Search

Background: Opioid medications are frequently used to address pain among patients with cirrhosis, including those on the liver transplant (LT) waitlist and after transplantation. However, opioid use has been associated with poor allograft outcomes and reduced transplant survival. We examined the impact of opioid use across the spectrum of advanced liver disease, from the initial hepatology consultation for cirrhosis through transplant referral, listing, and the post‐LT process. Methods: The study includes all patients referred for cirrhosis management in a single healthcare system in the United States. Data were extracted retrospectively through medical chart review. Results: Of 414 patients included in the study, 104 (25%) were treated with opioid. Patients on opioids were more likely to be White, have body mass indices (BMI) >30, have HCV, suffer from hepatic encephalopathy, cigarette smokers, and use benzodiazepines concurrently. Higher doses of opioids were associated with multiple emergency department (ED). Eighty‐nine underwent LT, including 20 opioid‐treated patients. There was no difference found between the opioid and non‐opioid groups with regard to allograft loss, ED visits, and hospital readmissions at 2 years post‐LT follow‐up. Conclusions: Opioid treatment was common among patients with cirrhosis. We did not find increased negative outcomes among opioid users across the spectrum of cirrhosis. However, the sample for LT patients was small. [ABSTRACT FROM AUTHOR]

Background: With the introduction of direct‐acting antiviral therapies (DAAs), the non‐use rate of hepatitis C virus (HCV)‐positive donor organs (D+) has decreased significantly. We present the donor, recipient, and transplant allograft characteristics, along with recipient outcomes, in one of the largest cohorts of HCV‐D+ transplants into HCV‐naïve recipients (R−). Methods: Charts of HCV D+/R− kidney (KT), liver (LT), and simultaneous liver‐kidney (SLKT) transplant recipients between January 2019 and July 2022 were reviewed. Primary outcomes of interest included waitlist times and 1‐year graft failure. Secondary outcomes included hospital and intensive care unit length of stay, post‐transplant complications, effectiveness of DAA therapy, and characteristics of patients who relapsed from initial DAA therapy. Results: Fifty‐five HCV D+/R− transplants at our center [42 KT (26 nucleic acid testing positive [NAT+], 16 NAT−), 12 LT (eight NAT+, four NAT−), and one SLKT (NAT+)] had a median waitlist time of 69 days for KT, 87 days for LT, and 15 days for SLKT. There were no graft failures at 1 year. All viremic recipients were treated with a 12‐week course of DAAs, of which 100% achieved end of treatment response (EOTR)—85.7% (n = 30) achieved sustained virologic response (SVR) and 14.3% relapsed (n = 5; four KT, one LT). All relapsed recipients were retreated and achieved SVR. The most common post‐transplantation complications include BK virus infection (n = 9) for KT and non‐allograft infections (n = 4) for LT. Conclusions: Our study has demonstrated no graft failures or recipient deaths at 1 year, and despite a 14.3% relapse rate, we achieved 100% SVR. Complications rates of D+/R− appeared comparable to national D−/R− complication rates. Further studies comparing D+/R− to D−/R− outcomes are needed. [ABSTRACT FROM AUTHOR]

Summary. To determine changes in Factor VIII (FVIII) and von Willebrand Factor (VWF) in the first 3 days of the puerperium. A prospective study assessing FVIII clotting activity, VWF activity and antigen levels in 95 women (with singleton uncomplicated pregnancies) during labour and on days 1, 2 and 3 of the puerperium. There were no significant differences in FVIII, VWF:Ag and VWF:CB on days 1 and 2 of the puerperium compared with levels during labour. There was a significant decrease in VWF:Ag ( P = 0.009) and VWF:CB ( P = 0.04) on day 3. Age, ethnicity, duration of labour and mode of delivery did not have any significant effect on the changes in FVIII and VWF levels. The pregnancy induced increase in FVIII and VWF is maintained in the first 48 h after delivery. VWF levels start to decline on day 3 postdelivery. [ABSTRACT FROM AUTHOR]

Frequent occurrences of soil compaction damage resulting from high raindrop impact energy, and from human and animal trafficking during field operations pose a problem to farmers around the tropics. We studied the effect of some crop and soil management practices (manure, mulch, NPK applications, tillage and crop type) on some soil compactibility indices (dry bulk density, cone index, total soil porosity, gravimetric soil water content) in a Typic Paleustult in southeastern Nigeria. The study was carried out for three consecutive planting seasons using two tillage systems and four other soil management practices (poultry droppings + NPK, mulch + NPK, NPK alone and no amendment). These were laid out as split-plot in a RCB design replicated three times and using maize (Zea mays L.) and groundnut (Arachis hypogea) as test crops. Results indicate that the different soil management techniques adopted influenced dry bulk density, penetration resistance, total soil porosity and gravimetric soil water content at 44 and 66 days after planting (DAP) whereas only gravimetric soil water content was affected at 90 DAP. The dry bulk density of tilled maize and groundnut plots increased significantly (P<0.05) by between 2 and 14% relative to no-till plots at 44 and 66 DAP. In both maize and groundnut plots, dry bulk density decreased significantly (P<0.05) in plots amended with poultry droppings +NPK relative to the control plots by 3–10% at 44 and 66 DAP. Tilled maize and groundnut plots had 37–45% lower (P< 0.05) penetration resistance than their corresponding no-till plots at both 44 and 66 DAP. Penetration resistance measurements were lower by 16.5–25% in plots amended with poultry droppings + NPK relative to unamended plots at 44 and 66 DAP. Cumulative (1996, 1997, 1998) data indicate that gravimetric soil water content in maize and groundnut plots generally increased significantly (P<0.05) in no-till plots relative to tilled plots by 18–27% at both 44 and 66 DAP. Plots amended with poultry droppings + NPK had between 24 and 111% increase (P<0.05) in soil gravimetric soil water content at both 44 and 66 DAP. Results are indicative that all soil compactibility indices measured were not affected at 90 DAP except for soil gravimetric soil water content in 1996 and 1998. Results from this work demonstrate that some crop and soil management practices could be used to reduce soil compactibility problems thus increasing productivity of such soils. [ABSTRACT FROM AUTHOR]

Background: The utility of ex vivo Magnetic resonance imaging proton density fat fraction (MRI-PDFF) in donor liver fat quantification is unknown. Purpose: To evaluate the diagnostic accuracy and utility in predicting early allograft dysfunction (EAD) of ex vivo MRI-PDFF measurement of fat in deceased donor livers using histology as the gold standard. Methods: We performed Ex vivo, 1.5 Tesla MRI-PDFF on 33 human deceased donor livers before implantation, enroute to the operating room. After the exclusion of 4 images (technical errors), 29 MRI images were evaluable. Histology was evaluable in 27 of 29 patients. EAD was defined as a peak value of aminotransferase >2000 IU/mL during the first week or an INR of ≥1.6 or bilirubin ≥10 mg/dL at day 7. Results: MRI-PDFF values showed a strong positive correlation (Pearson's correlation coefficient) when histology (macro-steatosis) was included (r = 0.78, 95% confidence interval 0.57‐0.89, p<0.0001). The correlation appeared much stronger when macro plus micro-steatosis were included (r = 0.87, 95% confidence interval 0.72‐0.94, p<0.0001). EAD was noted in 7(25%) subjects. AUC (Area Under the Curve) for macro steatosis (histology) predicted EAD in 73% (95% CI: 48–99), micro plus macro steatosis in 76% (95% CI: 49–100). AUC for PDFF values predicted EAD in 67(35–98). Comparison of the ROC curves in a multivariate model revealed, adding MRI PDFF values to macro steatosis increased the ability of the model in predicting EAD (AUC: 79%, 95% CI: 59–99), and addition of macro plus micro steatosis based on histology predicted EAD even better (AUC: 90%: 79–100, P = 0.054). Conclusion: In this pilot study, MRI-PDFF imaging showed potential utility in quantifying hepatic steatosis ex-vivo donor liver evaluation and the ability to predict EAD related to severe allograft steatosis in the recipient. [ABSTRACT FROM AUTHOR]

Economic and environmental considerations have elucidated research interests on the best approach to managing electronic waste (e-waste), which has increasing social, environmental, and economic impacts. Proper e-waste managementis essential for resource recovery, environmental sustainability, and public health protection, and effective management of e-waste necessitates analytical techniques to assess and characterize their elemental composition. Despite expansive literature published on the topic of e-waste, there is scarce coverage of the various analytical techniques employed to characterize the inorganic contents of e-waste. This review discusses the various e-waste characterization techniques used in studies published between 2013 and 2023. Specifically, this review covers the analytical approaches employed to characterize the inorganic content of e-waste, the electronic devices or their components analyzed, the elements identified, the sample preparation methods adopted, and the merits and demerits of the analytical procedures. This review highlights the disparate approaches to e-waste characterization and the need for reliable and repeatable e-waste analysis and sample preparation methods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Oxidized organosulfur compounds and, in particular, sulfoxides are of interest as solvents in the semiconductor and pharmaceutical industry, environmental contaminants, and simulants in deactivation of chemical warfare agents. An experimental study is reported of the interaction of porphyrin aluminum metal-organic framework Al-MOF-TCPPH 2 (Compound 2) with diethyl sulfoxide (DESO) in pure form and in aqueous solution. First, the suitability of Compound 2 as sorbent in aqueous solution was assessed; namely, its long-term stability (up to 15 days) in liquid water has been investigated at room temperature and under stirring. Here, a novel facile spectroscopic method has been used, a periodic micro-sampling of sorbent from suspension, followed by vacuum mini-filtration and an ex situ time-dependent attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR) analysis. Next, the interaction of Compound 2 with pure liquid DESO under ambient conditions was investigated, which yields the stoichiometric adsorption complex (Al-MOF-TCPPH 2 ) 1 (DESO) 2 denoted Compound 3. In this adsorption complex, molecules of DESO interact with the OH group and carboxylate group of the sorbent. Then, the removal of DESO from Compound 3 was assessed, using facile treatment with warm water in the micro Soxhlet apparatus followed by the ATR FT-IR analysis. Finally, Compound 2 was tested in sorption of DESO from diluted aqueous solution. In the initial step, the sorption proceeds very quickly (in <1 min the concentration of DESO decreases by about 20%) followed by a much slower step. The maximum amount of adsorbed DESO corresponds to half of the amount adsorbed from pure DESO as found by the high-performance liquid chromatography-ultraviolet detection method. This adsorbed amount corresponds to 1 mol DESO adsorbate per mol of sorbent. Porphyrin aluminum metal-organic framework Compound 2 is promising for the removal of DESO from diluted aqueous solution, and it is of interest for the removal of similar oxidized organosulfur compounds., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The current COVID-19 pandemic has greatly changed the way surgery is delivered. In particular, current guidelines and policies have highlighted the need to use high level Personal Protective Equipment to reduce the risk of viral infection during open and laparoscopic surgical procedures. In particular, it was felt that the laparoscopic approach was at higher risk of viral transmission due to the chimney effect of the smoke escape from the trocars during and after the procedure. However, with this being a new and largely unknown viral agent, guidelines have been based on speculation and extrapolation from previous studies conducted in completely different situations, and led to anxiety amongst surgeons and theatre staff. We decided to conduct a systematic review of the Literature to try to clarify whether inhalation of surgical smoke can increase the risk of COVID-19 infection., Methods: A thorough search of the relevant Literature was performed following the PRISMA guidelines and the most relevant papers on this topic were selected for qualitative analysis. Duplicates, review, personal opinions and guidelines have been excluded. Quantitative analysis has not been performed due to the lack of homogeneous high-quality studies., Results: Literature search identified 740 papers but only 34 of them were suitable for qualitative analysis. The quality of those studies is generally quite low. We were not able to find any evidence directly linking surgical smoke with viral transmission, other than in patients with active HPV infection., Discussion: Inhalation of surgical smoke can be generally hazardous, and therefore the use of PPE during surgical operations must be recommended in any case. However, the present systematic review of the existent Literature did not identify any significant evidence of the risk of viral transmission with the surgical smoke, therefore the current guidelines restricting the use of laparoscopy and/or diathermy during the current Covid-19 pandemic may be considered excessive and non-evidence based., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2021 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)