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In this study, 10 years of procurement quality monitoring data were analyzed to identify potential risk factors associated with procurement-related injury and their association with long-term graft survival. All deceased kidney, liver, and pancreas donors from 2012 to 2022 and their corresponding recipients in the Netherlands were retrospectively included. The incidence of procurement-related injuries and potential risk factors were analyzed. Of all abdominal organs procured, 23% exhibited procurement-related injuries, with a discard rate of 4.0%. In kidneys and livers, 23% of the grafts had procurement-related injury, with 2.5% and 4% of organs with procurement-related injury being discarded, respectively. In pancreas procurement, this was 27%, with a discard rate of 24%. Male donor gender and donor BMI >25 were significant risk factors for procurement-related injury in all three abdominal organs, whereas aberrant vascularization was significant only for the kidney and liver. In the multivariable Cox regression analyses, procurement-related injury was not a significant predictor for graft failure (kidney; HR 0.99, 95% CI 0.75-1.33, p = 0.99, liver; HR 0.92, 95% CI 0.66-1.28, p = 0.61, pancreas: HR 1.16; 95% CI 0.16-8.68, p = 0.88). The findings of this study suggest that transplant surgeons exhibited good decision-making skills in determining the acceptability and repairability of procurement-related injuries. [ABSTRACT FROM AUTHOR]

Background: While [18F]-fluordeoxyglucose ([18F]FDG) uptake is associated with arterial inflammation, [18F]-sodium fluoride ([18F]NaF) is a marker for arterial micro-calcification. We aimed to investigate the prospective correlation between both PET markers over time and whether they are prospectively ([18F]FDG) and retrospectively ([18F]NaF) related to progression of systemic arterial disease in a longitudinal study in patients with type 2 diabetes mellitus (T2DM). Methods: Baseline [18F]FDG PET/Low Dose (LD) Computed Tomography (CT) scans of ten patients with early T2DM without cardiovascular history (70% men, median age 63 years) were compared with five-year follow-up [18F]NaF/LDCT scans. Systemic activity was expressed as mean target-to-background ratio (meanTBR) by dividing the maximal standardized uptake value (SUVmax) of ten arteries by SUVmean of the caval vein. CT-assessed macro-calcifications were scored visually and expressed as calcified plaque (CP) score. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). Five-year changes were expressed absolutely with delta (Δ) and relatively with %change. Results: Baseline meanTBR[18F]FDG was strongly correlated with five-year follow-up meanTBR[18F]NaF (r = 0.709, P =.022). meanTBR[18F]NaF correlated positively with ΔCPscore, CPscore at baseline, and follow-up (r = 0.845, P =.002 and r = 0.855, P =.002, respectively), but not with %change in CPscore and PWV. Conclusion: This proof-of-concept study demonstrated that systemic arterial inflammation is an important pathogenetic factor in systemic arterial micro-calcification development. [ABSTRACT FROM AUTHOR]

Organ transplantation is performed worldwide, but policies regarding donor imaging are not uniform. An overview of the policies in different regions is missing. This study aims to investigate the various protocols worldwide on imaging in deceased organ donation. An online survey was created to determine the current policies. Competent authorities were approached to fill out the survey based on their current protocols. In total 32 of the 48 countries approached filled out the questionnaire (response rate 67%). In 16% of the countries no abdominal imaging is required prior to procurement. In 50%, abdominal ultrasound (US) is performed to screen the abdomen and in 19% an enhanced abdominal Computed Tomography (CT). In 15% of the countries both an unenhanced abdominal CT scan and abdominal US are performed. In 38% of the countries a chest radiographic (CXR) is performed to screen the thorax, in 28% only a chest CT, and in 34% both are performed. Policies regarding radiologic screening in deceased organ donors show a great variation between different countries. Consensus on which imaging method should be applied is missing. A uniform approach will contribute to quality and safety, justifying (inter)national exchange of organs. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Beta-cell replacement is the best therapeutic option for patients with type 1 diabetes. Because of donor scarcity, more extended criteria donors are used for transplantation. Donation after circulatory death donors (DCD) are not commonly used for pancreas transplantation, because of the supposed higher risk of complications. This review gives an overview on the pathophysiology, risk factors, and outcome in DCD transplantation and discusses different preservation methods.Recent Findings: Studies on outcomes of DCD pancreata show similar results compared with those of donation after brain death (DBD), when accumulation of other risk factors is avoided. Hypothermic machine perfusion is shown to be a safe method to improve graft viability in experimental settings. DCD should not be the sole reason to decline a pancreas for transplantation. Adequate donor selection and improved preservation techniques can lead to enhanced pancreas utilization and outcome. [ABSTRACT FROM AUTHOR]

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Background: Data on chronic pain after kidney donation are sparse. The aim of this study was to assess the incidence of chronic pain after hand‐assisted laparoscopic nephrectomy. Methods: Living kidney donors who donated between 2011 and 2017 at the University Medical Centre Groningen were included. All patients underwent hand‐assisted laparoscopic donor nephrectomy. Postdonation pain and movement disabilities were assessed using the Carolinas Comfort Scale (CCS) and a visual analogue scale (VAS). The prevalence, severity of pain and the need for analgesics were reported. Results: Some 333 living kidney donors with a mean age of 56 years were included. At a median of 19 (i.q.r. 10–33) months after donation, 82 donors (24·6 per cent) had a CCS score above 0, of which 58 (71 per cent) had a CCS score of at least 2 and 57 (70 per cent) reported movement limitations. Some 110 donors (33·0 per cent) had a VAS score of more than 0. Complaints mainly occurred during bending over (12·3 per cent) and exercising (12·4 per cent). Thirty‐two donors (9·7 per cent) required analgesics during follow‐up between donation and the time of measurement, and six of 82 (7 per cent) reported chronic inguinal pain. In multivariable analysis, donor age (odds ratio (OR) 0·97, 95 per cent c.i. 0·95 to 0·99; P = 0·020) and length of hospital stay (OR 1·21, 1·01 to 1·51; P = 0·041) were independently associated with chronic pain. Conclusion: One‐quarter of donors experienced chronic postdonation pain or discomfort, most of which was bothersome. Younger donors and those with a longer postoperative hospital stay had more symptoms. Living donor nephrectomy is associated with chronic pain in 25 per cent of donors. Complaints occur during bending over and exercising. Younger donors and donors with a longer hospital stay had more complaints. Significant in a quarter of patients [ABSTRACT FROM AUTHOR]

Let μ be a Borel measure on a compactum X. The main objects in this paper are s-ideals Ipdimq, J0pμq, Jf pμq of Borel sets in X that can be covered by countably many compacta which are finite-dimensional, or of μ-measure null, or of finite μ-measure, respectively. Answering a question of J. Zapletal, we shall show that for the Hilbert cube, the s-ideal Ipdimq is not homogeneous in a strong way. We shall also show that in some natural instances of measures μ with nonhomogeneous s-ideals J0pμq or Jf pμq, the completions of the quotient Boolean algebras BorelpXq{J0pμq or BorelpXq{Jf pμq may be homogeneous. We discuss the topic in a more general setting, involving calibrated s-ideals. [ABSTRACT FROM AUTHOR]

Background: This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age -wGA-) in Spain.Methods: A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes.Results: Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model.Conclusions: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in Spain. [ABSTRACT FROM AUTHOR]

Background Rumination syndrome is characterized by recurrent regurgitation of recently ingested food into the mouth. Differentiation with other diagnoses and gastroesophageal reflux disease ( GERD) in particular, is difficult. Recently, objective pH-impedance ( pH- MII) and manometry criteria were proposed for adults. The aim of this study was to determine diagnostic ambulatory pH- MII and manometry criteria for rumination syndrome in children. Methods Clinical data and 24-hour pH- MII and manometry recordings of children with a clinical suspicion of rumination syndrome were reviewed. Recordings were analyzed for retrograde bolus flow extending into the proximal esophagus. Peak gastric and intraesophageal pressures closely related to these events were recorded and checked for a pattern compatible with rumination. Events were classified into primary, secondary, and supragastric belch-associated rumination. Key Results Twenty-five consecutive patients (11 males, median age 13.3 years [ IQR 5.9-15.8]) were included; recordings of 18 patients were suitable for analysis. Rumination events were identified in 16/18 patients, with 50% of events occurring <30 minutes postprandially. Fifteen of 16 patients showed ≥1 gastric pressure peak >30 mmHg, while only 50% of all events was characterized by peaks >30 mmHg and an additional 20% by peaks >25 mmHg. Four patients had evidence of acid GERD, all showing secondary rumination. Conclusions and Inferences Combined 24-hour pH- MII and manometry can be used to diagnose rumination syndrome in children and to distinguish it from GERD. Rumination patterns in children are similar compared with adults, albeit with lower gastric pressure increase. We propose a diagnostic cutoff for gastric pressure increase >25 mmHg associated with retrograde bolus flow into the proximal esophagus. [ABSTRACT FROM AUTHOR]

Objective Tooth extraction is considered as the starting point of jaw atrophy via osteoclast activity stimulation. The maintenance of dental alveolar bone depends on surgery procedure and use of materials to maintain prior space favoring bone regeneration. Among substitutes used in dentistry to fill bone defects, Ostim-Pastes ( Ostim®) is a nanocrystalline paste tested for treatment of severe clinical conditions. This research first investigated the effect of Ostim on alveolar healing, comparing in the same healthy subjects, an Ostim®-filled socket with a not-filled one. Moreover, it also proposed a new surgical protocol for the post-extractive socket treatment using the graft materials without elevation of full-thickness flaps. Material and methods Fourteen patients were enrolled to bilateral maxillary or mandibular extraction that was performed without elevation of full-thickness flaps. In each patient, one socket was filled using Ostim®, and the other one was allowed to undergo natural healing. No suture was carried out. Clinical and biologic parameters were screened at 1, 7, and 14 days. Results Obtained results evidenced that nanocrystalline hydroxyapatite supports bone regeneration, increasing the synthesis of pro-osteogenic factors as bone morphogenetics protein ( BMP)-4, BMP-7, alkaline phosphatase, and osteocalcin. Moreover, filling post-extractive socket with nanocrystalline hydroxyapatite paste leads to a complete epithelialization already at 7 days after extraction, despite the fact that the teeth were extracted without elevation of full-thickness flaps . The improved epithelialization is mediated by increased vascular endothelial growth factor ( VEGF) expression. No significant change was observed in inflammatory parameters, with exception of an early and transient IL-1β induction, that could trigger and improve alveolar healing. Conclusions Clinical and biomolecular observations of this explorative study evidenced that nanocrystalline hydroxyapatite improves alveolar socket healing, increasing angiogenesis, epithelialization, and osteogenesis, also in absence of elevation of full-thickness flaps. [ABSTRACT FROM AUTHOR]

The efficacy of four methods to recover DNA from Papanicolaou (Pap)-stained archival cervical smears for optimal detection of human papillomavirus (HPV) DNA by GP5+/bioGP6+ polymerase chain reaction (PCR) was investigated. Two of the methods were based on proteinase K treatment and two based on treatment with guanidinium thiocyanate (GTC). The quality of the DNA as measured by PCR assays amplifying different sizes of the β-globin gene appeared to be superior for the GTC-based assays. Using competitive β-globin PCR assays, one of the GTC-based, assays, provisionally named High Pure PCR Template Preparation (HPPTP) assay, yielded by far the highest quantity of amplifiable DNA. It allowed the recovery of 2.2 × 10[SUP5] to 3 × 10[SUP5] genome equivalents in smears containing 5 × 10[SUP5] to 20 × 10[SUP5] nucleated cells, indicating a mean efficiency of 26% (range of 15-44%). In contrast, the other methods revealed markedly lower efficiencies varying from 1% to 10%. The use of the HPPTP assay as a reliable processing procedure was validated by demonstrating a complete agreement in HPV detection and 93% agreement in HPV typing between 39 archival Pap-stained and paired fresh-frozen cervical smears. This method was applied to 40 archival smears from ten cervical cancer patients (selected from a group of 200 patients) which had a history of 3-6 smears with the first smear being Pap 1 or 2 taken at least 5 years before cancer was diagnosed. The average time period between the first Pap 1/2 smear that contained the same HPV type as in the corresponding carcinoma and diagnosis of cervical cancer was 12.0 ± 2.9 years. All subsequent smears were invariably positive for the same HPV type which was also found in the cervical cancer biopsy. In conclusion, the HPPTP assay provides a reliable and efficient means to extract DNA from Pap-stained archival cervical smears for the detection of HPV DNA by PCR and would be the method of choice... [ABSTRACT FROM AUTHOR]

Develops a geographical information system (GIS) for the assessment of the agricultural potential of the Southern African Development Community (SADC) region. Main value of GIS is the integration of agricultural resource information; Advantages of the GIS for compiling, storing, retrieving and analyzing quantities of data.

The effects of recanalization by early intracoronary streptokinase in acute myocardial infarction on myocardial perfusion were studied in a subset of 236 out of 533 patients enrolled in a prospective multicentre trial, randomly allocated to either conventional treatment or to thrombolysis. Maximal symptom-limited thallium-201 stress testing was performed nine to 14 (median 12) weeks after the acute event in 236 patients with a first myocardial infarction, of whom 108 patients were allocated to conventional treatment and 128 patients to thromolysis. Three-view thallium exercise and redistribution scintigrams were divided into eight segments. The number of normal thallium segments at redistribution was 5.3±1.6 (mean±SD) in the control group and 5.8±1.6 in the thrombolysis group (P <0.01), indicating increased myocardial perfusion after early thrombolytic treatment. This beneficial effect was particularly evident in patients with a first anterior infraction with 4.8±1.6 normal thallium segments in the control group and 5.9±1.6 normal segments in the thrombolysis group (P <0.001). There was no difference in residual ischaemia during exercise between the control and the thrombolysis group either in the patients with anterior or in those with inferior infarction. It is concluded that early thrombolysis within 4 h after onset of symptoms, in some of the patients followed by angioplasty or coronary artery bypass surgery, leads to sustained improvement of myocardial perfusion at rest without excessive ischaemia during exercise, particularly in patients with acute anterior infarction. [ABSTRACT FROM PUBLISHER]

We present a new characterization of σ-fragmentability and illustrate its usefulness by proving some results relating analyticity and crfragmentability. We show, for instance, that a Banach space with the weak topology is σ-fragmented if, and only if, it is almost Čech-analytic and that an almost Čech-analytic topological space is σ-fragmented by a lower-semicontinuous metric if, and only if, each compact subset of the space is fragmented by the metric. [ABSTRACT FROM PUBLISHER]

To determine whether the free availability of antimicrobial agents leads to misuse through self-medication, a house-to-house semi-structured interview was held in three different socio-economic areas of Karachi, Pakistan. Of the 2348 households visited, 1342 (57%) participated; this included 9209 individuals. Three hundred and twenty-two (3.5%) had used one or more antimicrobial in the previous 4 weeks, equivalent to 43 agents per 1000 persons per month. The most frequently used agents were amoxycillin (16.7%), co-trimoxazole (15.7%), erythromycin (10.9%), ampicillin/cloxacillin (Ampiclox, 9.1%) and metronidazole (4.5%). Of these, 91.4% were prescribed by a physician, 2.3% were advised by a chemist and 6.3% were used as self-medication. Self-medication increased with socio-economic status. High levels of resistance were found to ampicillin, co-trimoxazole, chloramphenicol and erythromycin. If these high resistance levels are related to the high frequency of antimicrobial use, over-the-counter availability cannot be held responsible. Education of the medical profession seems to be the single most important tool to control misuse of antimicrobial agents. Innovative approaches for continuous medical education are urgently needed. [ABSTRACT FROM AUTHOR]

We analyze measurements of the x-ray reflectivity and photoelectron yield of a Ni-C multilayer (103 layers; d=31 Å) in the NiL-edge region (700–950 eV). The measured reflectivity is shown to be consistent with the one calculated using x-ray scattering factors f1 and f2 for Ni as obtained from the photoelectron yield (∼f2). The analysis yields a new set of ‘‘effective’’ values for f1 in the NiL-edge region. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical performance of the PapilloCheck assay (Greiner Bio-One, Germany) with that of the clinically validated high-risk HPV GP5+/6+-PCR according to the international guidelines for HPV test requirements for cervical screening (Meijer et al., IJC., 2009). Methods 1,437 cervical scrapings of women without evidence CIN2+ and 192 of women with CIN3+, originating from a population-based screening cohort (POBASCAM) were tested with both PapilloCheck and the GP5+/6+-PCR. In addition, intra-laboratory reproducibility over time and inter-laboratory agreement of the PapilloCheck assay were assessed on another set of 550 cervical samples. Clinical sensitivity and specificity values of the PapilloCheck assay were compared with those of GP5+/6+-PCR by non-inferiority score testing using previously defined thresholds for non-inferiority, i.e., relative sensitivity for CIN2+ >90% and relative specificity for CIN2+ >98%. For intraand inter-laboratory agreement a lower confidence bound not less than 87 % was used as threshold. Conclusions When restricting PapilloCheck analysis to the 14 hrHPV types targeted by GP5+/6+-PCR the clinical sensitivity and specificity were 95.8 % (95 % CI 92.8–98.8) and 96.7 % (95 % CI 95.7–97.7), respectively. By comparison, these figures were 96.4 % (95 % CI : 93.9–98.9) and 97.7 % (95 % CI : 96.9–98.5), respectively, for GP5+6+-PCR. Both the clinical sensitivity and specificity of PapilloCheck were non-inferior to that of GP5+/6+-PCR (non-inferiority score test ; P < 0.0001 and P = 0.007, respectively). High reproducibility values for HPV-positivity were obtained for both the intra-laboratory reproducibility overtime (97.6 % ; 95 % CI 96.3 %–98.6 % ; kappa value 0.941) as well as the inter-laboratory agreement (94.0 % ; 95 % CI 92.1 %–95.7 % ; kappa 0.842). Thus, when only the 14 hrHPV types targeted by the GP5+/6+-PCR are considered, PapilloCheck fulfils the crosssectional clinical and reproducibility criteria of the international guidelines for HPV test requirements for cervical screening and can be considered clinically validated. [ABSTRACT FROM AUTHOR]