Long‐term follow‐up of the DeKAF cross‐sectional cohort study

The DeKAF study was developed to better understand the causes of late allograft loss. Preliminary findings from the DeKAF cross‐sectional cohort (with follow‐up < 20 months) have been published. Herein, we present long‐term outcomes in those recipients (mean follow‐up ± SD, 6.6 ± 0.7 years). Eligibility included being transplanted prior to October 1, 2005; serum creatinine ≤ 2.0 mg/dL on January 1, 2006; and subsequently developing new‐onset graft dysfunction leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Histologic findings and DSA were studied in relation to postbiopsy outcomes. Long‐term follow‐up confirms and expands the preliminary results of each of 3 studies: (1) increasing inflammation in area of atrophy (irrespective of inflammation in nonscarred areas [Banff i]) was associated with increasingly worse postbiopsy death‐censored graft survival; (2) hierarchical analysis based on Banff scores defined clusters (entities) that differed in long‐term death‐censored graft survival; and (3) C4d?/DSA? recipients had significantly better (and C4d+/DSA+ worse) death‐censored graft survival than other groups. C4d+/DSA‐ and C4d?/DSA+ had similar intermediate death‐censored graft survival. Clinical and histologic findings at the time of new‐onset graft dysfunction define high‐ vs low‐risk groups for long‐term death‐censored graft survival, even years posttransplant. These findings can help differentiate groups for potential intervention studies.     

A meta‐analysis of design‐ and manufacturing‐related parameters influencing the wear behavior of metal‐on‐metal hip joint replacements

This article aims to clarify the influence of design‐ and manufacturing‐related parameters on wear of metal‐on‐metal (MoM) joint bearings. A database search for publications on wear simulator studies of MoM bearings was performed. The results of published studies were normalized; groups with individual parameters were defined and analyzed statistically. Fifty‐six investigations studying a total of 200 implants were included in the analysis. Clearance, head size, carbon content, and manufacturing method were analyzed as parameters influencing MoM wear. This meta‐analysis revealed a strong influence of clearance on running‐in wear for implants of 36‐mm diameter and an increase in steady‐state wear of heat treated components. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1473–1480, 2009     

Pelvic‐floor imaging using three‐dimensional ultrasonography and magnetic resonance imaging in the long term follow‐up of the bladder‐exstrophy‐epispadias complex

Study Type – Therapy (case control)
Level of Evidence 3b

OBJECTIVE

To investigate whether established pelvic floor variables can be used to predict the risk of uterine prolapse after surgery and to compare two different operative strategies, pelvic adaptation with functional reconstruction and an open pelvis with urinary diversion, as a congenital bony pelvis and pelvic floor defect predisposes females with bladder‐exstrophy‐epispadias complex (BEEC) to uterine prolapse.

PATIENTS, SUBJECTS AND METHODS

We conducted a cross‐sectional study using perineal three‐dimensional ultrasonography (3D‐US) and magnetic resonance imaging (MRI) to describe pelvic floor anatomy in 19 women with BEEC (mean age 27.3 years) and five controls, with the outcome evaluated by a semi‐structured interview. The analysis of 3D‐US and MRI was conducted by two independent investigators.

RESULTS

Of the 19 women with BEEC, 13 initially had a functional bladder reconstruction, six a urinary diversion with removal of the exstrophic bladder, and 12 women had closure of the pelvis either by traction bandage or osteotomy, and in the other seven the symphysis was not approximated. Four patients had a complete and one a mild uterine prolapse. After a mean follow‐up of 24 years, the mean symphyseal diastasis was 4.5 cm after symphyseal approximation, 9.0 cm without symphyseal approximation in BEEC and 0.49 cm in controls. The mean levator hiatus was 4.9 cm on 3D‐US and 4.1 cm on MRI after symphyseal approximation, 5.9 and 7.6 cm without symphyseal approximation and 4.2 and 3.2 cm in controls, respectively. The respective mean levator angle was 86.6° and 87.3° after symphyseal approximation, 104.1° and 101.3° without and 71.3° and 45.5 in controls. Prolapse was statistically significantly more common in patients with no symphyseal approximation.

CONCLUSION

This is the first study showing that perineal 3D‐US is useful for pelvic floor imaging in BEEC. Established pelvic floor variables might be useful for predicting the risk of pelvic organ prolapse in BEEC.     

Epidemiology of the 2010 Outbreak of Foot‐and‐Mouth Disease in Mongolia

Foot‐and‐mouth disease (FMD) occurred in five provinces and 24 counties as part of the FMD incursion into Mongolia during 2010. The first detection occurred on 21 April 2010 (confirmed 26 April 2010) with the last detection occurring approximately 8 months later on 13 December 2010. The number of livestock detected in the spring phase of the outbreak was 323 cattle and in the summer phase was 13 485 sheep, 6748 cattle, 5692 goats and 10 camels (total livestock summer phase = 25 935; for spring and summer phases combined = 26 258). Infection of livestock was confirmed by PCR for each affected county but not necessarily for every outbreak cluster involving more than one herder. It is likely that the summer phase of the outbreak was a continuation of the spring event. In the summer phase, the spatio‐temporal pattern of spread suggested an extension of infection from the main cluster in the Sukhbaatar county. There was also a number of long‐distance clusters established. The relative importance of spread by three potential pathways of gazelle, livestock, animal product and fomite movements has not been determined and will require further study. The estimated dissemination ratio (EDR) did not provide evidence of high rate of transmission of infection between herders; however, the data are limited by the quality of surveillance and the method of calculation which used the date of detection rather than the date of infection.     

HIV‐Positive‐to‐HIV‐Positive Liver Transplantation

Most countries exclude human immunodeficiency virus (HIV)‐positive patients from organ donation because of concerns regarding donor‐derived HIV transmission. The Swiss Federal Act on Transplantation has allowed organ transplantation between HIV‐positive donors and recipients since 2007. We report the successful liver transplantation from an HIV‐positive donor to an HIV‐positive recipient. Both donor and recipient had been treated for many years with antiretroviral therapy and harbored multidrug‐resistant viruses. Five months after transplantation, HIV viremia remains undetectable. This observation supports the inclusion of appropriate HIV‐positive donors for transplants specifically allocated to HIV‐positive recipients.     

Low‐order multi‐rate linear time‐invariant decentralized trackers using the new observer‐based sub‐optimal method for unknown sampled‐data nonlinear time‐delay system with closed‐loop decoupling

This paper presents the low‐order multi‐rate linear time‐invariant decentralized trackers using the new observer‐based sub‐optimal method for a class of unknown sampled‐data nonlinear time‐delay system with closed‐loop decoupling. For the unknown sampled‐data nonlinear time‐delay system, we assume that the inner time delay is clearly known. Under this prerequisite, the appropriate (low‐) order decentralized linear observer for the unknown sampled‐data nonlinear system is determined by the off‐line observer/Kalman filter identification (OKID) method with artificial delay input and actual delay output. Then, the above observer has been further improved based on the proposed new observer‐based sub‐optimal approach. Sequentially, the decentralized tracker with the high gain property is proposed, so that the closed‐loop system has the decoupling property. The proposed approach constructs complete mathematics method including the concept of optimal control theory and state‐matching digital redesign technique and is quite useful for the complicated interconnected large‐scale sampled‐data nonlinear time‐delay system with unknown system equation. Copyright © 2010 John Wiley & Sons, Ltd.     

Tracheotomy in the SARS‐CoV‐2 pandemic

The severe acute respiratory syndrome (SARS)‐CoV‐2 pandemic continues to produce a large number of patients with chronic respiratory failure and ventilator dependence. As such, surgeons will be called upon to perform tracheotomy for a subset of these chronically intubated patients. As seen during the SARS and the SARS‐CoV‐2 outbreaks, aerosol‐generating procedures (AGP) have been associated with higher rates of infection of medical personnel and potential acceleration of viral dissemination throughout the medical center. Therefore, a thoughtful approach to tracheotomy (and other AGPs) is imperative and maintaining traditional management norms may be unsuitable or even potentially harmful. We sought to review the existing evidence informing best practices and then develop straightforward guidelines for tracheotomy during the SARS‐CoV‐2 pandemic. This communication is the product of those efforts and is based on national and international experience with the current SARS‐CoV‐2 pandemic and the SARS epidemic of 2002/2003.     

Three‐decade‐delayed post‐traumatic small‐bowel stenosis

Injury to the small bowel is uncommon after trauma. There are rare reported cases of delayed post‐traumatic stenosis of the small bowel occurring weeks, months or even years later. In this study, we present a case of a delayed stenosis that caused a small‐bowel obstruction three decades after the trauma.