft complex for volume reconstruction purpose. In vitro results indicate that the collagen based hydrogel can significantly improve the survivability of cells inside isolated graft. In a 6-month investigation on artificial created defect model, this hydrogel/fat graft complex filler has demonstrated the ability of promoting fat pad formation inside the targeted defect area. The newly generated fat pad can cover the whole defect and restore its original dimension in 6-month time point. Compared to simple fat transplantation, this hydrogel/fat graft complex system provides much improvement on long term volume restoration effect against degeneration and volume shrinkage. One notable effect is that there is continuous proliferation of adipose tissue throughout the 6-month period. In summary, the hydrogel/fat graft system presented in this investigation demonstrated a better and more significant effect on volume reconstruction in large sized volume defect than simple fat transplantation. PMID:27446947

  6. Unrelated donor umbilical cord blood transplantation for inherited metabolic disorders in 159 pediatric patients from a single center: influence of cellular composition of the graft on transplantation outcomes

    PubMed Central

    Mendizabal, Adam; Parikh, Suhag H.; Szabolcs, Paul; Driscoll, Timothy A.; Page, Kristin; Lakshminarayanan, Sonali; Allison, June; Wood, Susan; Semmel, Deborah; Escolar, Maria L.; Martin, Paul L.; Carter, Shelly; Kurtzberg, Joanne

    2008-01-01

    Outcomes of 159 young patients with inherited metabolic disorders (IMDs) undergoing transplantation with partially HLA-mismatched unrelated donor umbilical cord blood were studied to investigate the impact of graft and patient characteristics on engraftment, overall survival (OS), and graft-versus-host disease (GVHD). Patients received myeloablative chemotherapy (busulfan, cyclophosphamide, ATG) and cyclosporine-based GVHD prophylaxis. Infused cell doses were high (7.57 × 107/kg) because of the patients' young age (median, 1.5 years) and small size (median, 12 kg). Median follow-up was 4.2 years (range, 1-11 years). The cumulative incidences of neutrophil and platelet engraftment were 87.1% (95% confidence interval [CI], 81.8%-92.4%) and 71.0% (95% CI, 63.7%-78.3%). A total of 97% achieved high (> 90%) donor chimerism. Serum enzyme normalized in 97% of patients with diseases for which testings exist. Grade III/IV acute GVHD occurred in 10.3% (95% CI, 5.4%-15.2%) of patients. Extensive chronic GVHD occurred in 10.8% (95% CI, 5.7%-15.9%) of patients by 1 year. OS at 1 and 5 years was 71.8% (95% CI, 64.7%-78.9%) and 58.2% (95% CI, 49.7%-66.6%) in all patients and 84.5% (95% CI, 77.0%-92.0%) and 75.7% (95% CI, 66.1%-85.3%) in patients with high (80-100) performance score. In multivariate analysis, favorable factors for OS were high pretransplantation performance status, matched donor/recipient ethnicity, and higher infused colony forming units. PMID:18587012

  7. Polyether/Polyester Graft Copolymers

    NASA Technical Reports Server (NTRS)

    Bell, Vernon L., Jr.; Wakelyn, N.; Stoakley, D. M.; Proctor, K. M.

    1986-01-01

    Higher solvent resistance achieved along with lower melting temperature. New technique provides method of preparing copolymers with polypivalolactone segments grafted onto poly (2,6-dimethyl-phenylene oxide) backbone. Process makes strong materials with improved solvent resistance and crystalline, thermally-reversible crosslinks. Resulting graft copolymers easier to fabricate into useful articles, including thin films, sheets, fibers, foams, laminates, and moldings.

  8. Graft selection in cerebral revascularization.

    PubMed

    Baaj, Ali A; Agazzi, Siviero; van Loveren, Harry

    2009-05-01

    Cerebral revascularization constitutes an important treatment modality in the management of complex aneurysms, carotid occlusion, tumor, and moyamoya disease. Graft selection is a critical step in the planning of revascularization surgery, and depends on an understanding of graft and regional hemodynamics, accessibility, and patency rates. The goal of this review is to highlight some of these properties.

  9. Grafting effects on vegetable quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vegetable grafting began in the 1920s to control soil-borne disease. It is now a common practice in Asia, parts of Europe, and the Middle East. In Japan and Korea most of the cucurbits and tomatoes (Lycopersicon esculentum Mill.) grown are grafted. This practice is rare in the U.S. and there have...

  10. Continuous ACL graft, results

    PubMed Central

    Díaz, Jorge Luis; Vega, Marcelo; Matesevach, Ivan

    2017-01-01

    Objectives: describe our technique using hamstring graft that respects the proximal continuity of Semitendinosus and uses the superior biological potential of the distal periosteum., preserving and stressing the ST reinforce the retropulsión and dynamic control of external rotation of the knee. Here the technique, results, difficulties and foundations. Methods: The sample of this research was composed of 229 cases operated between 01/03/97 and 01/03/13 in Arthroscopy Private Center., 166 male and 63 female, the postop follow-up was 86 months. Evaluated with IKDC, Lysholm, Hamstring EMG. Comparative histology study in rabbits. Results: IKDC and Lysholm score showed 93% of very good results. Conclusion: Dynamic ACL reconstruction achieves a static-dynamic stabilization of the knee. Grafts have a plus in their biological potential (proximal continuity - osteo-periosteal insertion of the tendons in the femoral tunnel). The hamstring maintains its functionality (EMG). 93% satisfactory results (IKDC, Lysholm). It is a valid surgical option in ACL injuries.

  11. Campfire burns of the palms in crawling infants in Saudi Arabia: results following release and graft of contractures.

    PubMed

    Al-Qattan, Mohammad M

    2009-01-01

    In Saudi Arabia, camping in the desert is commonly practiced by families. A campfire is usually lit and unsupervised crawling infants are at risk of burns from these campfires. During a 12-year period, a total of 53 children with hand contractures related to campfire burns were treated. The mean age at the time of burn was 9 months (range: 5-12 months). All patients presented with isolated palmar contractures of one (n=24) or both (n=29) hands. Surgical release and skin grafting were performed for a total of 82 hands. Full-thickness skin grafts from the groin area were used in mild cases, and thick split-thickness skin grafts harvested from the thigh were used in severe contractures. Graft take ranged from 90 to 100% "take" in all patients. Follow-up ranged from 6 months to 10 years. Recurrence of contracture was calculated for 30 children (52 grafted hands) who had follow-up for more than 5 years. Twenty hands (group I) had thick split-thickness skin grafts, and 10 (50%) of these required a second release and grafting procedure. The remaining 32 hands (group II) had full-thickness grafts and only 3 (9.4%) required a second release and grafting procedure. The difference was statistically significant (P=.003), indicating that group I are more likely to require secondary surgery on long-term follow-up.

  12. Urban-rural differences in dental caries of 5-year old children in Scotland.

    PubMed

    Levin, Kate A; Davies, Carolyn A; Douglas, Gail V A; Pitts, Nigel B

    2010-12-01

    Previous research suggests there are significant differences between urban and rural areas in Scotland for health outcomes including heart disease, cancer and self reported health. The aim of this study was to describe the contemporary urban/rural variation in obvious decay experience amongst 5-year-olds in Scotland. Scotland was split into 6 geographies, ranging from 'The 4 Cities' (Glasgow, Edinburgh, Dundee and Aberdeen) to 'Remote Rural' areas. Data derived from the 2007/08 National Dental Inspection Programme, representative of the whole of Scotland, were modelled using Bayesian multilevel zero-inflated Negative Binomial and multilevel Poisson modelling, adjusting for age, sex and deprivation. The outcome variables modelled were d(3)mft (carious, extracted or filled deciduous teeth), d(3)t (carious teeth), mt (missing teeth, extracted due to caries) and ft (filled teeth). The proportion of 5-year old children in Scotland with d(3)mft = 0 was 58% in 2008. Adjusting for age and sex, the odds of a child in a Remote Rural area having d(3)mft>0 was 0.52 that of a city dweller. However, when deprivation was included in the model, the odds of having d(3)mft >0 rose to 0.74. The odds of d(3)mft>0 in 'Accessible Rural' areas also remained significantly lower than in the 4 Cities after adjustment for deprivation. For those with d(3)mft>0, the relative risk of additional d(3)mft was also significantly lower in Remote Rural areas, however this was explained by deprivation, while in Accessible Rural areas this remained significant even after adjustment for deprivation. The odds of having any extractions was lower in Rural areas, even after adjustment for deprivation, while the Care Index (ft/d(3)mft) was higher in Remote Towns. Deprivation, therefore, accounted for much but not all of the geographical difference in d(3)mft which exist in Scotland. Children in Remote and Rural areas appear to have better dental health and a higher proportion of filled teeth when compared

  13. Haemophilus type B meningitis in Saudi children under 5 years old.

    PubMed

    Al-Mazrou, Yagob Y; Al-Jeffri, Mohamed H; Al-Haggar, Sami H; Musa, Elgeili K; Mohamed, Omer M; Abdalla, Mohamed N

    2004-06-01

    This study was designed to determine the magnitude of bacterial meningitis in general and Hib meningitis in particular among children below the age of 5 years. A population-based, prospective descriptive and analytical study was conducted in five regions, one each in northern, southern, eastern, western, and central parts of Saudi Arabia. Active surveillance for cases of bacterial meningitis among the study population, which comprised 171,818 children under 5 years of age, was implemented. A total of 208 cases of meningitis were identified, of which 141 (67.8 per cent) were identified with a definite causative organism. The remaining 67 cases (32 per cent) were labeled as aseptic meningitis. The overall incidence of meningitis was 60.53/10(5) in under-fives with a disease spectrum similar to that reported in studies conducted in other countries. The three leading causes of meningitis were Hib (Haemophilus influenzae type B), MCM (Neisseria menigitides) and SPN (Streptococcus pneumoniae). Hib meningitis constituted 28 per cent of cases with an incidence rate of 16.88/10(5) children. There was a marked regional variation in Hib incidence. MCM was the second leading cause (18 per cent) of meningitis with an incidence of 10.77/10(5) while SPN comprised 11 per cent of cases and its incidence was 9.69/10(5). Almost all MCM cases were related to meningitis outbreaks that occurred in Saudi Arabia during two successive Hajj seasons (2000-2001). Hib cases showed a bimodal seasonality, one peak during March-May, the other during September-November. The fact that this study is the first national base-line data on meningitis in general and Hib incidence in particular, has augmented further justification for introducing Hib vaccine within the national Expanded Program on Immunization (EPI). Based on the experience gained during this study regarding surveillance of meningitis disease, optimal methods to strengthen meningitis surveillance were identified. A model of Meningitis

  14. Extended (5-year) Outcomes of Accelerated Partial Breast Irradiation Using MammoSite Balloon Brachytherapy: Patterns of Failure, Patient Selection, and Dosimetric Correlates for Late Toxicity

    SciTech Connect

    Vargo, John A.; Verma, Vivek; Kim, Hayeon; Kalash, Ronny; Heron, Dwight E.; Johnson, Ronald; Beriwal, Sushil

    2014-02-01

    Purpose: Accelerated partial breast irradiation (APBI) with balloon and catheter-based brachytherapy has gained increasing popularity in recent years and is the subject of ongoing phase III trials. Initial data suggest promising local control and cosmetic results in appropriately selected patients. Long-term data continue to evolve but are limited outside of the context of the American Society of Breast Surgeons Registry Trial. Methods and Materials: A retrospective review of 157 patients completing APBI after breast-conserving surgery and axillary staging via high-dose-rate {sup 192}Ir brachytherapy from June 2002 to December 2007 was made. APBI was delivered with a single-lumen MammoSite balloon-based applicator to a median dose of 34 Gy in 10 fractions over a 5-day period. Tumor coverage and critical organ dosimetry were retrospectively collected on the basis of computed tomography completed for conformance and symmetry. Results: At a median follow-up time of 5.5 years (range, 0-10.0 years), the 5-year and 7-year actuarial incidences of ipsilateral breast control were 98%/98%, of nodal control 99%/98%, and of distant control 99%/99%, respectively. The crude rate of ipsilateral breast recurrence was 2.5% (n=4); of nodal failure, 1.9% (n=3); and of distant failure, 0.6% (n=1). The 5-year and 7-year actuarial overall survival rates were 89%/86%, with breast cancer–specific survival of 100%/99%, respectively. Good to excellent cosmetic outcomes were achieved in 93.4% of patients. Telangiectasia developed in 27% of patients, with 1-year, 3-year, and 5-year actuarial incidence of 7%/24%/33%; skin dose >100% significantly predicted for the development of telangiectasia (50% vs 14%, P<.0001). Conclusions: Long-term single-institution outcomes suggest excellent tumor control, breast cosmesis, and minimal late toxicity. Skin toxicity is a function of skin dose, which may be ameliorated with dosimetric optimization afforded by newer multicatheter brachytherapy

  15. Autologous great saphenous vein tailored graft to replace an infected prosthetic graft in the groin.

    PubMed

    Barbon, Bruno; Militello, Carmelo; De Rossi, Aldo; Martella, Bruno; Ballotta, Enzo

    2007-01-01

    The authors propose a technique using the autologous great saphenous vein to replace an infected prosthetic limb graft at the groin. The whole great saphenous vein is incised longitudinally and divided into 2 approximately equal segments, which are sewn side to side. The longitudinal edges of the resulting great saphenous vein are then joined and anastomosed side to side to form a conduit, whose caliber is twice the original vein's diameter. The authors have used this technique to replace 1 limb of a prosthetic aortofemoral bypass infected at the groin. After 5 years, the new venous conduit is patent, with no recurrent infection, dilation, or aneurysmal degeneration. If validated by further experiences, this might be an attractive alternative to restoring flow through clean tissue planes using extra-anatomic bypass or the femoral vein in the infected fields.

  16. Challenges in machine perfusion preservation for liver grafts from donation after circulatory death

    PubMed Central

    2013-01-01

    Donation after circulatory death (DCD) is a promising solution to the critical shortage of donor graft tissue. Maintaining organ viability after donation until transplantation is essential for optimal graft function and survival. To date, static cold storage is the most widely used form of preservation in clinical practice. However, ischemic damage present in DCD grafts jeopardizes organ viability during cold storage, and whether static cold storage is the most effective method to prevent deterioration of organ quality in the increasing numbers of organs from DCD is unknown. Here we describe the historical background of DCD liver grafts and a new preservation method for experimental and clinical transplantation. To prevent ischemia-reperfusion injury in DCD liver grafts, a hypothermic machine perfusion (HMP) technique has recently been developed and may be superior to static cold preservation. We present evidence supporting the need for improving liver perfusion performance and discuss how doing so will benefit liver transplantation recipients. PMID:24283383

  17. Graft-infiltrating host dendritic cells play a key role in organ transplant rejection

    PubMed Central

    Zhuang, Quan; Liu, Quan; Divito, Sherrie J.; Zeng, Qiang; Yatim, Karim M.; Hughes, Andrew D.; Rojas-Canales, Darling M.; Nakao, A.; Shufesky, William J.; Williams, Amanda L.; Humar, Rishab; Hoffman, Rosemary A.; Shlomchik, Warren D.; Oberbarnscheidt, Martin H.; Lakkis, Fadi G.; Morelli, Adrian E.

    2016-01-01

    Successful engraftment of organ transplants has traditionally relied on preventing the activation of recipient (host) T cells. Once T-cell activation has occurred, however, stalling the rejection process becomes increasingly difficult, leading to graft failure. Here we demonstrate that graft-infiltrating, recipient (host) dendritic cells (DCs) play a key role in driving the rejection of transplanted organs by activated (effector) T cells. We show that donor DCs that accompany heart or kidney grafts are rapidly replaced by recipient DCs. The DCs originate from non-classical monocytes and form stable, cognate interactions with effector T cells in the graft. Eliminating recipient DCs reduces the proliferation and survival of graft-infiltrating T cells and abrogates ongoing rejection or rejection mediated by transferred effector T cells. Therefore, host DCs that infiltrate transplanted organs sustain the alloimmune response after T-cell activation has already occurred. Targeting these cells provides a means for preventing or treating rejection. PMID:27554168

  18. Clinical evaluation of 262 osseointegrated implants placed in sites grafted with calcium phosphosilicate putty: a retrospective study.

    PubMed

    Babbush, Charles A; Kanawati, Ali

    2015-02-01

    Along with the widespread use of dental implants, regenerative procedures have become an indispensable tool for implant surgeons in managing residual ridges and the surrounding bone. Putty bone grafts have significantly superior handling characteristics in comparison to particulates. These include ease of placement, enhanced particle containment, and a viscous consistency that has allowed for unique delivery systems to be developed. The aim of this study was to report the clinical efficacy of calcium phosphosilicate (CPS) putty in a wide variety of indications related to implant reconstruction and to report the survival rate of implants placed in these grafted sites. The CPS putty was used as the graft material of choice. Treatments were categorized into following groups: extraction graft, extraction with immediate implant placement, all-on-four concept, peri-implantitis treatment, bone augmentation before implant placement, implant replacement graft, and grafting around implant placed in resorbed ridges. Included in the analysis were 65 patients (36 men, 29 women) with a mean age of 63 ± 12 years. In total, 262 implants were placed. Four implants were diagnosed with peri-implantitis and were treated as described in category 4, for a total of 266 grafted sites. Two implants from the extraction graft category and 3 implants from the all-on-four group were lost and replaced with successfully osseointegrated implants during a mean study follow-up period of 12.24 ± 2.32 months. The implant success rate at 1 year was 98.1% (257/262). Based on results of this large-scale, retrospective study we conclude that (1) the use of putty bone grafts can simplify bone-grafting procedures and reduce intraoperative time in various grafting indications, (2) this study verified the efficacy of a CPS putty bone graft biomaterial in a large array of implant-related surgical indications, and (3) implants placed in sites grafted with CPS putty yield very high survival rates.

  19. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection.

  20. Pre-Transplant Depression Is Associated with Length of Hospitalization, Discharge Disposition, and Survival after Liver Transplantation

    PubMed Central

    Rogal, Shari S.; Mankaney, Gautham; Udawatta, Viyan; Chinman, Matthew; Good, Chester B.; Zickmund, Susan; Bielefeldt, Klaus; Chidi, Alexis; Jonassaint, Naudia; Jazwinski, Alison; Shaikh, Obaid; Hughes, Christopher; Fontes, Paulo; Humar, Abhinav; DiMartini, Andrea

    2016-01-01

    Depression after liver transplantation has been associated with decreased survival, but the effects of pre-transplant depression on early and late post-transplant outcomes remain incompletely evaluated. We assessed all patients who had undergone single-organ liver transplantation at a single center over the prior 10 years. A diagnosis of pre-transplant depression, covariates, and the outcomes of interest were extracted from the electronic medical record. Potential covariates included demographics, etiology and severity of liver disease, comorbidities, donor age, graft type, immunosuppression, and ischemic times. In multivariable models adjusting for these factors, we evaluated the effect of pre-transplant depression on transplant length of stay (LOS), discharge disposition (home vs. facility) and long-term survival. Among 1115 transplant recipients with a median follow-up time of 5 years, the average age was 56±11 and MELD was 12±9. Nineteen percent of the study population had a history of pre-transplant depression. Pre-transplant depression was associated with longer LOS (median = 19 vs. 14 days, IRR = 1.25, CI = 1.13,1.39), discharge to a facility (36% vs. 25%, OR 1.70,CI = 1.18,2.45), and decreased survival (HR = 1.54,CI = 1.14,2.08) in this cohort, accounting for other potential confounders. In conclusion, pre-transplant depression was significantly associated with longer transplant length of stay, discharge to a facility, and mortality in this cohort. PMID:27820828

  1. Radiation grafting on natural films

    NASA Astrophysics Data System (ADS)

    Lacroix, M.; Khan, R.; Senna, M.; Sharmin, N.; Salmieri, S.; Safrany, A.

    2014-01-01

    Different methods of polymer grafting using gamma irradiation are reported in the present study for the preparation of newly functionalized biodegradable films, and some important properties related to their mechanical and barrier properties are described. Biodegradable films composed of zein and poly(vinyl alcohol) (PVA) were gamma-irradiated in presence of different ratios of acrylic acid (AAc) monomer for compatibilization purpose. Resulting grafted films (zein/PVA-g-AAc) had their puncture strength (PS=37-40 N mm-1) and puncture deformation (PD=6.5-9.8 mm) improved for 30% and 50% PVA in blend, with 5% AAc under 20 kGy. Methylcellulose (MC)-based films were irradiated in the presence of 2-hydroxyethyl methacrylate (HEMA) or silane, in order to determine the effect of monomer grafting on the mechanical properties of films. It was found that grafted films (MC-g-HEMA and MC-g-silane) using 35% monomer performed higher mechanical properties with PS values of 282-296 N mm-1 and PD of 5.0-5.5 mm under 10 kGy. Compatibilized polycaprolactone (PCL)/chitosan composites were developed via grafting silane in chitosan films. Resulting trilayer grafted composite film (PCL/chitosan-g-silane/PCL) presented superior tensile strength (TS=22 MPa) via possible improvement of interfacial adhesion (PCL/chitosan) when using 25% silane under 10 kGy. Finally, MC-based films containing crystalline nanocellulose (CNC) as a filling agent were prepared and irradiated in presence of trimethylolpropane trimethacrylate (TMPTMA) as a grafted plasticizer. Grafted films (MC-g-TMPTMA) presented superior mechanical properties with a TS of 47.9 MPa and a tensile modulus (TM) of 1792 MPa, possibly due to high yield formation of radicals to promote TMPTMA grafting during irradiation. The addition of CNC led to an additional improvement of the barrier properties, with a significant 25% reduction of water vapor permeability (WVP) of grafted films.

  2. Procedural Metacognition and False Belief Understanding in 3- to 5-Year-Old Children

    PubMed Central

    Bernard, Stéphane; Proust, Joëlle; Clément, Fabrice

    2015-01-01

    Some studies, so far limited in number, suggest the existence of procedural metacognition in young children, that is, the practical capacity to monitor and control one’s own cognitive activity in a given task. The link between procedural metacognition and false belief understanding is currently under theoretical discussion. If data with primates seem to indicate that procedural metacognition and false belief understanding are not related, no study in developmental psychology has investigated this relation in young children. The present paper aims, first, to supplement the findings concerning young children’s abilities to monitor and control their uncertainty (procedural metacognition) and, second, to explore the relation between procedural metacognition and false belief understanding. To examine this, 82 3- to 5-year-old children were presented with an opt-out task and with 3 false belief tasks. Results show that children can rely on procedural metacognition to evaluate their perceptual access to information, and that success in false belief tasks does not seem related to success in the task we used to evaluate procedural metacognition. These results are coherent with a procedural view of metacognition, and are discussed in the light of recent data from primatology and developmental psychology. PMID:26517260

  3. Bachelor of Midwifery: reflections on the first 5 years from two Victorian universities.

    PubMed

    McKenna, Lisa; Rolls, Colleen

    2007-06-01

    Bachelor of Midwifery programs in the state of Victoria, Australia commenced in 2002 through an affiliation of three universities in Melbourne named the 'Werna Naloo Bachelor of Midwifery consortium'. The approach allowed for collaborative synergies in program delivery through offering online 'consortium' units each semester in addition to on-campus content at each university. It is now 5 years since the first cohort of students commenced the course. During those years, members of the consortium have experienced a range of challenges and tensions. This paper provides a reflection by the course coordinators from two remaining members of the consortium, Australian Catholic University and Monash University. It explores issues confronted, regulation and registration, educational and clinical practice issues. In addition, the authors discuss course outcomes in terms of employment of graduates and their integration into the workforce, career development pathways and demand for the course. The authors conclude that the consortium has been successful and course outcomes positive with graduates successful in securing employment. Overall, the future for the Bachelor of Midwifery at both universities appears positive.

  4. Unilateral vocal fold immobility: a tertiary hospital's experience over 5 years.

    PubMed

    Prasad, Vyas M N; Fakhoury, Raja; Helou, Diane; Lawson, Georges; Remacle, Marc

    2017-03-17

    The objective of the study was to determine the etiology and subsequent management of patients with unilateral vocal fold immobility (UVFI) and compare our results with other such studies. This was a retrospective case series of all patients that were treated for UVFI at one single tertiary referral centre between 2010 and 2014. The medical records of 161 patients over a 5-year period diagnosed with UVFI were analyzed. We looked at the patient demographics, side of immobility, etiology, management and voice assessment. A total of 21 patients were excluded due to varying reasons including second presentation and incomplete data. Our results demonstrated 37.1% of cases to be due to non-thyroid surgery (mainly vascular or anterior cervical spine surgery) compared to thyroid or parathyroid (18.6%). Carotid endarterectomy was the commonest cause followed by cervical spine discectomy or fusion. Other iatrogenic causes included thoracic surgery either involving the lung or not. Our results are very much in keeping with those seen by our colleagues in North America. A better appreciation of the causes of UVFI especially in cases not performed by otolaryngologists and head and neck surgeons should be highlighted and the necessary steps should be taken to prevent this iatrogenic complication.

  5. Conflict resolution in 5-year-old boys: does postconflict affiliative behaviour have a reconciliatory role?

    PubMed

    Ljungberg; Westlund; Lindqvist Forsberg AJ

    1999-11-01

    In nonhuman primates, affiliative behaviours, such as social grooming and various forms of body contact, become more frequent after an aggressive interaction. Since such behaviours lead to a decrease in postconflict aggressive behaviour and displacement activities and to increased social tolerance, they have been labelled reconciliatory. We videofilmed sessions of free play in daycare centres in Stockholm and investigated whether affiliative behaviours used by 5-year-old boys in the postconflict period had a similar reconciliatory function. For 219 conflicts in 21 h 40 min of observation we recorded postconflict affiliative/prosocial, aggressive and displacement behaviours. When affiliative behaviours were shown and accepted by the opponent, aggressive and displacement behaviours decreased and play was promoted. These behaviours thus serve a function similar to reconciliatory behaviour in nonhuman primates and we think it is applicable to call accepted affiliative behaviours in postconflict periods of preschool children reconciliatory. However, conflicts were often polyadic and nonconflict periods consisted of intense play with a rich exchange of affiliative behaviours. These factors were limitations to the postconflict/matched-control method traditionally used in primatological research to document reconciliatory behaviour. We suggest that for preschool children, video recordings and an analysis and description of postconflict affiliative, aggressive and displacement behaviours can be used instead. Copyright 1999 The Association for the Study of Animal Behaviour.

  6. Microdeletion 19p13.2 in an almost 5-year-old boy.

    PubMed

    Haberlandt, Edda; Spreiz, Ana; Sigl, Sara Baumgartner; Janetschek, Carolin; Röthlisberger, Benno; Zotter, Sibylle; Rostasy, Kevin; Zschocke, Johannes; Kotzot, Dieter

    2012-05-01

    Deletions of the short arm of chromosome 19 are rarely found by conventional cytogenetic techniques. This region has a high gene density and this is likely the reason why deletions in this region are associated with a severe phenotype. Since the implementation of modern high-resolution SNP- and CGH-array techniques more cases have been reported. Here, we present an almost 5-year-old boy with intellectual disability, minor dysmorphisms, febrile seizures, and a de novo deletion of 834.2 kb on 19p13.2 encompassing 32 genes. The deletion was found by the Illumina Infinium HD Human1M-Duo v1 BeadChip SNP-array and confirmed by the NimbleGen Human CGH 2.1M Whole Genome Tiling v2.0D oligonucleotide array. PCR amplification of the junction fragment and subsequent sequencing defined the breakpoints and indicated that formation was mediated by non-allelic homologous recombination (NAHR). The phenotype of our patient shows that microrearrangements even at gene-dense chromosomes may result in mild clinical consequences.

  7. Residual strength of repaired graphite/epoxy laminates after 5 years of outdoor exposure

    NASA Technical Reports Server (NTRS)

    Deaton, Jerry W.

    1990-01-01

    The NASA Langley Research Center has sponsored research to develop generic repair techniques and processes for advanced graphite/epoxy (Gr/Ep) composites applicable to secondary structures for commercial transport aircraft. The long-term durability of such repairs is being addressed in a 10-year outdoor exposure program at the Langley Research Center. Details of the program and results of residual strength tests after 5 years of outdoor exposure are presented. Four repair methods are being evaluated. These include: (1) externally bolted aluminum-plus adhesive; (2) precured, bonded external Gr/Ep; (3) cure-in-place external Gr/Ep; and (4) cure-in-place flush Gr/Ep. Repaired specimens as well as undamaged and damaged unrepaired controls are being exposed outdoors for 1, 3, 5, 7, and 10 years. The residual tensile strength of stressed, unstressed, and fatigue specimens from each group is reported and compared with the tensile strength of baseline specimens which received no outdoor exposure. Identification of the commercial products and companies is used to describe adequately the test materials. The identification of these commercial products does not constitute endorsement, expressed or implied, of such products by the National Aeronautics and Space Administration.

  8. Associations between teacher emotional support and depressive symptoms in Australian adolescents: a 5-year longitudinal study.

    PubMed

    Pössel, Patrick; Rudasill, Kathleen Moritz; Sawyer, Michael G; Spence, Susan H; Bjerg, Annie C

    2013-11-01

    Approximately 1/5 of adolescents develop depressive symptoms. Given that youths spend a good deal of their lives at school, it seems plausible that supportive relationships with teachers could benefit their emotional well-being. Thus, the purpose of this study is to examine the association between emotionally supportive teacher relationships and depression in adolescence. The so-called principle-effect and stress-buffer models could explain relationships between teacher emotional support and depressive symptoms, yet no study has used both models to test bidirectional relationships between teacher support and depressive symptoms in students separately by sex. Four-thousand three-hundred forty-one students (boys: n = 2,063; girls: n = 2,278) from Grades 8 to 12 completed the Center for Epidemiological Studies Depression Scale (CES-D), List of Threatening Experiences Questionnaire (LTEQ), and an instrument developed for the study to measure teacher support annually for 5 years. Results support neither of the 2 proposed models. Instead, they indicate that in the 1st years of high school, students of both sexes with average and high numbers of stressful events benefit from teacher support, while teacher support might have iatrogenic effects on students experiencing low numbers of stressful events. Possible explanations for the findings and future research are discussed.

  9. [Auto-injection with epinephrine in the finger of a 5-year-old child].

    PubMed

    Janssen, R L H; Roeleveld-Versteegh, A B C; Wessels-Basten, S J W; Hendriks, T

    2008-04-26

    A 5-year-old boy with food allergies complicated by anaphylactic reactions with dyspnoea and angioedema had been prescribed an autoinjector with epinephrine (0.15 mg) so that his parents could treat him at home if necessary. The patient accidentally injected himself in a finger, which likely makes him the youngest patient to receive an epinephrine auto-injection reported to date. Treatment consisted of phentolamine (0.15 mg in 0.5 ml normal saline) injected subcutaneously at the site of accidental injection; the dose and volume were not adapted according to the age and body weight of the patient as only a local effect was intended. Finger circulation was restored within 20 minutes. Headache, nausea and vomiting were observed after 30 minutes and were most likely a systemic side effect of phentolamine. No other complications occurred. The patient recovered fully and was discharged the following morning. Intramuscular epinephrine autoinjection is standard therapy for severe anaphylactic reactions. The epinephrine autoinjector was introduced in 1980. As allergy and anaphylaxis become more common, increasing numbers of autoinjectors are prescribed, and it is likely that the number of accidental digital autoinjections will also increase. These digits are then at risk of ischaemic necrosis. There is no consensus on therapeutic strategies in such cases. Phentolamine administration appears to be an effective intervention. However, several recent studies have shown that epinephrine may be used safely in hand surgery, which suggests that accidental digital epinephrine autoinjection may not always require immediate treatment.

  10. The South American Land Data Assimilation System (SALDAS) 5-Year Retrospective Atmospheric Forcing Datasets

    NASA Technical Reports Server (NTRS)

    deGoncalves, Luis Gustavo G.; Shuttleworth, William J.; Vila, Daniel; Larroza, Elaine; Bottino, Marcus J.; Herdies, Dirceu L.; Aravequia, Jose A.; De Mattos, Joao G. Z.; Toll, David L.; Rodell, Matthew; Houser, Paul

    2008-01-01

    The definition and derivation of a 5-year, 0.125deg, 3-hourly atmospheric forcing dataset for the South America continent is described which is appropriate for use in a Land Data Assimilation System and which, because of the limited surface observational networks available in this region, uses remotely sensed data merged with surface observations as the basis for the precipitation and downward shortwave radiation fields. The quality of this data set is evaluated against available surface observations. There are regional difference in the biases for all variables in the dataset, with biases in precipitation of the order 0-1 mm/day and RMSE of 5-15 mm/day, biases in surface solar radiation of the order 10 W/sq m and RMSE of 20 W/sq m, positive biases in temperature typically between 0 and 4 K, depending on region, and positive biases in specific humidity around 2-3 g/Kg in tropical regions and negative biases around 1-2 g/Kg further south.

  11. The pragmatics of clinical hypermedia: experiences from 5 years of participatory design in the MEDEA project.

    PubMed

    Timpka, T; Sjöberg, C; Svensson, B

    1995-02-01

    To explore a medical hypermedia design process where requirements engineering and participatory design are used in a naturalistic setting, 5 years of participatory action research (PAR) have been performed in the development of a hypermedia system to be used in primary care practice. In PAR, the participating organizations cooperate with the researchers in deciding and later evaluating organizational actions, and the results are concluded cooperatively. A new type of system emerged from the study, in that the resulting design has its focus on the management of large volumes of hypermedia material, the traceability of authority in the documents, and teamwork support. Regarding the participatory design process, it was found to be essential to deal with social and organizational issues in the design group and its surroundings--and not to cover these over. For instance, an agreement was reached with the managers responsible for health care in the county where the design process took place, whereby the design activity was also given priority at the highest local administrative level. Since health care is a practice organization, there is a potential market for similar systems if only ways of organizing design and marketing the products of participatory design are further developed. Modified versions of structured product specification methods could be a valuable complement. The conclusion of the study is that the development and spread of hypermedia systems in health care may require considerable changes in current design routines and organizations.

  12. Characterization of corrosion products from atmospheric exposures for up to 5 years

    SciTech Connect

    Hernandez, L.S.; Miranda, J.M.; Narvaez, L.; Garcia, G.

    1998-12-31

    Four metallic materials of economic significance were exposed to an urban atmosphere up to five years. These materials were low carbon steel, zinc (as galvanized steel), copper and aluminum all of commercial quality. The corrosion rate was measured after 1, 2, 3 and 5 years using a weight loss method. Sulfur dioxide deposition rate and climatological parameters were determined monthly. At the same time, different techniques were used to characterize the corrosion products developed on the above materials. Results obtained by polarization resistance technique (Rp) in a 0.1 M Na{sub 2}SO{sub 4} solution revealed that, the longer the exposure time, the greater the corrosion products protection, as result of broadening and compactness of such products, this was verified by scanning electron microscopy (SEM). Through x-rays diffraction (XRD), the expected crystalline compounds on steel and copper were identified and also, the transformation of middling protective initial products into other more protective was followed. For aluminum and zinc it was not possible to identify the crystalline compounds perhaps due to the very thin corrosion products layers. So, these materials were analyzed by means of Raman spectroscopy. a-Al{sub 2}O, was identified on an aluminum sample whereas on zinc any corrosion product could not be identified due to excessive fluorescence.

  13. English Premiership Academy knee injuries: lessons from a 5 year study.

    PubMed

    Moore, Oliver; Cloke, David J; Avery, Peter J; Beasley, Ian; Deehan, David J

    2011-11-01

    This study addresses the epidemiology of knee injuries in adolescent males. Data were collected prospectively from 41 Premiership soccer academies over a 5 year period from July 2000 to June 2005. A total of 12,306 player seasons were registered in the U9 to the U16 age categories with a total of 1750 recordable injuries specific to the knee joint. There was a mean incidence of 0.71 (95% confidence interval ± 0.05) knee injuries per player per year, and a median of 17 (inter-quartile range 9-38) training days and 2 (inter-quartile range 1-4) matches missed per knee injury. Knee injuries were found to be most common in the 14-16 year age group. Six hundred and nine (35% of total) injuries were classed as severe resulting in more than 28 days' absence. Injuries were more likely to be sustained in a competitive or match-play environment (862 or 52%) than in training (796 or 48%), and a non-contact mechanism was implicated in 823 (55%) of recorded cases. Peaks in injury numbers were seen in early season and subsequent to the winter break. Sprain was the most common diagnosis recorded, with the medial collateral ligament affected in 23% of all knee injuries. Knee injuries are common in elite youth footballers. In this uninsured age group, it could be argued that earlier medical intervention may reduce long-term damage to the immature skeleton.

  14. DASCH ON KU Cyg: A {approx} 5 YEAR DUST ACCRETION EVENT IN {approx} 1900

    SciTech Connect

    Tang Sumin; Grindlay, Jonathan; Los, Edward; Servillat, Mathieu

    2011-09-01

    KU Cyg is an eclipsing binary consisting of an F-type star accreting through a large accretion disk from a K5III red giant. Here we present the discovery of a 5 year dip around 1900 found from its 100 year DASCH light curve. It showed a {approx}0.5 mag slow fading from 1899 to 1903 and brightened back around 1904 on a relatively shorter timescale. The light curve shape of the 1899-1904 fading-brightening event differs from the dust production and dispersion process observed in R Coronae Borealis stars, which usually has a faster fading and slower recovery, and for KU Cyg is probably related to the accretion disk surrounding the F star. The slow fading in KU Cyg is probably caused by increases in dust extinction in the disk, and the subsequent quick brightening may be due to the evaporation of dust transported inward through the disk. The extinction excess which caused the fading may arise from increased mass transfer rate in the system or from dust clump ejections from the K giant.

  15. Reappearance of Bitot's spots after complete resolution in children between 1 and 5 years of age.

    PubMed

    Kapil, Umesh; Bhadoria, Ajeet Singh; Sareen, Neha

    2015-04-01

    There is limited data on proportion of Bitot's spots (BS), which could reappear after receiving mega dose of Vitamin A (MDVA), and their complete resolution. A prospective, community-based, cohort study with 12 months follow-up was conducted among children (1-5 years) with BS at a district from North India. On diagnosis, 200,000 IU of vitamin A was administered on the same day, then after 4 weeks and subsequently after 6 months. Out of 262 children with BS, 157 (59.9%, 95% CI: 54.1-65.9) children had shown resolution of BS after the MDVA supplementation. Out of 157 children, 97 (61.8%, 95% CI: 54.2-69.4) had reappearance of BS after complete resolution. Kaplan-Meir analysis found that median duration of reappearance of BS was 5 months (95% CI: 3.8-6.2) after their complete resolution. The reappearance of BS after administration of two MDVA within 12 months suggests that children with possibly adequate serum retinol level status may have reappearance of BS.

  16. Femoral head epiphysis growth and development among Chinese children aged 0-5 years.

    PubMed

    Luo, Jiayou; Tang, Jin; Zhou, Libo; Zeng, Rong; Mou, Jinsong; Zhang, Lingli

    2009-05-01

    The aim of this study was to examine the pattern of femoral head epiphysis growth and development among Chinese children. Between January and December, 2007, we randomly sampled 1,450 healthy Chinese children (0-5 years old) from Hunan Provincial Children's Hospital in Changsha, Hunan, China. The diameter of femoral head epiphysis was measured by pelvic X-ray photography and processed by medical image processing software. The growth of femoral head epiphysis in girls was 2-3 months earlier than that in boys. The diameter of femoral head epiphysis increased with advancing age in both girls and boys, but the diameter of femoral head epiphysis in 2, 3, 4, 6, and 10-month-old girls was significantly larger than that in boys. Cubic regression equations between the diameter of femoral head epiphysis and age were created for boys and girls that could be used to predict the diameter of femoral head epiphysis. In conclusion, there was gender difference in femoral head epiphysis growth and development among Chinese children, and our prediction models will provide the guidance for early diagnosis of diseases related to the growth and development of the femoral head epiphysis.

  17. Health benefits of the Mediterranean Diet: an update of research over the last 5 years.

    PubMed

    Gotsis, Efthymios; Anagnostis, Panagiotis; Mariolis, Anargyros; Vlachou, Athanasia; Katsiki, Niki; Karagiannis, Asterios

    2015-04-01

    The Mediterranean Diet (MedDiet) has been reported to be protective against the occurrence of several diseases. Increasing evidence suggests that the MedDiet could counter diseases associated with chronic inflammation, including metabolic syndrome, atherosclerosis, cancer, diabetes, obesity, pulmonary diseases, and cognition disorders. Adoption of a MedDiet was associated with beneficial effects on the secretion of anti-inflammatory cytokines, antioxidant cellular and circulating biomarkers as well as with regulation of gene polymorphisms involved in the atherosclerotic process. The MedDiet has been considered for the prevention of cardiovascular and other chronic degenerative diseases focusing on the impact of a holistic dietary approach rather than on single nutrients. Epidemiological dietary scores measuring adherence to a MedDiet have been developed. This narrative review considers the results of up-to-date clinical studies (with a focus on the last 5 years) that evaluated the effectiveness of the MedDiet in reducing the prevalence of chronic and degenerative diseases.

  18. Diarrhea Prevalence, Care, and Risk Factors among Poor Children Under 5 Years of Age in Mesoamerica

    PubMed Central

    Colombara, Danny V.; Hernández, Bernardo; McNellan, Claire R.; Desai, Sima S.; Gagnier, Marielle C.; Haakenstad, Annie; Johanns, Casey; Palmisano, Erin B.; Ríos-Zertuche, Diego; Schaefer, Alexandra; Zúñiga-Brenes, Paola; Zyznieuski, Nicholas; Iriarte, Emma; Mokdad, Ali H.

    2016-01-01

    Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011–2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ2 tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0–5 months, those 6–23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines. PMID:26787152

  19. Diarrhea Prevalence, Care, and Risk Factors Among Poor Children Under 5 Years of Age in Mesoamerica.

    PubMed

    Colombara, Danny V; Hernández, Bernardo; McNellan, Claire R; Desai, Sima S; Gagnier, Marielle C; Haakenstad, Annie; Johanns, Casey; Palmisano, Erin B; Ríos-Zertuche, Diego; Schaefer, Alexandra; Zúñiga-Brenes, Paola; Zyznieuski, Nicholas; Iriarte, Emma; Mokdad, Ali H

    2016-03-01

    Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011-2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ(2) tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0-5 months, those 6-23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.

  20. Effect of Giardia infection on growth and psychomotor development of children aged 0-5 years.

    PubMed

    Simsek, Z; Zeyrek, F Yildiz; Kurcer, M A

    2004-04-01

    Giardiasis, an intestinal protozoan infection caused by Giardia intestinalis, is common in southeastern Anatolia, Turkey. In this cross-sectional survey, to investigate the role of giardiasis on growth and psychomotor development, we studied 160 children aged 0-5 years. Data were collected using a structured questionnaire, anthropometry, Ankara Developmental Screening Inventory, and laboratory analysis of fecal samples. The results showed that 50 per cent of the subjects were infected with at least one pathogen of intestinal parasitic infections. Giardia intestinalis was the most frequent pathogenic parasite. Giardia-infected children had a risk for stunted (OR = 7.67, 95 per cent CI = 2.25-26.16; p = 0.001) and poor psychomotor development (OR = 2.68, 95 per cent CI = 1.09-6.58; p = 0.030). The data indicate that Giardia intestinalis infection has an adverse impact on child linear growth and psychomotor development. In the primary healthcare centers, during the programme of the monitoring growth and developmental status of children, following children in terms of Giardia, diagnosis and treatment will have a positive effect on child health.

  1. Friability and aggregate stability of loamy soil after 5 years of biochar application

    NASA Astrophysics Data System (ADS)

    Utomo, Wani; Ganika, Shaory; Wisnubroto, Erwin; Islami, Titiek

    2016-04-01

    The effect of biochar application on soil friability and aggregate stability of loamy soil was studied at Brawijaya University field experimental station, Jatikerto, Malang, Indonesia. The soil has been planted with cassava for 4 years continuously and 1 year planted with maiz. The biochar applied was made from cassava stem and farm yard manure. It was found that biochar application, either made from cassava stem or farm yard manure improved soil qualities. Soil applied with biochar was more friable compared to that of the no biochar soil, although biochar application did not influence Atterberg limits. It seems that the higher friability of biochar applied soil was associated with the higher soil organic matter. It was found that until 5 years application, the biochar treated soil had a higher soil organic matter content. Soil applied with biochar possessed a better soil aggregate stability, both dry and wet stability. This was shown by the higher aggregate mean weight diameter (MWD) of biochar applied soil. The cassava biochar applied soil had MWD of 2.22 mm (dry stability) and 1.56 mm (wet stability), whereas the control soil had MWD of 1.45 mm (dry stability) and 1.25 (wet stability). There was a significant positive correlation between soil friability and dry aggregate stability. The biochar applied soils also had higher soil permeability. Key words: soil qualities, soil physical properties, Atterberg limits, hydraulic conductivity

  2. Histology of a Marfan aorta 4.5 years after personalized external aortic root support.

    PubMed

    Pepper, John; Goddard, Martin; Mohiaddin, Raad; Treasure, Tom

    2015-09-01

    In 2008, a 26-year old man had personalized external aortic root support (PEARS) with a macroporous mesh. He was the 16th of 46 patients to have this operation. He had a typical Marfan habitus. His mother died of this disease as did his brother, with an aortic dissection. The patient himself died suddenly 4.5 years after his PEARS operation. At autopsy, there was no blood in the pericardium. The coronary orifices and proximal arteries were normal. His bicuspid aortic valve was minimally regurgitant as it was prior to operation and remained throughout follow-up. Macroscopically the implanted mesh was embedded in the adventitia and not separable from the aortic wall. Microscopically it was fully incorporated with collagen fibres as has been seen in our animal studies. The unsupported aortic arch showed some focal fragmentation of elastic fibres and a mild increase in mucopolysaccharides consistent with Marfan syndrome. These appearances were not present in the supported aortic root, which had the histological appearance of a normal aorta. He was the first patient to die with an implant. The histological appearances suggest the possibility that the incorporated support of the aortic root allowed recovery of the microstructure of the media.

  3. Temporally selective attention supports speech processing in 3- to 5-year-old children.

    PubMed

    Astheimer, Lori B; Sanders, Lisa D

    2012-01-01

    Recent event-related potential (ERP) evidence demonstrates that adults employ temporally selective attention to preferentially process the initial portions of words in continuous speech. Doing so is an effective listening strategy since word-initial segments are highly informative. Although the development of this process remains unexplored, directing attention to word onsets may be important for speech processing in young children who would otherwise be overwhelmed by the rapidly changing acoustic signals that constitute speech. We examined the use of temporally selective attention in 3- to 5-year-old children listening to stories by comparing ERPs elicited by attention probes presented at four acoustically matched times relative to word onsets: concurrently with a word onset, 100 ms before, 100 ms after, and at random control times. By 80 ms, probes presented at and after word onsets elicited a larger negativity than probes presented before word onsets or at control times. The latency and distribution of this effect is similar to temporally and spatially selective attention effects measured in adults and, despite differences in polarity, spatially selective attention effects measured in children. These results indicate that, like adults, preschool aged children modulate temporally selective attention to preferentially process the initial portions of words in continuous speech.

  4. Interventions to Increase Physical Activity in Children Aged 2-5 Years: A Systematic Review.

    PubMed

    Ling, Jiying; Robbins, Lorraine B; Wen, Fujun; Peng, Wei

    2015-08-01

    Comprehensive evaluation of prior interventions designed to increase preschoolers' physical activity is lacking. This systematic review aimed to examine the effect of interventions on objectively measured physical activity in children aged 2-5 years. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In May 2014, we searched PubMed, CINAHL, PsycINFO, ERIC, SPORTDiscus, Cochrane, and Embase. Two reviewers independently identified and appraised the studies. Twenty-four articles describing 23 independent studies and 20 unique interventions met inclusion criteria. Of the 8 interventions resulting in a significant effect in objectively measured physical activity, all were center-based and included a structured physical activity component, 6 included multiple components, 5 integrated theories or models, and 4 actively involved parents. Seven of the 8 were randomized controlled trials. Due to the heterogeneity of the study designs, physical activity measures, and interventions, drawing definitive conclusions was difficult. Although the overall intervention effect was less than optimal, the review indicated that theory-driven, multicomponent interventions including a structured physical activity component and targeting both parents and their children may be a promising approach for increasing preschoolers' physical activity and warrant continued investigation using rigorous designs to identify those that are most effective.

  5. [Dental decay in 5-year-old children: sociodemographic factors, monitoring points and parental attitudes].

    PubMed

    Nunes, Vinícius Humberto; Perosa, Gimol Benzaquen

    2017-01-01

    Dental decay affects many children, especially those from the lower socioeconomic classes. In this cross-sectional study designed to investigate the role played by sociodemographic factors, parental attitudes, and monitoring points, which are an indicator of personal perception of what controls individual health, on the prevalence of tooth decay among 5-year-old pre-school children living in a midsized city in São Paulo, Brazil. The ceo-d index of 426 children was assessed; the parents reported sociodemographic characteristics and completed two questionnaires concerning monitoring points and parental attitudes. The results show that 52.35% of the children had decay; higher levels of severe decay were observed among lower E-F socioeconomic classes. Higher socioeconomic status and low externality appear to be protective factors. Low parental internality emerged as a risk factor for decay in primary teeth, possibly because the mother expects or delegates the action to others, delaying care. Parental perceptions of control over a child's health seem to impact preventive care and, consequently, the level of tooth decay among children.

  6. Ensemble perception of size in 4-5-year-old children.

    PubMed

    Sweeny, Timothy D; Wurnitsch, Nicole; Gopnik, Alison; Whitney, David

    2015-07-01

    Groups of objects are nearly everywhere we look. Adults can perceive and understand the 'gist' of multiple objects at once, engaging ensemble-coding mechanisms that summarize a group's overall appearance. Are these group-perception mechanisms in place early in childhood? Here, we provide the first evidence that 4-5-year-old children use ensemble coding to perceive the average size of a group of objects. Children viewed a pair of trees, with each containing a group of differently sized oranges. We found that, in order to determine which tree had the larger oranges overall, children integrated the sizes of multiple oranges into ensemble representations. This pooling occurred rapidly, and it occurred despite conflicting information from numerosity, continuous extent, density, and contrast. An ideal observer analysis showed that although children's integration mechanisms are sensitive, they are not yet as efficient as adults'. Overall, our results provide a new insight into the way children see and understand the environment, and they illustrate the fundamental nature of ensemble coding in visual perception.

  7. Literature on the aetiology of hypospadias in the last 5 years: molecular mechanism and environmental factors.

    PubMed

    Yang, Q; Qu, W Y; Yang, L; Wang, K; Tu, H Y; Wang, J

    2014-08-01

    Year-by-year, there has been an increasing number of literature on hypospadias, and most of them are mainly focused on two aspects, namely surgical techniques and aetiology, including the molecular mechanism and associated environmental factors. Surgical techniques and nursing levels are being continuously improved. However, in stark contrast, the study of aetiology still lags behind. Up to now, there is still no consensus on the aetiology of hypospadias, including the molecular mechanism and associated environmental factors. To obtain an overall and latest result on the aetiology, we reviewed published literature regarding the aetiology of hypospadias including the molecular mechanism and associated environmental factors in PubMed in the last 5 years. Thirty-seven studies on the aetiology of hypospadias including molecular mechanism and associated environmental factors were found, of which 25 were about associated environmental factors, and they were described according to the aspects of chemicals, parental characteristics, nutrition and hormones. The remaining studies were about the hormone-dependent phase of molecular mechanism, namely androgen-related genes and oestrogen-related genes. Furthermore, the various points of view were classified and discussed in detail.

  8. French brain tumor database: 5-year histological results on 25 756 cases.

    PubMed

    Rigau, Valérie; Zouaoui, Sonia; Mathieu-Daudé, Hélène; Darlix, Amélie; Maran, Aurélie; Trétarre, Brigitte; Bessaoud, Faiza; Bauchet, Fabienne; Attaoua, Redha; Fabbro-Peray, Pascale; Fabbro, Michel; Kerr, Christine; Taillandier, Luc; Duffau, Hugues; Figarella-Branger, Dominique; Costes, Valérie; Bauchet, Luc

    2011-11-01

    This work aimed to prospectively record all primary central nervous system tumor (PCNST) cases in France, for which histological diagnosis is available. The objectives were to (i) create a national registry and a network to perform epidemiological studies; (ii) implement clinical and basic research protocols; and (iii) harmonize the health care of patients affected by PCNST. For 5 years, 25 756 cases of newly diagnosed and histologically confirmed PCNST have been recorded. Histological diagnoses included glioma (48.9%), all other neuroepithelial tumors (5%), meningioma (28.8%), nerve sheath tumors (8.4%), lymphoma (3.2%) and others (5.7%). Cryopreservation was reported for 6018 PCNST specimens. Tumor resections (R) were performed in 78% cases, while biopsies accounted for 22%. Median age (MA), sex, percentage R and number of cryopreserved tumors were detailed for each histology; for example, out of 6053 glioblastomas (MA 63 years, male 59.4%, R 62%, 1611 were cryopreserved), and out of 37 atypical teratoid/rhabdoid tumors (MA 2 years, male 56.8%, R 94%, 17 were cryopreserved). This database or databank dedicated to PCNST cases contains detailed data on clinical, histological and other characteristics, such as the inclusion of data on cryopreserved specimens that are not available in other European registries. Therefore, this is a valuable resource that can be used for planning future epidemiological and clinical research.

  9. Facebook as a medium for promoting statement of intent for organ donation: 5-years of experience.

    PubMed

    Brzeziński, Michał; Klikowicz, Paweł

    2015-03-12

    The number of potential registered organ donors does not cover the actual demand in most developed countries. Therefore, methods increasing awareness and interest in organ donation, including modern tools of social marketing, are being researched worldwide. The aim of this paper is to present our 5-year experiences with a Facebook networking campaign - the Dawca.pl Club. The mission of the campaign is to raise awareness and educate Polish society on tissue, cell, and organ transplants, to increase public acceptance for transplants as a treatment method, and to increase the number of voluntary donors signing consents for organ donation. The project is based on the idea of creating a community promoting transplantation, focused around the Dawca.pl Club. At present the club has over 48,000 registered members - people who declared willingness to donate their organs after death. We present a description of members of this social networking service, the possibilities of using it to promote transplants and organ donation, and the efficacy of selected schemes for creating and publishing content on Facebook. The example of Dawca.pl shows that 2-way relations, spread over time, are required for social media to effectively engage and exert influence in a chosen sphere of public health and medicine. Unfortunately, at this time it is difficult to assess how such campaigns, apart from raising social awareness and acceptance, will affect the number of transplantations of organs from living and deceased donors.

  10. Improving executive function in childhood: evaluation of a training intervention for 5-year-old children

    PubMed Central

    Traverso, Laura; Viterbori, Paola; Usai, Maria Carmen

    2015-01-01

    Executive function (EF) refers to a set of higher order cognitive processes that control and modulate cognition under continuously changing and multiple task demands. EF plays a central role in early childhood, is associated and predictive of important cognitive achievements and has been recognized as a significant aspect of school readiness. This study examines the efficacy of a group based intervention for 5-year-old children that focuses on basic components of EF (working memory, inhibitory control, cognitive flexibility). The intervention included 12 sessions, lasted 1 month and used low-cost materials. Seventy-five children took part in the study. The results indicate that the children who attended the intervention outperformed controls in simple and more complex EF tasks. Specifically, these children exhibited increased abilities to delay gratification, to control on-going responses, to process and update information, and to manage high cognitive conflict. These results suggest the possibility that this intervention, which may be easily implemented in educational services, can promote EF during preschool period before the entrance in primary school. PMID:25983706

  11. Procedural Metacognition and False Belief Understanding in 3- to 5-Year-Old Children.

    PubMed

    Bernard, Stéphane; Proust, Joëlle; Clément, Fabrice

    2015-01-01

    Some studies, so far limited in number, suggest the existence of procedural metacognition in young children, that is, the practical capacity to monitor and control one's own cognitive activity in a given task. The link between procedural metacognition and false belief understanding is currently under theoretical discussion. If data with primates seem to indicate that procedural metacognition and false belief understanding are not related, no study in developmental psychology has investigated this relation in young children. The present paper aims, first, to supplement the findings concerning young children's abilities to monitor and control their uncertainty (procedural metacognition) and, second, to explore the relation between procedural metacognition and false belief understanding. To examine this, 82 3- to 5-year-old children were presented with an opt-out task and with 3 false belief tasks. Results show that children can rely on procedural metacognition to evaluate their perceptual access to information, and that success in false belief tasks does not seem related to success in the task we used to evaluate procedural metacognition. These results are coherent with a procedural view of metacognition, and are discussed in the light of recent data from primatology and developmental psychology.

  12. Translating weight loss into agency: Men's experiences 5 years after bariatric surgery

    PubMed Central

    Natvik, Eli; Gjengedal, Eva; Moltu, Christian; Råheim, Målfrid

    2015-01-01

    Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences. PMID:26066518

  13. Parenteral iron therapy: a single institution's experience over a 5-year period.

    PubMed

    Laman, Christopher A; Silverstein, Scott B; Rodgers, George M

    2005-11-01

    Many patients require parenteral iron therapy for optimal correction of anemia, including cancer patients who require erythropoietic drugs. Available parenteral iron therapy options include iron dextran, iron gluconate, and iron sucrose. The purpose of this study is to summarize our institution's experience with parenteral iron therapy over a 5-year period, with a focus on comparative safety profiles. All patients receiving parenteral iron therapy over this period were included in the analysis. Chi-squared test and Fisher's exact test were used to compare the adverse event rates of each product. A total of 121 patients received 444 infusions of parenteral iron over this period. Iron dextran was the most commonly used product (85 patients) and iron sucrose was the least used (2 patients). Iron gluconate was used by 34 patients. Overall adverse event rates per patient with iron dextran and iron gluconate were 16.5% and 5.8%, respectively (P = .024). Premedication with diphenhydramine and acetaminophen before infusions of iron dextran reduced adverse event rates per infusion from 12.3% to 4.4% (P = .054). Test doses of iron dextran were used 88% of the time for initial infusions of iron dextran. All adverse events for all parenteral iron products were mild or moderate. There were no serious adverse events and no anaphylaxis was observed. Our results suggest that, if test doses and premedications are used, iron dextran is an acceptable product to treat iron deficiency.

  14. DRAWING SKILLS IN CHILDREN WITH NEURODEVELOPMENTAL DELAY AGED 2-5 YEARS.

    PubMed

    Morović, Maja Lang; Matijević, Valentina; Divljaković, Kristina; Kraljević, Marija; Dimić, Zdenka

    2015-06-01

    In typically developing children, drawing development occurs in stages from uncontrolled strokes to complex drawing. In this study, we examined drawing development in children with neurodevelopmental delay (NDD). In order to do so, we observed the influence of age, intraventricular hemorrhage (IVH) and gender on the development of drawing skills. The sample consisted of 52 children with NDD, aged 2 ye