An atypical autistic phenotype associated with a 2q13 microdeletion: a case report

Autism spectrum disorders are serious neurodevelopmental disorders that affect approximately 1% of the population. These disorders are substantially influenced by genetics. Several recent linkage analyses have...

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Severe abdominal pain and diarrhea – unusual multiple myeloma presentation with a severe prognosis: a case report

Multiple myeloma is a hematologic disease with high mortality rates all over the world. The diagnosis has always been challenging since the first case was reported in 1844. For that reason the diagnostic crite...

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Comparing Simultaneous Liver-Kidney Transplant Strategies: A Modified Cost-Effectiveness Analysis

Background The proportion of patients with kidney failure at time of liver transplantation is at an historic high in the United States. The optimal timing of kidney transplantation with respect to the liver transplant is unknown. Methods We used a modified cost-effectiveness analysis to compare four strategies: the old system ("pre-OPTN"), the new Organ Procurement Transplant Network (OPTN) system since August 10, 2017 ("OPTN"), and two strategies which restrict simultaneous liver-kidney transplants ("safety net" and "stringent"). We measured "cost" by deployment of deceased donor kidneys (DDKs) to liver transplant recipients and effectiveness by life years (LYs) and quality-adjusted life years (QALYs) in liver transplant recipients. We validated our model against Scientific Registry for Transplant Recipients data. Results The OPTN, safety net and stringent strategies were on the efficient frontier. By rank order, OPTN > safety net > stringent strategy in terms of LY, QALY and DDK deployment. The pre-OPTN system was dominated, or outperformed, by all alternative strategies. The incremental LY per DDK between the strategies ranged from 1.30 to 1.85. The incremental QALY per DDK ranged from 1.11 to 2.03. Conclusion These estimates quantify the "organ"-effectiveness of various kidney allocation strategies for liver transplant candidates. The OPTN system will likely deliver better liver transplant outcomes at the expense of more frequent deployment of DDKs to liver transplant recipients. Corresponding Authors: Jane C. Tan, 750 Welch Rd, Suite 200, MC 5785, Palo Alto CA 94304, 650-725-9891. janetan@stanford.edu; W. Ray Kim, 300 Pasteur Drive, Always M211, Stanford CA 94305, 650-725-6511. wrkim@stanford.edu Authorship: X.S.C.: Research design, data acquisition, data analysis, results interpretation, paper writing. W.R.K.: Research design, results interpretation, paper writing. J.C.T.: Research design, data acquisition, results interpretation, paper writing. G.M.C.: Research design, results interpretation, paper writing. J.G.: Research design, data analysis, results interpretation, paper writing. The authors declare no conflict of interest. Research reported here was supported by the John M. Sobrato Gift Fund (J.C.T.) and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K24DK092336 (W.R.K.) and K24 DK085446 (G.M.C.). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Real-Time Ultrasound-Assisted Thoracic Epidural Placement: A Feasibility Study of a Novel Technique

The placement of thoracic epidural catheters is complicated by the layering of the vertebral lamina. Therefore, traditional blind palpation techniques require insertion of an epidural needle with likely contact of lamina with redirections into the epidural space. We discuss a safe and consistent technique using true real-time ultrasound visualization of the needle with a paramedian sagittal oblique view to improve the consistency of placing an epidural in the thoracic spine for postoperative analgesia. Successful epidural placement was achieved in every patient. All catheters were found to be effective for use in the postoperative phase. Accepted for publication November 20, 2017. Address correspondence to: Amitabh Gulati, MD, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (e-mail: gulatia@mskcc.org). The authors have no sources of funding to declare for this article. This work was presented in part as an abstract at the American Society of Regional Anesthesia and Pain Medicine's 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting; April 6 to 8, 2017; San Francisco, CA. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Editorial Board

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Ion homeostasis and ion channels in NLRP3 inflammasome activation and regulation

Iva Hafner-Bratkovic | Pablo Pelegrín

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Immune-based identification of cancer patients at high risk of progression

Yann-Alexandre Vano | Florent Petitprez | Nicolas A Giraldo | Wolf H Fridman | Catherine Sautès-Fridman

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