Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population

OBJECTIVES: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING: A large quaternary free-standing children's hospital. PATIENTS: One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS: In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients

Low-energy effective representation of the Gutzwiller-projected BCS Hamiltonian close to half filling

We investigate analytically a connection between the t-J model and the strongly correlated Bardeen-Cooper-Schrieffer (BCS) Hamiltonian, with the effect of strong electron correlations accounted by the Gutzwiller projection. We show that in the immediate vicinity of half filling the projected 2D BCS Hamiltonian with strong pairing develops an antiferromagnetically (AF) ordered ground state. This result explicitly demonstrates that antiferromagnetism in this model appears as a natural consequence of the strong Coulomb repulsion in a low doped regime. At moderate doping the ground state of the Gutzwiller-projected BCS Hamiltonian becomes qualitatively similar to Anderson's resonating valence bond state which is known to fit nicely the properties of the t-J model in this regime. These two properties taken together indicate that the projected BCS Hamiltonian captures the essential low-energy physics of the t-J model in the whole underdoped region

Doped carrier formulation of the t-J model: the projection constraint and the effective Kondo-Heisenberg lattice representation

We show that the recently proposed doped carrier Hamiltonian formulation of the t-J model should be complemented with the constraint that projects out the unphysical states. With this new important ingredient, the previously used and seemingly different spin-fermion representations of the t-J model are shown to be gauge related to each other. This new constraint can be treated in a controlled way close to half-filling suggesting that the doped carrier representation provides an appropriate theoretical framework to address the t-J model in this region. This constraint also suggests that the t-J model can be mapped onto a Kondo-Heisenberg lattice model. Such a mapping highlights important physical similarities between the quasi two-dimensional heavy fermions and the high-T$_c$ superconductors. Finally we discuss the physical implications of our model representation relating in particular the small versus large Fermi surface crossover to the closure of the lattice spin gap.Comment: corrected and enlarged versio

Transient receptor potential melastatin 7 cation channel kinase new player in angiotensin II–induced hypertension

Transient receptor potential melastatin 7 (TRPM7) is a bifunctional protein comprising a magnesium (Mg2+)/cation channel and a kinase domain. We previously demonstrated that vasoactive agents regulate vascular TRPM7. Whether TRPM7 plays a role in the pathophysiology of hypertension and associated cardiovascular dysfunction is unknown. We studied TRPM7 kinase–deficient mice (TRPM7Δkinase; heterozygous for TRPM7 kinase) and wild-type (WT) mice infused with angiotensin II (Ang II; 400 ng/kg per minute, 4 weeks). TRPM7 kinase expression was lower in heart and aorta from TRPM7Δkinase versus WT mice, effects that were further reduced by Ang II infusion. Plasma Mg2+ was lower in TRPM7Δkinase versus WT mice in basal and stimulated conditions. Ang II increased blood pressure in both strains with exaggerated responses in TRPM7Δkinase versus WT groups (P&lt;0.05). Acetylcholine-induced vasorelaxation was reduced in Ang II–infused TRPM7Δkinase mice, an effect associated with Akt and endothelial nitric oxide synthase downregulation. Vascular cell adhesion molecule–1 expression was increased in Ang II–infused TRPM7 kinase–deficient mice. TRPM7 kinase targets, calpain, and annexin-1, were activated by Ang II in WT but not in TRPM7Δkinase mice. Echocardiographic and histopathologic analysis demonstrated cardiac hypertrophy and left ventricular dysfunction in Ang II–treated groups. In TRPM7 kinase–deficient mice, Ang II–induced cardiac functional and structural effects were amplified compared with WT counterparts. Our data demonstrate that in TRPM7Δkinase mice, Ang II–induced hypertension is exaggerated, cardiac remodeling and left ventricular dysfunction are amplified, and endothelial function is impaired. These processes are associated with hypomagnesemia, blunted TRPM7 kinase expression/signaling, endothelial nitric oxide synthase downregulation, and proinflammatory vascular responses. Our findings identify TRPM7 kinase as a novel player in Ang II–induced hypertension and associated vascular and target organ damage

T Cell Migration from Inflamed Skin to Draining Lymph Nodes Requires Intralymphatic Crawling Supported by ICAM-1/LFA-1 Interactions.

T cells are the most abundant cell type found in afferent lymph, but their migration through lymphatic vessels (LVs) remains poorly understood. Performing intravital microscopy in the murine skin, we imaged T cell migration through afferent LVs in vivo. T cells entered into and actively migrated within lymphatic capillaries but were passively transported in contractile collecting vessels. Intralymphatic T cell number and motility were increased during contact-hypersensitivity-induced inflammation and dependent on ICAM-1/LFA-1 interactions. In vitro, blockade of endothelial cell-expressed ICAM-1 reduced T cell adhesion, crawling, and transmigration across lymphatic endothelium and decreased T cell advancement from capillaries into lymphatic collectors in skin explants. In vivo, T cell migration to draining lymph nodes was significantly reduced upon ICAM-1 or LFA-1 blockade. Our findings indicate that T cell migration through LVs occurs in distinct steps and reveal a key role for ICAM-1/LFA-1 interactions in this process

Evaluation of Microencapsulation of The UFV-AREG1 Bacteriophage in Alginate-Ca Microcapsules using Microfluidic Devices

The indiscriminate use of antibiotics and the emergence of resistant microorganisms have become a major challenge for the food industry. The purpose of this work was to microencapsulate the bacteriophage UFV-AREG1 in a calcium alginate matrix using microfluidic devices and to study the viability and efficiency of retention. The microcapsules were added to gel of propylene glycol for use as an antimicrobial in the food industry. The technique showed the number of the phage encapsulation, yielding drops with an average 100-250 $\mu$m of diameter, 82.1 $\pm$ 2% retention efficiency and stability in the gel matrix for 21 days. The gel added to the microencapsulated phage showed efficiency (not detectable on the surface) in reducing bacterial contamination on the surface at a similar level to antimicrobial chemicals (alcohol 70%). Therefore, it was possible to microencapsulate bacteriophages in alginate-Ca and apply the microcapsules in gels for use as sanitizers in the food industry.Comment: 8 pages, 5 figure

Affine T-varieties of complexity one and locally nilpotent derivations

Let X=spec A be a normal affine variety over an algebraically closed field k of characteristic 0 endowed with an effective action of a torus T of dimension n. Let also D be a homogeneous locally nilpotent derivation on the normal affine Z^n-graded domain A, so that D generates a k_+-action on X that is normalized by the T-action. We provide a complete classification of pairs (X,D) in two cases: for toric varieties (n=\dim X) and in the case where n=\dim X-1. This generalizes previously known results for surfaces due to Flenner and Zaidenberg. As an application we compute the homogeneous Makar-Limanov invariant of such varieties. In particular we exhibit a family of non-rational varieties with trivial Makar-Limanov invariant.Comment: 31 pages. Minor changes in the structure. Fixed some typo

Educazione terapeutica ai malati oncologici: esperienza degli infermieri italiani

Introduction. Therapeutic patient’ education is a complex process requiring a proper level of communication between the patient and the healthcare professional. Nurses play a key role in providing the patients and their families with educational activities. Objective: This paper is the report of a study which investigates the experiences of some Italian nurses with regards to their role in therapeutic education to cancer patients. Methods: Qualitative research. Semi-structured interviews were carried out with 52 nurses working in different Local Health Service Units of two northern Italy regions: Piedmont and Valle d’Aosta. To identify categories and items arising from the data, the researchers used a qualitative content analysis. Results: The interview format was classified into six main categories: a) Patient education as daily care activity; b) Relevance of communication and dialogue for educational purposes; c) Relative usefulness of written information; d) Therapeutic education recording; e) Patients’ feedbacks as a tool for assessing therapeutic education; and f) Difficult communication. Conclusions: The experience of nurses in terms of their professional role in therapeutic education for cancer patients shows the steady presence of educational activities carried out in a non-planned way. This research confirms the need to launch educational interventions for nurses. Implications for Practice: It is essential to implement an action plan to promote opportunities of professional training in the field since among the most frequent reasons for project failure in therapeutic education is the lack of expert human resource