The aim of the study was to develop a tool to predict preoperatively whether a patient will need to attend an extended care facility (ECF) following liver transplantation (OLT). PATIENTS AND METHODS: A multidisciplinary group including 2 transplant surgeons, 2 transplant nurses, 1 nurse manager, 2 physical therapists, 1 case manager, 1 home healthcare professional, 1 rehabilitation physician and 1 statistician met to identify pre-operative factors relevant to discharge planning. Parameters which were examined as potential predictors of discharge status were age, sex, language, Karnofsky score, OLT alone versus combined procedure, creatinine, bilirubin, international normalized ratio (INR), albumin, body mass index (BMI), Child Turcotte Pugh (CTP) score, chemical Model End Stage Liver Disease (MELD) score, renal dialysis, location prior to transplant, co-morbidities: encephalopathy, ascites, hydrothorax, hepatopulmonary syndrome, diabetes mellitus (DM), cardiac ejection fraction and right ventricular systolic pressure, sex of the primary caregiver and availability, donor risk index (DRI) and donor characteristics. RESULTS: Between 01/2004 and 04/2010 777 patients 730(94%) received a liver only transplant and 47 (6%) patients received combined procedures. 519(67%) were discharged to home, 215(28%) to a facility and 43(5%) died early post OLT. Multivariable logistic regression analysis identified these parameters as significantly influencing discharge status: low Karnofsky score, older age, female sex, INR of 2.0, creatinine of 2.0mg/dl, DM, high bilirubin, low albumin, low and high BMI and pre-OLT renal dialysis. The nomogram was prospectively validated on a population of 126 OLT recipients with a concordance index of 0.813. CONCLUSION: A new approach to improving efficiency of hospital care is essential. We believe this tool will aid in reducing LOS and improve patient experience by facilitating early discharge planning. © 2012 American Association for the Study of Liver Diseases.

Flow coefficients v_{n} for n=2, 3, 4, characterizing the anisotropic collective flow in Au+Au collisions at sqrt[s_{NN}]=200  GeV, are measured relative to event planes Ψ_{n}, determined at large rapidity. We report v_{n} as a function of transverse momentum and collision centrality, and study the correlations among the event planes of different order n. The v_{n} are well described by hydrodynamic models which employ a Glauber Monte Carlo initial state geometry with fluctuations, providing additional constraining power on the interplay between initial conditions and the effects of viscosity as the system evolves. This new constraint can serve to improve the precision of the extracted shear viscosity to entropy density ratio η/s.

Cellular stresses, including growth factor deprivation, inflammatory cytokines or viral infection promote RAX/PACTdependent activation of the double-stranded RNA-dependent protein kinase, PKR, to phosphorylate eIF2α, resulting in translation inhibition and apoptosis. In addition, PKR has been reported to regulate p53, STAT1 and NFκB. Here, we report that RAX/PACT interacts with the SUMO E2 ligase Ubc9 to stimulate p53-Ubc9 association and reversible p53 sumoylation on lysine 386. In addition, expression of RAX/PACT in a variety of cell lines promotes p53 stability and activity to increase p53 target gene expression. Significantly, while the expression of RAX/PACT, PKR or p53 alone has little effect on the cell cycle of p53-null H1299 cells, co-expression of p53 with either RAX/PACT or PKR promotes a 25-35% increase of cells in G1. In contrast, co-expression of RAX/PACT with the sumoylation-deficient p53(K386R) mutant or with the desumoylase SENP1 fails to induce such a G1 arrest. Furthermore, co-expression of p53, RAX/PACT and the dominantnegative PKR(K296R) mutant inhibits RAX/PACT-induced, p53-dependent G1 growth arrest and expression of RAX/PACT in pkr+/+ but not pkr-/- MEF cells promotes p53 and p21 expression following gamma irradiation. Significantly, p53 stability is decreased in cells with reduced RAX/PACT or PKR following doxorubicin treatment, and expression of exogenous RAX/ PACT promotes phosphorylation of wild-type but not p53(K386R) on serine 392. Collectively, results indicate that, in response to stress, the RAX/PACT-PKR signaling pathway may inhibit p53 protein turnover by a sumoylation-dependent mechanism with promotion of p53 phosphorylation and translational activation leading to G 1 cell cycle arrest.

Back-to-back hadron pair yields in d+Au and p+p collisions at sqrt[s_{NN}]=200  GeV were measured with the PHENIX detector at the Relativistic Heavy Ion Collider. Rapidity separated hadron pairs were detected with the trigger hadron at pseudorapidity |η|<0.35 and the associated hadron at forward rapidity (deuteron direction, 3.0<η<3.8). Pairs were also detected with both hadrons measured at forward rapidity; in this case, the yield of back-to-back hadron pairs in d+Au collisions with small impact parameters is observed to be suppressed by a factor of 10 relative to p+p collisions. The kinematics of these pairs is expected to probe partons in the Au nucleus with a low fraction x of the nucleon momenta, where the gluon densities rise sharply. The observed suppression as a function of nuclear thickness, p_{T}, and η points to cold nuclear matter effects arising at high parton densities.

We present measurements of J/ψ yields in d+Au collisions at sqrt[s_{NN}]=200  GeV recorded by the PHENIX experiment and compare them with yields in p+p collisions at the same energy per nucleon-nucleon collision. The measurements cover a large kinematic range in J/ψ rapidity (-2.2<y<2.4) with high statistical precision and are compared with two theoretical models: one with nuclear shadowing combined with final state breakup and one with coherent gluon saturation effects. In order to remove model dependent systematic uncertainties we also compare the data to a simple geometric model. The forward rapidity data are inconsistent with nuclear modifications that are linear or exponential in the density weighted longitudinal thickness, such as those from the final state breakup of the bound state.

In vitro characterisation results for O(2) reduction at Pt-based microelectrodes are presented and compared with those for carbon-paste electrodes (CPEs). Cyclic voltammetry indicates a potential of -650 mV vs. SCE is required for cathodic reduction at both electrode types, and calibration experiments at this potential revealed a significantly higher sensitivity for Pt (-0.091 ± 0.006 μAmm(-2)μM(-1) vs.-0.048 ± 0.002 μAmm(-2)μM(-1) for CPEs). Since Pt electrodes are readily poisoned through contact with biological samples selected surface coated polymers (polyphenylenediamine (PPD), polymethyl methacrylate (PMMA) and Rhoplex(®)) were examined in biocompatibility studies performed in protein, lipid and brain tissue solutions. While small and comparable decreases in sensitivity were observed for bare Pt, Pt-Rhoplex and PMMA there was minimal change at the Pt-PPD modified electrode for each 24h treatment, including an extended 3 day exposure to brain tissue. The polymers themselves had no effect on the O(2) response characteristics. Further characterisation studies at the Pt-based microelectrodes confirmed interference free signals, no effect of pH and ion changes, and a comparable detection limit (0.08 ± 0.01 μM) and response time (<1 s) to CPEs. Although a significant temperature effect (ca. 3% change in signal for each 1 °C) was observed it is predicted that this will not be important for in vivo brain tissue O(2) measurements due to brain temperature homeostasis. These results suggest that amperometric Pt electrodes have the potential to be used reliably as an alternative to CPEs to monitor brain tissue O(2) over extended periods in freely-moving animals.

ABSTRACT: Three young grey seals (Halichoerus grypus) were presented separately for fracture repair to the veterinary teaching hospital of University College Dublin. The seals were premedicated with a combination of pethidine, midazolam and atropine; anaesthesia was induced with propofol via the front flipper vein and maintained with sevoflurane or isoflurane in oxygen. One of the seals did not breathe spontaneously after anaesthesia; a cardiac arrest, resulting in death, occurred after several hours of mechanical ventilation. Post-mortem examination revealed a severe lungworm infestation and parasitic pneumonia in this animal. The two other seals recovered uneventfully from anaesthesia.

Preoperative determinants of surgical risk in elderly patients with meningioma are not fully defined. This study was undertaken to determine whether the Charlson comorbidity index could be used to accurately predict postoperative outcomes among older patients with meningiomas undergoing neurosurgical resection and thereby make a selection for surgery easier. We performed a multi-institutional retrospective cohort analysis via the Nationwide Inpatient Sample (1998-2005). Patients 65 years of age and older who underwent tumor resection of intracranial meningiomas were identified by International Classification of Diseases, 9th revision, coding. The primary independent variable in multivariate regression was the Charlson comorbidity score, and the primary outcome was inpatient death. Secondary outcomes included inpatient complications, length of stay, and total hospital charges. We identified 5717 patients (66.6% female, and 81.8% white) with mean age of 73.6 years. Mean Charlson comorbidity score was 0.99. Inpatient mortality was 3.2%. Mean length of stay was 9.1 days, and mean total charges were $62,983. In multivariate analysis, the only factors consistently associated with worse outcome were increased Charlson comorbidity score and increased patient age (ie,>65 years of age). Only greater Charlson scores were additionally associated with greater odds of all major complications such as neurological, respiratory, and cardiac complications. Elective procedures were consistently associated with less inpatient death, length of stay, and total charges. All associations were statistically significant (P < 0.05). The safe surgical resection of intracranial meningiomas among older patients is possible through the ninth decade of life. The Charlson comorbidity score has been shown to be a strong, consistent predictor of inpatient outcomes.