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MAY 2, 2024 Wondering how much you should trust AI-detection tools? Consider this cautionary and true tale: One Thursday morning, a student at a large research university received the following [...]

ABSTRACT:Background:Causalgia and complex regional pain syndrome (CRPS) type II with nerve injury can be difficult to treat. Surgical peripheral nerve denervation for causalgia has been largely abandoned by pain clinicians because of a perception that this may aggravate a central component (anesthesia dolorosa).Methods:We selectively searched Pubmed, Cochrane, MEDLINE, EMBASE, CINAHL Plus, and Scopus from 1947 for articles, books, and book chapters for evidence of surgical treatments (nerve resection and amputation) and treatment related to autoimmunity and immune deficiency with CRPS.Results:Reviews were found for the treatment of causalgia or CRPS type II (n= 6), causalgia relieved by nerve resection (n= 6), and causalgia and CRPS II treated by amputation (n= 8). Twelve reports were found of autoimmunity with CRPS, one paper of these on associated immune deficiency and autoimmunity, and two were chosen for discussion regarding treatment with immunoglobulin and one by plasma exchange. We document a report of a detailed and unique pathological examination of a CRPS type II affected amputated limb and related successful treatment with immunoglobulin.Conclusions:Nerve resection, with grafting, and relocation may relieve uncomplicated causalgia and CRPS type II in some patients in the long term. However, an unrecognized and treatable immunological condition may underly some CRPS II cases and can lead to the ultimate failure of surgical treatments.

Abstract Neuropathic pain, caused by various central and peripheral nerve disorders, is especially problematic because of its severity, chronicity and resistance to simple analgesics. The condition affects 2%-3% of the [...]

Floodplain encroachment by embankments heightens flood risk. This is exacerbated by climate change and land‐use modifications. This paper assesses the impact of embankments on sediment transport, channel geometry, conveyance capacity, and flood inundation of a reach of the Nakkhu River, Nepal. Using the CAESAR‐Lisflood landscape evolution model based on a 2‐m digital elevation model, we simulate four flood scenarios with and without embankments and sediment transport: a historical 25‐year return period flood event used to design the embankments, 50‐year, 100‐year, and 1000‐year return period flood events forecast using the Generalized Logistic Model (using data from 1992 to 2017). Our results indicate that flow confinement by embankments reduces inundation by 99% (from 22.5 to 0.3 ha) for the historical 25‐year flood discharge of 42.23 m3/s${\mathrm{m}}^{3}/\mathrm{s}$and by 15% (from 28.8 to 24.4 ha) for the 1000‐year return period flood discharge of 95 m3/s${\mathrm{m}}^{3}\mathrm{/}\mathrm{s}$(similar to a 25‐year maximum mid‐future). The presence of embankments increases downstream sediment transport by more than 32% for all flood scenarios considered. Inclusion of sediment transport leads to a fivefold increase in predicted inundation area for a 25‐year maximum mid‐future flood compared to the no‐sediment case in the embanked channel. Changes in channel geometry due to sedimentation significantly reduce conveyance capacity increasing overtopping flood risk, particularly where the channel is sinuous or located on flat terrain. Our results indicate that sediment erosion in outer meanders may threaten embankment stability by promoting undercuts. It is recommended that sediment transport effects be factored into embankment design and floodplain planning. Our research explores the impact of flood protection embankments being constructed along the Nakkhu River in the Kathmandu Valley, Nepal, in a region that is experiencing rapid urban growth. Using advanced computer simulations, we study how these embankments influence the erosion and deposition of sediment in the river, and hence impact flood risk. Our findings indicate that the construction of embankments increases sediment transport, and alters the geometry of the river increasing downstream flood risk during extreme flood events. This is particularly the case for embankments designed to follow natural, meandering river courses. We recommend incorporating sediment transport analysis into the planning and design of embankments and developments in floodplain areas to reduce the risk of flooding. Our study indicates that embankment construction by itself may not always be a sustainable long‐term flood‐protection measure for rivers carrying high sediment loads. Inclusion of sediment processes is very important in predicting the effect of embankments on river flood riskFor the embanked Nakkhu, predicted inundation is fivefold larger for 25‐year maximum mid‐future event when sediment transport is includedSedimentation reduces channel capacity for flat terrain and large meanders; erosion at outer meanders threatens Nakkhu embankment stability Inclusion of sediment processes is very important in predicting the effect of embankments on river flood risk For the embanked Nakkhu, predicted inundation is fivefold larger for 25‐year maximum mid‐future event when sediment transport is included Sedimentation reduces channel capacity for flat terrain and large meanders; erosion at outer meanders threatens Nakkhu embankment stability

Neurofibromatosis 2 (NF2), an autosomal dominant disorder that is characterised by tumours of cells of neural crest origin, is caused by inactivating mutations of the NF2 gene on chromosome 22q12. [...]

Glacial lakes are rapidly growing in response to climate change and glacier retreat. The role of these lakes as terrestrial storage for glacial meltwater is currently unknown and not accounted for in global sea level assessments. Here, we map glacier lakes around the world using 254,795 satellite images and use scaling relations to estimate that global glacier lake volume increased by around 48%, to 156.5 km3, between 1990 and 2018. This methodology provides a near-global database and analysis of glacial lake extent, volume and change. Over the study period, lake numbers and total area increased by 53 and 51%, respectively. Median lake size has increased 3%; however, the 95th percentile has increased by around 9%. Currently, glacial lakes hold about 0.43 mm of sea level equivalent. As glaciers continue to retreat and feed glacial lakes, the implications for glacial lake outburst floods and water resources are of considerable societal and ecological importance.

Hypothermia is strongly associated with neonatal morbidities and mortality. There are several interventions to reduce the incidence of hypothermia following delivery. The aim of this systematic review was to compare the effectiveness of combining warming mattresses and plastic bags to plastic bags only for thermal regulation in preterm infants in the delivery suite and during stabilisation in the NICU. Four studies met the inclusion criteria. In comparison to the use of plastic bags only, the combination of warming mattresses and plastic bags reduces the incidence of hypothermia in preterm infants on admission to the NICU. However, there is a risk of hyperthermia. It is suggested that further research be carried out through more robust and rigorous methods.

Wartime memoir: a bachelor baby-sitter on the North Coast Limited helped his country produce the atomic bomb I arrived at Chicago Union Station in February 1944 in the morning on […]

The global stocktake seeks to enhance climate ambition through assessment and review of collective efforts every five years. A recent breakthrough in finance for addressing loss and damage is an opportunity to strengthen the finance agenda and rebuild much needed trust in the multilateral system.

The CASSIOPE (also known as Swarm‐E) satellite crossed the path of totality of the August 2017 eclipse at ~640‐km altitude ~10 min following the lunar umbra. Observations from CASSIOPE's Global Positioning System radio occultation receiver reveal total electron content variations of 0.2–0.3 total electron content units in the topside ionosphere—a signature of medium‐scale (100‐200 km) plasma disturbances in the lunar penumbra that were induced by the eclipse. The variations were only observed during the eclipse, their absence on preceding days being consistent with their very low (<10%) statistical occurrence probability. Their spectral characteristics match those of other contemporaneous measurements, and their detection is consistent with the simulated ionosphere‐thermosphere response to the eclipse. To capture the small‐scale size of the variations or to simulate those expected in the upcoming (July 2019) total eclipse, ionosphere‐thermosphere model runs with a spatial resolution of 50 km or better would be required. During the August 2017 “Great American Eclipse,” the Global Positioning System‐receiver‐based instrument on board the CASSIOPE (also known as Swarm‐E) satellite detected significant disturbances in the terrestrial ionosphere at multiple distributed locations above the United States. Previous research on solar eclipses has pointed out the difficulty in linking such disturbances to an eclipse, given other known generation mechanisms, casting doubt on their possible linkage to the August 2017 eclipse. By virtue of the multiple locations of the measurements over the continental United States during the eclipse and the days preceding the eclipse, and the techniques used in the analysis, the data offer compelling evidence that the disturbances were directly generated by the eclipse. The measurements offer unique insight into how the Earth's upper atmosphere and ionosphere respond to an impulsive event such as a solar eclipse. The detected disturbances have sizes of ~100‐200 km. To capture their “medium” scale size in model simulations including those expected to be seen in the upcoming July 2019 eclipse, it will be necessary to run the existing ionosphere‐thermosphere models at high spatial resolution (50 km or better). CASSIOPE GPS radio occultations reveal topside ionospheric disturbances induced by the August 2017 eclipse0.2–0.3 TECU variations were observed; the presence is atypical for topside but consistent with modeling simulations and other measurementsScale of disturbances necessitates better spatially resolved simulations to model the ionosphere‐thermosphere response to a total eclipse

Case presentation (Dr B Peters) A 40 year old heterosexual black African man presented to the accident and emergency department with a 4 minute episode of loss of consciousness with [...]

The Central European countries have made considerable progress with the transition to a market economy and now face the challenge of developing macroeconomic policy frameworks on the road to EU [...]

The article discusses that how students should position themselves to be best educated in light of employment trends and employer expectations. It mentions the Association of American Colleges and Universities began national surveys and focus groups to examine trends related to college graduates and the important learning experiences; and also mentions when hiring recent graduates, business executives and hiring managers place a high priority on demonstrated proficiency in a variety of skill.

Medium‐scale ionospheric ionization structures are a persistent global feature of the Earth's ionosphere. Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC) radio occultation measurements are well suited to address the incomplete global observational picture of plasma density irregularities, including the global climatology in both bottomside and topside Fregion layers, and their structure in the vertical dimension. A climatological database of Fregion ionospheric irregularities and their characteristics has been developed through detection of total electron content perturbations by Global Positioning System receivers onboard COSMIC satellites. This paper presents global occurrence rates and detailed characteristics of equatorial to midlatitude medium‐scale irregularities under quiet geomagnetic conditions. The study covers 4 years, two during solar minimum (2008–2009) and two during the ascending phase of solar cycle 24 (2012–2013). Irregularities were found to occur frequently at high latitudes and during nighttime in equatorial to midlatitude regions in both bottom and topside Fregion layers. Longitudinal‐seasonal occurrence trends at equatorial and midlatitudes are consistent with previous irregularity climatology, which reaffirms that localized enhancements in plasma instability growth rates contribute to irregularity occurrence. Seasonal occurrence patterns also indicate a high occurrence of irregularities in regions corresponding to the solar terminator, confined primarily to altitudes below ~300 km. The local time‐altitude distributions of equatorial and midlatitude irregularity occurrence, amplitude, and scale size provide further insight into irregularity generation mechanisms, and include features consistent with “spread F” irregularities and traveling ionospheric disturbances. COSMIC radio occultation TEC measurements are used to examine the global climatology of medium‐scale ionospheric plasma irregularitiesObservation of vertical irregularity structure and distribution provides new insight into irregularity occurrence and characteristicsIrregularities are persistently observed in nighttime equatorial to midlatitude regions, near the solar terminator, and at high latitudes

ABSTRACTHabitat assessments often require observers to estimate tree hollows in situ, which can be costly, destructive and prone to bias. An alternative is to count the number of trees above a specific size. The size at which a tree develops hollows differs substantially among tree species. To assist with setting standards for habitat assessment we defined a large tree as the size at which a species has a 50% probability of supporting a 2-cm diameter hollow. We estimated this size for 68 species using a meta-analysis based on 18 data sources. We found that large tree size ranged from 21 to 106 cm diameter at breast height (DBH). Each species was attributed to vegetation types (formations and classes) to explore variation in large tree sizes. Despite considerable variation within vegetation classes and formations, our results suggest that a large tree size of approximately 50 cm DBH may be appropriate for most vegetation types, with lower estimates in semi-arid vegetation (~30 cm) and higher estimates in wet sclerophyll forests (~80 cm). Our estimates provide empirical support for defining large trees at species vegetation class and formation levels within New South Wales, and highlights the need for more empirical data.

This paper presents validation of ionospheric Global Positioning System (GPS) radio occultation measurements of the GPS Attitude, Positioning, and Profiling Experiment occultation receiver (GAP‐O). GAP is one of eight instruments comprising the Enhanced Polar Outflow Probe (e‐POP) instrument suite on board the Cascade Smallsat and Ionospheric Polar Explorer (CASSIOPE) satellite. One of the main error sources for certain GAP‐O data products is the receiver differential code bias (rDCB). A minimization of standard deviations (MSD) technique has shown the most promise for rDCB estimation, with estimates ranging primarily from −40 to −28 total electron content units (TECU = 1016el m−2; 21.6 to 15.1 ns), including a long‐term decrease in rDCB magnitude and variability over the first 3 years of instrument operation. In application of the MSD method, the sensitivity of bias estimates to ionospheric shell height are as large as 4.5 TECU per 100 km. MSD calculations also agree well with the “assumption of zero topside TEC” method for rDCB estimate at satellite apogee. Bias‐corrected topside TEC of GAP‐O was validated by statistical comparison with topside TEC obtained from ground‐based GPS TEC and ionosonde measurements. Although GAP‐O and ground‐based topside TEC had similar variability, GAP‐O consistently underestimated the ground‐derived topside TEC by up to 7 TECU. Ionospheric electron density profiles obtained from Abel inversion of GAP‐O occultation TEC showed good agreement with Fregion densities of ground‐based incoherent scatter radar measurements. Comparison of GAP‐O and ionosonde measurements revealed correlation coefficients of 0.78 and 0.79, for peak Fregion density and altitude, respectively. GAP‐O provides high‐resolution radio occultation and topside TEC measurements of the ionosphere, primarily at northern high latitudesGAP‐O receiver bias estimates are in the range of ‐40 to ‐28 TECU, with a long‐term decrease in bias magnitude and day‐to‐day variabilityFregion ionospheric density profiles retrieved from inversion of occultation TEC correlate well with ISR and ionosonde measurements

Previously published at www.cmaj.ca See related research article by Drolet and colleagues, page 1731 'I wish I could state anything very satisfactory as to treatment of the after-pains, which are [...]

Pancreatic allograft thrombosis (PAT) remains the leading cause of nonimmunologic graft failure. Here, we propose a new computed tomography (CT)grading system of PATto identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplantations between 2009 and 2014. Triple‐phase CTscans were graded independently by 2 radiologists as grade 0, no thrombosis; grade 1, peripheral thrombosis; grade 2, intermediate non‐occlusive thrombosis; and grade 3, central occlusive thrombosis. Twenty‐four (23.3%) of 103 recipients were diagnosed with PAT(including grade 1). Three (2.9%) grafts were lost due to portal vein thrombosis. On multivariate analysis, pancreas after simultaneous pancreas–kidney transplantation/solitary pancreatic transplantation, acute rejection, and CTfindings of peripancreatic edema and/or inflammatory change were significant risk factors for PAT. Retrospective review of CTscans revealed more grade 1 and 2 thromboses than were initially reported. There was no significant difference in graft or patient survival, postoperative stay, or morbidity of recipients with grade 1 or 2 thrombosis who were or were not anticoagulated. Our data suggest that therapeutic anticoagulation is not necessary for grade 1 and 2 arterial and grade 1 venous thrombosis. The proposed grading system can assist clinicians in decision‐making and provide standardized reporting for future studies. The Cambridge Pancreatic Allograft Thrombosis grading system may be used to standardize reports of thrombosis, identify patients who would benefit from therapeutic anticoagulation, provide prognostic information, and allow better comparison of reports from different centers for improved understanding and management of this common condition.

Background and Aims: Mild traumatic brain injury is a common presentation to Emergency Departments. Early identification of patients with cognitive deficits and provision of discharge advice are important. The Abbreviated Westmead Post-traumatic Amnesia Scale provides an early and efficient assessment of post-traumatic amnesia for patients with mild traumatic brain injuries, compared with the previously used assessment, the Modified Oxford Post-traumatic Scale.Material and Methods: This retrospective cohort study reviewed 270 patients with mild traumatic brain injury assessed for post-traumatic amnesia over a 2-year period between February 2011 and February 2013. It identified those assessed with Abbreviated Westmead Post-traumatic Amnesia Scale versus Modified Oxford Post-traumatic Scale, the outcomes of these post-traumatic amnesia assessments, the hospital length of stay for patients, and their readmission rates.Results: The Abbreviated Westmead Post-traumatic Amnesia Scale was used in 91% of patient cases (and the Modified Oxford Post-traumatic Scale in 7%), and of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 94% cleared post-traumatic amnesia testing within 4 h. Of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 56% had a shorter length of stay than had they been assessed with the Modified Oxford Post-traumatic Scale, resulting in 295 bed-days saved. Verbal and written discharge advice was provided to those assessed for post-traumatic amnesia to assist their recovery. In all, 1% of patients were readmitted for monitoring of mild post-concussion symptoms.Conclusion: The Abbreviated Westmead Post-traumatic Amnesia Scale provides an effective and timely assessment of post-traumatic amnesia for patients presenting to the Emergency Department with mild traumatic brain injury compared with the previously used assessment tool. It helps identify patients with cognitive impairment and the need for admission and further investigation, resulting in appropriate access to care. It also results in a decreased length of stay and decreased hospital admissions, with subsequent cost savings to the hospital.

Metformin might reduce insulin requirement and improve glycaemia in patients with type 1 diabetes, but whether it has cardiovascular benefits is unknown. We aimed to investigate whether metformin treatment (added to titrated insulin therapy) reduced atherosclerosis, as measured by progression of common carotid artery intima-media thickness (cIMT), in adults with type 1 diabetes at increased risk for cardiovascular disease.

Future global mean sea level (GMSL) change is dependent on the complex response of the Antarctic ice sheet to ongoing changes and feedbacks in the climate system. The Lambert‐Amery glacial system has been observed to be stable over the recent period yet is potentially at risk of rapid grounding line retreat and ice discharge given that a significant volume of its ice is grounded below sea level, making its future contribution to GMSL uncertain. Using a regional ice sheet model of the Lambert‐Amery system, we find that under a range of future warming and extreme scenarios, the simulated grounding line remains stable and does not trigger rapid mass loss from grounding line retreat. This allows for increased future accumulation to exceed the mass loss from ice dynamical changes. We suggest that the Lambert‐Amery glacial system will remain stable or gain ice mass and mitigate a portion of potential future sea level rise over the next 500 years, with a range of +3.6 to −117.5 mm GMSL equivalent. A simulated Lambert‐Amery glacial system contributed a range of +3.6 to −117.5 mm global mean sea level equivalent over 500 yearsThe Lambert‐Amery glacial system maintains stability while a small ice shelf remains to buttress the ice flowResolving ice flow through narrow channels in the Lambert‐Amery glacial system is important for investigating its future stability

Transplant‐mediated alloimmune thrombocytopenia (TMAT) from donors with immune thrombocytopenia (ITP) can result in significant bleeding complications in the recipient. The risk to a recipient of TMATif they receive an organ from a donor with ITPis unknown. The outcomes of recipients of organs from deceased donors with ITPrecorded in the UKTransplant Registry between 2000 and 2015 were reviewed. Twenty‐one deceased organ donors had a predonation diagnosis of ITP. These donors were significantly more likely to have died from intracranial hemorrhage than were all other deceased organ donors (85% vs. 57%, p < 0.001). Organs from donors with ITPresulted in 49 organ transplants (31 kidney, 14 liver, four heart), with only one case of TMAT, which occurred in a liver transplant recipient and resulted in death from bleeding complications 18 days posttransplantation. The recipient of a kidney from the same organ donor was not affected. Unadjusted 5‐year patient and graft survival was significantly worse for liver transplant recipients from donors with ITPcompared with liver transplant recipients from donors without ITP(64% vs. 85%, p = 0.012). Organs from donors with ITPmay be considered for transplantation, but livers should be used with caution. Donors with immune thrombocytopenia may cause transplant‐mediated alloimmune thrombocytopenia in their recipients.

The lunar ionosphere is a ∼100 km thick layer of electrically charged plasma surrounding the moon. Despite knowledge of its existence for decades, the structure and dynamics of the lunar plasma remain a mystery due to lack of consistent observational capacity. An enhanced observational picture of the lunar ionosphere and improved understanding of its formation/loss mechanisms is critical for understanding the lunar environment as a whole and assessing potential safety and economic hazards associated with lunar exploration and habitation. To address the high priority need for observations of the electrically charged constituents nikear the lunar surface, we introduce a concept study for the Radio Instrument Package for Lunar Ionospheric Observation (RIPLIO). RIPLIO would consist of a multi‐CubeSat constellation (at least two satellites) in lunar orbit for the purpose of conducting “crosslink” radio occultation measurements of the lunar ionosphere, with at least one satellite carrying a very high frequency (VHF) transmitter broadcasting at multiple frequencies, and at least one satellite flying a broadband receiver to monitor transmitting satellites. Radio occultations intermittently occur when satellite‐to‐satellite signals cross through the lunar ionosphere, and the resulting phase perturbations of VikHF signals may be analyzed to infer the ionosphere electron content and high‐ resolution vertical electron density profiles. As demonstrated in this study, RIPLIO would provide a novel means for lunar observation, with the potential to provide long‐term, high‐resolution observations of the lunar ionosphere with unprecedented pan‐lunar detail. The lunar ionosphere comprises electrically charged particles within the lunar atmosphere and is derived from a wide range of sources and formation mechanisms that are not fully resolved. Although extremely tenuous compared to that of Earth's, the lunar ionosphere plays an integral role in physical processes occurring within the lunar environment. The composition and dynamics of the lunar ionosphere are mostly unknown at this point and may be linked to the lunar surface and sub‐surface, solar wind, magnetosphere, and Earth's atmosphere. Observation of the lunar ionosphere is essential to develop a complete picture of its structure and dynamic behavior and how it is formed. This is a critical aspect of assessing its physical role within the lunar environment and potential safety hazards for future lunar exploration and habitation. This paper presents the concept of a radio‐based mission for lunar ionospheric observation called the Radio Instrument Package for Lunar Ionospheric Observation (RIPLIO). This mission would employ multiple CubeSats in lunar orbit, equipped with radio transmitters and receivers, to observe the lunar ionosphere with unprecedented detail. This paper presents preliminary simulations of radio measurements of the lunar ionosphere, and discusses requirements for a potential RIPLIO mission and relevance to international science objectives. We propose a “crosslink” radio occultation method of observing electrically charged constituents of the lunar exosphereSimulations demonstrate that two CubeSats in lunar orbit result in a substantial increase in lunar ionosphere observational capacityWe demonstrate that a VHF transmitter‐receiver “crosslink” setup is ideal for making radio occultation observations of the lunar ionosphere We propose a “crosslink” radio occultation method of observing electrically charged constituents of the lunar exosphere Simulations demonstrate that two CubeSats in lunar orbit result in a substantial increase in lunar ionosphere observational capacity We demonstrate that a VHF transmitter‐receiver “crosslink” setup is ideal for making radio occultation observations of the lunar ionosphere

Reinvigorating the Debt Strategy A number of proposals have been made and actions have been taken in the past year or so to reinvigorate the debt strategy. They include the [...]

Context.The masses previously obtained for the X-ray binary 2S 0921–630 inferred a compact object that was either a high-mass neutron star or low-mass black-hole, but used a previously published value for the rotational broadening (vsin i) with large uncertainties.

An inspection of the DSS and 2MASS images of selected Milky Way regions has led to the discovery of 66 stellar groupings whose morphologies, color–magnitude diagrams, and stellar density distributions suggest that these objects are possible open clusters that do not yet appear to be listed in any catalogue. For 24 of these groupings, which we consider to be the most likely to be candidates, we provide extensive descriptions on the basis of 2MASS photometry and their visual impression on DSS and 2MASS. Of these cluster candidates, 9 have fundamental parameters determined by fitting the color–magnitude diagrams with solar metallicity Padova isochrones. An additional 10 cluster candidates have distance moduli and reddenings derived from Kmagnitudes and $(J-K)$color indices of helium-burning red clump stars. As an addendum, we also provide a list of a number of apparently unknown galactic and extragalactic objects that were also discovered during the survey.

We report the first case of anaphylaxis after ingestion of Lion's Mane Mushroom, Hericium erinaceus, a mushroom with increasing culinary popularity.

Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57‐year‐old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life‐supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma‐free red cell–based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situperfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situnormothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia. The authors report a liver transplant where ex situnormothermic machine perfusion was used to reduce cold ischemia and permit functional assessment of a donation after circulatory death liver before implantation.

After cessation of lactation, involution of the mouse mammary gland proceeds in two distinct phases, a reversible and an irreversible one, which leads to the death and removal of alveolar cells. Cell death is preceded by the loss of STAT5 activity, which abrogates cell differentiation and gain of STAT3 activity. Despite early observations implicating BCL2 (B cell lymphoma 2) family proteins in this process, recent evidence suggests that STAT3-controlled cathepsin activity is most critical for cell death at the early stage of involution. Somewhat surprisingly, this cell death associates with but does not depend on the activation of pro-apoptotic effector caspases. However, transgenic overexpression of BCL2, that blocks caspase activation, delays involution while conditional deletion of BclX accelerates this process, suggesting that BCL2 family proteins are needed for the effective execution of involution. Here, we report on the transcriptional induction of multiple pro-apoptotic BCL2 family proteins of the ‘BH3-only’ subgroup during involution and the rate-limiting role of BIM in this process. Loss of Bim delayed epithelial cell clearance during involution after forced weaning in mice, whereas the absence of related Bmf had minor and loss of Bad or Noxa no impact on this process. Consistent with a contribution of BCL2 family proteins to the second wave of cell death during involution, loss of Bim reduced the number of apoptotic cells in this irreversible phase. Notably, the expression changes observed within the BCL2 family did not depend on STAT3 signalling, in line with its initiating role early in the process, but rather appear to result from relief of repression by STAT5. Our findings support the existence of a signalling circuitry regulating the irreversible phase of involution in mice by engaging BH3-only protein-driven mitochondrial apoptosis.

We report for the first time the adoptive transfer of donor HLA‐specific allosensitization in two recipients following kidney transplantation from a highly sensitized donor. Kidneys from a donation after circulatory death donor were transplanted into two nontransfused, HLA‐specific antibody negative males receiving their first transplant. Antibody screening 7 days after transplant showed high level de novoIgG HLA class I‐ and class II‐specific antibodies in both recipients, with largely overlapping antibody profiles but no antibodies to donor HLA. The unusually rapid appearance of de novoalloantibodies in immunosuppressed nonsensitized recipients and absence of donor HLA‐specific antibody prompted testing of stored donor serum that revealed high antibody levels with specificities very similar to those seen in both recipients, but in addition the presence of strong antibodies to each recipient HLA. Alloantibody levels gradually declined but were still detectable at 3 months. These findings suggest that alloreactive passenger B cells/plasma cells within the kidneys of highly sensitized donors may give rise to rapid development of posttransplant de novoHLA‐specific alloantibodies. While the clinical significance of this phenomenon is uncertain it provides one explanation for the appearance of de novoHLA‐specific antibodies directed against third party but not donor HLA. Two cases described in this report suggest that adoptive transfer of alloreactive passenger B cells/plasma cells present within the kidneys of a highly sensitized donor may give rise to the rapid development of posttransplant de novoHLA‐specific alloantibodies in recipient sera, directed against third‐party HLA.

In order to develop a national allocation scheme for donor pancreases, factors affecting waiting time and transplant outcomes in the United States (US) and United Kingdom (UK) were analyzed and compared. Blood group, sensitization, dialysis requirement, and whether the patient was waiting for a kidney and pancreas or pancreas alone affected waiting time in both countries; ethnicity and body mass index (BMI) also affected waiting time in the US. Ninety‐day pancreas survival was similar in the UK and US, and was poorer for patients receiving a pancreas alone, with older donors, higher BMI and longer duration of ischemia in both countries. Factors affecting outcome, together with published data on factors affecting islet transplantation, informed the development of a points based allocation scheme for deceased donor pancreases in the UK providing equitable access for both whole organ and islet recipients through a single waiting list. Analysis of the allocation scheme 3 years after its introduction in December 2010 showed that the results were broadly as simulated, with a significant reduction in the number of long waiting patients and an increase in the number of islet transplants. There remains a surplus of highly sensitized patients in the waiting list, which the scheme should address in time. This article describes the results of the UK pancreas allocation scheme, developed to afford equal access to a pancreas for whole organ and islet recipients, and compares them to the simulations that underpin its design.

Despite a significant risk for early graft loss and recipient mo rtality after kidney transplantation using ECD and DCD donors relative to SCD donors, long‐term survival remains b etter for patients compared to those who remain on the transplant waiting list.

This review describes common and less common anatomical variants that confront surgeons during abdominal organ recovery and organ implantation, and gives tips on avoiding inadvertent structural injury during these procedures.

This study shows that the use of normothermic regional perfusion for organ recovery from controlled donation after circulatory death leads to an increased organ recovery rate and may improve short‐term transplant outcomes.

Landslides triggered by earthquake shaking pose a significant hazard in active mountain regions. Steep topography promotes gravitational instabilities and can amplify the seismic wavefield; however, the relationship between topographic amplification and landsliding is poorly understood. Here, we use numerical methods to investigate the link between low‐frequency ground shaking, topographic amplification, and the landslide distribution from the 2015 Gorkha, Nepal earthquake. Results show that the largest landslides initiated where the highest topographic amplification, highest elevations, and steepest slopes converged, typically in glacially‐sculpted terrain, with additional controls of rock strength and absolute ground motions. Additionally, the initiation of the largest and most fatal landslide was likely influenced by amplification throughout the rupture due the orientation of the ridge with respect to the propagating wavefield. These results indicate that topographic amplification is one of the key factors for understanding where large and potentially devastating landslides are likely to occur during future major earthquakes. Coseismic landslides, or landslides that happen because of earthquake shaking, can cause more damage and devastation to communities than the earthquake shaking itself. One potential cause of coseismic landslide initiation is increased seismic amplitudes at the tops of ridges due to constructive interference of seismic waves within a ridge, a phenomenon known as topographic amplification. The shaking from the 2015 Gorkha earthquake in Nepal caused 25,000 coseismic landslides. In this study, we model the ground shaking caused by the earthquake to isolate how topography affects the amplitudes of seismic waves and whether this contributed to landsliding. We find that topographic amplification plays an important role in initiating the largest landslides and that continual amplification of one ridge throughout the earthquake influenced the initiation of the largest and most fatal landslide. Modeling topographic amplification from future earthquakes could improve our estimates of where the largest and most devastating landslides are likely to occur. Initiation of the largest coseismic landslides corresponds to high topographic amplification, steep slopes, and high elevationsThe initiation of the Langtang Valley landslide was likely influenced by multiple episodes of amplification throughout the ruptureCharacterizing topographic amplification can provide insight into where large landslides are likely to occur during future earthquakes Initiation of the largest coseismic landslides corresponds to high topographic amplification, steep slopes, and high elevations The initiation of the Langtang Valley landslide was likely influenced by multiple episodes of amplification throughout the rupture Characterizing topographic amplification can provide insight into where large landslides are likely to occur during future earthquakes