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Nerve and educational results subsequent neonatal encephalopathy treated with beneficial hypothermia.
Bacterial infections are an important threat in the early post-liver transplantation period. Donor-transmitted infections, although rare, can have high mortality. The utility of routine culture from the donor bile duct as screening of donor-transmitted infection has not been evaluated. We performed a retrospective study of 200 consecutive liver transplants between 2010 and 2015. Demographic, clinical, and microbiological data were collected from the recipients' medical records. Clinical data included pretransplantation, perioperative, and posttransplantation information (until 30 days after the procedure). Three-month patient survival and/or retransplantation were recorded. A total of 157 samples from the donor bile duct were collected and cultured. Only 8 were positive. The microorganisms isolated were as follows 2 Klebsiella pneumoniae, 1 Escherichia coli, 1 Enterobacter cloacae, 1 Streptococcus anginosus, 1 Streptococcus sp, 1 multiple gram-negative bacilli, and 1 polymicrobial. All the microorganisms were susceptible to the antibiotic prophylaxis administered. During the first month after transplantation, 81 recipients developed 131 infections. Only 1 of these recipients had a donor with positive bile culture, and none of the infections were due to the microorganism isolated in the donor's bile. Three-month overall survival was 89.5%, and there were no differences between recipients with positive donor bile culture and those with negative donor bile culture (87.5% vs. 89.26%; P > 0.99). CONCLUSION Routine testing of donor bile culture does not predict recipients' infection or survival after liver transplantation and should not be recommended. This article is protected by copyright. All rights reserved.OBJECTIVES This study aimed to compare the quality of life (QOL) of patients, clinical results of the recipient site and morbidities of the donor site between the use of free anterolateral thigh flaps (ALTFs) and radial forearm flaps (RFFs) for reconstruction of full cheek defects following tumor resection. MATERIALS AND METHODS We retrospectively reviewed 52 patients who underwent reconstruction of full cheek defects using free ALTFs and free RFFs following tumor ablation at our center. The range of mouth opening, speech, swallowing, facial appearance, donor site complications, and subjective symptoms based on the University of Washington Quality of Life(UW-QOL) questionnaires findings were assessed in the ALTF and RFF groups at 3, 12, and 36 months after surgery. RESULTS QOL, range of mouth opening, facial appearance, mood and anxiety, donor site appearance,subjective feeling, and functional impairment were better in the ALTF group than in the RFF group based on the physical examination findings and questionnaire scores. CONCLUSION This study found better QOL, and better functional results at the recipient site and minor morbidities at the donor site with the use of free ALTFs in the reconstruction of full cheek defects. https://www.selleckchem.com/products/vy-3-135.html This article is protected by copyright. All rights reserved.Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a considerable risk during emergency colorectal surgery in a pandemic epicenter. It is well known that the primary route of SARS-CoV-2 transmission is through respiratory droplets. However, little is known about shedding of the virus in bodily fluids and associated risks. Although the current moratorium on elective surgery addresses multiple ongoing concerns, including the management of precious resources as well as unknown exposure risks, surgeons undeniably must face and mitigate risks related to exposure to patient airway management-related aerosols, bodily fluids, surgical smoke, contaminated insufflation, and specimen handling in emergency colorectal surgery. Given the significant concern of airborne transmission, the authors recommend conventional, in lieu of laparoscopic, access in emergency colorectal surgery in a COVID-19 pandemic epicenter.in English, German ZIEL  Die Umsetzung der EU-Direktive 2013/59 EURATOM (EU-BSS) von 2014 führte in Deutschland zu einer Neuordnung des Strahlenschutzrechts in Form eines neuen Strahlenschutzgesetzes (StrlSchG) von 2017 und einer neuen Strahlenschutzverordnung (StrlSchV) von 2018. Damit ergeben sich bei der Anwendung ionisierender Strahlen in der Medizin Veränderungen, die Radiologie, Nuklearmedizin und Strahlentherapie betreffen. In einem Vergleich zwischen alter und neuer Rechtsordnung werden die für die Radiologie relevanten Veränderungen analysiert. Für die wichtige neue Regelung meldepflichtiger Ereignisse wird ein Vergleich mit der Implementierung von Art. 63 EU-BSS in 7 europäischen Staaten durchgeführt. MATERIAL UND METHODEN  Die bis 2018 geltenden Regelungen der Röntgenverordnung und alten Strahlenschutzverordnung werden für die in der Radiologie relevanten Regelungen zum Strahlenschutz für Patienten, die Bevölkerung und zum beruflichen Strahlenschutz des Personals mit dem StrlSchG und der StrlSchV ven. Da sich alle neuen Regelungen nicht mehr nur in einer Verordnung finden, sind sowohl Kenntnisse des StrlSchG als auch der StrlSchV notwendig. KERNAUSSAGEN   · Die EU-Direktive 2013/59 EURATOM (EU-BSS) wurde im neuen Deutschen Strahlenschutzrecht 2018 umgesetzt.. · Die grundlegenden Regelungen der RöV und alten StrlSchV bleiben erhalten.. · Neu hinzugekommene Regelungen müssen bekannt sein und in der Praxis umgesetzt werden.. · Viele Regelungen der EU-BSS sind so unscharf formuliert, dass sie einen weiten Spielraum in der nationalen Umsetzung ermöglichen.. ZITIERWEISE · Loose R, Wucherer M, Walz M et al. The new radiation protection framework since 2019 – Implementation in Germany and comparison of some aspects in seven European countries. Fortschr Röntgenstr 2020; DOI 10.1055/a-1137-0096.BACKGROUND  Chemotherapy may be a cause of cancer-associated stroke, but whether it increases stroke risk remains uncertain. We investigated how chemotherapy affects stroke risk in cancer patients. METHODS  Of 27,932 patients in a hospital-based cancer registry (which contains clinical data on all patients treated for cancer at Osaka University Hospital) screened between 2007 and 2015, medical records of 19,006 patients with complete data were investigated. A validated algorithm was used to identify stroke events within 2 years of cancer diagnosis. Patients were divided based on whether their initial treatment plan included chemotherapy. The association between chemotherapy and stroke was analyzed using the Kaplan-Meier method and stratified Cox regression. RESULTS  Of 19,006 patients, 5,887 (31%) were in the chemotherapy group. Stroke occurred in 44 (0.75%) and 51 (0.39%) patients in the chemotherapy and nonchemotherapy group, respectively. Kaplan-Meier curve analysis showed that patients in the chemotherapy group had a higher stroke risk than those in the nonchemotherapy group (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.23-2.75). However, this difference was insignificant after adjustment for cancer status using inverse probability of treatment weighting with propensity scores (HR 1.20; 95% CI 0.76-1.91). Similarly, in the stratified Cox regression model, chemotherapy was not associated with stroke after adjustment for cancer status (HR 1.26; 95% CI 0.78-2.03). CONCLUSION  In our study, the elevated stroke risk in cancer patients who received chemotherapy was presumably due to advanced cancer stage; chemotherapy was not associated with the increased risk of stroke. Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Knowing the case fatality rates of recurrent venous thromboembolism (VTE) and major bleeding is important for weighing the relative risks and benefits of anticoagulation and deciding on the duration of anticoagulant therapy, but these rates are uncertain in patients with cancer-associated thrombosis. METHODS  We performed a systematic review and a meta-analysis to determine the incidence of recurrent VTE and major bleeding and their respective case fatality rates in patients with cancer-associated VTE. RESULTS  Our analysis included 29 studies (15 prospective cohort studies and 14 randomized controlled trials) from 1980 to January 2019. Data from 8,000 cancer patients with 4,786 patient-years of follow-up were summarized. Rates of recurrent VTE and fatal recurrent VTE were 23.7 (95% confidence interval [CI] 20.1-27.8) and 1.9 (95% CI 0.8-4.0) per 100 patient-years of follow-up, respectively, with a case fatality rate of 14.8% (95% CI 6.6-30.1%). The rates of major bleeding and fatal major bleeding events were 13.1 (95% CI 10.3-16.7) and 0.8 (95% CI 0.3-2.1) per 100 patient-years of follow-up, respectively, with a case fatality rate of 8.9% (95% CI 3.5-21.1%). While the estimates of case fatality vary by anticoagulation regimen and study design, the differences between them were not statistically significant. CONCLUSION  In cancer patients receiving anticoagulation, the case fatality rate of recurrent VTE is higher than the case fatality rate of major bleeding. These findings may help to inform decisions regarding the management of anticoagulation in patients with active cancer and VTE. Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Most episodes of venous thromboembolism (VTE) occurred in primary care. To date, no score potentially able to identify those patients who may deserve an antithrombotic prophylaxis has been developed. AIM  The objective of this study is to develop and validate a prediction model for VTE in primary care. METHODS  Using the Health Search Database, we identified a cohort of 1,359,880 adult patients between 2002 and 2013. The date of the first General Practitioner's (GP) visit was the cohort entry date. All VTE cases (index date) observed up to December 2014 were identified. The cohort was randomly divided in a development and a validation cohort. According to nested case-cohort analysis, up to five controls were matched to their respective cases on month and year of cohort entry and duration of follow-up.The score was evaluated according to explained variance (pseudo R2) as a performance measure, ratio of predicted to observed cases as model calibration and area under the curve (AUC) as discrimination measure. RESULTS  The score was able to explain 27.9% of the variation for VTE occurrence. The calibration measure revealed a margin of error lower than 10% in 70% of the population. In terms of discrimination, AUC was 0.82 (95% confidence interval 0.82-0.83). Results of sensitivity analyses substantially confirmed these findings. CONCLUSION  The present score demonstrated a very good accuracy in predicting the risk of VTE in primary care. This score may be therefore implemented in clinical practice so aiding GPs in making decision on patients potentially at risk of VTE. Georg Thieme Verlag KG Stuttgart · New York.The release of calcium ions (Ca2+) from the endoplasmic reticulum (ER) and related store-operated calcium entry (SOCE) regulate maturation of normal megakaryocytes. The N-methyl-D-aspartate (NMDA) receptor (NMDAR) provides an additional mechanism for Ca2+ influx in megakaryocytic cells, but its role remains unclear. We created a model of NMDAR hypofunction in Meg-01 cells using CRISPR-Cas9 mediated knockout of the GRIN1 gene, which encodes an obligate, GluN1 subunit of the NMDAR. We found that compared with unmodified Meg-01 cells, Meg-01-GRIN1 -/- cells underwent atypical differentiation biased toward erythropoiesis, associated with increased basal ER stress and cell death. Resting cytoplasmic Ca2+ levels were higher in Meg-01-GRIN1 -/- cells, but ER Ca2+ release and SOCE were lower after activation. Lysosome-related organelles accumulated including immature dense granules that may have contributed an alternative source of intracellular Ca2+. Microarray analysis revealed that Meg-01-GRIN1 -/- cells had deregulated expression of transcripts involved in Ca2+ metabolism, together with a shift in the pattern of hematopoietic transcription factors toward erythropoiesis.
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