Infectious Complications in Lung Transplant Recipients.

Lung transplantation is a lifesaving intervention for patients with advanced lung disease. Due to a combination of immunosuppression, continuous exposure of the lungs to the environment, and complications at the anastomotic sites, lung transplant recipients are at high risk for infectious complications. The aim of this review is to summarize recent developments in the field of infectious diseases as it pertains to lung transplant recipients.

Inter- and intra-observer variability of radial-endobronchial ultrasound image interpretation for peripheral pulmonary lesions.

Background: Radial probe endobronchial ultrasound (R-EBUS) is often utilized in guided bronchoscopy for the diagnosis of peripheral pulmonary lesions. R-EBUS probe positioning has been shown to correlate with diagnostic yield, but overall diagnostic yield with this technology has been inconsistent across the published literature. Currently there is no standardization for R-EBUS image interpretation, which may result in variability in grading concentricity of lesions and subsequently procedure performance. This was a survey-based study evaluating variability among practicing pulmonologists in R-EBUS image interpretation. Methods: R-EBUS images from peripheral bronchoscopy cases were sent to 10 practicing Interventional Pulmonologists at two different time points (baseline and 3 months). Participants were asked to grade the images as concentric, eccentric, or no image. Cohen's Kappa-coefficient was calculated for inter- and intra-observer variability. Results: A total of 100 R-EBUS images were included in the survey. There was 100% participation with complete survey responses from all 10 participants. Overall kappa-statistic for inter-observer variability for Survey 1 and 2 was 0.496 and 0.477 respectively. Overall kappa-statistic for intra-observer variability between the two surveys was 0.803. Conclusions: There is significant variability between pulmonologists when characterizing R-EBUS images. However, there is strong intra-rater agreement from each participant between surveys. A standardized approach and grading system for radial EBUS patterns may improve inter-observer variability in order to optimize our clinical use and research efforts in the field.

Computer-assisted surgery patterns of ligamentous deformity of the knee: a clinical and cadaveric study.

Knee malalignment during total knee arthroplasty (TKA) is commonly classified as either varus or valgus on the basis of a standing anteroposterior radiograph. Computer-assisted surgery (CAS) navigation TKA provides precise dynamic evaluation of knee alignment throughout the full range of motion (FROM). The goal of this study was to classify patterns of CAS-generated knee deformity curves that match specific soft tissue contracture combinations. This can then be applied as an algorithm for soft tissue balancing on the basis of the preoperative knee deformity curve. Computer navigation-generated graphs from 65 consecutive TKA procedures performed by a single surgeon were analyzed. A stress-strain curve of the coronal alignment of the knee was recorded throughout FROM before bony resection. All graphs were classified into groups according to their pattern. Cadaveric knee models were then used to test the correlation between isolated and combined ligamentous contractures and identified CAS deformity curves. An analysis of the intraoperative knee alignment graphs revealed four distinct patterns of coronal deformity on the basis of intraoperative data: 13% diagonal, 18.5% C-shaped, 43.5% comma shaped, and 25% S-shaped. Each represents the change in varus and valgus alignment during FROM. All patterns were reproduced with cadaveric knees by recreating specific contracture constellations. A tight posterior capsule gave an S-shaped curve, a tight lateral collateral ligament gave a C-shaped curve, tight medial collateral ligament gave a diagonal curve, and a tight posterior lateral corner gave a comma-shaped curve. Release of the specific contractures resulted in correction of all patterns of deformity as measured by CAS. We propose a new classification system for coronal plane knee deformity throughout FROM. This system intends to match individual and combined soft tissue pathological contractures to specific stress-strain curves obtained through routine knee CAS preparation. This classification system may provide surgeons with a general guide for soft tissue balancing during computer-navigated TKA.

Validation of translated Obstetric Quality of Recovery (ObsQoR-10A) score after nonelective cesarean delivery (CD) in an Arabic-speaking population.

Background: The ObsQoR-11 is a validated scale that assesses recovery after cesarean delivery (CD). This observational study aimed to evaluate the psychometric properties of its Arabic version. Methods: The original ObsQoR-11 was translated into an Arabic version (ObsQoR-10A). All participants completed the ObsQoR-10A at 24 h and 48 h postoperatively after CD. Validity, reliability, responsiveness, and feasibility were assessed. Results: The ObsQoR-10A correlated with Global Health Numerical Rating Scale (NRS) at 24 h (R = 0.68, 95% CI: 0.56-0.80, P < 0.001) and at 48 h (R = 0.66, 95% CI: 0.54-0.78, P < 0.001) and differentiated between good and poor recovery (median scores at 24 h 88 vs. 71, P < 0.001; at 48 h 95.5 vs. 70, P < 0.001). ObsQoR-10A correlated with hospital length of stay at 24 h (R = -0.21, 95% CI: -0.40 to -0.02, P = 0.03) and at 48 h (R = -0.21, 95% CI: -0.40 to -0.03, P = 0.02); gestational age at 24 h (R = 0.22, 95% CI: 0.03-0.40, P = 0.02); change in hemoglobin at 24 h (R = -0.30, 95% CI: 0.51 to -0.10, P < 0.01); and total opioids at 48 h (R = -0.45, 95% CI: -0.62 to -0.27, P < 0.001). There was a significant difference between 24 h and 48 h postoperative ObsQoR-10A scores (median difference: -18; P < 0.001 which shows responsiveness). Other key measures included a Cronbach's alpha of 0.87, split-half 0.75, and intra-class correlation >0.62 with no floor or ceiling effects. Median (IQR) completion time was 3 (3-5) and 3 (2.5-3.5) minutes at 24 h and 48 h. Conclusions: ObsQoR-10A is a valid, reliable, responsive, and a clinically feasible tool in an Arabic-speaking obstetric population.

Lung ultrasonography in end-stage renal disease: moving from evidence to practice-a narrative review.

Traditionally, point of care ultrasonography in nephrology has been used for renal biopsies and dialysis line placement. However, there is an emerging literature supporting the value of point of care lung ultrasonography in the assessment of volume status for dialysis patients. We conducted a review and identified 12 studies that examined the utility of lung ultrasonography in assessing volume status in patients with end-stage renal disease. We conclude that lung ultrasonography can be used to determine volume status in chronic dialysis patients by identifying lung congestion using the B-line score. Incorporating this technique into practice may have significant diagnostic and prognostic value for this high-risk population, as it provides the nephrologist with a useful bedside technique to assess extravascular lung water. Developing competence in lung ultrasonography is straightforward. The nephrology community should consider adding this useful tool into fellowship training, paralleling its broader use in other internal medicine specialties.

Role of Drosophila gene dunc-115 in nervous system.

Axonal guidance signals are transduced through growth cone surface receptors to the interior leading to changes of actin dynamics and actin binding proteins, which are critical in determining the outcome of actin cytoskeleton reorganization. We report here the characterization of the Drosophila actin binding protein abLIM/Unc-115 homolog Dunc-115 and its role in the nervous system. Three Dunc-115 isoforms are identified as Dunc-115L, M and S, respectively. While Dunc-115L is a canonical homolog of Unc-115 with four LIM domains and one villin headpiece domain, Dunc-115M and S are novel isoforms without counterparts in other species. Our molecular modeling shows Dunc-115L is likely to bind to actin. Mutant analysis reveals that Dunc-115 is involved in axonal projection in both the visual and central nervous system.

A Randomized, Controlled Trial of Levonorgestrel Vs. The Yuzpe Regimen as Emergency Contraception Method among Iranian Women.

BACKGROUND: We aimed to compare acceptability of Levonorgestrel with the Yuzpe regimen among Iranian women based on their side-effects and resulting changes in the amount and pattern of menses. METHODS: Five hundred twenty nine participants aged 15-49 having regular menses and one act of unprotected intercourse within 72 h were included in the double-blind, controlled trial in 2006-2007 and randomly assigned into LNG (n=263) and HD (n=266) groups, receiving Levonorgestrel 0.75 mg given 12 h apart and ethinyl estradiol 100 µg plus 0.5 mg Levonorgestrel 0.5 mg repeated after 12 h, respectively. RESULTS: The participants receiving Levonorgestrel experienced significantly lower side-effects in the case of nausea, vomiting, and dizziness (P<0.05). The changes occurred in the amount and pattern of menses were the same for both groups (P>0.05). No significant difference was observed between the efficiencies of the treatments. CONCLUSION: Significantly lower side-effects of Levonorgestrel can be considered as greater acceptability and translated to higher efficiency.