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Background Due to the rare incidence of tibial plateau nonunions, current studies are limited to small sample sizes and patient demographics. The aim of this systematic review is to quantify and report patient and fracture traits, possible risk factors, and treatment outcomes of tibial plateau nonunions. Methods PubMed, Clinical Key, and MEDLINE were searched for articles published prior to August 2020 in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The authors used varying combinations of the following terms to identify relevant articles: “tibial,” “plateau,” “nonunion,” “non-union.” Studies were assessed for patient demographics, pre-revision nonunion characteristics, treatment, and post-revision outcomes. Results Eight studies were included, yielding 31 tibial plateau nonunions (21 males, 10 females). The majority of nonunions were associated with high energy trauma (52.2%) and were Schatzker class VI (54.8%). Schatzker class I and II nonunions were not attributed to neglect, contradicting previous suggestions. Time to union was 4.0 months, the most common treatments being autologous bone grafting (76.7%) and revision plating (63.3%). Conclusion This study demonstrates the effectiveness of autologous bone grafts and revision plating for tibial plateau nonunions. Physicians may use these findings to guide decision making in the event of high energy plateau nonunions. Lastly, various limitations exist within the current literature, emphasizing the need for standardized reporting measures.

A pulse shape difference between photons and neutrons was observed in the output signals of scintillation light from the un-doped CsI calorimeter of the KOTO experiment for the K L → π 0 ν ν decay. We developed a discrimination method to reject neutrons and to accept photons in the deposited energy range from 0.1 to 2 GeV. The method rejects 67% of neutron-induced single hadronic clusters and 86% of neutron-induced two-cluster events while keeping more than 90% of photon-induced single electromagnetic clusters and two-photon events.

This investigation discusses the flow physics of the fully appended DSTO generic submarine model at both straight ahead conditions and during a 10° side-slip. Reynolds Averaged Navier Stokes (RANS) and Large Eddy Simulation (LES) computations have been performed and are compared with model-scale experiments. The experiments have been carried out in the DSTO Low-Speed Wind Tunnel, with data collected using pressure probes, Particle Image Velocimetry (PIV) and flow visualization using wool-tuft streamers. Computational studies using LES on unstructured meshes of up to 340 million cells provide detailed surface and off-body flow field data, complementing the experimental investigations and providing the opportunity for reciprocal validation of experiments and computations. Surface-flow patterns for the DSTO generic submarine model at 10° yaw and a freestream Reynolds (Re) number, based on wind tunnel speed and hull length, of Re=4.5×106 were obtained. The cross-stream velocity for the DSTO generic submarine model at 10° yaw and Re=2.7×106 was measured using PIV. The in-plane velocity was measured at three streamwise locations corresponding to 65%, 84% and 98% of the submarine model length. LES computations were performed using an incompressible LES flow solver developed using OpenFOAM and unstructured tetrahedral grids generated utilizing a patch-based approach to facilitate high near-wall resolutions and arbitrary refinement for appendage wakes.

Background Liver transplantation (LT) is an effective treatment for patients with end-stage liver disease caused by auto-immune hepatitis (AIH). However, diagnosis of AIH can be challenging for patients with end-stage liver disease at the time of transplantation. We classified patients into “probable” or “definite” AIH groups, using the diagnostic criteria of the International Autoimmune Hepatitis Group, and compared the clinical outcomes of AIH after LT in these 2 groups. Methods We performed a retrospective study of 18 patients who were diagnosed with AIH and underwent LT from March 2003 to March 2015 at a single institute. Of the 18 patients, 8 were diagnosed with definite AIH and 10 were diagnosed with probable AIH, according to the international scoring criteria. We evaluated the patient characteristics, recurrence rate, graft loss, and survival rates after LT. Results The mean follow-up duration was 59.3 months. Age, sex, medical condition at transplantation, warm ischemic time, cold ischemic time, and Model for End-Stage Liver Disease score did not differ significantly between the 2 groups. No patient died after LT in either group, but 1 patient in the definite AIH group had graft failure. In Kaplan-Meier analysis, the 5-year recurrence rates of the definite and probable groups were 14.3% and 0%, respectively (P = .992). Conclusions The recurrence of definite AIH appeared to be higher than that of probable AIH. However, careful immunosuppressive therapy allowed the long-term survival of both definite and probable AIH patients after LT.

Objective The aim of this study was to clarify risk factors and outcome of hepatic arterial complication after living-donor liver transplantations (LDLT). Methods From 2004 to 2010, 522 consecutive LDLTs were performed. We used univariate and multivariate analysis to identify the risk factor on a retrospective basis, and then analysis was performed for adult cases. Hepatic arterial complication included thrombosis, stenosis, and pseudoaneurysm. Results The arterial complication rate was 4.79% (25 cases). Each complication was 9 thromboses, 14 stenoses, and 2 pseudoaneurysms. Preoperative hemoglobin was significantly associated with thrombosis (P = .021), and arterial size with stenosis (P = .037). We could not find any association between arterial complications and biliary stricture. However, the outcome of biliary stricture treatment was associated with arterial stenosis. Of 9 cases with thrombosis, 7 patients underwent rearterialization and 2 were treated with low-molecular-weight heparin (LMWH). Of 14 stenosis cases, 2 patients were treated with the use of balloon dilatation, 10 patients were observed under LMWH, and 2 patients underwent retransplantation. In cases of pseudoaneurysm, 1 patient underwent revision of the aneurysm and the other was observed. Conclusions In our cohort, preoperative low hemoglobin level was a risk factor for thrombosis and artery size a risk factor for stenosis.

Scedosporium spp. is the most common mold infection in pneumonia resulting from near-drowning. Three fatal scedosporiosis cases developed after solid organ transplantation, probably transmitted from the nearly-drowned donor. One heart transplant recipient and two kidney transplant recipients developed fatal scedosporiosis following deceased donor transplantation from the same donor, a nearly-drowned victim of a suicide attempt. Genotypically, indistinguishable strains of Scedosporium auratiacum were recovered from the three recipients. Two liver transplant recipients from the same donor received prophylactic voriconazole without any subsequent signs of infection. To determine the safety of donation from nearly-drowned donors, a national traceback investigation was also performed of the causes of deaths in all transplant recipients who received organs from drowned donors between 2001 and 2013. Over 13 years, 2600 deceased donor transplants were performed in Korea. Among these 2600 deceased donor transplants, 27 (1%) victims of drowning donated their organs. From these 27 donors, 84 patients received organ transplants and 18 died, including the above three. We found no microbiologic evidence of invasive mold transmission from the nearly-drowned donors to the other 15 recipients. Although disseminated infection in the donor could not be demonstrated by culture, undiagnosed disseminated donor infection and transmission of Scedosporium spp. should be considered in near-drowning events.

Some research groups have produced immunodeficient mice with human liver tissue as a model system for the analysis of drug metabolism and liver regeneration. Mouse models are important for research and development of drugs and vaccines for viral infections. Recent progress in developing humanized mouse models permits studies of adaptive immune responses, innate host responses, and therapeutic approaches for several liver diseases of viral etiology. In this study, we generated a humanized liver mouse model by transplant with fresh patient-derived hepatocytes (1 × 106 cells/mouse, intrasplenic injection) into preconditioned (50 mg/kg ganciclovir, intraperitoneal injection) mice (herpes simplex virus type 1 thymidine kinase [TK] transgene expressed within the liver of a highly immunodeficient mouse strain [NOG]). Successful reconstitution of human hepatocytes in TK-NOG mouse liver tissues was observed with a strong proliferation of human cells in a time-dependent manner, using cytokeratin 8/18 stain. Similarly, we detected significantly increased human albumin levels in TK-NOG mouse liver tissue and blood sera on immune staining and enzyme-linked immunosorbent assay. Therefore, this humanized liver mouse model provides a biomedical tool for studying human liver physiology, drug metabolism, and liver pathogenesis of viral etiology or liver regeneration.

Liver transplantation (LT) is one of the few effective treatment options for hepatocellular carcinoma (HCC). Our aim in this study was to evaluate the risk factors for HCC recurrence and propose new criteria for LT based on pretransplantation findings. One hundred eighty patients who underwent LT for HCC between 2002 and 2008 were reviewed retrospectively. Outcome measures included maximal tumor size and number of tumors revealed by radiological studies before transplantation, demographics, and tumor recurrence. Maximal tumor size >6 cm, >7 tumors, and alpha-fetoprotein (AFP) levels >1000 ng/mL were identified as independent prognostic factors of HCC recurrence in univariate and multivariate analysis. Disease-free survival rate in patients with a maximal tumor size ≤6 cm, ≤7 tumors, and/or AFP levels ≤1000 ng/mL at 1, 3, and 5 years was 97.9%, 91.5%, and 90.0%, respectively, but the 1-, 3-, and 5-year disease-free survival rate of patients who had a maximal tumor size >6 cm, >7 tumors, and/or AFP levels >1000 ng/mL was 61.9%, 47.6%, and 47.6%, respectively (P < .001). In conclusion, LT can improve the survival of patients with advanced HCC if they have a maximal tumor size ≤6 cm, tumor number ≤7, and/or AFP levels ≤1000 ng/mL.

A set of three algorithms named PET2OGS is developed to integrate the static model (Petrel) with the dynamic model (OpenGeoSys). PET2OGS consists of three sub-algorithms that convert finite difference methods (FDMs) grids to finite element methods (FEMs) grids. The algorithms and the workflow of the integration procedures are described in detail. After the proposed algorithms are tested on a variety of grids both in homogeneous and heterogeneous media, the integrated platform of the static and dynamic models is applied to model CO"2 storage in a saline aquifer. A successful demonstration of the proposed algorithms proved a robust integration of the platform. With some minor modifications of the algorithms in the part of input and output, the proposed algorithms can be extended to integrate different combinations of FDM-based static models and FEM-based dynamic models beyond the example combination in the paper.

Background Most of breast cancer patients survive for a long-term period. The existing assessment of survivors’ prognosis has had some limitations in breast cancer because it is based on an evaluation at the time of diagnosis. Conditional survival reflects change over time after diagnosis and treatment of cancer. Conditional disease-free survival (CDFS) and conditional overall survival (COS) can provide more accurate prognosis to breast cancer patients. In this study, we aimed to determine 5-years CDFS and COS according to disease-free period after diagnosis and treatment of breast cancer in Korea. Methods We retrospectively reviewed clinical data of 5664 patients aged 16 to 86 who underwent curative surgery for breast cancer between January 2000 and December 2008 at Samsung Medical Center, a single tertiary hospital in Korea. The CDFS and COS rates were based on cumulative DFS and OS estimates up to 15 years using the Kaplan-Meier method. Results At baseline, each 5-years DFS and OS were 88.0% and 93.8%. For patients who kept disease free status from 1 to 9 years after surgery, the 5-years CDFS rates were calculated as 88.7%, 90.7%, 91.6%, 91.1%, 91.5%, 91.0%, 89.5%, 86.1% and 86.1%, respectively. The 5-year COS rates of the patients who had survived from 1 to 9 years after surgical treatment were calculated as 92.6%, 92.1%, 91.2%, 91.0%, 89.4%, 85.6%, 80.7%, 75.3%, and 73.0%, respectively. Conclusions Our study showed that 5-years CDFS and COS for most patients who have breast cancer in Korea seemed to be good prognosis for a long time. However, cancer recurrence tended to occur after a long period postoperatively. Further study is required to identify risk factors associated with recurrence after several years in Korean breast cancer patients. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background Many types of stem cells have been widely used for the treatment of liver diseases. The therapeutic effect of stem cells is predominantly based on the immune regulatory properties of these cells. Methods We isolated human liver stem cells (HLSCs), which are considered intrahepatic stem cells, and examined their suppression of T-cell proliferation induced by phytohemagglutinin. Results HLSCs inhibited phytohemagglutinin-induced T-cell proliferation not only in direct co-culture but also in indirect co-culture in a cell number–dependent manner. That is, T-cell proliferation was substantially inhibited by cell-to-cell contact regardless of soluble factor(s). B7-H1, a co-inhibitory molecule that relies on cell-to-cell contact, was found to be constitutively expressed at low levels on HLSCs. Furthermore, its expression was upregulated moderately by tumor necrosis factor-α and dramatically by interferon-γ. Conclusions These results suggest that HLSCs would have therapeutic effects through T-cell suppression in acute liver diseases.

The treatment of choice for combined hepatocellular and cholangiocarcinoma (cHCC-CC) is surgical resection. However, the efficacy of liver transplantation is not clear. We compared the surgical outcome of hepatic resection and liver transplantation for cHCC-CC.From 1995 to 2012, 89 patients were diagnosed with cHCC-CC after hepatic resection and 8 patients diagnosed with cHCC-CC after liver transplantation. We excluded 21 patients who were American Joint Committee on Cancer Staging Stage III or IV and lost to follow-up. The outcomes were reviewed retrospectively.The poor prognostic factors in cHCC-CC patients who underwent hepatectomy were large tumor size (5 cm), small safety margin (2 cm), and low preoperative albumin level. The disease-free survival (DFS) and overall survival (OS) between the hepatectomy group (n = 68) and the liver transplant group (n = 8) was not statistically different (5-year DFS: 26.2% vs 37.5%, P = .333; 5-year OS: 42.1% vs 50%, P = .591). In the small tumor subgroup (tumor size 5 cm), the DFS and OS between the 2 surgical procedures was not different, and in the adequate resection margin subgroup (safety margin2 cm), survival was comparable.In well-selected cases with small tumor size and with preserved liver function, liver resection should be considered when complete resection is possible.

In slightly heated grid turbulence, the mean turbulent kinetic energy and passive-scalar variance dissipation rates, 〈∊〉 and 〈χ〉, decay according to power laws. The isotropic forms of the transport equations for 〈∊〉 and 〈χ〉 suggest that the turbulent mixing (power-law) decay rates depend on the evolution of the ratios G / R λ u and G θ / R λ u , where G and Gθ are the destruction coefficients of 〈∊〉 and 〈χ〉, respectively, and R λ u is the Taylor microscale Reynolds number (λu is the Taylor microscale). The present measurements and previously published data for grid turbulence show that both G and Gθ increase with R λ u but the ratios G / R λ u and G θ / R λ u approach constant values. While G θ / R λ u is nearer to its asymptotic state than G / R λ u , both ratios appear to reach their asymptotic states as R λ u approaches 103. When this occurs, both velocity and scalar fields should be completely self-preserving.

Background Acute-on-chronic liver failure (AoCLF) occurs in lymphoma patients because of hepatitis B virus (HBV) reactivation. We aimed to identify characteristics of patients who underwent liver transplantation (OLT) because of AoCLF that occurred due to HBV reactivation in the setting of lymphoma and to compare these patients with AoCLF patients who did not have lymphoma. Methods Twenty patients underwent OLT due to AoCLF between February 2009 and June 2011. Among these patients, five were diagnosed with lymphoma before OLT and assigned to group 1. The remaining patients ( n = 15) were assigned to group 2. Results Hospitalization after transplantation in group 2 was longer than in group 1 ( P = .014). However, there were no differences in other variables between the two groups. The overall survival rate of group 1 was lower than that of group 2, but there was no difference between the two groups ( P = .134). With the exception of one patient, the median time from complete remission to liver transplantation in group 1 was 4.5 months (range, 1–15) in group 1. Lymphoma recurrence occurred in one patient 8 months after transplantation. Conclusion Our study revealed that OLT is a feasible and effective approach in AoCLF due to HBV reactivation in select lymphoma patients.

The BK nephropathy (BKN) shows a 10% prevalence among cases of kidney transplantation (KT). We assessed the incidence of BK replication in KT recipients as well as our updated screening strategy and the impact of interventions on BK virus infections.Since September 2007, our screening protocol for BK virus included examination of urine cytology or BK virus DNA real-time polymerase chain reaction (PCR) detection on postoperative days 1, 5, 9, 16, 24, 36, 48 weeks up to 1 year. IR present, we tested urine BK virus DNA PCR quantitation. We applied the updated screening protocol from August 2010. It urine BK DNA PCR quantification was above 10(7) copies/mL, we checked regularly blood the BK virus DNA PCR quantification. In addition, if the blood BK virus DNA load was above 10(4) copies/mL and the serum creatinine elevated, we was performed an allograft biopsy. Between September 2007 and December 2011, the 58 recipients who showed BK viremia were enrolled in the present study in 2 groups according to the period of screening protocol (era I, era II).The time between kidney transplantation and BK viremia detection of era II was shorter than that of era I (16 vs 29 weeks; P = .001). Viremia clearance rate at 6 months in era II was significant higher than that of era I (82% vs 36.8%; P = .001) as well as at 12 months (100% vs 61.1%, P .001) after intervention. Interestingly, viremia clearance at 12 months after intervention was 100% in era II.An updated screening protocol for BK virus allowed early detection and accurate diagnosis of BKN. Early detection of BK virus infection enabled early intervention and improved viral clearance rate.

Introduction We investigated the optimal method for transportation of isolated porcine islets from an isolation facility to a transplant hospital or research center in terms of temperature, oxygen supply, and shaking effect. Methods Commercially available insulator boxes with thermoregulators exposed for 5 hours under two external temperatures (4°C and 37°C) were monitored using HOBO temperature loggers. To find the optimal transport device, we compared islet counts, viability, quality, and function in conical tubes, gas-permeable bags (GPB) and gas-permeable flasks (GPF) after 1, 3 and 5 hours. To evaluate the effects of shaking on islets, we also analyzed the difference between a control and a shaking group in each device with time. Results Commercially available Styrofoam insulators with thermoregulators maintained the internal temperature near the target. Islet recovery rate for GPF, which was higher than other devices, was maintained, while those decreased with time for conical tube and GPB containers adenosine diphosphate/adenosine triphosphate (ADP/ATP) ratio for GPF was lower than other devices, albeit not significantly fluoroscein acrimide/propidium iodide (AO/PI) ratio for GPF was higher than other devices after 5 hours. Glucose stimulated index was not different among the devices. In comparison with the control group, shaking yielded comparable islet survival, viability and function. Conclusion Our study demonstrated that the use of commercially available insulator boxes with thermoregulators maintained internal temperature close to the target value and that GPF was more favorable for islet oxygenation during transportation. This study also suggested negligible impact of shaking on isolated porcine islets during transportation.

Liver transplantation, the only effective treatment for end-stage disease, is limited by donor availability. Cell transplantation offers the possibility to restore liver mass and function. Cryopreserved primary hepatocytes that can be thawed as needed might address this problem. Hepatocytes were harvested from a male Sprague Dawley rat, weighing approximately 250 g, using a 2-step in situ collagenase perfusion technique modified from the method described by Seglen. Hepatocytes were immobilized using a 100-mmol/L calcium with 1.5% alginate solution. Primary, immobilized hepatocytes transferred to various cryopreservation solutions containing 15% dimethyl sulfoxide were immediately placed into an isopropanol progressive freezing container at −80°C. We analyzed 4 cryopreservation solutions: Hormonally defined medium, histidine-tryptophan-ketoglutarate (HTK), fetal bovine serum (FBS), and HTK-modified cryopreservation solution (JH). After thawing, we measured viability, plating efficiency, urea synthesis, and albumin secretion to assess the effects of cryopreservation. Primary hepatocytes in HTK solution showed the better results in hepatocytes viability and urea synthesis after thawing. Cryopreserved immobilized hepatocytes in FBS maintained their viability and urea synthesis function. However, JH seemed to be the most effective medium for albumin secretion by both cyropreserved primary and immobilized hepatocytes.Our study suggested that HTK and JH cryopreservation solutions without FBS can be used to develop a bioartificial liver system.

Hepatocyte and various hepatic stem cell transplantations have been studied as alternative therapies to orthotopic liver transplantation for liver injury. The engraftment of transplanted cells into the parenchyma requires transmigration through sinusoidal endothelial cells (SECs), the only cellular barrier. In this study, we constructed a SEC-imaging perfusion culture system that mimics sinusoids with respect to hemorheologic properties. SECs were successfully maintained for 24 hours. Human liver stem cells (HLSCs) were used as a model of transplanted cells for in vitro engraftment to SECs under perfusion culture conditions. Conditions of high shear stress perfusion with 0.34 dyne/cm2 significantly reduced cell adhesion in contrast to lower shear stress conditions of 0.1 and 0.03 dyne/cm2. Among the biologic perfusion fluids, namely, fetal bovine serum (FBS), pig plasma, and 5% human albumin solution, HLSCs showed significantly greater attachment to SECs when perfused with FBS, which is well known to contain abundant amounts of adhesion molecules. This biomimetic SEC perfusion culture system may provide a useful tool to study engraftment mechanisms and to evaluate the effects of various enhancers as an alternative to animal models.

Background End-stage renal disease is associated with severe abnormalities in reproductive function. However, the abnormalities are reversed by successful kidney transplantation. The aim of the present study was to compare hormonal levels between recipients with successful kidney transplantations and healthy women with the same gynecologic conditions. Methods The study group consisted of 31 women of reproductive age with end-stage renal disease who underwent successful kidney transplantation. The ratio of the control group, composed of healthy woman, to the study group was 3:1 matched for age and symptoms. Results Abnormal bleeding ( n = 14) and infertility were the most common gynecologic conditions in kidney transplant recipients. The levels of estrogen (E2) and follicle-stimulating hormone (FSH) in the study group were higher than in the control group, but the levels of progesterone (P4) and luteinizing hormone (LH) were lower in the study group than in the control group. There were no significant differences in prolactin and thyroid-stimulating hormone between the two groups. The incidence of infertility in patients who receive steroid was higher than those with no steroid use ( P = .007). Conclusions Compared with healthy age- and symptom-matched women, female kidney transplant recipients have increased levels of E2 and FSH and decreased levels of P4 and LH. These differences in hormone profiles may predispose kidney transplant recipients to increased risk of gynecologic pathologies.

Objective Salvage liver transplantation (LT) has been proposed for patients with a small hepatocellular carcinoma (HCC) and preserved liver function. Few reports have been issued on salvage LT in a living-donor (LD) LT setting. Therefore, we performed this study to evaluate differences in tumor invasiveness and other risk factors on survival after salvage versus primary LDLT. Methods Between September 1996 and December 2008, 324 patients with HCC underwent LT. We excluded 138 patient from the analysis, leaving 186 HCC patients for analysis, including 17 (9.1%) who had undergone earlier resection, the salvage LDLT cohort. The other 169 patients underwent primary LDLT. Results Intrahepatic metastasis, Edmonson-Steiner histologic grade, microscopic vascular invasion, and preoperative serum alpha-fetoprotein levels significantly influenced tumor recurrence. Microscopic vascular invasion, intrahepatic metastasis, Edmonson-Steiner histologic grade, and treatment by salvage LDLT were significantly associated with poor patient survival univariate analysis. However, only microscopic vascular invasion was significant on multivariate analysis. The treatment modality (primary or salvage LDLT) was not observed to affect overall or disease-free survival significantly on multivariate analysis. Disease-free survival was significantly better in the primary than in the salvage LDLT group. Furthermore, patients in the primary LDLT group tended to show better survival. However, when stratified by the presence or absence of microscopic vascular invasion, no significant group difference was found for overall or disease-free survival among those without versus with microscopic vascular invasion. Conclusions Five-year overall survival after primary versus salvage LDLT were similar when differences in tumor pathologic features, such as microscopic vascular invasion, were taken into account. Multivariate analysis showed that the treatment itself was not a significant prognostic factor for survival.

N 2 physisorption on Single-Walled Carbon Nanotubes (SWCNTs) was investigated by cryogenic thermal-desorption spectroscopy (cryo-TDS). TDS spectra revealed a desorption peak at 48 K (α) for as-purified SWCNTs and an additional desorption peak at 73 K ( β ) for air-oxidized SWCNTs. When N 2 and H 2 were coadsorbed on SWCNTs, H 2 adsorption was blocked by the N 2 preadsorption. By comparing the TDS data with and without the N 2 preadsorption, the α and β peaks were attributed to N 2 adsorbed on the groove site and inside of SWCNTs, respectively.

Objective The best antithymocyte globulin (ATG) preparation for induction suppression in kidney transplant recipients is still not clear. The aim of this study was to identify short- and long-term outcomes in kidney transplant recipients who received Thymoglobulin or ATGAM as an induction agent. Methods We retrospectively reviewed patients who underwent kidney transplantation from 1996 to 2010. Recipients were classified according to the ATG preparation. Results One hundred fifty-two patients (64.4%) received thymoglobulin and 84 (35.6%) received ATGAM. The occurrence of delayed graft function in patients receiving Thymoglobulin was higher than in patients receiving ATGAM ( P = .005), but serum creatinine levels and acute rejection after kidney transplantation were not different between the two groups. The death-censored graft survival curve in Thymoglobulin recipients was higher than in ATGAM recipients ( P = .027). Bacterial infection was a predisposing factor for graft survival ( P = .008). Conclusion The efficacy of Thymoglobulin induction is generally better than that of ATGAM induction, and prevention of bacterial infections was just as important as the use of ATG because bacterial infection was an important risk factor for graft failure.

Zinc oxide (ZnO) nanowires have been synthesized by using tubular furnace chemical vapor deposition technique. The morphology, chemical composition and crystal structure of as-synthesized ZnO nanowires were examined by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD) techniques. Four-terminal current–voltage ( I – V ) measurements were employed to study the electrical conductance of ZnO nanowires under various testing gas environments for gas sensing purpose. The I – V curves at temperature ranging from 150 to 300 K were recorded in the testing chamber under vacuum. The Arrhenius plot shows perfect linear relationship between the logarithm of the current I and inverse temperature 1/ T . The donor level of the semiconducting nanowires is about 326 meV. The I – V behaviors were found to be reversible and repeatable with testing gases. The electrical conductivity was enhanced by a factor of four with ambient CO gas compared to that in vacuum and other testing gases. The optoelectronic properties of the ZnO nanowires were obtained by two-terminal I – V measurement method while the nanowires were illuminated by a ruby laser. The electrical conductivity was increased by 60% when the laser was present in comparison to that when the laser was off. Those significant changes suggest that nano-devices constructed by the ZnO nanowires could be used in gas sensing and optical switching applications.

Background The use of expanded criteria donor (ECD) kidneys has been encouraged to enlarge the donor pools due to the shortage of donors. However, a major concern with ECD kidneys is poor long-term graft survival. The objective of this study was to determine whether ECD kidneys had a negative impact on graft survival. Methods We analyzed all deceased donor renal transplantations at our center from September 1995 to December 2009. Results ECD donors show characteristics, such as comparatively older age, a history of hypertension and diabetes, the use of norepinephrine, high serum creatinine levels and deceased donor scores, and decreased albumin levels and estimated glomerular filtration rates. However, the occurrence of delayed graft function and primary nonfunction among ECD grafts was comparable to those of standard criteria donor (SCD) grafts. Graft survival was not significantly different between the two groups. Only serum creatinine levels at 3, 6, and 9 months after transplantation were lower in the ECD than the SCD group. Multivariate analysis identified longer hospital stay after transplantation, delayed graft function, and acute rejection episodes as independent predictors of poor graft survival. Conclusion Graft survival of ECD kidney was comparable to that of SCD kidneys. We observed that donor factors prior to procurement were not risk factors for graft failure.

Purpose. Portal vein complications (PVC) after pediatric living donor liver transplantation (LDLT) have rarely been reported. We evaluated the long-term incidence and of the risk factors for PVC after pediatric LDLT. Methods. From April 1997 to November 2008, 96 pediatric patients underwent LDLT using left lateral segments or left lobes. We investigated recipient factors, donor factors, and operative factors through medical records. The portal vein sizes in 96 recipients ranged from 2.7 mm to 13.0 mm (median = 5.0 mm). Portal vein reconstruction was usually performed with the graft portal vein anastomosed to the bifurcation of the recipient right and left portal veins, the so-called "branch patch". Results. PVC occured in 11 patients (11.5%) including early PVC (n = 3), late PVC (n = 8). The disease-free survivals at 1, 5, and 10 years after LDLT were 94.7%, 88.7%, and 86.0%. Upon univariate analysis, a portal vein size < 5 mm graft-to-recipient weight ratio (GRWR) ≥ 4%, transfusion volume ≥ 270 mL were significant risk factors for PVC. Body weight < 8 kg and previous operative history tendes to be adverse for PVC. Upon multivariate analysis by Cox regression, portal vein size < 5 mm was a highly significant factor for PVC after pediatric LDLT (hazard ratio = 5.627, P = .027). Conclusion. The disease-free survival at 10 years after LDLT was 86.0%. If the recipient's portal vein size < 5 mm received a large-for-size graft (GRWR ≥ 4%), it is important to observe by regular Doppler ultrasonography follow-up to detect PVC.

Orthotopic liver transplantation (OLT) patients are known to show decreased intraoperative anesthetic requirements compared with patients undergoing other liver surgeries. The aim of this study was to determine the relationship between inhalational anesthetic requirements and the severity of liver disease among OLT patients.Fifty patients undergoing first living donor OLT were divided into 2 groups: model for end-stage liver disease (MELD) score20 (low-MELD group; n=25) versus, MELD scoreor=20 (high-MELD group; n=25). Anesthesia was maintained with desflurane and inspired concentration was titrated to maintain the bispectral index between 40 and 50. Neither intraoperative opioid nor epidural or intrathecal analgesia was used. End-tidal desflurane concentration (ETdes) was measured every 5 minutes and averaged in 30-minute intervals. These values were divided into 3 phases: preanhepatic (P 0.5 hour, P 1 hour, and P 1.5 hours), anhepatic (A 0.5 hour, A 1 hour, A 1.5 hours, and A 2 hours), and postreperfusion (R 0.5 hour, R 1 hour, R 1.5 hours, R 2 hours, R 2.5 hours, and R 3 hours). Results were compared between the 2 groups.The demographic and intraoperative data were similar between the 2 groups. ETdes to maintain comparable anesthetic depth was significantly lower during the preanhepatic and anhepatic phases in the high-MELD than the low-MELD group, but there was no significant difference during the postreperfusion period.OLT patients with high MELD scores showed less inhalational anesthetic requirements during the preanhepatic and the anhepatic periods than those with low MELD scores.

Cytomegalovirus (CMV) infection is not only a common complication after liver transplantation (OLT), but also a significant contributing factor to morbidity and mortality. We investigated risk factors for CMV syndrome and tissue-invasive CMV disease in CMV antigenemia patients after OLT in a CMV endemic area. CMV antigenemia was regarded to be >1 positive CMV pp65 antigen positive cell per 400,000 white blood cells. We examined the epidemiology, clinical characteristics, and laboratory findings of liver transplant patients with CMV syndrome and tissue-invasive CMV disease. The incidence of CMV syndrome among patients with CMV antigenemia was 10.5% (37/353) and that of tissue-invasive CMV disease, 3.1% (11/353). Upon multivariate analysis the risk factors for CMV syndrome and tissue-invasive CMV disease were infection, low albumin level, high total bilirubin content, and high CMV peak titer. The 1-y, 2-y, and 3-year survival rates of subjects without CMV syndrome were 96.2%, 85.4% and 82.2% versus without tissue-invasive CMV disease, 86.9%, 83.0%, and 80.1%, or 70.3%, 56.1% and 51.8% for CMV syndrome or 72.7%, 62.3%, 49.9% for tissue-invasive CMV disease. The survival curve of patients without were superior to those with CMV syndrome (P = .000). Because OLT recipients had risk factors such as infection, low albumin level, high total bilirubin content, and high CMV peak titer, they were carefully monitored and aggressively managed due to the poor survivals of patients with CMV syndrome.

Introduction The aim of this study was to analyze risk factors for delayed graft function (DGF) after deceased donor kidney transplantation and to compare the clinical outcomes of non-DGF versus DGF recipients. Patients and methods From January 2004 to June 2008, 75/154 kidneys were transplanted into 74 recipients. We classified the recipients into two groups: group 1 ( n = 61) without DGF and group 2 ( n = 13) with DGF. Results On univariate analysis, recipient age ( P = .048) cause of brain death (traumatic brain injury vs disease, P = .016), blood urea nitrogen ( P = .002), serum creatinine ( P = .001), arterial pH ( P = .019), and serum sodium level ( P = .012) just before organ procurement showed significant differences. On multivariate analysis, the cause of brain death ( P = .015, hazard ratio [HR]: 7.086), the terminal serum creatinine ≥1.5 mg/dL before organ procurement ( P = .007, HR: 10.132), and recipient age over ≥50 years ( P = .021, HR: 7.767) were independent risk factors for the development of DGF. Graft failures occurred among 5/74 recipients with 5-year graft survivals between group 1 and group 2 of 91.7% and 84.6%, respectively. Patient death occurred in five cases, most by due to infection. The 5-year patient survival between groups 1 and 2 were 93.9% and 84.6%, respectively ( P = .106). Conclusion The independent risk factors for DGF were the cause of brain death, the terminal creatinine level, and the recipient age. In deceased donor kidney transplantation, DGF may have less effect on long-term patient and graft survivals.

Umbilical cord blood (UCB), a rich source of hematopoietic stem cells, offers practical and ethical advantages. It has been reported that various adult stem cells transplanted into a damaged liver show characteristics of a hepatic lineage. In a previous study, we reported on novel UCB-derived adult stem cells, termed umbilical cord blood-derived multipotent progenitor cells (UCB-MPCs). We demonstrated that these cells were capable of differentiating into hepatocyte- like cells in vitro. To assess the hepatic differentiation capacity of UCB-MPCs, rat models of hepatic injury were generated using carbon tetra-chloride (CCl 4 ) with transplantation of cells into the liver. The transplanted cells successfully incorporated into the liver of the recipient animal differentiated into functional hepatocyte-like cells that expressed hepatocyte-specific markers, such as CK-18 and albumin. Moreover, human albumin was detected in the serum of the recipient rat model. These data indicated that UCB-MPCs were capable of displaying similar characteristics to those of functional hepatocytes in a recipient liver. UCB-MPCs may prove to be a useful, transplantable alternative for hepatic progenitor cells in both experimental and therapeutic applications.

Objective Mesenchymal stem cells (MSCs) have been studied in regenerative medicine because of their unique immunologic characteristics. However, before clinical application in humans, animal models are needed to confirm their safety and efficacy. To date, appropriate methods and sources to obtain mouse MSCs have not been identified. Therefore, we investigated MSCs isolated from 3 strains of mice and 3 sources for the development of MSCs in a mouse model. Materials and Methods Male BALB/c, C3H and C57BL/6 mice were used to isolate MSCs from various tissues including bone marrow (BM), compact bone, and adipose tissue. The MSCs were maintained in StemXVivo medium. Immunophenotypes of the MSCs were analyzed by FACS and their growth potential estimated by the number of colony-forming unit fibroblasts. Results All MSCs that were isolated from BM, compact bone, and adipose tissue showed plastic-adherent, fibroblastic-like morphologic characteristics regardless of the mouse strain or cell source. However, culture of BM MSCs was less successful than the other tissue types. The FACS phenotype analysis revealed that the MSCs were positive for CD29, CD44, CD105, and Sca-1, but negative for CD34, TER-119, CD45, and CD11b. According to the results of the characterization, the adipose tissue MSCs showed higher growth potential than did other MSCs. Conclusion The results of this study showed that culture of adipose tissue and compact bone-MSCs was easier than BM MSCs. Based on the results of immunophenotype and growth potential, C57BL/6 AT-MSCs might be a suitable source to establish a mouse model of MSCs.

Wave motion in thin, uniform, curved beams with constant curvature is considered. The beams are assumed to undergo only in-plane motion, which is described by the sixth-order coupled differential equations based on Flugge's theory. In the wave domain the motion is associated with three independent wave modes. A systematic wave approach based on reflection, transmission and propagation of waves is presented for the analysis of structures containing curved beam elements. Displacement, internal force and propagation matrices are derived. These enable transformations to be made between the physical and wave domains and provide the foundation for systematic application of the wave approach to the analysis of waveguide structures with curved beam elements. The energy flow associated with waves in the curved beam is also discussed. It is seen that energy can be transported independently by the propagating waves and also by the interaction of a pair of positive and negative going wave components which are non-propagating, i.e. their wavenumbers are imaginary or complex. A further transformation can be made to power waves, which can transport energy independently. Numerical examples are given to illustrate the wave approach. The first concerns power transmission and reflection through a U-shaped connector between two straight beams while the second concerns the free vibration of finite curved beams where results are compared to other published results.

Waves can propagate freely without reflection in a certain class of non-uniform one-dimensional waveguides even though the properties of the waveguide vary rapidly. In these cases, the amplitude of the wave changes as a function of position but the power associated with the wave is preserved along the waveguide as in uniform waveguides. A generalised wave approach based on reflection, transmission and propagation of waves is used for the analysis of such non-uniform waveguides. The positive- and negative-going wave motions are separated so that the problem is always well-posed. Examples include longitudinal motion of bars and bending motion of Euler–Bernoulli beams, where the cross-section varies as a power of the length. The energy transport velocity, which is the velocity at which energy is carried by the waves in these waveguides, is derived using the relationship between power and energy. It is shown that this energy transport velocity depends on position as well as frequency and differs from the group velocity. Numerical results for wave transmission through a rectangular connector with linearly tapered thickness and constant width are obtained in a straightforward manner without approximation errors and at a low computational cost, irrespective of frequency.

The human immune system is a self-organizing and highly distributed multi-agent system. These properties impart a high degree of robustness and performance that has created great interest in implementing engineering systems. This adopted engineering analogue is called artificial immune system (AIS). This paper presents an immunity-based control framework, which has the ability to detect changes, adapt to dynamic environment and coordinate vehicles activities for goals achievement, to deploy a fleet of autonomous guided vehicles (AGVs) for material handling in an automated warehouse. A robust and flexible automated warehousing system is achieved through the self-organized and fully decentralized origination of AGVs.

An experiment was conducted with 240, 1-d-old, male broilers to investigate the effects of Saccharomyces cerevisiae (SC) cell components on the growth performance, meat quality, and ileal mucosa development. There were 4 dietary treatments, each consisting of 6 replicates. Whole yeast (WY), SC extract (YE), and SC cell wall (CW) were added at 0.5, 0.3, and 0.3%, respectively, to the control starter and finisher diets. From 0 to 3 wk of age, a lower feed/gain ratio (P ≤ 0.05) was observed with CW, whereas the WY-fed birds at 4 to 5 wk of age showed a lower feed/gain ratio compared with the control. From 0 to 5 wk of age, WY and CW gave higher BW gains than did the control. The shear force of raw drumstick decreased in the WY treatment relative to the control, and YE and CW treatments were intermediate. The shear forces in cooked breast and drumstick in treatments WY and YE decreased when compared with the control. The amount of 2-thiobarbituric acid-reactive substances (TBARS) in the breast meats of WY, YE, and CW were lower than the control at 10 d of incubation. In raw drumstick meats, TBARS values were lower in treatments WY and YE than that of the control at 6 and 10 d of incubation. At 10 d of incubation, skins from YE and CW treatments had lower TBARS values than did the control. Villus height was greater in WY and CW compared with those in control and YE. No differences were found in crypt depth among the 4 treatments. The villus height/ crypt depth ratios in WY and CW were greater than those of the control and YE. It could be concluded that dietary yeast components, such as WY or CW supplementation improved growth performance. Meat tenderness could be improved by the WY or YE. Both YE and CW had oxidation-reducing effects. Yeast cell wall may improve ileal villus development.

Time-resolved photoluminescence measurements of high-quality GaN show that the spectra of two-electron satellites (TES) in GaN include also lines coming from excited states of a donor-bound exciton (D 0 X) complex. The lines connected with recombination from the ground and excited states have generally similarly long lifetimes (1.1–1.4 ns, in the case of an exciton bound to oxygen donor). However, analysis of initial dynamics (between 0 and 0.5 ns) shows some transfer of energy between the lines. In fact, the ground-state-related line reaches its maximum 0.1 ns after the excited-state–related line. A rate-equation model taking into account internal transitions in the D 0 X complex gives a characteristic internal time constant of about 0.2 ns.

Bone marrow transplantation after treatment with busulfan and costimulatory blockade with monoclonal antibodies (mAb) cytotoxic T lymphocyte antigen 4 (CTLA4)-Ig and anti-CD154 mAb or two-signal blockade using anti-CD45RB and anti-CD154 mAb are nonmyeloablative treatment regimens for allogeneic transplantation. There may be differences in the mechanisms of donor cell engraftment and reactive cell deletion by which these regimens induce donor-specific tolerance. Therefore, this study was performed to investigate changes in T cells and cytokines during tolerance induction toward allogeneic skin grafts. BALB/c and C57BL/6 mice were used as donors and recipients, respectively. Skin and bone marrow transplantations were performed and busulfan was administered. Three groups were treated with mAb as follows: group 1, anti-CD154 mAb; group 2, anti-CD154 plus anti-CD45RB mAb; and group 3, anti-CD154 mAb plus CTLA4-Ig. The proportions of CD4+ or CD8+ T cells and the expression of CD45RB isoforms on splenocytes were measured using flow cytometry and the production of cytokines by CD4+ T cells using enzyme-linked immunosorbent assay. Group 2 showed a significant reduction in the proportions of CD8+ T cells and CD45RB high isoforms compared with groups 1 and 3. The levels of interleukin (IL)-2 and IL-4 in group 2 were lower and higher than those of groups 1 and 3, respectively. In conclusion, the combined use of anti-CD154 and anti-CD45RB mAb decreases the CD8+ T-cell population and the expression of CD45RB, resulting in a Th2 cytokine profile, which may be a characteristic mechanism leading to donor cell engraftment and reactive cell deletion for donor-specific tolerance.