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Background There are long-standing controversies about the transplant indications for alcoholic liver disease (ALD), because of the recognition that ALD is fundamentally self-inflicted. However, it is unclear whether psychosocial characteristics of ALD are different from that of non-alcoholic liver disease (NALD) in the selection of liver transplantation (LT) recipients. We aimed to clarify the psychosocial characteristics of ALD recipients (ALD-R)/ALD recipient candidates (ALD-RC) and NALD recipients (NALD-R)/ NALD recipient candidates (NALD-RC). Methods From 2011 to 2019, 75 patients were enrolled in this prospective observational study (ALD-RC, n = 19; NALD-RC, n = 56), LT were carried out as follow; ALD-R, n = 6; NALD-R, n = 52. We evaluated psychosocial characteristics in the preoperative period and 3, 12 months after LT (ALD-R, n = 3/3; NALD-R, n = 28/25). The following scales were used to evaluate psychosocial characteristics: Visual Analogue Scale, Alcohol Use Disorders Identification Test, Hospital Anxiety and Depression Scale, Beck Depression Inventory, Brief Evaluation of Medication Influences and Beliefs, Social Support Questionnaire (SSQ), Temperament and Character Inventory, Parental Bonding Instrument (PBI), the Short Form Health Survey (SF-36). Results When evaluating on the basis of abstinence rule, a comparison of ALD-RC and NALD-RC in the preoperative period identified similar patterns of psychosocial characteristics, except that the NALD-RC scored higher on the PBI item “overprotection from mother” (P Conclusion The psychosocial characteristics of ALD-RC and NALD-RC may be similar when evaluated on the basis of Japan’s abstinence rule. This result also imply that the psychosocial characteristics of ALD-RC may differ from the previously reported psychosocial characteristics of alcohol dependent patients. These findings have the potential to provide helpful information for the evaluation of ALD-RC.

The present study investigated the possible risk factors, including relationship/HLA matching between donor and recipient, and immunosuppressive therapies on the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LT). Subjects were 197 recipients of LT for PSC, among whom 180 surviving more than 1 year after LT were further analyzed for risk factors of recurrence. The 5- and 10-year patient- and graft survival rates were 83% and 68%, and 71% and 62%, respectively. The overall PSC recurrence rate was 25% with a 5- and 10-year graft survival rate of 34% and 18%, which was significantly lower than the survival rate of those without recurrence (P 0.001). Univariate analysis identified the following as risk factors for recurrence: donor age (P 0.001), cyclosporine use (P = 0.012), mono or no immunosuppressive agent (P 0.001), postoperative biliary complication (P 0.001), and active intestinal bowel disease after LT (P 0.001). Among these factors, donor age ≥45 years [hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.21-2.69; P = 0.003] and mono or no immunosuppressive agent 1-year after LT (HR, 2.38; 95% CI, 1.23-3.45; P = 0.011) were identified as independent risk factors in the final multivariate Cox regression model. The results were similar in sub-analysis for ABO-identical/compatible adult living donor LT cases.

Highlights • We presented a novel anatomic variation of intrahepatic biliary tree, which had never been reported. • The computerized overlay visualization of MRCP and 3-D CT helped biliary anatomical understanding for operation planning. • Precise preoperative evaluation helped safe living donor surgery and living donor liver transplantation., Introduction Anatomic variations of the biliary tree are common, making precise anatomic evaluation important before hepatobiliary surgery. Presentation of case A 52-year-old woman with no medical history was admitted to our hospital for a live-liver donation to her husband. During her evaluation, magnetic resonance cholangiopancreatography (MRCP) revealed a previously unknown anatomic variation in her biliary system. Segment 2 of the bile duct (B2) independently drained into the posterior branch and formed a common channel (B2+posterior) before joining the anterior branch. Then, bile duct segments 3 and 4 (B3+4) drained into this B2+posterior+anterior channel to form a common hepatic duct. The computerized overlay features shown by MRCP and three-dimensional computed tomography clarified this anatomic variation. A right lobe donor graft was then obtained successfully, with intraoperative cholangiography confirming that the donated graft had two bile duct orifices (i.e., posterior and anterior branches). We thus avoided surgical missteps that would have disallowed bile drainage of B2 and B3+4 into the common hepatic duct. Discussion Precise evaluation is mandatory for hepatobiliary surgical planning to rule out, or discover, challenging bile duct anatomy. Conclusion Preoperative computerized overlay visualization of MRCP and computed tomography allowed definition of a previously unknown biliary tree variation.

Background Chronic high Epstein-Barr virus loads (CHEBV) are commonly observed in pediatric liver transplant patients. However, it is unclear how CHEBV impacts the liver graft. The aim of this study was to clarify the clinical and pathological impacts of CHEBV on the liver graft. Methods From 2012 through 2020, we retrospectively investigated 46 pediatric liver transplant patients (under 16 years old) who survived ≥ 6 months. The patients were divided into two groups: CHEBV group (EBV DNA >10,000 IU/mL of whole blood for ≥ 6 months) and NCHEBV group (patients who did not meet CHEBV criteria). Tacrolimus was reduced to 5,000 IU/mL. Blood biochemistry date and pathological findings, obtained at the time of protocol and episodic biopsy, were compared between the two groups. Results Out of 46 patients, 28 CHEBV and 18 NCHEBV patients were enrolled. The blood biochemical examination did not show a significant difference between the two groups. In addition, no significant differences between the two groups were found in the pathological findings, including frequency of late acute rejection and the progression of fibrosis at the time of both protocol and episodic biopsy. Appropriate adjustment of immunosuppression for CHEBV management may have contributed to the prevention of the progression of fibrosis. Conclusion CHEBV had little adverse effect on the liver graft. Graft fibrosis might have been avoided through optimal dose modification of tacrolimus. Further long-term monitoring is necessary because CHEBV may affect the pediatric liver graft in the long term. This article is protected by copyright. All rights reserved.

The interfacial properties and water-in-CO2 (W/CO2) microemulsion (μE) formation with double- and novel triple-tail surfactants bearing trimethylsilyl (TMS) groups in the tails are investigated. Comparisons of these properties are made with those for analogous hydrocarbon (HC) and fluorocarbon (FC) tail surfactants. Surface tension measurements allowed for critical micelle concentrations (CMC) and surface tensions at the CMC (γCMC) to be determined, resulting in the following trend in surface activity FC > TMS > HC. Addition of a third surfactant tail gave rise to increased surface activity, and very low γCMC values were recorded for the double/triple-tail TMS and HC surfactants. Comparing effective tail group densities (ρlayer) of the respective surfactants allowed for an understanding of how γCMC is affected by both the number of surfactant tails and the chemistry of the tails. These results highlight the important role of tail group chemical structure on ρlayer for double-tail surfactants. For triple-tail surfactants, however, the degree to which ρlayer is affected by tail group architecture is harder to discern due to formation of highly dense layers. Stable W/CO2 μEs were formed by both the double- and the triple-tail TMS surfactants. High-pressure small-angle neutron scattering (HP-SANS) has been used to characterize the nanostructures of W/CO2 μEs formed by the double- and triple-tail surfactants, and at constant pressure and temperature, the aqueous cores of the microemulsions were found to swell with increasing water-to-surfactant ratio (W0). A maximum W0 value of 25 was recorded for the triple-tail TMS surfactant, which is very rare for nonfluorinated surfactants. These data therefore highlight important parameters required to design fluorine-free environmentally responsible surfactants for stabilizing W/CO2 μEs.

BACKGROUND In the field of living donor liver transplantation (LDLT), it is important to ensure donor's psychological well-being. We report on clinical features and long-term outcomes of LDLT donors who developed psychiatric disorders after their donor operations. Additionally, we compare patient backgrounds, as well as surgical and perioperative aspects between LDLT donors with and without postoperative psychiatric complications. MATERIAL AND METHODS Between November 1998 and March 2018, we identified 254 LDLT donors at our hospital. Among these, we investigated those who had newly developed psychiatric complications and required psychiatric treatment after donor operation. RESULTS The median duration of follow-up was 4 years. Sixty-five donors were lost to follow-up. Eight donors (3.1%) developed postoperative psychiatric complications, including major depressive disorder in 4, panic disorder in 2, conversion disorder and panic disorder in 1, and adjustment disorder in 1. The median duration from donor surgery to psychiatric diagnosis was 104.5 days (range, 12 to 657 days) and the median treatment duration was 18 months (range, 3 to 168 months). Of those, 3 donors required psychiatric treatment over 10 years, and 4 donors remained under treatment. The duration of hospital stay after donor operation was significantly longer and perioperative complications with Clavien classification greater than grade IIIa were more frequent in donors with psychiatric complications than in those without psychiatric complications (P=0.02 and P=0.006, respectively). CONCLUSIONS Accurate diagnosis and appropriate treatment for psychiatric disorders by psychiatrists and psychologists are important during LDLT donor follow-up. Minimization of physiological complications might be important to prevent postoperative psychiatric complications in LDLT donors.

We prepared some blue phase (BP) materials with different concentrations of reactive monomers. They exhibited a cubic blue phase (cubic BP) or blue phase III (BPIII). We obtained their polymer-stabilised cubic BP and BPIII liquid crystals using photo-polymerisation. The temperature ranges of both BPs widened with increasing monomer concentration. After removing the low-molecular-weight materials, we observed the remaining polymer networks using field-emission scanning electron microscopy (SEM). We investigated the relationship between the polymer-stabilised BP (PS-BP) temperature range and polymer network morphology. The polymer network derived from the non-stabilised PS-BPIII exhibited µm-sized pores. Increasing the monomer concentration, the BPIII temperature range widened from 13 K to more than 49 K and the pore size dramatically decreased from several µm to about 100 nm. On the other hand, periodic nanoporous structures were partially observed even for the PS-cubic BP. The nanoporous structures were spread to the whole area for the PS-cubic BP with a wide BP temperature range. Furthermore, we discuss how the polymer network stabilises BPIII.

To facilitate potential applications of water-in-supercritical CO2 microemulsions (W/CO2 μEs)efficient and environmentally responsible surfactants are required with low levels fluorination. As wellas being able to stabilize water-CO2 interfaces, these surfactants must also be economical, prevent bioaccumulation and strong adhesion, deactivation of enzymes, and also be tolerant to high salt environments.Recently, an ion paired catanionic surfactant with environmentally-acceptable fluorinated C6-tails wasfound to be very effective at stabilizing W/CO2 μEs with high water-to-surfactant molar ratios (W0) up to~50 (Sagisaka, M. et al. Langmuir, 2019, 35, 3445–3454). As the cationic and anionic constituentsurfactants alone did not stabilize W/CO2 μEs, this was the first demonstration of surfactant synergisticeffects in W/CO2 microemulsions. The aim of this new study is to understand the origin of these intriguingeffects by detailed investigations of nanostructure in W/CO2 microemulsions using high pressure smallangle neutron scattering (HP-SANS). These HP-SANS experiments have been used to determine theheadgroup interfacial area and volume, aggregation number and effective packing parameter (EPP). TheseSANS data suggest the effectiveness of this surfactant originates from increased EPP and decreasedhydrophilic/CO2-philic balance, related to a reduced effective headgroup ionicity. This surfactant bearsseparate C6F13-tails and oppositely-charged headgroups, and was found to have a EPP value similar tothat of a double C4F9-tail anionic surfactant (4FG(EO)2), which was previously reported to be one of mostefficient stabilizers for W/CO2 μEs (maximum W0 = 60-80). Catanionic surfactants based on this newdesign will be key for generating super-efficient W/CO2 μEs with high stability and water solubilization.

The delayed diagnosis of insulinoma remains a clinical issue. One of the main causes of such a delay is hypoglycemia unawareness. A 53-year-old woman fell unconscious during postprandial exercises. Flash glucose monitoring (FGM) systems revealed glucose profiles with fasting hypoglycemia, which facilitated the clinical diagnosis of insulinoma even though she was unaware of her hypoglycemia. The preoperative comparison of the blood glucose values provided by FGM with those obtained from capillary blood were consistent. Thus, FGM may have potential utility in revealing the presence of insulinoma-induced hypoglycemia.

OBJECTIVE To investigate the influence of donor age on recipient outcome after living-donor partial liver transplantation (LDLT). BACKGROUND Donor age is a well-known prognostic factor in deceased donor liver transplantation; however, its role in LDLT remains unclear. METHODS We retrospectively analyzed 315 consecutive cases of primary adult-to-adult LDLT in our center between April 2006 and March 2014. Recipients were divided into 5 groups according to the donor age: D-20s (n = 60); D-30s (n = 72); D-40s (n = 57); D-50s (n = 94); and D-60s (n = 32). The recipient survival and the association with various clinical factors were investigated. RESULTS Recipient survival proportions were significantly higher in D-20s compared with all the other groups (P = 0.008, < 0.001, < 0.001, and = 0.006, vs D-30s, -40s, -50s, and -60s, respectively), whereas there was no association between recipient survival and their own age. There are 3 typical relationships between donors and recipients in adult-to-adult LDLT: from child-to-parent, between spouses/siblings, and from parent-to-child. The overall survival in child-to-parent was significantly higher than in spouses/siblings (P = 0.002) and in parent-to-child (P = 0.005), despite significantly higher recipient age in child-to-parent [59 (42-69) years, P < 0.001]. Contrastingly, parent-to-child exhibited the lowest survival, despite the youngest recipient age [26 (20-43) years, P < 0.001]. In addition, younger donor age exhibited significantly better recipient survival both in hepatitis C virus-related and in non-hepatitis C virus diseases. Univariate and multivariate analyses both demonstrated that donor age and graft-type (right-sided livers) are independent prognostic factors for recipient survival. CONCLUSIONS Donor age is an independent, strong prognostic factor in adult-to-adult LDLT.

Previous studies [Langmuir, 2014, 30, 21, 6057–6063, Phys. Chem. Chem. Phys., 2017,19, 23869–23877] have shown that surfactants bearing highly-methylated alkyl tails (so-called “hedgehog” groups) are able to reduce the limiting surface tension at the aqueous critical micelle concentration (CMC) to γCMC ~24 mN m−1, which is considerably lower than for common n-alkyl tail surfactants (30–40 mN m−1). In the quest to develop even more effective and efficient non-fluorinated surfactants, this study introduces new amphiphiles having double and triple hedgehog tails and examines relationships between surfactant structure and aqueous solution properties. Of particular interest are links between γCMC, the effective hydrophobic-tail layer density (ρlayer) and total number of carbon and silicon atoms in the hydrophobic tails (NC+Si). Interestingly, γCMC is seen to depend on ρlayer rather than NC+Si, and ρlayer ~0.63 g cm−3 appears to be an optimal surface layer density for promoting low γCMC. For a surfactant bearing trimethysilyl (TMS) chain tips, exchanging the surfactant counterions from Na+ to Mg2+ reduced γCMC from 23.8 mN m−1 to 21.5 mN m−1, which is very low for a hydrocarbon surfactant, and comparable to typical fluorinated surfactants. A new measure of the ability of different surfactants to lower surface tension is proposed, which is helpful for targeting low surface energy (tension) non-fluorinated surfactants. In terms of both γCMC and CMC TMS-terminal tips are shown to be key groups for promoting hydrophobicity and/or low surface tensions.

With an aim to control the surface hydrophobicity and water adhesion, as observed on various natural surfaces, novel 3,4-propylenedioxythiophene (ProDOT) monomers having one and two 3-trimethylsilylpropyl (TMS) groups were synthesized and subjected to electropolymerization to form surface coatings. The monomer ProDOT is employed owing to its tendency to form fibrous structures by electropolymerization [T. Darmanin, F. Guittard, Mater. Chem. Phys. 146 (2014) 6–11], whereas the TMS groups generate very low surface energies comparable to short chain fluorocarbons [N. M. Kovalchuk, et al., Colloids Surfaces A 604 (2020) 125277.]. It is shown that even though these two types of monomer lead to fibrous structures, the dimensions of the fibers as well as the wetting properties are different. The monomer with only a single TMS group (ProDOTSiMe3) generates extremely long nanofibers with only low surface roughness. The resulting surfaces have extremely high apparent contact angles (θw) up to 141.7° and strong water adhesion, similar to rose petals or gecko feet. On the other hand, the analogue with two TMS groups (ProDOT(SiMe3)2) forms short nanofibers but with extremely high surface roughness. The resulting surfaces are superhydrophobic with θw > 160° and ultra-low water adhesion (hysteresis and sliding angles < 1°), similar to lotus leaves. These results point to interesting applications offering control over water adhesion whilst maintaining high hydrophobicity.

Antibody-mediated rejection (AMR) is a refractory rejection after donor-specific antibody-positive or ABO blood-type incompatible (ABOi) organ transplantation. Rituximab dramatically improved the outcome of ABOi living-donor liver transplantation (LDLT); however, an effective treatment for posttransplant AMR, once occurred, is yet to be established. A 44-year-old woman with biliary cirrhosis underwent ABOi-LDLT from her sister (AB-to-A). Pretransplant rituximab diminished CD19/20-positive B lymphocytes to 0.6%/0.0%; however, AMR occurred on posttransplant day-6 with marked increase in both CD19/20 cells (17.1%/5.8%) and anti-B IgM/G-titers (1024/512). Despite rituximab readministration, steroid-pulse, intravenous immunoglobulin, and plasmapheresis, AMR was uncontrollable, with further increasing CD19/20 cells (23.0%/0.0%) and antibody-titers (2048/512). Bortezomib (1.0 mg/m2) was thus administered on posttransplant day-9, immediately ameliorating CD19/20 cells (1.3%/0.0%) and antibody-titers (

Introduction: Budd-Chiari syndrome (BCS) associated with hypereosinophilic syndrome (HES) is very rare, and only a few reports have described its treatment. Furthermore, no report to date has described the performance of liver transplantation for the treatment of BCS associated with HES. We herein describe a 54-year-old man who underwent deceased-donor liver transplantation (DDLT) for treatment of BCS associated with HES. Case: A 54-year-old man was found to have an increased eosinophil count during a medical check-up. After exclusion of hematopoietic neoplastic diseases and secondary eosinophilia, idiopathic hypereosinophilia was diagnosed. Oral prednisolone was administered to the patient, and his eosinophil count immediately decreased to a normal level. He had an uneventful course without complications for 11 months but then presented with bloating and malaise. Imaging studies including ultrasonography, enhanced computed tomography, and angiography revealed BCS associated with HES. Transjugular intrahepatic portosystemic shunt failed because of complete obstruction of the hepatic veins. Therefore, the patient was introduced to our hospital for liver transplantation. DDLT was performed with venovenous bypass 1 month after the patient was placed on the DDLT waiting list. The explanted hepatic veins were completely occluded and organized. The patient’s eosinophil count was maintained at a normal level with prednisolone treatment after DDLT. Conclusions: Liver transplantation can be a treatment option for BCS associated with HES if neoplastic diseases and secondary eosinophilia have been excluded. Life-long oral steroid therapy is required to control HES even after liver transplantation., ファイル公開：2020-11-01

High-water-content water-in-supercritical CO2 (W/CO2) microemulsions are considered to be green, universal solvents, having both polar and nonpolar domains. Unfortunately, these systems generally require environmentally unacceptable stabilizers like long and/or multifluorocarbon-tail surfactants. Here, a series of catanionic surfactants having more environmentally friendly fluorinated C4-C6 tails have been studied in terms of interfacial properties, aggregation behavior, and solubilizing power in water and/or CO2. Surface tensions and critical micelle concentrations of these catanionic surfactants are, respectively, lowered by ∼9 mN/m and 100 times than those of the constituent single fluorocarbon-tail surfactants. Disklike micelles in water were observed above the respective critical micelle concentrations, implying the catanionic surfactants have a high critical packing parameter, which should be suitable for the formation of reverse micelles. Based on visual observation of phase behavior and Fourier transform infrared spectroscopic and small-angle neutron scattering studies, one of the three catanionic surfactants tested was found to form transparent single-phase W/CO2 microemulsions with a water-to-surfactant molar ratio of up to ∼50. This is the first successful demonstration of the formation of W/CO2 microemulsions by synergistic ion-pairing of anionic and cationic single-tail surfactants. This indicates that catanionic surfactants offer a promising approach to generate high-water-content W/CO2 microemulsions.

Background. The ABO blood-type barrier in kidney and liver transplantation has been overcome by aggressive treatments such as B cell depletion using rituximab. However, the long-term effects of ABO-incompatible liver transplantation (ABO-I LTx) on immunological status have not previously been studied. Here, we assessed whether long-term immune hyporesponsiveness against ABO blood-group antigens was retained. Methods. We recruited 81 patients, 75 patients who had survived ABO-I LTx without retransplantation and 6 patients who had survived after retransplantation using blood type-compatible grafts. The time between ABO-I LTx and outpatient visits for blood sampling for this study ranged from 1.1 to 16.8 years. We also evaluated patients' backgrounds and postoperative therapies. Results. Overall, antidonor ABO antibody titers in the 75 patients without retransplantation decreased during long-term follow-up. In the subset of 40 patients with blood type O, anti-nondonor ABO antibody titers did not decrease and were significantly higher than antidonor ABO antibody titers. In addition, long-term antidonor ABO antibody titers were significantly lower in pediatric patients than in adult patients. In the 6 patients who were retransplanted with blood type–compatible grafts, antidonor ABO antibody immunoglobulin G titers remained low, but IgM titers increased slightly long after removal of the ABO-incompatible graft. Conclusions. These findings suggest that donor-specific hyporesponsiveness remains after ABO-I LTx, particularly in pediatric patients. Long-term persistence of blood antigens may contribute to this donor-specific hyporesponsiveness.

Purpose Novel diagnostic and therapeutic strategies for chronic lung allograft dysfunction (CLAD) are pressing priorities. We previously reported that CD26/DPP-4 inhibition attenuated ischemia-reperfusion injury, acute rejection and chronic fibrosis in mouse lung transplantation (LTx), and in our recent clinical study, a CD26/DPP-4 inhibitor improved CLAD-free survival (ISHLT 2020 abstract). To elucidate the mechanism of CD26/DPP-4 inhibitors in LTx, and apply them in the clinic, we investigated CD26 expression in CLAD clinical specimens. Methods Among patients who underwent LTx in our institution, we retrieved pathological specimens from re-LTx and autopsy cases. We also included two native lung samples from LTx recipients. We performed hematoxylin-eosin and Elastica-Masson staining and immunohistochemistry using a CD26 antibody. We evaluated the pathological findings and clinical characteristics. Results We evaluated 11 patients (6 females, 5 males) with a median age of 43 (8-58) years. The pathological samples were nine allografts and two native lung specimens. Of the allografts, six were obtained at autopsy, performed 38 (12-71) [median (range)] months after LTx, and three were obtained by resection during re-LTx, performed 20 (17-59) months after the initial LTx. Seven patients had diabetes mellitus, but none received CD26/DPP-4 inhibitors. Seven patients (four autopsy and three re-LTx cases) had CLAD with bronchiolitis obliterans (BO) pathology. Immunohistochemistry revealed clusters of CD26+ epithelial cells adjacent to the BO lesions or in the obstructed bronchial lumen in six of the seven CLAD patients. One CLAD patient without CD26 expression died from lung cancer, rather than CLAD, which was diagnosed at autopsy. In the non-CLAD or native lung samples, the CD26+ epithelial cell clusters were not detected. Conclusion Clusters of CD26+ epithelial cells were detected in CLAD, but not non-CLAD, samples. CD26 might be a novel biomarker and therapeutic target for CLAD.

Water-in-supercritical CO2 microemulsions formed using the hybrid F-H surfactant sodium 1-oxo-1-[4-(perfluorohexyl)phenyl]hexane-2-sulfonate, FC6-HC4, have recently been shown to have the highest water-solubilizing power ever reported. FC6-HC4 demonstrated the ability to outperform not only other surfactants but also other FCm-HCn analogues containing different fluorocarbon and hydrocarbon chain lengths (Sagisaka, M. et al. Langmuir 2015, 31, 7479-7487). With the aim of clarifying the key structural features of this surfactant, this study examined the phase behavior and water/supercritical CO2 aggregate formation of 1-oxo-1-[4-(perfluorohexyl)phenyl]hexane (Nohead FC6-HC4), which is an FC6-HC4 analogue but now, interestingly, without the sulfonate headgroup. Surprisingly, Nohead FC6-HC4, which would not normally be identified as a classic surfactant, yielded transparent single-phase W/CO2 microemulsions with polar cores able to solubilize a water-soluble dye, even at pressures and temperatures so low as to approach the critical point of CO2 (e.g., ∼100 bar at 35 °C). High-pressure small-angle scattering (SANS) measurements revealed the transparent phases to consist of ellipsoidal nanodroplets of water. The morphology of these droplets was shown to be dependent on the pressure, Nohead FC6-HC4 concentration, and water-to-surfactant molar ratio. Despite having almost the same structure as Nohead FC6-HC4, analogues containing both shorter and longer hydrocarbons were unable to form W/CO2 microemulsion droplets. This shows the importance of the role of the hydrocarbon chain in the stabilization of W/CO2 microemulsions. A detailed examination of the mechanism of Nohead FC6-HC4 adsorption onto the water surface suggests that the hexanoyl group protrudes into the aqueous core, allowing for association between the carbonyl group and water.

Dark conglomerates of domains with opposite handedness, which are designated dark conglomerate phases (DC phases), have attracted much attention. We prepared an achiral liquid crystal trimer, 4,4'-bis{9-[4-(5-octyloxypyrimidin-2-yl)phenyloxy]nonyloxy}biphenyl (I-9), and investigated the physical properties. A droplet of trimer I-9 formed a conventional nematic phase on cooling from the isotropic liquid, and then changed to an optical isotropic phase with homochirality. X-ray diffraction measurements reveal that the isotropic phase has an intercalated layer structure with a correlation length of 95 nm. We prepared binary mixtures with a nematic liquid crystal, 4'-hexyloxy-4-cyanobiphenyl (6OCB). The mixtures containing 30-75 mol % of 6OCB exhibited smectic phases above the isotropic phase. We investigated mesogenic properties of trimer I-n (n = 5-9) depending on the parity of the linking group. Only trimer I-9 possessing the longest odd-numbered spacers showed the chiral isotropic phase, suggesting that a rigid bent structure is not necessary for the appearance of the isotropic phase. The experimental results reveal that trimer I-9 exhibits a soft crystalline DC phase representing a new modification of chiral symmetry breaking in lamellar liquid crystal phases.

Tokyo Metro Co., Ltd. (hereinafter, Tokyo Metro) comprises nine lines operating over 195.1km and 179 stations, and is used by 7.07 million passengers per day. Tokyo Metro operates on the belief that security equals safety plus service. In regard to safety, special effort is devoted toward countermeasures for natural disasters. In light of recent extreme weather events, countermeasures for heavy rains are particularly important. It was reported in the updated expectations for flood damage published in 2009 that metropolitan area's 17 lines and 97 stations and 147km of the tunnels will be completely submerged underwater. In response to expectations, we are developing and installing various waterproofing facilities at all tunnel entrances, ventilation openings, underground station entrances and other openings. Among these, underground station entrances are expected to suffer the most damage. Most Tokyo Metro station entrances are situated on sidewalks, there are many obvious spatial restrictions. In light of these restrictions, conventional waterproofing doors (hinged doors that apply positive pressure against floodwater pressure) cannot be used to improve all entrances, thus we have continued to develop counterpressure doors, hinged double doors, shutters, bi-fold doors and other types of waterproofing doors that fit the environments of individual entrances. In addition, few of the many buildings to which Tokyo Metro tunnels connect underground are prepared for the updated expectations for flood damage, meaning that Tokyo Metro must take action on its own property to prevent flood water inundation from such buildings. This means taking flood control measures in underground concourses with severe spatial limitations. Thus, we have developed counterpressure sliding doors capable of withstanding water pressure from flooding up to 15 m deep. This report describes updated expectations for floods, Tokyo Metro's improvement policy and descriptions of various types of underground waterproofing doors and the performance required of them.

Previous work (M. Sagisaka, et al. Langmuir 31 (2015) 7479-7487), showed the most effective fluorocarbon (FC) and hydrocarbon (HC) chain lengths in the hybrid surfactants FCm-HCn (sodium 1-oxo-1-[4-(perfluoroalkyl)phenyl]alkane-2-sulfonates, where m = FC length and n = HC length) were m and n = 6 and 4 for water solubilization, whereas m 6 and n 6, or m 6 and n 5, were optimal chain lengths for reversed micelle elongation in supercritical CO2. To clarify why this difference of only a few methylene chain units is so effective at tuning the solubilizing power and reversed micelle morphology, nanostructures of water-in-CO2 (W/CO2) microemulsions were investigated by high-pressure small-angle neutron scattering (SANS) measurements at different water-to-surfactant molar ratios (W 0) and surfactant concentrations. By modelling SANS profiles with cylindrical and ellipsoidal form factors, the FC6-HCn/W/CO2 microemulsions were found to increase in size with increasing W 0 and surfactant concentration. Ellipsoidal cross-sectional radii of the FC6-HC4/W/CO2 microemulsion droplets increased linearly with W 0, and finally reached ~39 Å and ~78Å at W 0 = 85 (close to the upper limit of solubilizing power). These systems appear to be the largest W/CO2 microemulsion droplets ever reported. The aqueous domains of FC6-HC6 rod-like reversed micelles increased in size by 3.5 times on increasing surfactant concentration from 35 mM to 50 mM: at 35 mM, FC6-HC5 formed rod-like reversed micelles 5.3 times larger than FC6-HC6. Interestingly, these results suggest that hybrid HC-chains partition into the microemulsion aqueous cores with the sulfonate headgroups, or at the W/CO2 interfaces, and so play important roles for tuning the W/CO2 interfacial curvature. The super-efficient W/CO2-type solubilizer FC6-HC4, and the rod-like reversed micelle forming surfactant FC6-HC5, represent the most successful cases of low fluorine content additives. These surfactants facilitate VOC-free, effective and energy-saving CO2 solvent systems for applications such as extraction, dyeing, dry cleaning, metal-plating, enhanced oil recovery and organic/inorganic or nanomaterial synthesis.

Supplemental digital content is available in the text., Background Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease, with liver transplantation being the sole life-saving treatment for end-stage PSC-related liver disease. However, recurrence of PSC after liver transplantation is a common complication, with the risk factors for recurrence being controversial. Methods We conducted a retrospective chart review of 45 patients who had undergone liver transplantation for PSC at our institute. The risk factors for PSC recurrence and graft failure after liver transplantation were analyzed. Results The graft survival rates were 55.4% at 5 years and 32.8% at 10 years after liver transplantation for PSC. PSC recurrence was diagnosed in 16 (40%) of 40 patients, at a median 30 months (range, 9-70 months) after liver transplantation. The cumulative incidence rate of PSC recurrence was 24.5% at 3 years, 39.3% at 5 years, and 45.8% at 6 years. Among the 16 patients diagnosed with PSC recurrence, the graft survival rate was 56.3% at 5 years, and 21.9% at 10 years after the recurrence. Active inflammatory bowel disease after liver transplantation was identified as an independent risk factor for PSC recurrence. Age younger than 30 years at the time of PSC diagnosis and bacteremia were factors significantly associated with graft failure after liver transplantation on multivariate analysis. Conclusions PSC frequently recurred and progressed to graft failure after liver transplantation for PSC. Maintaining an inactive status of inflammatory bowel disease might offer protection against PSC recurrence.

We studied the hyper-swollen behavior of a perfluorinated smectic liquid crystal, 11-(4′-cyanobiphenyl-4-yloxy)undecyl pentadecafluorooctanoate (BI), through addition of perfluorinated oils. The studied compound, BI, has a bilayer SmA–SmC phase sequence due to microphase separation of hydrocarbon chains and perfluorinated chains. We found that BI can be diluted with straight-chain, soft perfluorinated oils and that the repeat distance of the smectic layer can be greatly swollen to about three times thicker than that of pure BI. However, there was no clear physical mechanism for the long-range interlayer repulsive forces, such as the electrostatic force, observed in the lyotropic system. Furthermore, we found that interlayer tilting can be propagated along the smectic layers in the SmC phase even in the hyper-swollen state, despite insertion of thick liquid layers of perfluorinated oil between the smectic layers of BI. The orientation of the intercalated perfluorinated oils was also discussed based on the conoscope observation.

Previous work (M. Sagisaka, et al. Langmuir 31 (2015) 7479-7487), showed the most effective fluorocarbon (FC) and hydrocarbon (HC) chain lengths in the hybrid surfactants FCm-HCn (sodium 1-oxo-1-[4-(perfluoroalkyl)phenyl]alkane-2-sulfonates, where m = FC length and n = HC length) were m and n = 6 and 4 for water solubilization, whereas m 6 and n 6, or m 6 and n 5, were optimal chain lengths for reversed micelle elongation in supercritical CO

Indocyanine green fluorescent image-guided surgery was developed to identify primary and metastatic nodules of various malignancies. However, currently, surgeons need to identify the fluorescent image on a monitor, which impedes surgical procedures. Herein, we developed a novel projection mapping device that can cast the real-time fluorescent image onto the surface of the targeted organ. We performed surgical resection of a lung metastasis of hepatoblastoma using this technique. The projection mapping technique clearly detected the pulmonary lesion, and no other lesions were identified in the ipsilateral thorax. The patient is well and free of recurrence 2 years after surgery.

Background The cause of late graft dysfunction has not been elucidated. Although an antibody-mediated reaction is suspected as a potential mechanism, the target antigens have not been clarified. Methods To clarify the etiology of idiopathic posttransplantation hepatitis (IPTH), we simultaneously examined the presence of antibodies that react with liver tissue (ARLT) by means of indirect immunofluorescence staining, as well as the presence of donor-specific anti-human leukocyte antigen antibodies (HLA-DSA). A subanalysis of the IPTH group was also performed. Within the IPTH group, the correlation between ARLT titer and clinical data were analyzed. Results In the sera of patients with IPTH (30 patients), ARLT were found at a significantly higher frequency than in patients without IPTH (42 patients; P < 0.001). Moreover, the ARLT titer appeared to be correlated with the severity of hepatitis or hepatic injury. In contrast, the frequency of HLA-DSA was significantly lower in patients with IPTH than in patients without IPTH (P = 0.001). Conclusion Our findings indicate that ARLT, and not HLA-DSA, profoundly influence the etiology of IPTH., The authors show that antibodies that react with liver tissue and not donor-specific anti-human leukocyte antigen antibodies, profoundly influence the etiology of idiopathic posttransplantation hepatitis in children providing a rationale for therapy.

[Purpose]Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. [Methods]We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. [Results]Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child–Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C:n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7 %, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9 %; 3 years: 58.9 vs. 77.7 %; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child–Pugh score were independent risk factors for the postoperative prognosis. [Conclusions]Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable., First online: 08 February 2014

Antibody-mediated rejection (AMR) is difficult to diagnose after ABO-compatible or ABO-identical (ABO-C) liver transplantation. To determine whether complement component 4d (C4d) immunostaining would be useful for diagnosing AMR, we compared the results of C4d immunohistochemistry for allograft biopsy samples with assays for anti-donor antibodies performed at the time of biopsy. One hundred fourteen patients with ABO-C grafts and 29 patients with ABO-incompatible (ABO-I) grafts were included. Linear C4d endothelial staining (identifiable with a 4× objective lens) or staining seen in 50% or more of the portal tracts was considered positive. Five of the 114 patients (4%) with ABO-C grafts and 15 of the 29 patients (52%) with ABO-I grafts showed C4d positivity. In the ABO-C cases, C4d positivity in late biopsy samples (≥30 days after transplantation) was associated with stage 2 or higher fibrosis (METAVIR score; P = 0.01) and with the presence of donor-specific anti–human leukocyte antigen DR antibodies (HLA-DR DSAs) with a mean fluorescence intensity > 5000 according to the Luminex single-antigen bead assay (P = 0.04). Conversely, the presence of HLA-DR DSAs was associated with the presence of stage 2 or higher fibrosis, acute cellular rejection, and C4d positivity. During the 2-year follow-up, neither C4d positivity nor HLA-DR DSAs were related to graft loss. Among ABO-I patients, C4d positivity was not associated with allograft dysfunction or fibrosis. Only 3 of the 15 C4d-positive patients (20%) showed periportal hemorrhagic edema, which could be a histological sign of AMR in ABO-I grafts, and they were the only cases associated with elevations in anti-donor A/B antibody titers. In conclusion, C4d endothelial positivity among ABO-C patients is an uncommon event that could be associated with chronic graft damage with or without clinical AMR. C4d positivity is common among ABO-I patients and may not be associated with allograft dysfunction if alloantibody titers are not elevated. Liver Transpl 20:200-209, 2014. © 2013 AASLD.

To develop an efficient and fluorine-free solubilizer for a water/supercritical CO₂ microemulsion (W/CO₂ μE), in this study, a highly methyl-branched alkyl, isostearyl group was focused on as a CO₂-philic tail, and the custom-made isostearyl surfactant, sodium 2-(4,4-dimethylpentan-2-yl)-5,7,7-trimethyloctyl sulfate (SIS1) was synthesized. The surface tension (γ) of an aqueous SIS1 solution was measured at ambient pressure as a function of surfactant concentration, and it was found to be 25 mN/m at concentrations of > 1.5 mM. A low γ value can generally be reached only by a fluorocarbon surfactant, which implies that SIS1 has an excellent solubilizing power for the W/CO₂ μE, similar to some fluorocarbon surfactants reported previously. Visual observations of the SIS1/W/CO₂ mixtures revealed the formation of transparent single phases without separated water, identified as W/CO₂ μE. The μE was well-stabilized at pressures > 210 bar and temperatures > 55 °C. At 75 °C and 370 bar, SIS1 was found by spectral measurements using a water-soluble UV-light absorber to solubilize water contents up to a maximum water-to-surfactant molar ratio (W0) = 50. The achievement of W0 = 50 in a W/CO₂ μE system has not been reported previously in similar hydrocarbon surfactant/W/CO₂ systems, and this demonstrates that a highly methyl-branched alkyl group can act as a good CO₂-philic group for a W/CO₂ -type surfactant.

Few studies have examined the long-term outcomes and prognostic factors associated with pediatric living living-donor liver transplantation (LDLT) using reduced and hyper-reduced left lateral segment grafts. We conducted a retrospective, single-center assessment of the outcomes of this procedure, as well as clinical factors that influenced graft and patient survival. Between September 2000 and December 2009, 49 patients (median age: 7 months, weight: 5.45 kg) underwent LDLT using reduced (partial left lateral segment; n = 5, monosegment; n = 26), or hyper-reduced (reduced monosegment grafts; n = 18) left lateral segment grafts. In all cases, the estimated graft-to-recipient body weight ratio of the left lateral segment was more than 4%, as assessed by preoperative computed tomography volumetry, and therefore further reduction was required. A hepatic artery thrombosis occurred in two patients (4.1%). Portal venous complications occurred in eight patients (16.3%). The overall patient survival rate at 1, 3 and 10 years after LDLT were 83.7%, 81.4% and 78.9%, respectively. Multivariate analysis revealed that recipient age of less than 2 months and warm ischemic time of more than 40 min affected patient survival. Pediatric LDLT using reduced and hyper-reduced left lateral segment grafts appears to be a feasible option with acceptable graft survival and vascular complication rates.

Cubic and blue phases have attracted a significant amount of attention because of their unusual phase structures with optical isotropy and because of their application to ion transfer in the cubic phase and to electrooptical switching in the blue phase. However, the driving forces for the frustrated liquid-crystalline phases differ from those for a conventional liquid-crystalline phase composed of rod-like molecules. We show that preprogrammed liquid-crystalline supermolecules can stabilize frustrated molecular organization in optically isotropic phases. Competition between steric effects caused by a taper-shaped oligomeric structure and segregation effects attributable to hydrocarbon/fluorocarbon amphiphilicity produces fluctuation of the layer structure, inducing the lamellar-to-cubic phase transition. Cooperation between inherent molecular chirality and the chirality-induced twist conformations of the mesogenic units stabilizes double-twist structures in blue phases. Furthermore, we demonstrate high-transmittance, sub-millisecond responses and hysteresis-free switching in a room temperature amorphous blue phase stabilized by a liquid crystal supermolecule. We present a molecular design of a preprogrammed supermolecule that can stabilize frustrated molecular organization of an isotropic liquid-crystalline phase. The tapered amphiphilic compound exhibited an unusual smectic A to cubic phase transition. The chiral T-shaped compound showed amorphous blue phase III with a temperature range of 25 K. We demonstrate high-transmittance, sub-millisecond response and hysteresis-free switching in room temperature amorphous blue phase stabilized by a designed LC supermolecule.

AIM: Hepatitis B recurrence after liver transplantation can be reduced to less than 10% by combination therapy with lamivudine (LAM) and hepatitis B immunoglobulin (HBIG). The aim of this study was to evaluate the efficacy and safety of prophylaxis with entecavir (ETV), which has higher efficacy and lower resistance rates than LAM, combined with HBIG in preventing hepatitis B recurrence after living-donor liver transplantation (LDLT). METHODS: Twenty-six patients who received ETV plus HBIG (ETV group) after LDLT for hepatitis B virus (HBV)-related end-stage liver disease were analyzed by comparing with 63 control patients who had received LAM plus HBIG (LAM group). RESULTS: The survival rates of the patients treated with ETV plus HBIG was 73% after both 1 and 3 years, and there was no statistical difference between the patients in the ETV group and LAM group. No HBV recurrence was detected during the median follow-up period of 25.1 months in the ETV group, whereas the HBV recurrence rate was 4% at 3 years and 6% at 5 years in the LAM group. No patients had adverse effects related to ETV administration. CONCLUSION: ETV combined with HBIG provides effective and safe prophylaxis in preventing hepatitis B recurrence after LDLT.

An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re-form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re-formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT.

To prevent small-for-size syndrome in adult-to-adult living donor liver transplantation (A-LDLT), larger grafts (ie, right lobe grafts) have been selected in many transplant centers. However, some centers are investigating the benefits of portal pressure modulation. Five hundred sixty-six A-LDLT procedures using right or left lobe grafts were performed between 1998 and 2008. In 2006, we introduced intentional portal pressure control, and we changed the graft selection criteria to include a graft/recipient weight ratio >0.7% instead of the original value of >0.8%. All recipients were divided into period I (1998-2006, the era of unintentional portal pressure control; n = 432) and period II (2006-2008, the era of intentional portal pressure control; n = 134). The selection of small-for-size grafts increased from 7.8% to 23.9%, and the selection of left lobe grafts increased from 4.9% to 32.1%. Despite the increase in the number of smaller grafts in period II, 1-year patient survival was significantly improved (87.9% versus 76.2%). In 129 recipients in period II, portal pressure was monitored. Patients with a portal pressure or=15 mm Hg (n = 43, 66.3%). The recovery from hyperbilirubinemia and coagulopathy after transplantation was significantly better in patients with a portal pressure