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Liver transplantation (LT) from donors‐with‐HIV to recipients‐with‐HIV (HIV D+/R+) is permitted under the HOPE Act. There are only three international single‐case reports of HIV D+/R+ LT, each with limited follow‐up. We performed a prospective multicenter pilot study comparing HIV D+/R+ to donors‐without‐HIV to recipients‐with‐HIV (HIV D−/R+) LT. We quantified patient survival, graft survival, rejection, serious adverse events (SAEs), human immunodeficiency virus (HIV) breakthrough, infections, and malignancies, using Cox and negative binomial regression with inverse probability of treatment weighting. Between March 2016–July 2019, there were 45 LTs (8 simultaneous liver‐kidney) at 9 centers: 24 HIV D+/R+, 21 HIV D−/R+ (10 D− were false‐positive). The median follow‐up time was 23 months. Median recipient CD4 was 287 cells/µL with 100% on antiretroviral therapy; 56% were hepatitis C virus (HCV)‐seropositive, 13% HCV‐viremic. Weighted 1‐year survival was 83.3% versus 100.0% in D+ versus D− groups (p= .04). There were no differences in one‐year graft survival (96.0% vs. 100.0%), rejection (10.8% vs. 18.2%), HIV breakthrough (8% vs. 10%), or SAEs (all p> .05). HIV D+/R+ had more opportunistic infections, infectious hospitalizations, and cancer. In this multicenter pilot study of HIV D+/R+ LT, patient and graft survival were better than historical cohorts, however, a potential increase in infections and cancer merits further investigation. A multicenter study of HIV+ donor to HIV+ recipient liver transplantation under the HOPE Act shows that patient and graft survival were better than historical cohorts, but the possible increased incidence of infections and cancer merits further investigation.

Chironjioil extraction from the Buchanania lanzanseeds using Soxhlet extraction and cold pressing method has been reported. Soxhlet extraction of Chironji oil was carried out using polar solvents such as methanol (M), ethanol (E), dichloromethane (DCM), and ethyl acetate (EA), nonpolar solvents like petroleum ether (PE) and hexane (H), and a combination of polar and nonpolar solvents in various ratios such as PE: M (1:1), DCM:M (1:1, 2:1) and DCM:E (1:1). The Soxhlet extraction using petroleum ether provided the higher oil extraction yield (50.16%) than cold press method (21.57%), but the cold-pressed oil was superior in quality (e.g., no loss of aroma). Chironji oils extracted by the solvent extraction method and cold-pressed method have been analyzed using gas chromatography and mass spectroscopy to get the composition of fatty acids which have nutritional and medicinal significance. Also, the existence of various functional groups such as alkanes, ester, and alkene in the Chironji oil were confirmed by Fourier Transform Infrared Spectroscopy of the extracted oil. Analysis of oil by phytochemical tests and physicochemical properties was carried out, and the presence of tannins, flavonoids, saponins, steroids, and terpenoids was confirmed.

IMPORTANCE: Although the safety of labor epidural analgesia (LEA) for neonates has been well documented, the long-term health effects of LEA on offspring remain to be investigated. OBJECTIVE: To assess the association between maternal LEA exposure and risk of autism spectrum disorders (ASDs) in offspring. DESIGN, SETTING, AND PARTICIPANTS: Data for this retrospective longitudinal birth cohort study were derived from electronic medical records from a population-based clinical birth cohort. A total of 147 895 singleton children delivered vaginally between January 1, 2008, and December 31, 2015, in a single integrated health care system were included. Children were followed up from the age of 1 year until the first date of the following occurrences: clinical diagnosis of ASD, last date of health plan enrollment, death, or the study end date of December 31, 2018. EXPOSURES: Use and duration of LEA. MAIN OUTCOMES AND MEASURES: The main outcome was clinical diagnosis of ASD. Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) of ASD associated with LEA exposure. RESULTS: Among the cohort of 147 895 singleton children (74 425 boys [50.3%]; mean [SD] gestational age at delivery, 38.9 [1.5] weeks), 109 719 (74.2%) were exposed to maternal LEA. Fever during labor was observed in 13 055 mothers (11.9%) in the LEA group and 510 of 38 176 mothers (1.3%) in the non-LEA group. Autism spectrum disorders were diagnosed in 2039 children (1.9%) in the LEA group and 485 children (1.3%) in the non-LEA group. After adjusting for potential confounders, including birth year, medical center, maternal age at delivery, parity, race/ethnicity, educational level, household income, history of comorbidity, diabetes during pregnancy, smoking during pregnancy, preeclampsia or eclampsia, prepregnancy body mass index, gestational weight gain, gestational age at delivery, and birth weight, the HR associated with LEA vs non-LEA exposure was 1.37 (95% CI, 1.23-1.53). Relative to the unexposed group, the adjusted HR associated with LEA exposure of less than 4 hours was 1.33 (95% CI, 1.17-1.53), with LEA exposure of 4 to 8 hours was 1.35 (95% CI, 1.20-1.53), and with LEA exposure of more than 8 hours was 1.46 (95% CI, 1.27-1.69). Within the LEA group, there was a significant trend of ASD risk associated with increasing duration of LEA exposure after adjusting for covariates (HR for linear trend, 1.05 [95% CI, 1.01-1.09] per 4 hours). Adding fever to the model did not change the HR estimate associated with LEA exposure (adjusted HR for LEA vs non-LEA, 1.37 [95% CI, 1.22-1.53]). CONCLUSIONS AND RELEVANCE: This study suggests that maternal LEA may be associated with increased ASD risk in children. The risk appears to not be directly associated with epidural-related maternal fever.

Many methods are used during shoulder surgery to prevent wound contamination with Cutibacterium acnes, but there are no accepted standards for prevention. Some surgeons use an electrosurgical instrument instead of a scalpel blade during open shoulder surgery in an effort to prevent deep tissue contamination with C. acnes. We sought to compare the transference rate of C. acnesbetween a scalpel blade at room temperature and an electrosurgical blade heated to 41°C (temperature of electrosurgical blade after standard deltopectoral approach). In our model, using a scalpel blade versus a heated electrosurgical blade resulted in no difference in pathogen transference.

Purpose: The purpose of this study is to determine the current status of Sustainable Lean Six Sigma (SLSS) practices execution in the industries by identifying the research gaps and also methodologies that are applied by different researchers and practitioners. Design/methodology/approach: To find the current status of SLSS practices all over world, the literature review of the articles available through SCOPUS data base is given in different categories such as a country-wise and year-wise publication of the articles, journal-wise publication of articles, case study implementation focus in industry and data analysis techniques used by the researchers. Findings: The different methodologies applied by the researchers and practitioners have been explained and the gaps for further research are identified. The extensive review of articles of last 18 years revealed that there are various opportunities such as quantitative study, framework modeling on the SLSS, and implementation of developed models in different industries, etc. which are required to be explored. Originality/value: In the present study, a review of 129 articles for the time span of January 2000 to February 2018 is considered. The SCOPUS database was used for selecting the articles for review. A total of 129 articles were considered for the literature review, and the case study implementation in different industries with the focused areas such as cost reduction, defect reduction, economic, environmental and social aspects was explained.