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Introduction: Hematopoietic stem cell transplantation (HSCT) in children is associated with severe complications that need admission to critical care units. Mortality in this group of patients remains high with reported survival that ranges between 38 and 71%. Goals: To analyze the predictive factors of mortality of pediatric patients who received HSCT and were admitted to the pediatric intensive care unit (PICU) Material and methods: Retrospective review and analysis of a population of children and adolescents who underwent hematopoietic stem cell transplantation from 12/01/2008 to 11/30/2018 and were admitted to the pediatric intensive care unit (PICU) of a university hospital. Results: Of 248 patients subjected to the analysis, 109 patients were admitted. Overall mortality was 29% (n=32). After univariate analysis, the type of transplant (unrelated), baseline disease (malignant vs non-malignant), febrile neutropenia, cytomegalovirus (CMV) infection, multiorgan failure, respiratory failure, graft versus host disease (GVHD), conditioning regimen with myeloablative chemotherapy and pre-transplant malnutrition were associated with higher mortality. After the Multivariate Analysis of Logistic Regression, the variables GVHD (OR 2, 23 95% CI: 1.92 a 2, 98), need of mechanical ventilation ( OR 2.47,95% CI 1.39 a 5.73) unrelated allogeneic transplants (OR 1.58, 95% CI 1.14 a 2.17) and previous malnutrition (OR: 1.78, 95% CI 1,223-3.89) were statistically associated with mortality. Conclusion: In our population two of three children receiving HSCT and admitted to PICU survived. Graft vs. host disease, need of mechanical ventilation, unrelated transplantation and previous malnutrition were predictors of mortality.

Since January 2015 we have carried out a multiple-intervention strategic plan to reduce hospital stay in renal transplant recipients. The main objective of this study is to compare results of renal transplantation before and after putting into effect this plan in terms of graft and patient survival, readmissions and incidence of acute rejection during the first year post transplantation. In this retrospective analysis we included all patients 18 years of age or older who were transplanted at our institution. The strategic plan resulted in a significant reduction of hospital stay of renal recipients from 13.5 days in the pre-plan group (n=97) to 4.6 days in the post-plan group (n=62; p≤0.0001). The incidence of acute rejection during the first year was similar (pre-plan group=14.4% vs. post-plan group=16% [p=0.77]) as it was graft survival (88% vs. 90% [p=0.71]) and patient survival (95% vs. 98% [p=0.37]), respectively. The multiple-intervention strategic plan has significantly reduced the hospital stay of patients after renal transplantation without affecting graft or patient survival, which are comparable to those internationally published, and without jeopardizing patient's safety.

Diversification rate estimates for Saxifraga from BayesRate and BAMM (DOCX 32Â kb)

Orphanet journal of rare diseases : OJRD 12(1), 86 (2017). doi:10.1186/s13023-017-0640-2, Published by BioMed Central, London

1. Best scoring GEOSSE models for state-dependent diversification of Saxifraga in QTP region. 2. Parameter estimates for best scoring GEOSSE model for state-dependent diversification of Saxifraga in QTP region (DOCX 35Â kb)

Results for model fitting of simulated traits in Saxifraga (PDF 416Â kb)

Results of prior sensitivity tests and species number comparisons in BAMM (PDF 1143Â kb)

Minimum and maximum species numbers for all Saxifraga sections (DOCX 29Â kb)

1. Best scoring GEOSSE models for state-dependent diversification of Saxifraga in Hengduan Mountains. 2. Initial parameter estimates of GEOSSE models for state-dependent diversification of Saxifraga in Hengduan Mountains (DOCX 39Â kb)

This paper discusses computer-supported outbreak detection using routine surveillance data, as implemented at six institutes for infectious disease control in five European countries. We give an overview of the systems used at the Statens Serum Institut (Denmark), Health Protection Agency (England, Wales and Northern Ireland), Robert Koch Institute (Germany), Governmental Institute of Public Health of Lower Saxony (Germany), National Institute for Public Health and the Environment (the Netherlands) and Swedish Institute for Infectious Disease Control (Sweden). Despite the usefulness of the algorithms or the outbreak detection procedure itself, all institutes have experienced certain limitations of the systems. The paper therefore concludes with a list of recommendations for institutes planning to introduce computer-supported outbreak detection, based on experiences on the practical usage of the systems. This list - which concerns usability, standard operating procedures and evaluation - might also inspire improvements of systems in use today. .

The DEXA Cluster consisted of three closely interlinked projects. In 2003 the DEXA Cluster concluded by demonstrating the successful development of critical technologies for Diesel exhaust particulate after-treatment, without adverse effects on NO[x] emissions and maintaining the fuel economy advantages of the Diesel engine well beyond the EURO IV (2000) emission standards horizon. In the present paper the most important results of the DEXA Cluster projects in the demonstration of advanced particulate control technologies, the development of a simulation toolkit for the design of diesel exhaust after-treatment systems and the development of novel particulate characterization methodologies, are presented. The motivation for the DEXA Cluster research was to increase the market competitiveness of diesel engine powertrains for passenger cars worldwide, and to accelerate the adoption of particulate control technology.

This paper describes a wideband (7 kHz) speech coding scheme using code-excited linear prediction (CELP) with mixed time and frequency domain excitation. The proposed frequency domain innovation can be used alternatively or in parallel to a time domain codebook. In addition an improved synthesis filter is used consisting of a signal dependent combination of a forward adaptive and a backward adaptive (FA/BA) structure. An experimental codec operating at 15.5 or 20.0 kbit/s is demonstrated.

This paper describes a wideband (7 kHz) speech compression scheme operating at a bit rate of 13.0 kbit/s, i.e. 0.8 bit per sample. We apply a split-band (SB) technique, where the 0-6 kHz band is critically subsampled and coded by an ACELP approach. The high frequency signal components (6-7 kHz) are generated by an improved high-frequency-resynthesis (HFR) at the decoder such that no additional information has to be transmitted. In informal listening tests, the subjective speech quality was rated to be comparable to the CCITT G.722 wideband codec at 48 kbit/s.

This paper describes a combined adaptive transform codec (ATC) and code-excited linear prediction (CELP) algorithm, called ATCELP, for the compression of wideband (7 kHz) signals. The CELP algorithm applies mainly to speech, whereas the ATC mode is selected for music and noise signals. We propose a switching scheme between CELP and ATC mode and describe a frame erasure concealment technique. Subjective listening tests have shown that the ATCELP codec at bit rates of 16, 24 and 32 kbit/s achieved performances close to those of the CCITT G.722 at 48, 56 and 64 kbit/s, respectively, at most operating conditions.

Die Echinokokkose ist in Deutschland eine seltene Erkrankung. Dennoch sollte sie bei raumfordernden Prozessen der Leber und Lunge in die differenzialdiagnostischen Erwagungen einbezogen werden, da eine auf einer Fehldiagnose beruhende falsche Behandlung den Verlauf deutlich verschlechtern kann. Seit Einfuhrung der Meldepflicht im Jahr 2001 liegen deutschlandweit nun erstmals Daten fur alle Echinokokkoseformen vor.

Everything you'll need to know about par stocks, purchasing requirements, invoices, vendor bids, direct deliveries, and all the other minutiae associated with outfitting a new operation

It was confirmed through electrocardiography that within two hours after epinephrine treatment, four day chick embryos either maintained normal rhythm or developed a severe cardiac dysrhythmia (22/93, 24% dysrhythmic). The ECG dysrhythmia in epinephrine treated embryos were characterized by periods of bradycardia, asystole, and various supraventricular or ventricular dysrhythmias. Within four hours after treatment, dysrhythmic embryos either reestablished normal rhythmicity or died. Electrocardiographic data also demonstrated that metoprolol pretreatment will block epinephrine induced dysrhythmias (0/46, 0% dysrhythmic). We conclude that metoprolol possesses antidysrhythmic properties in the epinephrine treated chick embryo.

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Verfasser haben zwischen 454 Patienten, die wegen einer Lungentuberkulose operiert worden sind, 57 Falle (12,5%) mit postoperativer Bronchusinsuffizienz oder mit einem Stumpfgranulom gefunden. Aus diesem Material stellte sich heraus, das in dem Falle einer Fistel in dem Bronchusstumpf mit einer Frequenz von 84,2% spezifische oder unspezifische Veranderungen histologisch feststellbar waren. Verfasser glauben, das die histologisch nachweisbaren Veranderungen des Bronchusstumpfes die Lage zu einer postoperativen Fistel oder Stumpfgranulation vorbereiten konnen. Daraus folgt, das man den Bronchusstumpf bei jeder Lungenresektion histologisch untersuchen lassen und in dem Falle einer spezifischen oder unspezifischen Veranderung die Nachbehandlung mit groster Sorgfalt durchfuhren soll.

In their discussion of the problem of antibiotic prophylaxis in general surgery the authors maintain that routine-like antibiotic prophylaxis is not indicated in general surgery, but is superfluous and even harmful. So-called "b ind prophylaxis" is senseless and there is no "total prophylaxis". Antibiotic prophylaxis can be successful when it is selective, aimed, adapted to the individual subject and the antibiotic reaches an effective concentration at the appropriate moment not only in the serum but also in the tissues. Infection can be of exogenous and of endogenous origin. Prevention of exogenous infections does not depend upon antibiotic treatment. Antibiotic prophylaxis is contra-indicated when the operation is performed o a clean region. The problem of antibiotic prophylaxis in the course of operations of the bile duct, the stomach, the intestine and pancreas. during appendectomy and colorectal operations is discussed in detail. Post-operative infections of the respiratory tract cannot be prevented by antibiotic prophylaxis. Finally, the authors try to find an answer to the problem when and how antibiotic prophylaxis should be applied, what antibiotic should be used for how long and in what doses.

The role of antibiotics in the therapeutical result and in the postoperative complications was studied after 557 thoracic operations. It was found that antibiotics have no decisive role in the therapeutic result and there was no difference in the incidence of wound infections between the groups treated with different antibiotics. The principles and practice of treatment of would infections and pyothorax are discussed in detail. No relationship was found between the incidence of postoperative respiratory complications and the various drug treatments. Prevention and treatment of postoperative respiratory complications are discussed. The length of the febrile period was independent of the antibiotics applied. Their time of application, the problem of changing drugs and their side-effects after thoracic operations are analyzed.

The effects of a teratogenic dose (5 micrograms) of epinephrine on mean ventricular blood pressure (MVBP) and cardiac output (CO) at one and two hours after treating stage 24 chick embryos were investigated. Previous work demonstrated that a differential response in terms of cardiac rhythm during the first hour after epinephrine treatment was related to pathogenesis of two contrasting types of aortic arch malformations. Absence of one or more aortic arches occurred more frequently in embryos which developed a characteristic dysrhythmia, while persistence of the left fourth aortic arch (PL4AA) occurred more frequently in nondysrhythmic embryos. In this study, dysrhythmic epinephrine-treated embryos exhibited reductions in both MVBP and CO at one hour after treatment when compared to control values. Nondysrhythmic epinephrine-treated embryos exhibited elevated MVBP and no change in CO at one hour after treatment. MVBP and CO in recovered dysrhythmic and nondysrhythmic embryos were similar to control values at two hours following epinephrine treatment. MVBP and CO measurements were obtained from embryos which were pretreated with metoprolol and then subsequently treated with epinephrine. Metoprolol is a beta 1-adrenoreceptor antagonist which was previously shown to block the teratogenic effects of epinephrine and other catecholamines with beta 1-adrenoreceptor agonist properties. Pretreating embryos with metoprolol in this study reduced the dysrhythmogenic potential of epinephrine and also blocked the MVBP and CO changes observed in embryos treated with epinephrine alone. We conclude that pathogenesis of 1) abnormally absent aortic arches is related to dysrhythmogenesis, reduced MVBP, and reduced CO, and 2) an abnormally persistent left fourth aortic arch is related to elevated MVBP in the epinephrine model.

Amoxycillin levels were measured in the serum, bile, lung, gallbladder, and liver tissue in 19 cases of lung and 22 cases of cholecyst operations following intramuscular administration of 1 g amoxycillin. After 60-160 min, 4.4-5.6 mcg/g intact lung tissue and 1.5-3.9 mcg/g tumorous lung tissue concentrations were found, representing 41-48% and 15-32%, respectively, of the corresponding serum levels. Between 70 and 160 min when the ducts cysticus was open, the cystic bile contained 5.2-8.8 mcg/ml, the bile taken from the biliary ducts showed 10.9-13.2 mcg/ml, whereas the wall of the gallbladder and the liver tissue displayed 4.4-5.1 and 1.7-2.8 mcg/g amoxycillin levels. These levels represented 50-92, 118-136, 50-52 and 17-28% of the actual serum levels. As in the serum levels, the bile and tissue levels were about twice as high as those following ampicillin administration. The amoxycillin levels measured in the serum, bile, and other tissue tissues in most cases exceeded the minimal inhibitory concentrations for most of the bacteria usually considered. Therefore, amoxycillin can be applied successfully to treat respiratory and biliary infections.