Ratio of hepatic arterial flow to recipient body weight predicts biliary complications after deceased donor liver transplantation

ObjectivesAdequate hepatic arterial (HA) flow to the bile duct is essential in liver transplantation. This study was conducted to determine if the ratio of directly measured HA flow to weight is related to the occurrence of biliary complications after deceased donor liver transplantation.MethodsA retrospective review of 2684 liver transplants carried out over a 25-year period was performed using data sourced from a prospectively maintained database. Rates of biliary complications (biliary leaks, anastomotic and non-anastomotic strictures) were compared between two groups of patients with HA flow by body weight of, respectively, <5 ml/min/kg (n = 884) and ≥5 ml/min/kg (n = 1800).ResultsPatients with a lower ratio of HA flow to weight had higher body weight (92 kg versus 76 kg; P < 0.001) and lower HA flow (350 ml/min versus 550 ml/min; P < 0.001). A lower ratio of HA flow to weight was associated with higher rates of biliary complications at 2 months, 6 months and 12 months (19.8%, 28.2% and 31.9% versus 14.8%, 22.4% and 25.8%, respectively; P < 0.001).ConclusionsA ratio of HA flow to weight of < 5 ml/min/kg is associated with higher rates of biliary complications. This ratio may be a useful parameter for application in the prevention and early detection of biliary complications.     

Molecular findings and clinical data in a cohort of 150 patients with anophthalmia/microphthalmia

Anophthalmia and microphthalmia (AM) are the most severe malformations of the eye, corresponding respectively to reduced size or absent ocular globe. Wide genetic heterogeneity has been reported and different genes have been demonstrated to be causative of syndromic and non‐syndromic forms of AM. We screened seven AM genes [GDF6 (growth differentiation factor 6), FOXE3 (forkhead box E3), OTX2 (orthodenticle protein homolog 2), PAX6 (paired box 6), RAX (retina and anterior neural fold homeobox), SOX2 (SRY sex determining region Y‐box 2), and VSX2 (visual system homeobox 2 gene)] in a cohort of 150 patients with isolated or syndromic AM. The causative genetic defect was identified in 21% of the patients (32/150). Point mutations were identified by direct sequencing of these genes in 25 patients (13 in SOX2, 4 in RAX, 3 in OTX2, 2 in FOXE3, 1 in VSX2, 1 in PAX6, and 1 in GDF6). In addition eight gene deletions (five SOX2, two OTX2 and one RAX) were identified using a semi‐quantitative multiplex polymerase chain reaction (PCR) [quantitative multiplex PCR amplification of short fluorescent fragments (QMPSF)]. The causative genetic defect was identified in 21% of the patients. This result contributes to our knowledge of the molecular basis of AM, and will facilitate accurate genetic counselling.     

Extra-large letter spacing improves reading in dyslexia

Although the causes of dyslexia are still debated, all researchers agree that the main challenge is to find ways that allow a child with dyslexia to read more words in less time, because reading more is undisputedly the most efficient intervention for dyslexia. Sophisticated training programs exist, but they typically target the component skills of reading, such as phonological awareness. After the component skills have improved, the main challenge remains (that is, reading deficits must be treated by reading more--a vicious circle for a dyslexic child). Here, we show that a simple manipulation of letter spacing substantially improved text reading performance on the fly (without any training) in a large, unselected sample of Italian and French dyslexic children. Extra-large letter spacing helps reading, because dyslexics are abnormally affected by crowding, a perceptual phenomenon with detrimental effects on letter recognition that is modulated by the spacing between letters. Extra-large letter spacing may help to break the vicious circle by rendering the reading material more easily accessible.     

Platform switching and matrix metalloproteinase-8 levels in peri-implant sulcular fluid

Objectives: The concept of platform switching has been introduced to implant therapy, however long‐term data are sparse. The aim of this study was to biochemically investigate the inflammatory response mediated by MMP‐8 to platform switching after 3 years of loading, in order to understand the long‐term effect of implant/abutment mismatching on peri‐implant health. Methods: A total of 70 implants had been inserted in the posterior maxilla in 26 patients and were randomly assigned to one of the four treatment regimens (implant diameter 3.8 [control group], 4.3 [Test group 1, T₁], 4.8 [Test group 2, T₂] and 5.5 mm [Test group 3, T₃]). All implants were restored using a 3.8 mm abutment. In the test groups, this restoration resulted in a mismatching of 0.25–0.85 mm of implant–abutment diameters. Results: Thirty‐six months after prosthetic rehabilitation, peri‐implant sulcular fluid samples were taken from two aspects of all implants and from periodontally healthy adjacent teeth. Samples were processed in a conventional ELISA using monoclonal antibodies recognizing the active entity of MMP‐8. In the test groups, MMP‐8 mean values were 2.76 ng for T₁ (SD: 2.91), 3.30 ng for T₂ (SD: 1.94) and 3.18 ng for T₃ (SD: 2.46). For the control group, MMP‐8 mean value was 3.6 ng (SD: 2.23), whereas 3.38 ng (SD: 2.2) was recorded at the adjacent teeth. There were no statistically significant differences in MMP‐8 values between the groups (P=0.113, Kruskal–Wallis). Conclusions: The presence of an implant/abutment mismatching specific for this prosthetic concept is compatible with long‐term peri‐implant health as demonstrated by analysis of a sensitive biomarker of the peri‐implant inflammatory response.     

Cognitive impairment or inadequate norms? A study of healthy,rural, older adults with limited education

Abstract

This study established preliminary norms for nine commonly administered neuropsychological tests for a biracial sample (N = 133; White = 64, African American = 69) of nondemented, rural community-dwelling elders (mean age = 76.48; SD = 7.87) with 10 or fewer years of formal education (mean education = 6.65 years; SD = 2.14). Hierarchical multiple regression analyses revealed that education was an important predictor of performance on the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), Clock Drawing, Ravens' Colored Progressive Matrices, Wechsler Adult Intelligence Scale-Revised (WAIS-R) Vocabulary and Block Design, Verbal Fluency (Category) and Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale-Revised (WMS-R), but did not predict scores on the Fuld Object Memory Evaluation or memory savings scores from the WMS-R. Race was a predictor only for WAIS-R Vocabulary and Block Design, and WMS-R Logical Memory Delayed. Approximately half of the subjects scored below the published cut-offs for the MMSE and MDRS and would have been considered mildly to moderately impaired on many of the test measures.