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Living donor liver transplantation has expanded in recent years, particularly in North America. As experience with this procedure has matured over the last 25 years, centers are increasingly faced with potential living donors who are more medically complex. As donors move through the evaluation process, completing the informed consent process continues to be challenged by a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise "healthy" living liver donor population. Two recently published studies examined long-term outcomes post-living liver donation using Korean registry data and reported similar results, with excellent overall survival when compared to appropriately matched controls. However, the authors of these studies were presented differently, with one reporting an alarmist view based on one aspect of a suboptimal analysis approach using an inappropriate comparator group. Herein, the North American Living Liver Donor Innovation Group (NALLDIG) consortium discusses these two studies and their potential impact on living liver donation in North America, ultimately highlighting the importance of scientific integrity in data presentation and dissemination when using transplant registry data.

Background: Outcomes in liver transplantation with organs obtained via donation after cardiocirculatory death (DCD) have been suboptimal compared to donation after brain death, attributed mainly to the high incidence of ischemic cholangiopathy (IC). We evaluated the effect of a 10-year learning curve on IC rates among DCD liver graft recipients at a single centre.Methods: We analyzed all DCD liver transplantation procedures from July 2006 to July 2016. Patients were grouped into early (July 2006 to June 2011) and late (July 2011 to July 2016) eras. Those with less than 6 months of follow-up were excluded. Primary outcomes were IC incidence and IC-free survival rate.Results: Among the 73 DCD liver transplantation procedures performed, 70 recipients fulfilled the selection criteria, 32 in the early era and 38 in the late era. Biliary complications were diagnosed in 19 recipients (27%). Ischemic cholangiopathy was observed in 8 patients (25%) in the early era and 1 patient (3%) in the late era (p = 0.005). The IC-free survival rate was higher in the late era than the early era (98% v. 79%, p = 0.01). The warm ischemia time (27 v. 24 min, p = 0.049) and functional warm ischemia time (21 v. 17 min, p = 0.002) were significantly lower in the late era than the early era.Conclusion: We found a significant reduction in IC rates and improvement in IC-free survival among DCD liver transplantation recipients after a learning curve period that was marked by more judicious donor selection with shorter procurement times.Contexte : L'issue des greffes de foie suite a un don d'organe apres deces cardiocirculatoire (DDC) a ete sous-optimale comparativement aux dons suivant la mort cerebrale. Cela serait surtout attribuable a une forte incidence de cholangiopathie ischemique (CI). Nous avons evalue l'effet d'une courbe d'apprentissage echelonnee sur 10 ans sur les taux de CI chez des receveurs de greffe de foie apres DDC dans un seul centre.Methodes : Nous avons analyse toutes les greffes de foie consecutives a des DDC entre juillet 2006 et juillet 2016. Les patients ont ete regroupes en 2 epoques, la premiere, de juillet 2006 a juin 2011, et la seconde, de juillet 2011 a juillet 2016. Ceux pour lesquels on disposait de moins de 6 mois de suivi ont ete exclus. Les parametres principaux etaient l'incidence de CI et le taux de survie sans CI.Resultats : Parmi les 73 greffes de foie par suite de DDC, 70 receveurs repondaient aux criteres de selection, 32 pour la premiere epoque et 38 pour la seconde epoque. Des complications biliaires ont ete diagnostiquees chez 19 receveurs (27%). La cholangiopathie ischemique a ete observee chez 8 patients (25%) de la premiere epoque et 1 patient (3%) de la seconde (p = 0,005). Le taux de survie sans CI a ete plus eleve pendant la seconde epoque que pendant la premiere (98% c. 79%, p = 0,01). Le temps d'ischemie chaude (27 minutes c. 24, p = 0,049) et le temps d'ischemie chaude fonctionnelle (21 minutes c. 17, p = 0,002) ont ete significativement plus courts durant la seconde epoque que durant la premiere.Conclusion : Nous avons observe une reduction significative des taux de CI et une amelioration de la survie sans CI chez les receveurs de greffes de foie par DDC apres une courbe d'apprentissage qui a ete marquee par une selection plus judicieuse des donneurs et des delais d'obtention plus courts., Recommended strategies to expand the donor pool in liver transplantation and decrease waiting list mortality include using extended-criteria donors and living donation. Encompassed among extended-criteria donors is donation after cardiocirculatory [...]

Arheološka izkopavanja, ki so leta 1999 potekala v Ljubljani, v inzuli XXVII Emone, so odkrila ostanek trupa stebra z organskim jedrom, postavljenega na kamnito plinto. V prispevku predstavljamo najdbo, njen arheološki kontekst in morebitne analogije, mineraloško-petrografsko sestavo ometa, tip pigmenta ter analizo naravnega kamna, uporabljenega za plinto. Od trupa stebra je ostal le zunanji del iz ometa, nanesenega v štirih plasteh in barvanega z rdečo okro, v notranjosti pa se je ohranil odtis trstičja. Plinta je pravokotni blok, narejen iz lokalnega spodnjejurskega oolitskega apnenca, verjetno z območja Podpeči. Oblika stebra kaže, da bi bil lahko del portika ali peristila, arheološki kontekst pa nakazuje povezavo z bazenom oz. kopališčnim kompleksom v tem delu poznorimske Emone.

Background: Early reports of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) outcomes have been suboptimal. The literature has confirmed that learning curves influence surgical outcomes. We [...]

Background. Previous studies in high and low expressors has demonstrated that a variant in the GNPAT gene (D519G, Rs11558492, chromosome 1, exon 11) has been associated with severe iron overload in C282Y homozygotes for hemochromatosis. In this study, a GNPATvariant was assessed prospectively in patients referred for HFE testing over a range of serum ferritin levels.Material and methods. Consecutive patients sent for HFE testing were studied for the GNPAT variant using a TaqMan kit assay (Life Technologies, Burlington, ON). Serum ferritin and iron removed by phlebotomy was compared in C282Y homozygotes with and without the GNPATvariant. The frequency of the GNPATvariant in referred patients was compared to a control population of voluntary blood donors without HFE mutations.Results. There were 533 patients that had GNPATanalysis. The allele frequency for the GNPATvariant in C282Y homozygotes (n = 75) was 0.226 and in wild type control patients (n = 458) was 0.213 (p = .07). Forty-eight percent (of the C282Y homozygotes were heterozygous (n = 28) or homozygous (n = 8) for the GNPATvariant. The mean (log)ferritin and iron removed did not significantly differ between C282Y homozygous with GNPAT homozygotes, GNPAT heterozygotes, and without the GNPATvariant (p = 0.84).Conclusions. C282Y homozygotes referred for HFE testing commonly have a GNPATvariant. This GNPATvariant does not appear be a co-modifying gene affecting expression of HFE related hemochromatosis in this population. The GNPATvariant does not predict the severity of iron overload.

Background/Aim: In patients with advanced post-transplant hepatitis C virus (HCV) recurrence, antiviral treatment (AVT) with interferon and ribavirin is indicated to prevent graft failure. The aim of this study was to determine and report Canadian data with respect to the safety, efficacy, and spontaneous virologic response (SVR) predictors of AVT among transplanted patients with HCV recurrence. Patients and Methods: A retrospective chart review was performed on patients transplanted in London, Ontario and Edmonton, Alberta from 2002 to 2012 who were treated for HCV. Demographic, medical, and treatment information was collected and analyzed. Results: A total of 85 patients with HCV received pegylated interferon with ribavirin post-liver transplantation and 28 of the 65 patients (43%) with genotype 1 achieved SVR. Of the patients having genotype 1 HCV who achieved SVR, there was a significantly lower stage of fibrosis (1.37 ± 0.88 vs. 1.89 ± 0.96; P = 0.03), increased ribavirin dose (total daily dose 1057 ± 230 vs. 856 ± 399 mg; P = 0.02), increased rapid virologic response (RVR) (6/27 vs. 0/31; P = 0.05), increased early virologic response (EVR) (28/28 vs. 18/35; P = 0.006), and longer duration of therapy (54.7 ± 13.4 weeks vs. 40.2 ± 18.7; P = 0.001). A logistic regression model using gender, age, RVR, EVR, anemia, duration of therapy, viral load, years′ post-transplant, and type of organ (donation after cardiac death vs. donation after brain death) significantly predicted SVR (P < 0.001), with duration of therapy having a significant odds ratio of 1.078 (P = 0.007). Conclusions: This study identified factors that predict SVR in HCV-positive patients who received dual therapy post-transplantation. Extending therapy from 48 weeks to 72 weeks of dual therapy is associated with increased SVR rates. Future studies examining the role of extended therapy are needed to confirm these findings, since the current study is a retrospective one.

The study reported here provides an example of the complex interface among historical study, current issues, and adolescents' complex social worlds. The authors investigated the ways in which a group of eighth grade students conceptualize the significance of gender in the context of a study of antebellum U.S. history. Fifty students participated in a set of inquiries into women's involvement in nineteenth-century U.S. reform movements, industrialization, and culture contact and conflict on the shifting frontier. Classroom interactions, museum-like displays, presentations, and interviews contrast students' public constructions and private responses to issues of gender and sexuality in the context of historical study. Among other findings, students identified women's experiences as historically significant, recognized, analyzed, and expressed interest in the variety of perspectives represented by women they studied, and worried about "reverse sexism"--studying women at the expense of men. In addition, students' historical inquiries generated discussion about current issues of gender and sexuality, both inside and outside the classroom. In discussing the contrasts between the classroom culture and the encircling "homophobic hallways," the authors suggest the importance of establishing environments where 1) gender is not an "add-on" or "extra" but fundamental point of analysis, and 2) adolescents build a vocabulary for discussing human rights issues and engage in critiquing current practices in regard to gender and sexuality. (Contains 3 notes.)

Introduces a theme issue on rethinking social studies education, discussing: pluralist visions of human possibility; citizenship education and participation; classrooms as laboratories of culture; and educating the educators. The paper suggests that these articles might provoke further discussion about how social studies could influence and shape future generations. (SM)

Introduction. Hepatitis B virus (HBV) related liver transplant (LT) recipients face a high risk of HBV reinfection in the absence of continuous post-operative HBV prophylaxis. Combination HBV prophylaxis with hepa-titis B immune globulin (HBIg) and nucleos(t)ide anti-viral agents prevents HBV recurrence in 90 to 100% of patients who undergo transplantation for hepatitis B and is considered the standard of care in Canada. Post liver transplant HBV prophylaxis protocols vary with regard to the dosing, duration and routes of HBIg administration. All Canadian transplant centres managing liver transplant patients were surveyed as to their HBV transplant protocols.Results. Results of the survey showed that the majority of the Canadian transplant centres use an oral antiviral in combination with long term or indefinite HBIg for prevention of HBV recurrence post liver transplantation. Studies were done to test new protocols using lower HBIg doses given intramuscularly or subcutaneously alone or in combination with antiviral agents.Conclusion. Long term HBIg administration post transplantation in combination with antiviral agents is an integral part of Canadian HBV related liver transplant protocol.

BACKGROUND: Matching to a gastroenterology (GI) fellowship position in Canada is increasingly competitive.

We report the results of investigation of dielectric spectroscopy study of single crystals of Bi12GeO20 and Bi12GeO20 doped with Co nanoparticles. The complex dielectric constant was measured in the temperature interval from 5 to 450 K and frequencies from 1 Hz to 1 MHz. The electrical conductivity of both samples was thermally activated with potential barriers of 0.55 eV and 0.59 eV, respectively. Doped samples had bigger complex dielectric constants and σ′ exhibited slightly steeper temperature dependence than in the pure sample. The dielectric relaxation was observed in pure and doped single crystals and relaxation frequencies showed similar activation energies as electrical conductivities.

Today, combination antiviral therapy with pegylated interferon-alpha and ribavirin (RBV) allows many patients infected with hepatitis C virus (HCV) to achieve a sustained virological response, which is equivalent to cure. Data also support the clinical benefit of combination antiviral therapy in patients coinfected with HCV and HIV, and in patients who have received a liver transplant.

The complex dielectric constant/ac electrical conductivity was investigated as a function of frequency and temperature in Pb5Cr3F19. The system undergoes a ferroelectric phase transition at higher temperatures. At lower temperatures the real part of the complex ac electric conductivity was found to follow the universal dielectric response (UDR) σ′ ∝ νs, typical for hopping or tunneling of localized charge carriers. A detailed analysis of the temperature dependence of the UDR parameter s in terms of the theoretical model for tunneling of small polarons revealed that, at low temperatures, this mechanism governs the charge transport in Pb5Cr3F19. The value of the inverse attempt frequency τ0 indicates the femtosecond tunneling of polarons in the system similar to the Büttiker–Landauer transversal time.

Chronic fatigue syndrome is heterogeneous, with wide variation in presenting symptoms, severity of fatigue and degree of functional impairment. Social and role functioning may be significantly impaired capabilities. Cognitive behavioural therapy offers a novel approach to the treatment of chronic fatigue syndrome. It is based on the hypothesis that inaccurate and unhelpful beliefs, ineffective coping behaviour, negative mood states, social problems and pathophysiological processes all interact to perpetuate the disorder. Treatment aims to help patients to re-evaluate their understanding of the disorder and to adopt more effective coping behaviours. Cognitive behavioural model involve the physical and the psychological view. Therapeutic interventions are often useful to start with behavioural interventions and then to move on to cognitive strategies. The principal behavioural intervention is to stabilise and then to gradually increase activity. The principal cognitive interventions are work on negative thoughts, beliefs, and attitudes about disorder.

Studies literature produced from 1920 to 1940 appropriate for children between 9 and 12 years of age. Critiques the values that are transmitted during this period. Maintains that, although children's literature should be integrated into the social studies curriculum, this should be done in a critical way. Includes a bibliography of books reviewed. (SLM)

Focuses on what students read in social studies classrooms. Illustrates the manner in which literature supports students, even young children, in grappling with the dilemmas and choices that people have faced throughout history. (MG)

BACKGROUND: Hepcidin is a circulating hepatic hormone that regulates iron balance. It has been speculated that hepcidin insufficiency or dysregulation may be the primary defect in genetic hemochromatosis.

Background: The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs. Methods: We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors. Results: The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) µmol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%. Conclusion: Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged. Contexte : L'ecart entre le nombre de patients en attente de transplantation d'organe et la disponibilite d'organes de donneurs se creuse chaque annee au Canada. Le don apres la mort cardiaque (DMC) suivant le retrait du maintien des fonctions vitales chez les patients dont le pronostic est sans espoir permet de lutter contre la penurie et pourrait augmenter le nombre d'organes transplantables. Methodes : Nous avons effectue une etude retrospective unicentrique de dossiers portant sur des organes donnes apres la mort cardiaque par le Programme de transplantation d'organes multiples au Centre des sciences de la sante de London entre juillet 2006 et decembre 2007. Au total, on a preleve 34 organes pleins (24 reins et 10 foies) de 12 donneurs en etat de mort cardiaque. Resultats : Les donneurs avaient en moyenne 38 (intervalle de 18 a 59) ans. Les deces avaient ete causes par un traumatisme craniocerebral (n = 7), un accident vasculaire cerebral (n = 4) et une hypoxie cerebrale (n = 1). Les 10 foies ont ete transplantes a notre centre, ainsi que 14 des 24 reins. Les 10 autres reins ont ete transplantes a d'autres centres. L'ischemie froide du rein a dure en moyenne 6 (intervalle de 3 a 9,5) heures. Chez 12 des 14 receveurs d'un rein (86 %), le greffon a commence a fonctionner tardivement, mais tous les reins ont recommence a fonctionner. Au suivi a 1 an, la fonction renale etait bonne, la concentration moyenne de creatinine serique s'etablissait a 145 (intervalle de 107 a 220) µmol/L et la clairance glomerulaire estimative moyenne, a 64 (intervalle de 41 a 96) mL/min. L'ischemie froide du rein a dure en moyenne 5,8 (plage de 5,5 a 8) heures. Il y a eu un cas de non-fonctionnement primitif qui a oblige a proceder a une autre transplantation. Les 9 autres foies ont bien fonctionne. Un patient a presente une stenose anastomotique biliaire qui est disparue apres la pose d'un stent par endoscopie. Tous les receveurs d'un foie etaient vivants apres un suivi moyen de 11 (intervalle de 3 a 20) mois. Depuis le debut de ce programme de don apres la mort cardiaque, le nombre de donneurs diriges a notre centre a augmente de 14 %. Conclusion : Nos premiers resultats se comparent favorablement a ceux de la transplantation d'organes preleves chez des donneurs apres la mort cerebrale. Le don apres la mort cardiaque peut etre un moyen important d'accroitre le nombre d'organes disponibles pour la transplantation. Il faudrait en encourager la generalisation au Canada., The disparity between the number of patients on transplant waiting lists and the number of organs donated from deceased individuals increases each year in Canada. This organ shortage has prompted [...]