BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary compl...BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 years.METHODS Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 years.After excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both groups.RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation failure.The incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both groups.There were no significant differences in the patient and graft survival between the groups.Moreover,only three deaths were attributed to BC.While female donors were protective factors for BC,donor cardiac arrest was a risk factor.CONCLUSION The incidence of BC was relatively low on using liver grafts>70 years.It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.展开更多
BACKGROUND Although the availability of related living donors(LDs)provides a better chance for receiving kidney transplantation(KT),the evaluation protocols for LD selection remain a safeguard for the LD’s safety.The...BACKGROUND Although the availability of related living donors(LDs)provides a better chance for receiving kidney transplantation(KT),the evaluation protocols for LD selection remain a safeguard for the LD’s safety.These protocols are variable from one center to another,resulting in variable rates of decline of the potential LDs(PLDs).The decline of willing PLDs may occur at any stage of evaluation,starting from the initial contact and counseling to the day of operation.AIM To identify the causes of the decline of PLDs,the predictors of PLD candidacy,and the effect on achieving LDKT.METHODS A retrospective study was performed on the willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022.The variables influencing their candidacy rate and the fate of their potential recipients were studied.Two groups of PLDs were compared:Candidate PLDs after a completed evaluation vs non-candidate PLDs with a complete or incomplete evaluation.A multivariate logistic regression was performed to assess the factors contributing to the achievement of PLD candidacy.RESULTS Of 321 willing PLDs,257 PLDs(80.1%)accessed the evaluation to variable extents for 212 potential recipients,with a mean age(range)of 40.5±10.4(18-65)years,including 169 females(65.8%).The remaining 64 PLDs(19.9%)did not access the evaluation.Only 58 PLDs(18.1%)succeeded in donating,but 199 PDLs(62.0%)were declined;exclusion occurred in 144 PLDs(56.0%)for immunological causes(37.5%),medical causes(54.9%),combined causes(9.7%),and financial causes(2.1%).Regression and release occurred in 55 PLDs(17.1%).The potential recipients with candidate PLDs were not significantly different from those with non-candidate PLDs,except in age(P=0.041),rates of completed evaluation,and exclusion of PLDs(P<0.001).There were no factors that independently influenced the rate of PLD candidacy.Most patients who failed to have KT after the decline of their PLDs remained on hemodialysis for 6 mo to 6 years.CONCLUSION The rate of decline of willing related PLDs was high due to medical or immunological contraindications,release,or regression of PLDs.It reduced the chances of high percentages of potential recipients in LDKT.展开更多
BACKGROUND Despite its association with higher postoperative morbidity and mortality,the use of extended criteria donor(ECD)livers for transplantation has increased globally due to the high demand for the procedure.AI...BACKGROUND Despite its association with higher postoperative morbidity and mortality,the use of extended criteria donor(ECD)livers for transplantation has increased globally due to the high demand for the procedure.AIM To investigate the prevalence of ECD in donation after brain death(DBD)and its impact on organ acceptance for transplantation.METHODS Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre.The incidence of the Eurotransplant risk factors to define an ECD(ET-ECD)among DBD donors and the likelihood of organ acceptance over the years were analysed.The relationship between organ refusal for transplantation,the occurrence,and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.RESULTS A total of 1619 organ donors were evaluated.Of these,78.31%(n=1268)had at least one ET-ECD criterion.There was an increase in the acceptance of ECD DBD organs for transplantation(1 criterion:from 23.40%to 31.60%;2 criteria:from 13.10%to 27.70%;3 criteria:From 6.30%to 13.60%).For each addition of one ETECD variable,the estimated chance of organ refusal was 64.4%higher(OR 1.644,95%CI 1.469-1.839,P<0.001).Except for the donor serum sodium>165 mmol/L(P=0.310),all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.CONCLUSION A high prevalence of ECD DBD was observed.Despite the increase in their utilisation,the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.展开更多
Background: Donated blood contaminated with S. Typhi can cause post-transfusion sepsis. This study aimed to determine the correlation between some risk factors of typhoid fever and seroprevalence of antibodies against...Background: Donated blood contaminated with S. Typhi can cause post-transfusion sepsis. This study aimed to determine the correlation between some risk factors of typhoid fever and seroprevalence of antibodies against S. Typhi among blood donors. Methodology: Following informed consent, socio-demographic and information on risk factors of typhoid infection was obtained using pre-structured questionnaires from 400 apparently healthy blood donors at the Tema General Hospital. Blood was also collected for serology and cultured for identification of pathogens by standard bacteriological method. Results: Blood culture did not reveal any S. Typhi isolate out of the tested 400 (348 males and 52 females) samples from apparently healthy blood donors. However, IgM and IgG antibody seroprevalence of 9.3% and 3.5% were detected. Age group of 17 - 24 years was the highest risk group, persons with a history of typhoid infection, and sources of drinking water were major risk factors for typhoid infection. It was also observed that prevalence of IgM was highest among new donors (62.2%), but lower in donors with a history of 1 to 3 blood donations (32.4%) and least among regular donors (>3 donations (5.4%)). In addition, typhoid prevention awareness and typhoid knowledge (knowledge about typhoid transmission) among the donors were poor (4.3% and 5.9% respectively). Conclusions: This study has shown an overall seroprevalence of 9% and 3.5% for IgM and IgG antibodies respectively among blood donors in the Tema area in Ghana. We advocate for the mandatory screening of donor units intended for transfusion for S. Typhi. Furthermore, there is an urgent need for the health education of all persons in Ghana on preventive measures and the spread of S. Typhi.展开更多
Introduction: The prevention of transmission of infections transmitted by blood transfusion depends on the correct selection of donors and the performance of adequate serological tests for the detection of pathogens, ...Introduction: The prevention of transmission of infections transmitted by blood transfusion depends on the correct selection of donors and the performance of adequate serological tests for the detection of pathogens, in particular viral hepatitis B and C viruses. The main objective of our study was to evaluate the seroprevalences of viral markers B and C in blood donors in the Agadir region. The secondary objectives were to evaluate these prevalences according to the socio-demographic characteristics of the donors and to evaluate the seroprevalence of other markers, in particular the human immunodeficiency virus. Methods: A retrospective analysis of files from the blood donor registers of the Agadir regional transfusion center, covering the period from 1 January to 31 December 2020, was conducted. Results: The study included 13,092 donors, the mean age was 34 ± 11, the M/F sex ratio was 2.6. The overall seroprevalences of HBsAg, anti-HCV, anti-HIV were respectively: 1.3%, 0.2% and 0.3% respectively. For HBsAg, the prevalence was higher in men (p = 0.007). The prevalence of anti-HCV was higher in rural areas than in urban areas (p Conclusion: The low prevalences of viral markers B and C in our study compared to those recorded in the general Moroccan population reflect the effectiveness of preventive measures with regard to donor selection.展开更多
Objective: To take the unpaid blood donors in Wuzhou City as the research object, analyze the characteristics and prevalence of HIV infection, further explore its epidemiological characteristics, and lay a solid found...Objective: To take the unpaid blood donors in Wuzhou City as the research object, analyze the characteristics and prevalence of HIV infection, further explore its epidemiological characteristics, and lay a solid foundation for the recruitment of unpaid blood donors and the safety of blood transfusion, so as to reduce the risk of HIV transmission through blood transfusion. Methods: This paper collected the anti-HIV test results of unpaid blood donors and the confirmation results of reactive samples from 2015 to 2020, and carried out statistical analysis on the relevant information of positive samples. Result: From 2015 to 2020, a total of 233,242 unpaid blood donors were tested, and the positive rate of anti-HIV initial screening was 0.057% (132/233,242), and the positive rate of anti-HIV confirmed was 0.022% (51/233,242);the comparison of positive rates in each year was P < 0.05. Among the total number of infections, 76.47% (39/51) of confirmed positive persons were infected with HIV alone, followed by combined TP infection, accounting for 15.69% (8/51);for the people between 46 and 55 years old, the infection rate was the highest, reaching 37.3%;and more men (90.2%) were infected than women. In terms of education background, junior high school and below were the majority, accounting for 58.83% of the total;in terms of marital status, the number of unmarried people was 27, accounting for 52.9%. In terms of occupation, there were two main groups: farmers and workers, accounting for 66.7% of the total number of infections, and students accounting for 15.7%. Among the confirmed positives, the proportion of first-time blood donors and whole blood donors was higher than that of those who donated blood again or donated component blood. Conclusion: The situation of HIV infection among unpaid blood donors in Wuzhou City was relatively stable from 2015 to 2020, with no significant change in the absolute number of infected people compared to the previous period (the HIV infection rate from 2010 to 2013 was 0.03%), and most of them were males, unmarried people and those with low education. Therefore, attention must be paid to the consultation and recruitment of blood donors before blood donation, as well as the HIV screening in the laboratory after blood donation, so as to ensure the safety of clinical blood use.展开更多
Background: Adequate selection of a prospective whole blood donor protects his health and safety of the recipient. Objectives: The main objective of this study was to determine the haematology parameters of apparently...Background: Adequate selection of a prospective whole blood donor protects his health and safety of the recipient. Objectives: The main objective of this study was to determine the haematology parameters of apparently healthy prospective whole blood donors. Participants and Methods: This was a hospital based prospective study carried out from August to October 2020 at the blood transfusion unit of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria. A structured pretested questionnaire was used for data collection. The socio demographic status and the haematology parameters of apparently healthy prospective whole blood donors who tested negative for HIV, hepatitis B and C markers were captured. Obtained data were analysed with the statistical package for the social scientist software version 20. Results: One hundred male (97.1%) and three female (2.9%) apparently healthy prospective whole blood donors were studied. The median age of study subjects was 30 years. Obtained median haematology parameter values were 13 g/dl, 40%, 4.9/nl and 203.9/nl for haemoglobin concentration, haematocrit, total white cell and platelet counts respectively. The median values for the mean corpuscular haemoglobin concentration (MCHC), mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) of participants were 32.6 g/dl, 27.7 pg and 85.7 fl respectively. Observed prevalence of subnormal haematology parameters for haemoglobin concentration, total white cells, platelets were 12.6%, 25.2%, and 13.6% respectively. Also subnormal values for MCHC, MCH, MCV were 11.7%, 26.2%, and 16.5% respectively among prospective whole blood donors in this study. No higher than normal haematology parameter values were observed. Median values for erythrocyte sedimentation rate was 8.4 mm/hr. Conclusion: A significant percentage of apparently healthy prospective whole blood donors had subnormal haematology parameters values. Obtained normal values in our study are comparable with local reference range reports from previous studies in Nigeria and other parts of Africa. 124947 .展开更多
Copolymerization of an electron-rich donor(D)unit with an electron-deficient acceptor(A)unit to construct efficient D-π-A-πtype donors is an effective strategy for organic solar cell applications.The electron-defici...Copolymerization of an electron-rich donor(D)unit with an electron-deficient acceptor(A)unit to construct efficient D-π-A-πtype donors is an effective strategy for organic solar cell applications.The electron-deficient unit fusion,endows extendedπ-conjugation plane and insures excellent photoelectronic property,has great advantages to build A moiety and gradually receives considerable attention.In this work,we adopt benzo[2,1-b:3,4-b’]dithiophene and benzopyrazine(BP),benzothiadiazole(BT)and benzoselenadiazole(BS)to cleverly construct a series of fused A units with different electrondeficient ability,and further synthesize three polymer donors PBDP-BP,PBDP-BT,and PBDP-BS,respectively.The relationships between structure and performance were systematically investigated.PBDPBT shows a moderate aggregation behavior in both solution and film,and the highest hole mobility among the three polymers.After blending with Y6,the PBDP-BT:Y6-based film has the strongest absorption,favorable compatibility,superior crystallinity,and uniform phase separation morphology compared with PBDP-BP or PBDP-BS based blend films.Thus,the device based on PBDP-BT:Y6 has the highest and balanced charge mobility,suppressive recombination,reduced energy loss and achieves an outstanding PCE of 15.14%,which is superior to PBDP-BP:Y6(8.55%)and PBDP-BS:Y6(6.85%).These results provide learnable guidelines for future fused electron-deficient unit-based donor design for photovoltaic application.展开更多
Objective:To investigate the quality of life(QOL)of living donor liver transplantation(LDLT)donors.Methods:The Euro Qol 5-dimensional questionnaire(EQ-5D)was used to measure the QOL of donors.Results:One donor repor ...Objective:To investigate the quality of life(QOL)of living donor liver transplantation(LDLT)donors.Methods:The Euro Qol 5-dimensional questionnaire(EQ-5D)was used to measure the QOL of donors.Results:One donor repor ted“a little problem”of mobility(MO),and 2 donors(9.1%)repor ted“a little problem”of usual activities(UA).Moreover,there were 8 donors(36.4%)and 7 donors(31.8%)declaring“a little problem”of pain/discomfor t(PD)and anxiety/depression(AD),respectively.And both dimensions have a donor repor ting“moderate problem.”The mean visual analog scale(VAS)was 83.1±12.4.Conclusions:Donors can gain a stable and preferable QOL after donation in both the shor t and long terms.ED-5D application in the field of liver transplant could be an effective choice in QOL studies.展开更多
Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a signifi...Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.展开更多
BACKGROUND In brain death donors(BDDs),donor management is the key in the complex donation process.Donor management goals,which are standards of care or clinical parameters,have been considered an acceptable barometer...BACKGROUND In brain death donors(BDDs),donor management is the key in the complex donation process.Donor management goals,which are standards of care or clinical parameters,have been considered an acceptable barometer of successful donor management.AIM To test the hypothesis that aetiology of brain death could influence haemodynamic management in BDDs.METHODS Haemodynamic data(blood pressure,heart rate,central venous pressure,lactate,urine output,and vasoactive drugs)of BDDs were recorded on intensive care unit(ICU)admission and during the 6-h observation period(Time 1 at the beginning;Time 2 at the end).RESULTS The study population was divided into three groups according to the aetiology of brain death:Stroke(n=71),traumatic brain injury(n=48),and postanoxic encephalopathy(n=19).On ICU admission,BDDs with postanoxic encephalopathy showed the lowest values of systolic and diastolic blood pressure associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs.At the beginning of the 6-h period(Time 1),BDDs with postanoxic encephalopathy showed higher values of heart rate,lactate,and central venous pressure together with a higher need of other vasoactive drugs.CONCLUSION According to our data,haemodynamic management of BDDs is affected by the aetiology of brain death.BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.展开更多
Screening tests for blood donations are based upon sensitivity,cost-effectiveness and their suitability for high-throughput testing.Enzyme immunoassay(EIAs)for hepatitis C virus(HCV)antibodies were the initial screeni...Screening tests for blood donations are based upon sensitivity,cost-effectiveness and their suitability for high-throughput testing.Enzyme immunoassay(EIAs)for hepatitis C virus(HCV)antibodies were the initial screening tests introduced.The"first generation"antibody EIAs detected seroconversion after unduly long infectious window period.Improved HCV antibody assays still had an infectious window period around 66 d.HCV core antigen EIAs shortened the window period considerably,but high costs did not lead to widespread acceptance.A fourth-generation HCV antigen and antibody assay(combination EIA)is more convenient as two infectious markers of HCV are detected in the same assay.Molecular testing for HCV-RNA utilizing nucleic acid amplification technology(NAT)is the most sensitive assay and shortens the window period to only4 d.Implementation of NAT in many developed countries around the world has resulted in dramatic reductions in transfusion transmissible HCV and relative risk is now<1 per million donations.However,HCV serology still continues to be retained as some donations are serology positive but NAT negative.In resource constrained countries HCV screening is highly variable,depending upon infrastructure,trained manpower and financial resource.Rapid tests which do not require instrumentation and are simple to perform are used in many small and remotely located blood centres.The sensitivity as compared to EIAs is less and wherever feasible HCV antibody EIAs are most frequently used screening assays.Efforts have been made to implement combined antigen-antibody assays and even NAT in some of these countries.展开更多
ALM To determine the frequencies of HGV and TTVinfections in blood donors in Hangzhou.METHODS RT-nested PCR for HGV RNA detection and semi-nested PCR for TTV DNA detection in the sera from 203 blood donors, and nucleo...ALM To determine the frequencies of HGV and TTVinfections in blood donors in Hangzhou.METHODS RT-nested PCR for HGV RNA detection and semi-nested PCR for TTV DNA detection in the sera from 203 blood donors, and nucleotide sequence analysis were performed.``RESULTS Thirty-two ( 15.8%) and 30 (14.8%) of the 203serum samples were positive for HGV RNA and TTV DNA,respectively. And 5 (2.5%) of the 203 serum samples were detectable for both HGV RNA and TTV DNA.Homology of the nucleotide sequences of HGV RT-nested PCR products and TTV semi-nested PCR products from 3serum samples compared with the reported HGV and TTV sequences was 89.36%. 87.94%, 88.65% and 63.51%.65.77% and 67.12%. respectively.``CONCLUSION The infection rates of HGV and/or TTV inblood donors are relatively high. and to establish HGV and TTV examinations to screen blood donors is needed for transfusion security. The genomic heterogeneity of TTV or HGV is present in the isolates from different areas.展开更多
INIRODUCIIONA newly discovered DNA virus,transfusiontransmitted virus (TTV),was reported as a cause ofpost-transfusion hepatitis of unknown etiology inJapan.In order to investigate TTV prevalence insouthern China,a st...INIRODUCIIONA newly discovered DNA virus,transfusiontransmitted virus (TTV),was reported as a cause ofpost-transfusion hepatitis of unknown etiology inJapan.In order to investigate TTV prevalence insouthern China,a study was carried out amongblood donors,patients with liver diseases andhemodialysis to determine the epidemiologicalcharateristics.展开更多
Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for ...Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.展开更多
AIM: To define the normal range of liver stiffness(LS) values using transient elastography in living-related liver transplantation candidate donors with normal liver histology. METHODS: LS was measured using Fibroscan...AIM: To define the normal range of liver stiffness(LS) values using transient elastography in living-related liver transplantation candidate donors with normal liver histology. METHODS: LS was measured using Fibroscan in 50(16 women, 34 men) healthy potential donors(mean age 28.4 ± 5.9 years) who were being evaluated for liver donation for their relatives at the National Liver Institute, Menoufeya University, Egypt. All potential donors had normal liver tests and were negative for hepatitis B or C virus infection. Abdominal ultrasounds showed normal findings. None of the subjects had diabetes, hypertension, renal impairment, heart disease, or body mass index > 30 kg/m2. All subjects had normal liver histology upon liver biopsy. They all donated the right lobe of their liver with successful outcomes.RESULTS: The mean LS was 4.3 ± 1.2 k Pa(range: 1.8-7.1 k Pa). The 5th and 95 th percentiles of normal LS were 2.6 k Pa and 6.8 k Pa, respectively, with a median of 4 k Pa; the interquartile range was 0.6 ± 0.4. LS measurements were not significantly different between men and women(4.4 ± 1.1 k Pa vs 3.9 ± 1.3 k Pa) and did not correlate with age. However, stiffness values were significantly lower in subjects with a body mass index < 26 kg/m2 compared to those with an index ≥ 26 kg/m2(4.0 ± 1.1 k Pa vs 4.6 ± 1.2 k Pa; P <0.05). There were no differences in hospital stay or postoperative bilirubin, albumin,alanine and aspartate transaminases, or creatinine levels(at discharge) between donors with livers stiffness ≤ 4 k Pa and those with stiffness > 4 k Pa. CONCLUSION: Healthy donors with normal liver histology have a median LS of 4 k Pa. Stiffness values are elevated relative to increase in body mass index.展开更多
AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with dono...AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.展开更多
AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic b...AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic bibliographic databases prior to March 2013.Studies with diagnostic results and fulfilled inclusion criteria were included.The methodological quality of the studies was assessed.Sensitivity,specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model.Summary receiver operating characteristic(SROC)curves were used to summarize overall test performance.Publication bias was assessed using Deek’s funnel plot asymmetry test.Sensitivity analysis was adopted to explore the potential sources of heterogeneity.RESULTS:Twelve studies involving 869 subjects were eligible to the analysis.The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14.The summary estimates of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88(95%CI:0.84-0.92),0.95(95%CI:0.93-0.97),15.33(95%CI:10.70-21.95),0.15(95%CI:0.11-0.20)and 130.77(95%CI:75.91-225.27),respectively.No significant heterogeneity was detected in all the above four measures.Area under SROC curve was 0.971.Little publication bias was noted across the studies(P=0.557).Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result,which suggested the little influence of this study on the overall results.CONCLUSION:Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.展开更多
The growing gap between demand and supply for kidney transplants has led to renewed interest in the use of expanded criteria donor(ECD) kidneys in an effort to increase the donor pool. Although most studies of ECD kid...The growing gap between demand and supply for kidney transplants has led to renewed interest in the use of expanded criteria donor(ECD) kidneys in an effort to increase the donor pool. Although most studies of ECD kidney transplantation confirm lowerallograft survival rates and, generally, worse outcomes than standard criteria donor kidneys, recipients of ECD kidneys generally have improved survival compared with wait-listed dialysis patients, thus encouraging the pursuit of this type of kidney transplantation. The relative benefits of transplantation using kidneys from ECDs are dependent on patient characteristics and the waiting time on dialysis. Because of the increased risk of poor graft function, calcineurin inhibitor(CNI)-induced nephrotoxicity, increased incidence of infections, cardiovascular risk, and malignancies, elderly recipients of an ECD kidney transplant are a special population that requires a tailored immunosuppressive regimen. Recipients of ECD kidneys often are excluded from transplant trials and, therefore, the optimal induction and maintenance immunosuppressive regimen for them is not known. Approaches are largely center specific and based upon expert opinion. Some data suggest that antithymocyte globulin might be the preferred induction agent for elderly recipients of ECD kidneys. Maintenance regimens that spare CNIs have been advocated, especially for older recipients of ECD kidneys. CNI-free regimens are not universally accepted due to occasionally high rejection rates. However, reduced CNI exposure and CNI-free regimens based on mammalian target of rapamycin inhibitors have shown acceptable outcomes in appropriately selected ECD transplant recipients.展开更多
Typically,conjugated polymers are composed of conjugated backbones and alkyl side chains.In this contribution,a cost-effective strategy of tailoring the length of alkyl side chain is utilized to design highperforming ...Typically,conjugated polymers are composed of conjugated backbones and alkyl side chains.In this contribution,a cost-effective strategy of tailoring the length of alkyl side chain is utilized to design highperforming thieno[3,4-c]pyrrole-4,6-dione(TPD)-based large bandgap polymer donors PBDT-BiTPD(Cχ)(χ=48,52,56),in which x represents the alkyl side chain length in term of the total carbon number.A combination of light absorption,device,and morphology examinations make clear that the shorter alkyl side chains yield(i) higher crystallinity and more predominant face-on crystallite orientation in their neat and BHJ blend films,(ii) higher charge mobilities(6.7×10^(-4) cm~2 V^(-1) s^(-1) for C48 vs.3.2×10^(-4) cm~2 V^(-1) s^(-1) for C56),and negligible charge recombination,consequently,(iii) significantly improved fill-factor(FF) and short current(J_(SC)),while almost the same open circuit voltage(V_(OC)) of ca.0.82 V in their corresponding BHJ devices.In parallel,as alkyl side chain lengths decrease from C56 to C48,power conversion efficiencies(PCEs) increased from 7.8% for C56 to 11.1% for C52,and further to14.1% for C48 in their BHJ solar cells made with a narrow bandgap non-fullerene acceptor Y6.This systematic study declares that shortening the side chain,if providing appropriate solubility in device solution processing solvents,is of essential significance for developing high-performing polymer donors and further improving device photovoltaic performance.展开更多
文摘BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 years.METHODS Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 years.After excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both groups.RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation failure.The incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both groups.There were no significant differences in the patient and graft survival between the groups.Moreover,only three deaths were attributed to BC.While female donors were protective factors for BC,donor cardiac arrest was a risk factor.CONCLUSION The incidence of BC was relatively low on using liver grafts>70 years.It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.
文摘BACKGROUND Although the availability of related living donors(LDs)provides a better chance for receiving kidney transplantation(KT),the evaluation protocols for LD selection remain a safeguard for the LD’s safety.These protocols are variable from one center to another,resulting in variable rates of decline of the potential LDs(PLDs).The decline of willing PLDs may occur at any stage of evaluation,starting from the initial contact and counseling to the day of operation.AIM To identify the causes of the decline of PLDs,the predictors of PLD candidacy,and the effect on achieving LDKT.METHODS A retrospective study was performed on the willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022.The variables influencing their candidacy rate and the fate of their potential recipients were studied.Two groups of PLDs were compared:Candidate PLDs after a completed evaluation vs non-candidate PLDs with a complete or incomplete evaluation.A multivariate logistic regression was performed to assess the factors contributing to the achievement of PLD candidacy.RESULTS Of 321 willing PLDs,257 PLDs(80.1%)accessed the evaluation to variable extents for 212 potential recipients,with a mean age(range)of 40.5±10.4(18-65)years,including 169 females(65.8%).The remaining 64 PLDs(19.9%)did not access the evaluation.Only 58 PLDs(18.1%)succeeded in donating,but 199 PDLs(62.0%)were declined;exclusion occurred in 144 PLDs(56.0%)for immunological causes(37.5%),medical causes(54.9%),combined causes(9.7%),and financial causes(2.1%).Regression and release occurred in 55 PLDs(17.1%).The potential recipients with candidate PLDs were not significantly different from those with non-candidate PLDs,except in age(P=0.041),rates of completed evaluation,and exclusion of PLDs(P<0.001).There were no factors that independently influenced the rate of PLD candidacy.Most patients who failed to have KT after the decline of their PLDs remained on hemodialysis for 6 mo to 6 years.CONCLUSION The rate of decline of willing related PLDs was high due to medical or immunological contraindications,release,or regression of PLDs.It reduced the chances of high percentages of potential recipients in LDKT.
文摘BACKGROUND Despite its association with higher postoperative morbidity and mortality,the use of extended criteria donor(ECD)livers for transplantation has increased globally due to the high demand for the procedure.AIM To investigate the prevalence of ECD in donation after brain death(DBD)and its impact on organ acceptance for transplantation.METHODS Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre.The incidence of the Eurotransplant risk factors to define an ECD(ET-ECD)among DBD donors and the likelihood of organ acceptance over the years were analysed.The relationship between organ refusal for transplantation,the occurrence,and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.RESULTS A total of 1619 organ donors were evaluated.Of these,78.31%(n=1268)had at least one ET-ECD criterion.There was an increase in the acceptance of ECD DBD organs for transplantation(1 criterion:from 23.40%to 31.60%;2 criteria:from 13.10%to 27.70%;3 criteria:From 6.30%to 13.60%).For each addition of one ETECD variable,the estimated chance of organ refusal was 64.4%higher(OR 1.644,95%CI 1.469-1.839,P<0.001).Except for the donor serum sodium>165 mmol/L(P=0.310),all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.CONCLUSION A high prevalence of ECD DBD was observed.Despite the increase in their utilisation,the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.
文摘Background: Donated blood contaminated with S. Typhi can cause post-transfusion sepsis. This study aimed to determine the correlation between some risk factors of typhoid fever and seroprevalence of antibodies against S. Typhi among blood donors. Methodology: Following informed consent, socio-demographic and information on risk factors of typhoid infection was obtained using pre-structured questionnaires from 400 apparently healthy blood donors at the Tema General Hospital. Blood was also collected for serology and cultured for identification of pathogens by standard bacteriological method. Results: Blood culture did not reveal any S. Typhi isolate out of the tested 400 (348 males and 52 females) samples from apparently healthy blood donors. However, IgM and IgG antibody seroprevalence of 9.3% and 3.5% were detected. Age group of 17 - 24 years was the highest risk group, persons with a history of typhoid infection, and sources of drinking water were major risk factors for typhoid infection. It was also observed that prevalence of IgM was highest among new donors (62.2%), but lower in donors with a history of 1 to 3 blood donations (32.4%) and least among regular donors (>3 donations (5.4%)). In addition, typhoid prevention awareness and typhoid knowledge (knowledge about typhoid transmission) among the donors were poor (4.3% and 5.9% respectively). Conclusions: This study has shown an overall seroprevalence of 9% and 3.5% for IgM and IgG antibodies respectively among blood donors in the Tema area in Ghana. We advocate for the mandatory screening of donor units intended for transfusion for S. Typhi. Furthermore, there is an urgent need for the health education of all persons in Ghana on preventive measures and the spread of S. Typhi.
文摘Introduction: The prevention of transmission of infections transmitted by blood transfusion depends on the correct selection of donors and the performance of adequate serological tests for the detection of pathogens, in particular viral hepatitis B and C viruses. The main objective of our study was to evaluate the seroprevalences of viral markers B and C in blood donors in the Agadir region. The secondary objectives were to evaluate these prevalences according to the socio-demographic characteristics of the donors and to evaluate the seroprevalence of other markers, in particular the human immunodeficiency virus. Methods: A retrospective analysis of files from the blood donor registers of the Agadir regional transfusion center, covering the period from 1 January to 31 December 2020, was conducted. Results: The study included 13,092 donors, the mean age was 34 ± 11, the M/F sex ratio was 2.6. The overall seroprevalences of HBsAg, anti-HCV, anti-HIV were respectively: 1.3%, 0.2% and 0.3% respectively. For HBsAg, the prevalence was higher in men (p = 0.007). The prevalence of anti-HCV was higher in rural areas than in urban areas (p Conclusion: The low prevalences of viral markers B and C in our study compared to those recorded in the general Moroccan population reflect the effectiveness of preventive measures with regard to donor selection.
文摘Objective: To take the unpaid blood donors in Wuzhou City as the research object, analyze the characteristics and prevalence of HIV infection, further explore its epidemiological characteristics, and lay a solid foundation for the recruitment of unpaid blood donors and the safety of blood transfusion, so as to reduce the risk of HIV transmission through blood transfusion. Methods: This paper collected the anti-HIV test results of unpaid blood donors and the confirmation results of reactive samples from 2015 to 2020, and carried out statistical analysis on the relevant information of positive samples. Result: From 2015 to 2020, a total of 233,242 unpaid blood donors were tested, and the positive rate of anti-HIV initial screening was 0.057% (132/233,242), and the positive rate of anti-HIV confirmed was 0.022% (51/233,242);the comparison of positive rates in each year was P < 0.05. Among the total number of infections, 76.47% (39/51) of confirmed positive persons were infected with HIV alone, followed by combined TP infection, accounting for 15.69% (8/51);for the people between 46 and 55 years old, the infection rate was the highest, reaching 37.3%;and more men (90.2%) were infected than women. In terms of education background, junior high school and below were the majority, accounting for 58.83% of the total;in terms of marital status, the number of unmarried people was 27, accounting for 52.9%. In terms of occupation, there were two main groups: farmers and workers, accounting for 66.7% of the total number of infections, and students accounting for 15.7%. Among the confirmed positives, the proportion of first-time blood donors and whole blood donors was higher than that of those who donated blood again or donated component blood. Conclusion: The situation of HIV infection among unpaid blood donors in Wuzhou City was relatively stable from 2015 to 2020, with no significant change in the absolute number of infected people compared to the previous period (the HIV infection rate from 2010 to 2013 was 0.03%), and most of them were males, unmarried people and those with low education. Therefore, attention must be paid to the consultation and recruitment of blood donors before blood donation, as well as the HIV screening in the laboratory after blood donation, so as to ensure the safety of clinical blood use.
文摘Background: Adequate selection of a prospective whole blood donor protects his health and safety of the recipient. Objectives: The main objective of this study was to determine the haematology parameters of apparently healthy prospective whole blood donors. Participants and Methods: This was a hospital based prospective study carried out from August to October 2020 at the blood transfusion unit of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria. A structured pretested questionnaire was used for data collection. The socio demographic status and the haematology parameters of apparently healthy prospective whole blood donors who tested negative for HIV, hepatitis B and C markers were captured. Obtained data were analysed with the statistical package for the social scientist software version 20. Results: One hundred male (97.1%) and three female (2.9%) apparently healthy prospective whole blood donors were studied. The median age of study subjects was 30 years. Obtained median haematology parameter values were 13 g/dl, 40%, 4.9/nl and 203.9/nl for haemoglobin concentration, haematocrit, total white cell and platelet counts respectively. The median values for the mean corpuscular haemoglobin concentration (MCHC), mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) of participants were 32.6 g/dl, 27.7 pg and 85.7 fl respectively. Observed prevalence of subnormal haematology parameters for haemoglobin concentration, total white cells, platelets were 12.6%, 25.2%, and 13.6% respectively. Also subnormal values for MCHC, MCH, MCV were 11.7%, 26.2%, and 16.5% respectively among prospective whole blood donors in this study. No higher than normal haematology parameter values were observed. Median values for erythrocyte sedimentation rate was 8.4 mm/hr. Conclusion: A significant percentage of apparently healthy prospective whole blood donors had subnormal haematology parameters values. Obtained normal values in our study are comparable with local reference range reports from previous studies in Nigeria and other parts of Africa. 124947 .
基金financially supported by the National Natural Science Foundation of China(21733005,21975115 and 51903116)the Shenzhen Fundamental Research Program(JCYJ20200109140801751,JCYJ20190809163011543 and JCYJ20190809161413310)+2 种基金the Guangdong Provincial Key Laboratory of Catalysis(2020B121201002)the Guangdong Innovative and Entrepreneurial Research Team Program(2016ZT06G587)the Shenzhen Sci-Tech Fund(KYTDPT 20181011104007)。
文摘Copolymerization of an electron-rich donor(D)unit with an electron-deficient acceptor(A)unit to construct efficient D-π-A-πtype donors is an effective strategy for organic solar cell applications.The electron-deficient unit fusion,endows extendedπ-conjugation plane and insures excellent photoelectronic property,has great advantages to build A moiety and gradually receives considerable attention.In this work,we adopt benzo[2,1-b:3,4-b’]dithiophene and benzopyrazine(BP),benzothiadiazole(BT)and benzoselenadiazole(BS)to cleverly construct a series of fused A units with different electrondeficient ability,and further synthesize three polymer donors PBDP-BP,PBDP-BT,and PBDP-BS,respectively.The relationships between structure and performance were systematically investigated.PBDPBT shows a moderate aggregation behavior in both solution and film,and the highest hole mobility among the three polymers.After blending with Y6,the PBDP-BT:Y6-based film has the strongest absorption,favorable compatibility,superior crystallinity,and uniform phase separation morphology compared with PBDP-BP or PBDP-BS based blend films.Thus,the device based on PBDP-BT:Y6 has the highest and balanced charge mobility,suppressive recombination,reduced energy loss and achieves an outstanding PCE of 15.14%,which is superior to PBDP-BP:Y6(8.55%)and PBDP-BS:Y6(6.85%).These results provide learnable guidelines for future fused electron-deficient unit-based donor design for photovoltaic application.
基金sponsored by the Natural Science Foundation of Min Hang District(grant no.2021MHZ021)。
文摘Objective:To investigate the quality of life(QOL)of living donor liver transplantation(LDLT)donors.Methods:The Euro Qol 5-dimensional questionnaire(EQ-5D)was used to measure the QOL of donors.Results:One donor repor ted“a little problem”of mobility(MO),and 2 donors(9.1%)repor ted“a little problem”of usual activities(UA).Moreover,there were 8 donors(36.4%)and 7 donors(31.8%)declaring“a little problem”of pain/discomfor t(PD)and anxiety/depression(AD),respectively.And both dimensions have a donor repor ting“moderate problem.”The mean visual analog scale(VAS)was 83.1±12.4.Conclusions:Donors can gain a stable and preferable QOL after donation in both the shor t and long terms.ED-5D application in the field of liver transplant could be an effective choice in QOL studies.
文摘Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.
文摘BACKGROUND In brain death donors(BDDs),donor management is the key in the complex donation process.Donor management goals,which are standards of care or clinical parameters,have been considered an acceptable barometer of successful donor management.AIM To test the hypothesis that aetiology of brain death could influence haemodynamic management in BDDs.METHODS Haemodynamic data(blood pressure,heart rate,central venous pressure,lactate,urine output,and vasoactive drugs)of BDDs were recorded on intensive care unit(ICU)admission and during the 6-h observation period(Time 1 at the beginning;Time 2 at the end).RESULTS The study population was divided into three groups according to the aetiology of brain death:Stroke(n=71),traumatic brain injury(n=48),and postanoxic encephalopathy(n=19).On ICU admission,BDDs with postanoxic encephalopathy showed the lowest values of systolic and diastolic blood pressure associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs.At the beginning of the 6-h period(Time 1),BDDs with postanoxic encephalopathy showed higher values of heart rate,lactate,and central venous pressure together with a higher need of other vasoactive drugs.CONCLUSION According to our data,haemodynamic management of BDDs is affected by the aetiology of brain death.BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.
文摘Screening tests for blood donations are based upon sensitivity,cost-effectiveness and their suitability for high-throughput testing.Enzyme immunoassay(EIAs)for hepatitis C virus(HCV)antibodies were the initial screening tests introduced.The"first generation"antibody EIAs detected seroconversion after unduly long infectious window period.Improved HCV antibody assays still had an infectious window period around 66 d.HCV core antigen EIAs shortened the window period considerably,but high costs did not lead to widespread acceptance.A fourth-generation HCV antigen and antibody assay(combination EIA)is more convenient as two infectious markers of HCV are detected in the same assay.Molecular testing for HCV-RNA utilizing nucleic acid amplification technology(NAT)is the most sensitive assay and shortens the window period to only4 d.Implementation of NAT in many developed countries around the world has resulted in dramatic reductions in transfusion transmissible HCV and relative risk is now<1 per million donations.However,HCV serology still continues to be retained as some donations are serology positive but NAT negative.In resource constrained countries HCV screening is highly variable,depending upon infrastructure,trained manpower and financial resource.Rapid tests which do not require instrumentation and are simple to perform are used in many small and remotely located blood centres.The sensitivity as compared to EIAs is less and wherever feasible HCV antibody EIAs are most frequently used screening assays.Efforts have been made to implement combined antigen-antibody assays and even NAT in some of these countries.
文摘ALM To determine the frequencies of HGV and TTVinfections in blood donors in Hangzhou.METHODS RT-nested PCR for HGV RNA detection and semi-nested PCR for TTV DNA detection in the sera from 203 blood donors, and nucleotide sequence analysis were performed.``RESULTS Thirty-two ( 15.8%) and 30 (14.8%) of the 203serum samples were positive for HGV RNA and TTV DNA,respectively. And 5 (2.5%) of the 203 serum samples were detectable for both HGV RNA and TTV DNA.Homology of the nucleotide sequences of HGV RT-nested PCR products and TTV semi-nested PCR products from 3serum samples compared with the reported HGV and TTV sequences was 89.36%. 87.94%, 88.65% and 63.51%.65.77% and 67.12%. respectively.``CONCLUSION The infection rates of HGV and/or TTV inblood donors are relatively high. and to establish HGV and TTV examinations to screen blood donors is needed for transfusion security. The genomic heterogeneity of TTV or HGV is present in the isolates from different areas.
文摘INIRODUCIIONA newly discovered DNA virus,transfusiontransmitted virus (TTV),was reported as a cause ofpost-transfusion hepatitis of unknown etiology inJapan.In order to investigate TTV prevalence insouthern China,a study was carried out amongblood donors,patients with liver diseases andhemodialysis to determine the epidemiologicalcharateristics.
文摘Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.
文摘AIM: To define the normal range of liver stiffness(LS) values using transient elastography in living-related liver transplantation candidate donors with normal liver histology. METHODS: LS was measured using Fibroscan in 50(16 women, 34 men) healthy potential donors(mean age 28.4 ± 5.9 years) who were being evaluated for liver donation for their relatives at the National Liver Institute, Menoufeya University, Egypt. All potential donors had normal liver tests and were negative for hepatitis B or C virus infection. Abdominal ultrasounds showed normal findings. None of the subjects had diabetes, hypertension, renal impairment, heart disease, or body mass index > 30 kg/m2. All subjects had normal liver histology upon liver biopsy. They all donated the right lobe of their liver with successful outcomes.RESULTS: The mean LS was 4.3 ± 1.2 k Pa(range: 1.8-7.1 k Pa). The 5th and 95 th percentiles of normal LS were 2.6 k Pa and 6.8 k Pa, respectively, with a median of 4 k Pa; the interquartile range was 0.6 ± 0.4. LS measurements were not significantly different between men and women(4.4 ± 1.1 k Pa vs 3.9 ± 1.3 k Pa) and did not correlate with age. However, stiffness values were significantly lower in subjects with a body mass index < 26 kg/m2 compared to those with an index ≥ 26 kg/m2(4.0 ± 1.1 k Pa vs 4.6 ± 1.2 k Pa; P <0.05). There were no differences in hospital stay or postoperative bilirubin, albumin,alanine and aspartate transaminases, or creatinine levels(at discharge) between donors with livers stiffness ≤ 4 k Pa and those with stiffness > 4 k Pa. CONCLUSION: Healthy donors with normal liver histology have a median LS of 4 k Pa. Stiffness values are elevated relative to increase in body mass index.
文摘AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.
文摘AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic bibliographic databases prior to March 2013.Studies with diagnostic results and fulfilled inclusion criteria were included.The methodological quality of the studies was assessed.Sensitivity,specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model.Summary receiver operating characteristic(SROC)curves were used to summarize overall test performance.Publication bias was assessed using Deek’s funnel plot asymmetry test.Sensitivity analysis was adopted to explore the potential sources of heterogeneity.RESULTS:Twelve studies involving 869 subjects were eligible to the analysis.The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14.The summary estimates of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88(95%CI:0.84-0.92),0.95(95%CI:0.93-0.97),15.33(95%CI:10.70-21.95),0.15(95%CI:0.11-0.20)and 130.77(95%CI:75.91-225.27),respectively.No significant heterogeneity was detected in all the above four measures.Area under SROC curve was 0.971.Little publication bias was noted across the studies(P=0.557).Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result,which suggested the little influence of this study on the overall results.CONCLUSION:Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.
文摘The growing gap between demand and supply for kidney transplants has led to renewed interest in the use of expanded criteria donor(ECD) kidneys in an effort to increase the donor pool. Although most studies of ECD kidney transplantation confirm lowerallograft survival rates and, generally, worse outcomes than standard criteria donor kidneys, recipients of ECD kidneys generally have improved survival compared with wait-listed dialysis patients, thus encouraging the pursuit of this type of kidney transplantation. The relative benefits of transplantation using kidneys from ECDs are dependent on patient characteristics and the waiting time on dialysis. Because of the increased risk of poor graft function, calcineurin inhibitor(CNI)-induced nephrotoxicity, increased incidence of infections, cardiovascular risk, and malignancies, elderly recipients of an ECD kidney transplant are a special population that requires a tailored immunosuppressive regimen. Recipients of ECD kidneys often are excluded from transplant trials and, therefore, the optimal induction and maintenance immunosuppressive regimen for them is not known. Approaches are largely center specific and based upon expert opinion. Some data suggest that antithymocyte globulin might be the preferred induction agent for elderly recipients of ECD kidneys. Maintenance regimens that spare CNIs have been advocated, especially for older recipients of ECD kidneys. CNI-free regimens are not universally accepted due to occasionally high rejection rates. However, reduced CNI exposure and CNI-free regimens based on mammalian target of rapamycin inhibitors have shown acceptable outcomes in appropriately selected ECD transplant recipients.
基金financially supported by the National Natural Science Foundation of China (Nos. 21805097, 21671071)the Basic and Applied Basic Research Major Program of Guangdong Province (No. 2019B030302007)+2 种基金the Guangdong Natural Science Foundation (Nos. 2019A1515012137, 2016A030310428)the Guangdong Applied Science and Technology Planning Project (Nos. 2015B010135009, and 2017B090917002)the Guangzhou Science and Technology Foundation (No. 201904010361)。
文摘Typically,conjugated polymers are composed of conjugated backbones and alkyl side chains.In this contribution,a cost-effective strategy of tailoring the length of alkyl side chain is utilized to design highperforming thieno[3,4-c]pyrrole-4,6-dione(TPD)-based large bandgap polymer donors PBDT-BiTPD(Cχ)(χ=48,52,56),in which x represents the alkyl side chain length in term of the total carbon number.A combination of light absorption,device,and morphology examinations make clear that the shorter alkyl side chains yield(i) higher crystallinity and more predominant face-on crystallite orientation in their neat and BHJ blend films,(ii) higher charge mobilities(6.7×10^(-4) cm~2 V^(-1) s^(-1) for C48 vs.3.2×10^(-4) cm~2 V^(-1) s^(-1) for C56),and negligible charge recombination,consequently,(iii) significantly improved fill-factor(FF) and short current(J_(SC)),while almost the same open circuit voltage(V_(OC)) of ca.0.82 V in their corresponding BHJ devices.In parallel,as alkyl side chain lengths decrease from C56 to C48,power conversion efficiencies(PCEs) increased from 7.8% for C56 to 11.1% for C52,and further to14.1% for C48 in their BHJ solar cells made with a narrow bandgap non-fullerene acceptor Y6.This systematic study declares that shortening the side chain,if providing appropriate solubility in device solution processing solvents,is of essential significance for developing high-performing polymer donors and further improving device photovoltaic performance.
