Heart-liver-kidney transplantation for AL amyloidosis using normothermic recovery and storage from a donor following circulatory death: Short-term outcome in a first-in-world experience.

AL amyloidosis is a rare condition characterized by the overproduction of an unstable free light chain, protein misfolding and aggregation, and extracellular deposition that can progress to multiorgan involvement and failure. To our knowledge, this is the first worldwide report to describe triple organ transplantation for AL amyloidosis and triple organ transplantation using thoracoabdominal normothermic regional perfusion recovery with a donation from a circulatory death (DCD) donor. The recipient was a 40-year-old man with multiorgan AL amyloidosis with a terminal prognosis without multiorgan transplantation.

Intravenous acetaminophen associated with acute liver failure.

A woman in her mid-60s, without known liver disease, was admitted to the hospital with a partial malignant colonic obstruction. Over a 6-day course, she received a total of 13 g of intravenous acetaminophen not exceeding 4 g over a 24-hour period. She developed encephalopathy and an international normalised ratio of 6.

Heart failure associated with ustekinumab therapy for treatment of Crohn's Disease.

A man in his 60s with penetrating ileocolonic Crohn's disease (CD), recently started on ustekinumab therapy, presented with new onset dyspnoea, paroxysmal nocturnal dyspnoea and dependent oedema. He was diagnosed with heart failure (HF) 10 months after starting ustekinumab therapy. His symptoms resolved with discontinuation of ustekinumab and he had recovery of his cardiac function.

Selective Androgen Receptor Modulator-Induced Liver Injury in Active Duty Male.

Selective androgenic receptor modulators (SARMs) are extensively advertised as safer and more effective analogues to traditional androgenic anabolic steroids, yet there are increasing cases of hepatotoxicity secondary to their use. We present the case of a previously healthy young active duty Marine who presented with cholestatic liver injury secondary to SARM use. This is the first reported case in a service member and contributes to the growing amount of evidence regarding the potential detrimental effects of SARMs.

June: open-source individual-based epidemiology simulation.

We introduce June, an open-source framework for the detailed simulation of epidemics on the basis of social interactions in a virtual population constructed from geographically granular census data, reflecting age, sex, ethnicity and socio-economic indicators. Interactions between individuals are modelled in groups of various sizes and properties, such as households, schools and workplaces, and other social activities using social mixing matrices. June provides a suite of flexible parametrizations that describe infectious diseases, how they are transmitted and affect contaminated individuals.

Volume Resuscitation and Progression to Organ Failure in Shiga Toxin-Producing Infection in Adults.

Unlabelled: Shiga toxin-producing infection is associated with dysentery and the hemolytic uremic syndrome, marked by the triad of microangiopathic hemolytic anemia, acute kidney failure, and thrombocytopenia. Descriptions of Shiga toxin-producing outbreaks causing hemolytic uremic syndrome in adults are sparse, and management strategies are largely adapted from pediatric literature where aggressive fluid administration is recommended. However, these may not be ideal for adults.

Reevaluating Goals of Therapy in Primary Biliary Cholangitis: Is Good Enough Is Not Good Enough Anymore?

Primary biliary cholangitis (PBC) is an autoimmune-mediated inflammatory cholestatic liver disease, which can progress to cirrhosis. This issue of The American Journal of Gastroenterology features the results of the GLOBAL PBC Study Group evaluating patients with PBC over a 10-year period. Although biochemical response was evaluated in previous studies, this study showed that bilirubin levels ≤0.

Mass-Discrepancy Acceleration Relation: A Natural Outcome of Galaxy Formation in Cold Dark Matter Halos.

We analyze the total and baryonic acceleration profiles of a set of well-resolved galaxies identified in the eagle suite of hydrodynamic simulations. Our runs start from the same initial conditions but adopt different prescriptions for unresolved stellar and active galactic nuclei feedback, resulting in diverse populations of galaxies by the present day. Some of them reproduce observed galaxy scaling relations, while others do not.

The Association between Sexually Transmitted Infections, Length of Service and Other Demographic Factors in the U.S. Military.

Background: Numerous studies have found higher rates of sexually transmitted infections (STIs) among military personnel than the general population, but the cumulative risk of acquiring STIs throughout an individual's military career has not been described.

Methods: Using ICD-9 diagnosis codes, we analyzed the medical records of 100,005 individuals from all service branches, divided in equal cohorts (n = 6,667) between 1997 and 2011. As women receive frequent STI screening compared to men, these groups were analyzed separately.

Is delayed operative treatment worth the trouble with perforated appendicitis is children?

Background: Approximately 30% to 50% of appendicitis in children is already perforated at presentation. The optimal management of these children remains controversial.

Methods: Ninety-six children (aged 2 to 16 years) were treated for perforated appendicitis.

The impact of surgery on infants born at extremely low birth weight.

Purpose: The aim of this study was to determine the outcome of extremely low-birth-weight infants (ELBW) requiring surgical interventions for the complications of prematurity

Methods: One hundred eighty-seven consecutive infants with a birth weight less than 1,000 g treated over a 5-year period were reviewed. Outcome variables included number and types of surgical procedures; length of stay; survival rate and; pulmonary, neurologic, and gastrointestinal morbidity.

Results: Surgical interventions were required in 66 (35%) infants (group S) weighing less than 1,000 g at birth (33% necrotizing enterocolitis/bowel perforation, 36% patent ductus arteriosus, 56% other).