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Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.
No full textInherited and acquired coagulopathy are frequently associated with major bleeding in severe trauma, cardiac surgery with cardiopulmonary bypass, and postpartum hemorrhage. Perioperative management is multifactorial and includes preoperative optimization and discontinuation of anticoagulants and antiplatelet therapy in elective procedures. Prophylactic or therapeutic use of antifibrinolytic agents is strongly recommended in guidelines and has been shown to reduce bleeding and need for allogeneic blood administration. In the context of bleeding induced by anticoagulants and/or antiplatelet therapy, reversal strategies should be considered when available. Targeted goal-directed therapy using viscoelastic point-of-care monitoring is increasingly used to guide the administration of coagulation factors and allogenic blood products. In addition, damage control surgery, which includes tamponade of large wound areas, leaving surgical fields open, and other temporary maneuvers, should be considered when bleeding is refractory to hemostatic measures
Factors for Differential Outcome Across Cancers in Clinical Molecule-Targeted Fluorescence Imaging.
No full textClinical imaging performance using a fluorescent antibody was compared across 3 cancers to elucidate physical and biologic factors contributing to differential translation of epidermal growth factor receptor (EGFR) expression to macroscopic fluorescence in tumors. Methods: Thirty-one patients with high-grade glioma (HGG, n = 5), head-and-neck squamous cell carcinoma (HNSCC, n = 23), or lung adenocarcinoma (LAC, n = 3) were systemically infused with 50 mg of panitumumab-IRDye800 1-3 d before surgery. Intraoperative open-field fluorescent images of the surgical field were acquired, with imaging device settings and operating room lighting conditions being tested on tissue-mimicking phantoms. Fluorescence contrast and margin size were measured on resected specimen surfaces. Antibody distribution and EGFR immunoreactivity were characterized in macroscopic and microscopic histologic structures. The integrity of the blood-brain barrier was examined via tight junction protein (Claudin-5) expression with immunohistochemistry. Stepwise multivariate linear regression of biologic variables was performed to identify independent predictors of panitumumab-IRDye800 concentration in tissue. Results: Optimally acquired at the lowest gain for tumor detection with ambient light, intraoperative fluorescence imaging enhanced tissue-size dependent tumor contrast by 5.2-fold, 3.4-fold, and 1.4-fold in HGG, HNSCC, and LAC, respectively. Tissue surface fluorescence target-to-background ratio correlated with margin size and identified 78%-97% of at-risk resection margins ex vivo. In 4-μm-thick tissue sections, fluorescence detected tumor with 0.85-0.89 areas under the receiver-operating-characteristic curves. Preferential breakdown of blood-brain barrier in HGG improved tumor specificity of intratumoral antibody distribution relative to that of EGFR (96% vs. 80%) despite its reduced concentration (3.9 ng/mg of tissue) compared with HNSCC (8.1 ng/mg) and LAC (6.3 ng/mg). Cellular EGFR expression, tumor cell density, plasma antibody concentration, and delivery barrier were independently associated with local intratumoral panitumumab-IRDye800 concentration, with 0.62 goodness of fit of prediction. Conclusion: In multicancer clinical imaging of a receptor-ligand-based molecular probe, plasma antibody concentration, delivery barrier, and intratumoral EGFR expression driven by cellular biomarker expression and tumor cell density led to heterogeneous intratumoral antibody accumulation and spatial distribution whereas tumor size, resection margin, and intraoperative imaging settings substantially influenced macroscopic tumor contrast
Deconstruction of Faith: A Pastoral Approach for Latin American Pentecostal Churches
No full textThere is a growing number of people going through deconstructive faith experiences in Latin American Pentecostal churches. Factors like globalization, individualism, high educational rates, the post-colonial experience of the Latin American church, fundamentalism, connectivity, and others contribute to accelerate this trend and shape the environment of faith communities that find themselves amongst increasingly postmodern tendencies. Most pastors are either ignoring the situation, rejecting deconstruction all together, or embracing it blindly. I propose a pastoral response from a distinctively Pentecostal perspective that engages deconstruction of faith critically, while staying open to conceive it as a tool for Spirit-led discipleship that can produce a more mature faith.I examine six affirmations made by Jacques Derrida that explain deconstruction as something that happens, happens from the inside, is not a method, is call, is a yes to the other, and is affirmative of institutions. Each of these is contrasted with specific examples of cultural changes in Costa Rica, Peter’s experience at the house of Cornelius, and a Latin American Pentecostal perspective.
By exploring a variety of authors, I have identified different tools that can help Latin American Pentecostal pastors to better engage in discipleship practices that can produce mature believers in a postmodern era.</p
Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up.
No full textStudy designRetrospective review of a prospective database.ObjectiveThe aim of this study was to evaluate postop clinical recovery among adult spinal deformity (ASD) patients between frailty states undergoing primary procedures SUMMARY OF BACKGROUND DATA.: Frailty severity may be an important determinant for impaired recovery after corrective surgery.MethodsIt included ASD patients with health-related quality of life (HRQLs) at baseline (BL), 1 year (1Y), and 3 years (3Y). Patients stratified by frailty by ASD-frailty index scale 0-1(no frailty: 0.5 [SF]). Demographics, alignment, and SRS-Schwab modifiers were assessed with χ/paired t tests to compare HRQLs: Scoliosis Research Society 22-question Questionnaire (SRS-22), Numeric Rating Scale (NRS) Back/Leg Pain, Oswestry Disability Index (ODI). Area-under-the-curve (AUC) method generated normalized HRQL scores at baseline (BL) and f/u intervals (1Y, 3Y). AUC was calculated for each f/u, and total area was divided by cumulative f/u, generating one number describing recovery (Integrated Health State [IHS]).ResultsA total of 191 patients were included (59 years, 80% females). Breakdown of patients by frailty status: 43.6% NF, 40.8% MF, 15.6% SF. SF patients were older (P = 0.003), >body mass index (P = 0.002). MF and SF were significantly (P ConclusionAlthough all frailty groups exhibited improved postop disability/pain scores, SF patients recovered better in SRS-22 and NRS Back. Despite SF patients having more complications and larger invasiveness scores, they had overall better patient-reported outcomes, signifying that with frailty severity, patients have more room for improvement postop compared to BL quality of life.Level of evidence3
¹H, ¹³C, and ¹⁵N resonance assignments and secondary structure prediction of the full-length transition state regulator AbrB from Bacillus anthracis.
No full textThe AbrB protein is a transcription factor that regulates the expression of numerous essential genes during the cells transition phase state. AbrB from Bacillus anthracis is, nototriously, the principal protein responsible for anthrax toxin gene expression and is highly homologous to the much-studied AbrB protein from Bacillus subtilis having 85% sequence identity and the ability to regulate the same target promoters. Here we report backbone and sidechain resonance assignments and secondary structure prediction for the full-length AbrB protein from B. anthracis
Walking the Back of The Crocodile: A Manual of Biblical Interpretation for Queer Members of the Black Church
No full textJune 26, 2015, the Supreme Court of the United States, ruled that same sex marriage was constitutional, extending the right and its accompanying benefits to millions of persons to whom legal recognition of their marriages were denied on a federal level. With a sense of urgency, several of the Black Church denominations put out statements affirming that marriage is only recognized in a heterosexual frame. And while expressing love for the Queer community, each statement from these Black Church denominations stated that same sex marriage was against the Bible. The response of the Black Church concerning same sex marriage illustrates its weaponization of the Bible against Queer members of the Black Church who, are often unequipped to blunt the weaponization of the Bible against them, opting for either a rejection of affectional orientation, or a passive existence both which reinforce shamed based pathologies and correlates with unsafe practices which fester in contexts where communal accountability is absent. This project aims to provide Queer members of the Black Church with a manual for biblical interpretation, one which is rooted in the interpretative strategies of the Church, and particularly that of the Black Church whose interpretative strategies blunted the weaponization of the Bible in support of slavery and Black inferiority. Available research from historians, biblical scholars, theologians, social scientists, and journalist were utilized in support of this project. This project examines: the taboo framing of Black sexuality, how the Bible was developed, biblical interpretative strategies, Black Church interpretative strategies, and the importance of self-awareness in biblical interpretation.
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Characterization of βARKct engineered cellular extracellular vesicles and model specific cardioprotection
No full text βARKct, the peptide inhibitor of GRK2, improves survival and metabolic functions of cardiac-derived progenitor cells. As any benefit of stem cells in the ischemic and injured heart suggests paracrine mechanisms via secreted EVs, we investigated whether CDC-βARKct engineered EVs would show any benefit over control CDC-EVs. Compared with control EVs, βARKct-containing EVs displayed some unique beneficial properties that may be due to altered pro- and anti-inflammatory cytokines within the vesicles. </jats:p
Author Correction: Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications.
No full textIn Fig. 4 of this article signs for points associated in all 3 components are incorrect and should be reversed, e.g. + 2 should be − 2 and vise versa; Fig. 4 should have appeared as shown below. The original article has been correcte
Homogenization for chemical vapor infiltration process
No full textMulti-scale modeling and numerical simulations of the isothermal chemical vapor infiltration (CVI) process for the fabrication of carbon fiber reinforced silicon carbide (C/SiC) composites were presented in [Bai, Yue and Zeng, Commun. Comput. Phys., 7(3):597-612, 2010]. The homogenization theory, which played a fundamental role in the multi-scale algorithm, will be rigorously established in this paper. The governing system, which is a multi-scale reaction-diffusion equation, is different in the two stages of CVI process, so we will consider the homogenization for the two stages respectively. One of the main features is that the reaction only occurs on the surface of fiber, so it behaves as a singular surface source. The other feature is that in the second stage of the process when the micro pores inside the fiber bundles are all closed, the diffusion only occurs in the macro pores between fiber bundles and we face up with a problem in a locally periodic perforated domain
Ecosystem Services Conceptual Model Application: Testing General Model Adaptability
No full textThis case study, a companion to Ecosystem Services Conceptual Model Application: NOAA and NERRS Salt Marsh Habitat Restoration summarizes initial efforts to apply a general salt marsh ecosystem services conceptual model to specific sites. The case study proposes that developing a set of reference ecosystem services conceptual models for a constrained set of common management interventions would increase the efficiency and consistency of incorporation of ecosystem services in decision-making contexts. The case study discusses efforts to test whether a generalized model can be adapted to specific sites. It describes three cases: a retrospective case, a prospective case, and a quantitative case. Integrated in these studies is a discussion of the considerations that arise and revisions that should be made to a general model applied to a particular site