Airway pressure release ventilation for in-vivo donor lung management and lung transplant outcomes

Background:Airway pressure release ventilation (APRV) can be used for cadaveric donor lung recruitment. APRV elevates PaO₂ in donor lungs; however, reported outcomes in recipients with APRV-managed donor lungs are limited. Methods:We retrospectively reviewed patients who underwent lung transplantation (LTx) from 2012 to 2013 and divided them into two groups based on mode of ventilation used during donor management and organ extraction (A: non-APRV; B: APRV). Kaplan-Meier method and multivariate Cox regression were used for analysis. Results:We found 126 LTx recipients (LTxRs); 9 were excluded for use of portable ventilation perfusion systems. Of the remaining 117 patients, 81 (69%) were in Group A; 36 (31%) were in Group B. Preoperative LTxR characteristics (age, sex, lung allocation score, end-stage lung disease type) were comparable between groups. Donors for Group B were older (P=0.03) and had higher body mass index (BMI) (P<0.001), higher incidence of death from chest trauma (P=0.008), longer ventilation duration after brain death (P<0.001), and higher pre-explant PaO₂/FiO₂ ratios (P<0.001). Post-LTx duration of mechanical ventilation, hospital stay, and median survival were similar in both groups. Risk of death was comparable between the two groups at the end of follow-up (HR =1.42; 95% CI: 0.57-3.56; P=0.45). Conclusions:APRV is a safe and effective pre-LTx donor lung management strategy. Short- and long-term survival outcomes were comparable in LTx recipients, irrespective of donor ventilation mode. APRV may help recruit lungs from older donors with higher BMI who die from chest trauma and have anticipated longer ventilation duration.     

Long-term efficacy and safety of anti-hyperglycaemic agents in new-onset diabetes after transplant: Results from outpatient-based 1-year follow-up and a brief review of treatment options

Background and aimsEvaluation of long-term efficacy and safety of various anti-hyperglycaemic agents (AHA) for glycaemic control in NODAT, in stable kidney transplant recipients (KTRs) during 1-year outpatient follow-up.MethodsWe collected FPG, PPG, HbA1c, serum creatinine, eGFR, blood tacrolimus level, hypoglycaemia and body weight values from an existing database of KTRs diagnosed to have NODAT. Those newly initiated on AHA over 3 months post-transplant; received standard triple immunosuppressive therapy; and followed up for 1-year after referral, were included.ResultsIn ninety-five patients’ (Male = 65), mean decrease at 1-year from baseline in FPG (185.01 ± 62.11 mg/dL), PPG (293.21 ± 85.23 mg/dL) and HbA1c (8.48 ± 1.08%) was 67.09, 126.11 and 1.4 respectively (p < 0.0001). At 1-year, mean HbA1c was 7.08 ± 0.38%, ninety-one patients achieving HbA1c ≤ 7.5%. Fifty-two patients received oral combination therapy based on linagliptin/metformin/repaglinide/gliclazide, 19 received insulin-based regimen, and 24 received linagliptin monotharapey. Thirty patients reported hypoglycaemia (10 with gliclazide and 15 with insulin) and fifty patients gained body-weight at 1-year. Mean serum creatinine and eGFR significantly improved by 0.29 and 15.77 from baseline of 1.56 ± 0.62 mg/dL and 53.95 ± 16.10 mL/min/1.73 m² respectively.ConclusionsSignificant proportion of NODAT patients achieved long-term glycemic control with improved renal function. Combination therapy was needed in most within 1-year. Linagliptin monotherapy was effective, without producing hypoglycaemia or weight gain.     

Agreement and repeatability of Icare ic100 tonometer

Purpose:To find the agreement and repeatability of Icare ic100 tonometer.Methods:We included 150 subjects above the age of 18 years for this cross-sectional, multicenter study with intraocular pressure (IOP) ≥7 mmHg. After the initial ophthalmic examination, two masked examiners took five IOP measurements using three different instruments; Icare ic100, Icare TA01i, and Goldmann applanation tonometer (GAT) in only one eye of the participants. Comparison of agreement of IOP using different instruments was quantified with intraclass correlation coefficient (ICC) using the two-way random effects models of absolute agreement and Cronbach''s alpha. The test-retest variability of the instruments was assessed by deriving repeatability coefficient (RC) and coefficient of variation (CV).Results:Agreement between the tonometers across the different IOP groups had no statistically significant difference in their mean IOP. Icare ic100 was found to have good reliability across all IOP groups (ICC value >0.78) when compared with Icare TA01i. In comparison with GAT, Icare ic100 showed good reliability across all IOP groups (ICC >0.87) except >16 to <23 mmHg group where it showed moderate reliability (ICC = 0.52). Icare ic100 showed good repeatability with RC and CV of 2.67 and 4.89, respectively.Conclusion:Icare ic100 rebound tonometer can measure IOP with relatively small measurement error and can provide a reliable and repeatable reading in comparison with GAT across a wide pressure range without hampering corneal health.     

Author affiliation addition: “Hepatitis B virus detected in paper currencies in a densely populated city of India: A plausible source of horizontal transmission?”

Addition of authors’ affiliation to "Hepatitis B virus detected in paper currencies in a densely populated city of India: A plausible source of horizontal transmission?" World J Hepatol 2020 Oct 27; 12(10): 775-791. In this article, one of the affiliations of two authors was not mentioned. Ruchi Supekar, a joint first author and Subhajit Biswas, the corresponding author are affiliated to Academy of Scientific and Innovative Research (AcSIR) Ghaziabad- 201002, India.     

A class of Covariate-Adjusted Response-Adaptive Allocation Designs for Multitreatment Binary Response Trials

A class of covariate-adjusted response-adaptive randomization procedures is developed for binary treatment outcomes in a phase III clinical trial set up involving multiple treatments. The target allocation is developed by combining the ethical aspects with statistical precision under the existence of treatment covariate interaction. Relevant measures of the performance for the proposed allocation designs are studied and compared.     

Exploring two contrasting surface‐active exopolysaccharides from a single strain of Ochrobactrum utilizing different hydrocarbon substrates

During production and characterization of exopolysaccharides (EPS) of Ochrobactrum pseudintermedium C1, it was observed that an experimental change in the basic hydrocarbon type of substrate for bacterial utilization led to elicitation of different surface‐active properties in the EPS produced. In the sugar substrate, it elicited surfactant property, while in oil substrates it elicited emulsifying property, which indicated that the EPS might be different. Consequently, attention was focused on a detailed analysis of this substrate‐specific EPS. Utilizing waste sugar, edible, and mineral oil substrates, EPS produced in each situation was characterized. Besides estimating surface activity and thermostability, each substrate‐specific EPS was analyzed by Fourier‐transform infrared spectroscopy, gas chromatography‐mass spectroscopy, ¹H‐nuclear magnetic resonance, and matrix‐assisted laser desorption/ionization—time of flight mass spectroscopy to find any structural difference. The results were significantly contrasting although the similarity in molecular mass suggested a basic similarity in polysaccharide structure. Morphological differences were also evident both macroscopically and microscopically with scanning electron microscopy. As the surface‐active property of EPS was dependent on the substrate utilized, their structural differences might account for it. These diverse surface activities of EPS produced by a single bacterial strain simply by changing the nature of substrate would also augment their bioapplications. Moreover, utilization of waste and easily available substrates should make such applications convenient, ecofriendly, and cost‐worthy.     

Study of crevice fluid in relation to periodontal disease in children

Crevicular fluid from four groups of children was examined. The crevice fluid was collected at random from the anterior region of the mouth (6 distal and 6 mesial) in filter paper strips and the volume of the ascending fluid in each strip was measured by techniques previously described by Smith, Golub & Duperon (1974). Gingival condition was assessed on the basis of the Löe and Silness Index (1963). The crevice fluid was pooled on the basis of age, sex and gingival inflammation, and each pool was analyzed for protein, carbohydrate, total calcium, phosphate and nitrogen. Protein and carbohydrate were analyzed by taking an aliquot of the pooled sample directly, whereas total calcium content, phosphate and nitrogen were analyzed in a sample digested with concentrated sulfuric acid and 30 per cent (V/V) hydrogen peroxide. Standard chromogenic reagents were used in analysis. Each component was regarded as a single variable. In this study the corresponding means were compared and graphed. The results were presented as the effects of age, sex and G. I. and various interactions. The data was analyzed to determine i) the absolute quantity of each component and ii) the concentration of each (μg/μl) in the crevice fluid. The concentration of protein in the fluid was higher in females than in males and was also higher in the post-pubertal group than in the pre-pubertal group. The concentration of carbohydrate and calcium followed almost the same trend as that of protein. The difference in the concentration of phosphate was not significant. The levels of calcium and phosphate were several times higher than serum levels, indicating that calcium and phosphate were hyperconcentrated within the crevice overnight, as occurred with urea (Golub, Borden & Kleinberg 1971). The high protein content may be related to the high urea content of the crevice fluid from inflamed gingivae. The high urea content will give rise to a high pH-a pH which can be favourable to the calcification process. Also, the hyperconcentration of calcium and phosphate, particularly in the post-pubertal group, may favour this process.