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Acute kidney injury is a common complication following the Norwood operation. Most neonatal studies report acute kidney injury peaking within the first 48 hours after cardiac surgery. The aim of this study was to evaluate if persistent acute kidney injury (>48 postoperative hours) after the Norwood operation was associated with clinically relevant outcomes.
Two-centre retrospective study among neonates undergoing the Norwood operation. Acute kidney injury was initially identified as developing within the first 48 hours after cardiac surgery and stratified into transient (≤48 hours) and persistent (>48 hours) using the neonatal modification of the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Severe was defined as stage ≥2. Primary and secondary outcomes were mortality and duration of ventilation and hospital length of stay.
One hundred sixty-eight patients were included. Transient and persistent acute kidney injuries occurred in 24 and 17%, respectively. Cardiopulmonary bypass and aortic cross clamp duration, and incidence of cardiac arrest were greater among those with persistent kidney injury. Mortality was four times higher (41 versus 12%, p < 0.001) and mechanical ventilation duration 50 hours longer in persistent acute kidney injury patients (158 versus 107 hours; p < 0.001). In multivariable analysis, persistent acute kidney injury was not associated with mortality, duration of ventilation or length of stay. Severe persistent acute kidney injury was associated with a 59% increase in expected ventilation duration (aIRR:1.59, 95% CI:1.16, 2.18; p = 0.004).
Future large studies are needed to determine if risk factors and outcomes change by delineating acute kidney injury into discrete timing phenotypes.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
By applying a display ecology to the Deeper, Wider, Faster proactive, simultaneous telescope observing campaign, we have shown a dramatic reduction in the time taken to inspect DECam CCD images for potential transient candidates and to produce time-critical triggers to standby telescopes. We also show how facilitating rapid corroboration of potential candidates and the exclusion of non-candidates improves the accuracy of detection; and establish that a practical and enjoyable workspace can improve the experience of an otherwise taxing task for astronomers. We provide a critical road test of two advanced displays in a research context—a rare opportunity to demonstrate how they can be used rather than simply discuss how they might be used to accelerate discovery.
Infectious mononucleosis is a clinical manifestation of primary Epstein–Barr virus infection. It is unknown whether genetic factors contribute to risk. To assess heritability, we compared disease concordance in monozygotic to dizygotic twin pairs from the population-based California Twin Program and assessed the risk to initially unaffected co-twins. One member of 611 and both members of 58 twin pairs reported a history of infectious mononucleosis. Pairwise concordance in monozygotic and dizygotic pairs was respectively 12·1% [standard error (s.e.)=1·9%] and 6·1% (s.e.=1·2%). The relative risk (hazard ratio) of monozygotic compared to dizygotic unaffected co-twins of cases was 1·9 [95% confidence interval (CI) 1·1–3·4, P=0·03], over the follow-up period. When the analysis was restricted to same-sex twin pairs, that estimate was 2·5 (95% CI 1·2–5·3, P=0·02). The results are compatible with a heritable contribution to the risk of infectious mononucleosis.
The three-dimensional structure of the anti-apoptotic
protein Bcl-xL complexed to a 25-residue peptide
from the death promoting region of Bad was determined using
NMR spectroscopy. Although the overall structure is similar
to Bcl-xL bound to a 16-residue peptide from
the Bak protein (Sattler et al., 1997), the Bad peptide
forms additional interactions with Bcl-xL. However,
based upon site-directed mutagenesis experiments, these
additional contacts do not account for the increased affinity
of the Bad 25-mer for Bcl-xL compared to the
Bad 16-mer. Rather, the increased helix propensity of the
Bad 25-mer is primarily responsible for its greater affinity
for Bcl-xL. Based on this observation, a pair
of 16-residue peptides were designed and synthesized that
were predicted to have a high helix propensity while maintaining
the interactions important for complexation with Bcl-xL.
Both peptides showed an increase in helix propensity compared
to the wild-type and exhibited an enhanced affinity for
The thin film reaction between Ti and Al-0.5%Cu to form TiAl3 is common in the microelectronics industry. In this paper the stress changes in Al-0.5%Cu films at elevated temperatures during the reaction are measured. The changes are measured in blanket films as well as in passivated interconnect lines. Results show that in blanket films the Al-0.5%Cu does not experience any stress change due to the reaction. However in passivated lines, where the layers are not allowed to relax in the normal direction, tensile stresses build up in the Al-0.5%Cu due to the volume shrinkage that happens when these films react.
We describe an Escherichia coli O157[ratio ]H7 outbreak
associated with a fresh water lake at a
county park. Campers were surveyed for diarrhoeal illness within 10
days of their visit, and a
case-control study of day visitors was conducted. A confirmed case was a
with a stool culture positive for E. coli O157[ratio ]H7
and a probable case was a person with
bloody diarrhoea. Clinical isolates of E. coli O157 were subtyped
by pulsed field gel
electrophoresis (PFGE). In the camper survey, 12 (38%) of 32 swimmers
had a diarrhoeal
illness (relative risk [RR]=12·4; 95% confidence
interval [RR]=1·7–89·7). For the case-control
study, the 12 cases were more likely than controls to have purposefully
ingested lake water
(odds ratio [OR]=6·9, 95% CI=0·9–55·8).
The PFGE patterns of six clinical isolates were
indistinguishable. This report further demonstrates that contaminated
fresh-water lakes can be
the source of community outbreaks of E. coli O157[ratio ]H7.
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