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The Renewable Fuel Standard (RFS) is a regulation that requires refineries in the U.S. to output a certain percentage of their fuel from renewable sources, such as plants or animal [...]

The mean salary for an ob-gyn in the United States, according to the Bureau of Labor Statistics, is $239,120 annually. (1) The question is; if every physician were paid this [...]

Senior centers have been operating in the United States for nearly 75 years. The first center was introduced in New York City in 1943 to help older adults remain in [...]

Less than 60 years ago, the first senior center opened in New York City. Today, there are more than 15,000 senior centers across the country serving more than 10 million [...]

All the pent-up excitement I had for the Ford Bronco vanished the instant I saw your renderings ['Bronco Is Back,' February 2020], Is Jeep paying you to kill the buzz [...]

Mother-young relationships in sheep are characterized by individual recognition and a rapidly developing exclusive bond. The authors examined the role of opioids in establishment of the lamb's preference for its mother. Newborn lambs received the opioid receptor antagonist naltrexone (0.0, 1.5, or 3.0 mg/kg ip), and lambs were tested at 24 hr and 48 hr of age. At 24 hr, controls spent significantly more time near the mother than near an alien ewe; no significant difference was obtained for the naltrexone-treated groups. The effect of naltrexone persisted at 48 hr. No other significant behavioral difference was observed. Results support the hypothesis that opioids mediate the establishment of mother preference and the view that positive affect associated with social attachment and maternal care may be modulated by opioids.

As the 21st century approaches, therapeutic recreation specialists will be challenged to find meaningful and purposeful activity ideas with older adults. Older persons identify possessions as meaningful based on their […]

The parks and recreation movement was born out of changes resulting from the industrial revolution in the 1800s (Jarvi, 1993). The profession emanated from citizen's efforts to address social issues […]

In this study, we had two inter-related goals: (a) to examine sex and minority status differences on children’s motivation for physical education (PE; i.e., their expectancy beliefs, subjective task values, and situational interest) and their psychomotor learning outcomes (i.e., motor competence, cardiorespiratory fitness, and in-class physical activity); and (b) to examine the relationships between children’s motivation and their psychomotor learning outcomes while testing the moderation effects of sex and minority status. We recruited 195 fourth and fifth-grade students (101 boys; 94 girls; Mage= 10.7, SD =0.7 years) from three elementary schools in North Texas. Using multivariate analysis of variance, we identified a significant sex difference that favored boys in motivation and psychomotor learning outcomes, with no significant minority status difference in relation to these variables. Regression analysis revealed that children’s expectancy beliefs were significantly associated with both motor competence (R2= 11%) and cardiorespiratory fitness (R2= 16%), while both situational interest and sex were associated with in-class physical activity (R2= 18%). Thus, improving children’s expectancy beliefs may be a means of enhancing psychomotor learning outcomes in PE, especially for girls. Enhancing children’s beliefs in their own ability and offering diversified PE content so as to generate greater interest may facilitate psychomotor learning.

Some accident victims report poorer sleep during the months after the trauma, which may double the risk for and is a mediator of the development of a PTSD. Furthermore, subjective and objective sleep measures are often discrepant in PTSD-patients, which is why a ‘sleep state misperception’ of PTSD patients is often hypothesized. The goal of this study is to assess differences in sleep quality in victims of a traffic accident compared to healthy participants without an accident history as well as differences between objective and subjective sleep quality measures. We recruited 25 hospitalized accident victims within ten days of an accident and 31 age and sex-matched controls without an accident history. Three months later, participants were given a structured clinical interview (SCID), they completed the Pittsburg Sleep Quality Index (PSQI) for the previous two weeks, wore a wrist actigraph, and kept a sleep log for two consecutive nights. At the three-month follow-up, none of the victims met the criteria for any kind of mental disorder, but scored higher on the Posttraumatic Diagnostic Scale. On the PSQI they reported slightly worse sleep than controls for the previous two weeks, although sleep log and actigraphy measures on the two recording nights showed no group differences. Actigraphy measures showed shorter sleep onset latencies compared to log measures. The accident victims suffered only minimal sleep disturbances three months later. The assumption of a ‘sleep state misperception’ in traffic accident victims is questioned by these results.

Like all kids, youth with chronic illnesses need opportunities for challenge an growth. But unlike most youngsters, those with chronic diseases have many fewer options available to them. Fortunately, in […]

The reported use of 3D printing in hand and wrist rehabilitation has been mostly limited to feasibility studies and case series so far. Some of the reasons are the lack of purpose-built scanning applications, complicated digital design software, and lengthy and error-prone printing processes. We propose a multidisciplinary workflow for in-hospital mass production of patient-specific 3D-printed devices for hand and wrist rehabilitation.

Mit der COVID-19-Pandemie stehen die Notaufnahmen als Schnittstelle der ambulanten und stationären Krankenversorgung vor einer großen Herausforderung. Die Dynamik der Pandemie zwang die Notfallversorgung des Universitätsklinikums Münster zu umfassenden Anpassungsprozessen, die in kürzester Zeit erfolgen mussten. Dazu gehörte die Etablierung einer ambulanten Coronateststelle und einer studentischen Telefonhotline. Innerklinisch wurden neue Isolationskapazitäten in der Notaufnahme sowie eine eigene COVID-19-Station eingerichtet. Der Patientenfluss wurde durch Flussdiagramme sowohl für den ambulanten als auch für den stationären Bereich neu geregelt. Das allgemeine und spezielle Notfallmanagement wurde für die reibungslose Versorgung COVID-19-positiver Patienten optimiert und das Personal in der Benutzung von Schutzausrüstung trainiert. Dieser Erlebnisbericht soll anderen Notaufnahmen in der Vorbereitung auf die COVID-19-Pandemie unterstützen.

Now add a V-8 or the twin-turbo 3.5-liter V-6 and F-150 towing numbers if you actually want me to buy one. Why have all the hardware of an exhaust-driven turbo when an electric motor would be so much simpler? - George Hovany, Gig Harbor, WA Your description of a turbo spun by an electric motor and without the exhaust-driven hardware is actually an electric supercharger. However, electrified turbos, where an electric motor assists the exhaust-driven turbine, are the next frontier. [Extracted from the article]

54-2446 KF4850 CIP Gregory, Anthony. American surveillance: intelligence, privacy, and the Fourth Amendment. Independent Institute/Wisconsin, 2016. 263p bibl index ISBN 9780299308803 cloth, $44.95 The balance between privacy and national security [...]

The relationship between workload and situation awareness (SA) has been researched generally; however, the relationship between measures of SA and workload, SPAM and NASA TLX respectively, has not been established. This study was completed using a tactical military scenario in which two participants acted as they would standing watch on a US Navy ship. One participant, the Tactical Action Officer (TAO) had reduced speech intelligibility in some trials. The results showed that the relationship between workload and SA differed by role (TAO or CICWO) and by the speech intelligibility level. This work shows the complex relationship between workload and SA and shows the need further investigation in this area, especially in teams.

We use the GEOS‐Chem four‐dimensional variational data assimilation system to estimate emissions of carbon monoxide (CO) and nitrogen oxides (NOx) in November 2009 and July 2010. We assimilated CO retrievals from The Measurements of Pollution In The Troposphere (MOPITT), ozone (O3) retrievals from the Tropospheric Emission Spectrometer (TES) and the Optical Spectrograph and InfraRed Imager System (OSIRIS), and NO2columns from the Ozone Monitoring Instrument (OMI). By assimilating data for multiple chemical species with the four‐dimensional variational scheme we obtain a consistent chemical state over the assimilation period. The modeled O3bias was reduced to less than 3.5 ppbv everywhere, relative to independent aircraft O3data, except in the high‐latitude upper troposphere and lower stratosphere. We found that in November, the CO and NOxemission estimates obtained with the multiple species assimilation were generally comparable to those inferred from assimilating only MOPITT or OMI data, respectively, whereas in July the differences were larger. For the main anthropogenic source regions, the inferred North American and European emissions responded most strongly to the multispecies information in the assimilation. In July, North American and European CO emission estimates differed by 31% and 65% relative to the MOPITT‐only estimates, respectively. We also found large differences for the North American and European NOxemission estimates, which differed by 27% and 16% relative to the OMI‐only estimates, respectively. Our results highlight the potential benefit of exploiting the additional constraints offered by multispecies chemical data assimilation. Multispecies data assimilation provides a means of indirectly estimating tropospheric OHMultispecies DA better fits assimilated MOPITT CO, whereas OMI‐only DA better fits OMI NO2dataEuropean emission estimates are most sensitive to the multispecies information in GEOS‐Chem

Gaze supported non-tactile gestural control uses a combination of gestures based body movements with eye gaze positioning to provide an input source for a user’s control with a system. Combining body gestures with eye movements allows for unique computer control methods other than the traditional mouse. However, research is mixed on the effectiveness of emerging control types, such as gestures and eye-tracking, with some showing positive performance outcomes for one or more control aspects but performance detriments in other areas that would prohibit the use of such novel control methods. One important aspect that is often ignored is familiarity with the control method. Unlike the mouse, users are typically unfamiliar with eye and gestures based control methods. In order to truly understand the benefit of new concepts like gaze supported gestural controls, testing experienced users is necessary. In the current experiment, participants were trained on the gaze supported gestures system in order to become “experts” and achieve similar levels of proficiency with the different control methods to be assessed, to include mouse, non-gaze and gaze supported gestural controls. Results showed that after as few as five practice sessions participants were able to perform a simple point and click task as well or even better than mouse control when using gaze supported gestures.

Despite attempts to limit noise exposure, noise-induced hearing loss remains prevalent in the military. Both hearing loss and the noise itself can lead to communication issues which could negatively impact operational performance. This study builds upon a series of experiments examining the relationship between reduced speech intelligibility and performance in a naval command and control environment by equipping Navy watch standers with hearing loss simulators that control speech intelligibility in real time as they were engaged in a simulated operational scenario. This effort focused on the effects that a Sailor with impaired hearing might have on unimpaired shipmates and how the mission might specifically be impacted. Results showed that as speech intelligibility decreased for the impaired watch stander perceived workload increased in an unimpaired shipmate and the latency of the crew to respond to incoming missile threats and a direct order to kill an enemy ship increased significantly.

Der Morbus Dupuytren als benigne fibroproliferative Erkrankung mit strangartiger Verdickung der Kollagenfasern der Palmaraponeurose führt zu schwerwiegenden Funktionseinschränkungen im Bereich der Hand. Untersuchung des Stellenwertes der nichtoperativen Behandlung der Dupuytren-Kontraktur mittels injizierbarer Kollagenase Clostridium histolyticum(CCH) Beobachten von 120 Patienten, die mittels injizierbarer CCH behandelt wurden. Dokumentieren des Bewegungsumfangs präinterventionell, des Bewegungsumfangs 12 Monate postinterventionell sowie von sämtlichen unerwünschten Nebenwirkungen. Es wurde eine Kohorte von 120 Patienten (107 Männer, 13 Frauen) untersucht (durchschnittliches Lebensalter 62 Jahre, Spanne 30–84 Jahre). Es wurden zu 49 % Kleinfinger, zu 44 % Ringfinger, zu 4 % Mittelfinger und zu 3 % Zeigefinger behandelt. Es wurde in 71 % der Fälle eine komplette Stranglösung, in 26 % eine teilweise Stranglösung und in 3 % keine Veränderung erreicht. Die durchschnittliche Beugekontraktur für das Fingergrundgelenk betrug vor Behandlung 37° (Spanne 25–100°) und 51° (Spanne 30–97°) für das Fingermittelgelenk. Die durchschnittliche Beugekontraktur für das Fingergrundgelenk betrug nach 12 Monaten 9° (Spanne 0–25°) und 21° (Spanne 10–36°) für das Fingermittelgelenk. Unerwünschte Nebenwirkungen traten in den ersten 3 Monaten bei 96 % der Patienten auf. Es traten keine Beugesehnenrupturen, Nervenverletzungen oder allergische Reaktionen auf. Dupuytren’s disease as a benign fibroproliferative disease leads to hyperplasia of the collagen fibers of the fascia of the palm, which can result in severe impairment of the functionality of the hand. Examination of the significance of non-operative treatment of Dupuytren’s disease with injectable collagenase clostridium histolyticum (CCH) Observation of 120 patients treated with injectable collagenase. Documentation of the range of motion before the intervention, 12 months after the intervention, and documentation of any adverse events. All in all, 120 patients were treated (107 male, 13 female) (mean age 62 years, range 30–84 years). In 49% the little finger, in 44% the ring finger, in 4% the middle finger, and in 3% the index finger were treated. Full release was accomplished in 71%, partial release in 26%, and no change in 3% of the patients. The median contracture before the treatment was 37° for the metacarpophalangeal (MP) joint (range 25–100°) and 51° for the proximal interphalangeal (PIP) joint (range 30–97°). After 12 months, the mean contracture for the MP joint was 9° (range 0–25°) and 21° (range 10–36°) or the PIP joint. Adverse events occurred in 96% of patients within 3 months after treatment. No tendon ruptures, anaphylactic reactions, nerve, or ligament injuries were observed.

An understanding of how cells respond to perturbation is essential for biological applications; however, most approaches for profiling cellular response are limited in scope to pre-established targets. Global analysis of molecular mechanism will advance our understanding of the complex networks constituting cellular perturbation and lead to advancements in areas, such as infectious disease pathogenesis, developmental biology, pathophysiology, pharmacology, and toxicology. We have developed a high-throughput multiomics platform for comprehensive, de novo characterization of cellular mechanisms of action. Platform validation using cisplatin as a test compound demonstrates quantification of over 10 000 unique, significant molecular changes in less than 30 days. These data provide excellent coverage of known cisplatin-induced molecular changes and previously unrecognized insights into cisplatin resistance. This proof-of-principle study demonstrates the value of this platform as a resource to understand complex cellular responses in a high-throughput manner.

The complex nature of human cognition has resulted in cognitive genomics lagging behind many other fields in terms of gene discovery using genome-wide association study (GWAS) methods. In an attempt to overcome these barriers, the current study utilized GWAS meta-analysis to examine the association of common genetic variation (~8M single-nucleotide polymorphisms (SNP) with minor allele frequency ⩾1%) to general cognitive function in a sample of 35 298 healthy individuals of European ancestry across 24 cohorts in the Cognitive Genomics Consortium (COGENT). In addition, we utilized individual SNP lookups and polygenic score analyses to identify genetic overlap with other relevant neurobehavioral phenotypes. Our primary GWAS meta-analysis identified two novel SNP loci (top SNPs: rs76114856 in the CENPO gene on chromosome 2 and rs6669072 near LOC105378853 on chromosome 1) associated with cognitive performance at the genome-wide significance level (P<5 × 10−8). Gene-based analysis identified an additional three Bonferroni-corrected significant loci at chromosomes 17q21.31, 17p13.1 and 1p13.3. Altogether, common variation across the genome resulted in a conservatively estimated SNP heritability of 21.5% (s.e.=0.01%) for general cognitive function. Integration with prior GWAS of cognitive performance and educational attainment yielded several additional significant loci. Finally, we found robust polygenic correlations between cognitive performance and educational attainment, several psychiatric disorders, birth length/weight and smoking behavior, as well as a novel genetic association to the personality trait of openness. These data provide new insight into the genetics of neurocognitive function with relevance to understanding the pathophysiology of neuropsychiatric illness.

The article offers information on the changing health outlook and demographics for older adults in the U.S. Topics discussed include the reauthorization of the Older Americans Act (OAA) of 1965 in 2016, the establishement of various senior centers in the country to offer educational and recreational programs for older adults, and the income, education and employment status of older people.

This review covers various aspects of the single-electron tunneling pumps based on Al junctions studied at NIST over the past 15 years. The operation of a pump is described, and some important error mechanisms are summarized, which allows for a sketch of the basic pump parameters required for metrological accuracy. Fabrication of pumps, filtering of leads in the cryostat, and the electronics used to drive the pump are described next. The shuttle error technique that allows measurement of very rare errors is then described, and some outstanding questions about limitations of pumps based on Al junctions are mentioned. A detailed algorithm for cancelling the cross capacitance in a pump is described in an appendix.

Anxiety disorders (ADs), namely generalized AD, panic disorder and phobias, are common, etiologically complex conditions with a partially genetic basis. Despite differing on diagnostic definitions based on clinical presentation, ADs likely represent various expressions of an underlying common diathesis of abnormal regulation of basic threat–response systems. We conducted genome-wide association analyses in nine samples of European ancestry from seven large, independent studies. To identify genetic variants contributing to genetic susceptibility shared across interview-generated DSM-based ADs, we applied two phenotypic approaches: (1) comparisons between categorical AD cases and supernormal controls, and (2) quantitative phenotypic factor scores (FS) derived from a multivariate analysis combining information across the clinical phenotypes. We used logistic and linear regression, respectively, to analyze the association between these phenotypes and genome-wide single nucleotide polymorphisms. Meta-analysis for each phenotype combined results across the nine samples for over 18?000 unrelated individuals. Each meta-analysis identified a different genome-wide significant region, with the following markers showing the strongest association: for case–control contrasts, rs1709393 located in an uncharacterized non-coding RNA locus on chromosomal band 3q12.3 (P=1.65 × 10-8); for FS, rs1067327 within CAMKMTencoding the calmodulin-lysine N-methyltransferase on chromosomal band 2p21 (P=2.86 × 10-9). Independent replication and further exploration of these findings are needed to more fully understand the role of these variants in risk and expression of ADs.

Inbreeding depression refers to lower fitness among offspring of genetic relatives. This reduced fitness is caused by the inheritance of two identical chromosomal segments (autozygosity) across the genome, which may expose the effects of (partially) recessive deleterious mutations. Even among outbred populations, autozygosity can occur to varying degrees due to cryptic relatedness between parents. Using dense genome-wide single-nucleotide polymorphism (SNP) data, we examined the degree to which autozygosity associated with measured cognitive ability in an unselected sample of 4854 participants of European ancestry. We used runs of homozygosity—multiple homozygous SNPs in a row—to estimate autozygous tracts across the genome. We found that increased levels of autozygosity predicted lower general cognitive ability, and estimate a drop of 0.6 s.d. among the offspring of first cousins (P=0.003–0.02 depending on the model). This effect came predominantly from long and rare autozygous tracts, which theory predicts as more likely to be deleterious than short and common tracts. Association mapping of autozygous tracts did not reveal any specific regions that were predictive beyond chance after correcting for multiple testing genome wide. The observed effect size is consistent with studies of cognitive decline among offspring of known consanguineous relationships. These findings suggest a role for multiple recessive or partially recessive alleles in general cognitive ability, and that alleles decreasing general cognitive ability have been selected against over evolutionary time.

DNA methyltransferase 3A (DNMT3A) mutations are observed in myeloid malignancies, including myeloproliferative neoplasms (MPN), myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Transplantation studies have elucidated an important role for Dnmt3ain stem cell self-renewal and in myeloid differentiation. Here, we investigated the impact of conditional hematopoietic Dnmt3aloss on disease phenotype in primary mice. Mx1-Cre-mediated Dnmt3aablation led to the development of a lethal, fully penetrant MPN with myelodysplasia (MDS/MPN) characterized by peripheral cytopenias and by marked, progressive hepatomegaly. We detected expanded stem/progenitor populations in the liver of Dnmt3a-ablated mice. The MDS/MPN induced by Dnmt3aablation was transplantable, including the marked hepatomegaly. Homing studies showed that Dnmt3a-deleted bone marrow cells preferentially migrated to the liver. Gene expression and DNA methylation analyses of progenitor cell populations identified differential regulation of hematopoietic regulatory pathways, including fetal liver hematopoiesis transcriptional programs. These data demonstrate that Dnmt3aablation in the hematopoietic system leads to myeloid transformation in vivo, with cell-autonomous aberrant tissue tropism and marked extramedullary hematopoiesis (EMH) with liver involvement. Hence, in addition to the established role of Dnmt3ain regulating self-renewal, Dnmt3aregulates tissue tropism and limits myeloid progenitor expansion in vivo.

The detection of variations of fundamental constants of the Standard Model would provide us with compelling evidence of new physics, and could lift the veil on the nature of dark matter and dark energy. In this work, we discuss how a network of atomic and molecular clocks can be used to look for such variations with unprecedented sensitivity over a wide range of time scales. This is precisely the goal of the recently launched QSNET project: A network of clocks for measuring the stability of fundamental constants. QSNET will include state-of-the-art atomic clocks, but will also develop next-generation molecular and highly charged ion clocks with enhanced sensitivity to variations of fundamental constants. We describe the technological and scientific aims of QSNET and evaluate its expected performance. We show that in the range of parameters probed by QSNET, either we will discover new physics, or we will impose new constraints on violations of fundamental symmetries and a range of theories beyond the Standard Model, including dark matter and dark energy models.

To investigate the role of donor‐specific indirect pathway T cells in renal transplant tolerance, we analyzed responses in peripheral blood of 45 patients using the trans‐vivodelayed‐type hypersensitivity assay. Subjects were enrolled into five groups—identical twin, clinically tolerant (TOL), steroid monotherapy (MONO), standard immunosuppression (SI) and chronic rejection (CR)—based on transplant type, posttransplant immunosuppression and graft function. The indirect pathway was active in all groups except twins but distinct intergroup differences were evident, corresponding to clinical status. The antidonor indirect pathway T effector response increased across patient groups (TOL < MONO < SI < CR; p < 0.0001) whereas antidonor indirect pathway T regulatory response decreased (TOL > MONO = SI > CR; p < 0.005). This pattern differed from that seen in circulating naïve B‐cell numbers and in a cross‐platform biomarker analysis, where patients on monotherapy were not ranked closest to TOL patients, but rather were indistinguishable from chronically rejecting patients. Cross‐sectional analysis of the indirect pathway revealed a spectrum in T‐regulatory:T‐effector balance, ranging from TOL patients having predominantly regulatory responses to CR patients having predominantly effector responses. Therefore, the indirect pathway measurements reflect a distinct aspect of tolerance from the recently reported elevation of circulating naïve B cells, which was apparent only in recipients off immunosuppression.

Recent research has indicated that operators may utilize the system-wide trust strategy when presented with two automation aids of unknown reliability (Keller, Bean, & Rice, 2009; Keller & Rice, 2010; Keller & Rice, 2009). This is undesirable as operators may under-utilize reliable aids when they are paired with unreliable aids. Two variables derived from Gestalt psychology’s law of similarity were employed in an attempt to overcome this effect: gauge shape congruence and operator knowledge of the aids’ reliability. Results indicated that altering the gauge shapes had no effect on operator performance. However, providing aid reliability information to the operator did have a positive effect on operator performance. More specifically, operators reacted to alarms more quickly and reduced their false alarm rates; however, they did not improve their hit rates. Future work should be conducted to assess more fully the role of aid reliability information and Gestalt psychology as they relate to the system-wide trust strategy.

Obliterative bronchiolitis (OB) is the key impediment to the long‐term survival of lung transplant recipients and the lack of a robust preclinical model precludes examining OB immunopathogenesis. In the current study, lungs from C57BL/10 H‐2bmice that are MHC compatible, but minor histocompatability antigen incompatible, were transplanted into C57BL/6 mice. Histological features and cytokine profiles of OB were assessed. Moderate rejection (grade A3) developed by day 14, with evidence of OB at that time point. At 21 days, OB was present in 55% of grafts and moderate to severe rejection (grade A3‐A4) was present in all mice. At 28 days, OB was present in 44% of mice and severe rejection (grade A4) was present in all. IL‐17A, but not IL‐17F, splenic mRNA transcripts and serum protein levels were increased only in mice that developed OB, whereas IL‐10 transcripts and protein were increased only in non‐OB mice. Neutralizing IL‐17 prevented OB, down regulated acute rejection, and upregulated systemic IL‐10. Collectively, these data show that transplantation of minor histoincompatible lungs from C57BL/10 mice into C57BL/6 mice results in a highly reproducible preclinical model of OB. In addition, these data indicate that neutralizing IL‐17A or augmenting IL‐10 could be therapeutic interventions to prevent OB.

Introduction: Esophagectomy with reconstruction by collar anastomosis has an impact on the patients' quality of life (QOL). The aim of this study was to explore a potential difference in QOL between elective and emergency esophagectomy with collar reconstruction.Patients and Methods: Quality of life questionnaires were evaluated in 17 patients prior to esophagectomy, shortly after surgery, hospital discharge, and at least > 9 months after surgery using the EORTC QLQ C30 and EORTC OES 18 forms. In all patients reconstruction was performed by high collar anastomosis. Patients in group A received elective esophageal resection. In group B emergency esophagectomy was performed because of esophageal perforation for various reasons apart from cancer. In this group, delayed reconstruction was performed in a second operation 3–6 months after esophagectomy.Results: There was a temporary decrease of postoperative QOL in both groups, which returned to preoperative values in the follow-up except for physical functioning, which remained decreased in group A (p < 0,05). There were no persisting differences in QOL after elective and emergency esophagectomy in the follow-up.Discussion: Patients with elective and emergency esophagectomy and reconstruction by high collar anastomosis gained a good long-term QOL in our cohort of patients. This gives evidence that the observed QOL after elective resection of esophageal cancer is not only caused by a relief of cancer burden, but also due to a surgical procedure which is able to provide a good long-term QOL.

DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a rare drug hypersensitivity reaction with a significant mortality. We describe a 60-year-old man with polyarthritis treated with sulfasalazine who developed DRESS and fulminant liver failure after additional vancomycin treatment. Liver histology revealed infiltration of granzymeB CD3 lymphocytes in close proximity to apoptotic hepatocytes. After a superurgent liver transplantation and initial recovery, the patient developed recurrent generalized exanthema and eosinophilia, but only moderate hepatitis. Histology showed infiltration of FasL lymphocytes and eosinophils in the transplanted liver. Treatment with high-dose methylprednisolone was unsuccessful. Postmortem examination revealed extensive necrosis of the liver transplant. This case report illustrates that patients with DRESS may develop fulminant liver failure and that DRESS recurrence can recur in the transplanted liver. Histological and immunological investigations suggest an important role of granzymeB and FasL mediated cell death in DRESS associated hepatitis.

ABSTRACTThe goals of this study were to optimize processing methods of cryopreserved peripheral blood mononuclear cells (PBMC) for immunological assays, identify acceptance parameters for the use of cryopreserved PBMC for functional and phenotypic assays, and to define limitations of the information obtainable with cryopreserved PBMC. Blood samples from 104 volunteers (49 human immunodeficiency virus-infected and 55 uninfected) were used to assess lymphocyte proliferation in response to tetanus, candida, and pokeweed-mitogen stimulation and to enumerate CD4+and CD8+T cells and T-cell subpopulations by flow cytometry. We determined that slowly diluting the thawed PBMC significantly improved viable cell recovery, whereas the use of benzonase improved cell recovery only sometimes. Cell storage in liquid nitrogen for up to 15 months did not affect cell viability, recovery, or the results of lymphocyte proliferation assays (LPA) and flow cytometry assays. Storage at -70°C for =3 weeks versus storage in liquid nitrogen before shipment on dry ice did not affect cell viability, recovery, or flow cytometric results. Storage at -70°C was associated with slightly higher LPA results with pokeweed-mitogen but not with microbial antigens. Cell viability of 75% was the acceptance parameter for LPA. No other acceptance parameters were found for LPA or flow cytometry assay results for cryopreserved PBMC. Under optimized conditions, LPA and flow cytometry assay results for cryopreserved and fresh PBMC were highly correlated, with the exception of phenotypic assays that used CD45RO or CD62L markers, which seemed labile to freezing and thawing.

With improved survival in the antiretroviral era, data from ongoing studies suggest that HIV patients can be safely transplanted. The disproportionate burden of HIV-related end-stage renal disease in minority populations may impose additional obstacles to successful completion of the transplant evaluation. We retrospectively reviewed 309 potentially eligible HIV patients evaluated for kidney transplant at our institution since 2000. Only 20% of HIV patients have been listed, compared to 73% of HIV-negative patients evaluated over the same period (p < 0.00001). Failure to provide documentation of CD4 and viral load (36% of candidates) was the most common reason for failure to progress beyond initial evaluation. Other factors independently associated with failure to complete the evaluation included CD4 < 200 at initial evaluation (OR 15.17; 95% CI 1.94–118.83), black race (OR 2.33; 95% CI 1.07–5.06), and history of drug use (OR 2.56; 95% CI 1.22–5.37). More efficient medical record sharing and an awareness of factors associated with failure to list HIV-positive transplant candidates may enable transplant centers to more effectively advocate for these patients

Improvements in human immunodeficiency virus (HIV)‐associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9–4.9). One‐ and 3‐year liver recipients’ survival was 91% and 64%, respectively; kidney recipients’ survival was 94%. One‐ and 3‐year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999–2004 transplants in the national database. CD4+ T‐cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1‐ and 3‐year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28–75%) and 70% (48–92%), respectively. Two‐thirds of hepatitis C virus (HCV)‐infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV‐related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV‐infected patients cared for at centers with adequate expertise.