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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 chirality of spherical liquid crystal droplets was investigated in this study. We report the effect of confinement on blue phase III (BPIII) spheres. We investigated the behaviours of the spher...

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.

The photo-induced isomerization of an azobenzene unit not only induces a phase transition between two different phases but also brings about marked changes of physical properties in solids and liquid crystals. We prepared a homologous series of symmetric liquid crystal trimers that possess an azobenzene unit, 4,4′-bis{9-[4-(5-hexylpyrimidin-2-yl)phenyloxy]alkyloxy}azobenzene (I-n: n = 7–11). We investigated their phase transition properties and those of their binary mixtures with a host liquid crystal. Trimers I-8, I-9, I-10 and I-11 exhibited nematic phases whereas trimer I-7 showed no liquid-crystalline properties. Trimers I-9, I-10 and I-11 were found to produce chiral conglomerates in the achiral smectic phase of their mixtures with the host liquid crystal under UV irradiation. Furthermore, odd-membered liquid crystal trimers I-9 and I-11 induced grain boundaries between smectic blocks. We explain the phase transition phenomena in terms of guest–host interactions between the photo-induced cis-trimer and its surrounding host liquid-crystalline molecules.

Spontaneous mirror symmetry breaking in self-assembled achiral trimers under a nonequilibrium state induces supramolecular chirality, which is stabilized by a polymer network to produce a homochiral material. Chirality is transferred to the polymer film in the course of polymerization of achiral reactive monomers on the surface.

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.

In living donor liver transplantation (LDLT), anastomotic biliary stricture is a serious and refractory complication. In this study, we reviewed the transition of post-LDLT anastomotic biliary strictures and evaluated long-term outcomes of stent placement inside the bile duct, which is referred to as an "inside-stent." Of 805 consecutive adult LDLT recipients in our institution (2000-2018), we reviewed 639 patients with duct-to-duct biliary reconstruction and analyzed chronological changes of post-LDLT biliary strictures. Moreover, we focused on the year 2006 when various surgical modifications were introduced and compared the details of post-LDLT biliary strictures before and after 2006, especially focusing on the long-term outcome of inside-stent placement. The proportion of left lobe grafts had increased from 1.8% before 2005 to 39.3% after 2006 (P < 0.001) to maximize the living donor safety. Overall, post-LDLT anastomotic biliary strictures occurred in 21.3% of the patients with a median follow-up period of 106.1 months, which was decreased from 32.6% before 2005 to 12.8% after 2006 (P < 0.001). Anastomotic biliary strictures were less frequent in patients with left lobe grafts than with right lobe grafts (9.4% versus 25.4%; P < 0.001). The overall technical success rate of inside-stent placement was 82.4%, with an improvement from 75.3% before 2005 up to 95.7% after 2006 (P < 0.01). Furthermore, the stricture resolution rate remained high at approximately 90% throughout the observation period. Increased use of left lobe grafts with several surgical modifications significantly reduced post-LDLT anastomotic biliary strictures, leading to favorable long-term outcomes of inside-stent placements for this condition.

Liquid crystal oligomers have a supermolecular structure in which two or more mesogenic units are interconnected through flexible spacers. They can form various molecular packing structures...

We prepared a homologous series of H-shaped liquid crystals I-n and investigated their phase transition properties using optical microscopy and differential scanning calorimetry. All the compounds ...

Background The purpose of this study was to examine the impact of pretreatments on outcomes after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). Methods From February 1999 to March 2015, 223 patients underwent LDLT for HCC. Until December 2006, there was no restriction in patient selection criteria regarding the number and size of tumors, following which we implemented the Kyoto criteria (tumor number ≤10, maximal diameter ≤5 cm, and des-gamma-carboxy prothrombin ≤400 mAU/ml) since January 2007. Results Of 223 patients, 156 had a history of pretreatments. Among 101 patients meeting the Milan criteria at the initial diagnosis, 38 progressed to beyond the criteria at liver transplantation (LT). Twenty-two out of 38 met the Kyoto criteria, and their survival and recurrence rates were significantly better than those of patients exceeding the Kyoto criteria (P = 0.004 and 0.035, respectively). Regarding the number of pretreatments (0 vs. 1-4 vs. ≥5), recurrence rate was significantly higher in the ≥5 pretreatments group than the 0 group. However, for patients meeting the Kyoto criteria, there were no significant differences in recurrence rates between these three groups. Conclusion Better outcomes will be achieved by performing LT for HCCs meeting the Kyoto criteria even after repeated pretreatments.

A flexible liquid-crystalline trimer in the optically isotropic chiral conglomerate phase catalyzes the direct aldol reaction of acetone with benzaldehyde. We report that the trimer exhibiting a porous surface acts as an enzyme-mimetic catalyst.

We prepared two achiral H-shaped liquid crystals, 4,4′-bis(7-{2-[4-(4-cyanophenyl)phenyloxycarbonyl]-5-octyloxyphenyloxycarbonyl}heptyloxy)biphenyl (I) and 4,4′-bis(7-{2-[4-(4-cyanophenyl)phenyloxycarbonyl]-5-octyloxyphenyloxycarbonyl}heptyloxy)octafluorobiphenyl (II), and investigated their phase transition properties using optical microscopy and differential scanning calorimetry. Both compounds exhibit a monotropic nematic (N) phase with compound I showing a higher Iso–N transition temperature than compound II. The phase transition behavior reveals that the molecules of both compounds form a rod-like shape instead of an H shape in the N phase. They exhibit monotropic blue phase III in their mixtures with a chiral compound. Furthermore, both compounds I and II are characterized by an electric-field-induced chiral nematic phase. When applying an AC electric field on homogeneously aligned sample cells of each compound in its nematic phase, the molecules reorient perpendicular to the substrate. Upon removing the electric field, the molecules align once again parallel to the substrate; however, this time their nematic texture changes to one consisting of domains with opposite helical handedness. We establish that coupling of the on/off switching of the electric field and the surface anchoring is responsible for breaking the mirror symmetry in the nematic phase of the flexible achiral liquid crystal oligomer.

We prepared a homologous series of achiral liquid crystal trimers (I-n) in which two phenylpyrimidine units and one biphenyl unit were connected via flexible spacers, and investigated the physical properties. All the trimers possessing odd-numbered methylene spacers exhibited soft crystalline chiral conglomerate phases. X-ray diffraction measurements reveal that they have an intercalated layer structure. On the other hand, the trimers possessing even-numbered spacers showed nematic and smectic C phases. We investigated the surface structures of odd-membered trimers in the soft crystalline phases using scanning electron microscopy. Trimers I-3 and I-5 were found to form cylindrical tubes, whereas trimers I-7, I-9 and I-11 toroidal pits. We discuss the formation of diverse supramolecular architectures in terms of the anisotropy of the chirality transfer.

A simple DoA estimation technique that virtually reduces the noise sensitivity of the classical Prony method is presented. With the discriminant test that detects the potential outliers, the proposed scheme provides a better RMSE in the classical Prony DoA estimation with a low computational cost. Unlike the traditional enhancement techniques for classical Prony, where a priori order information is necessary for the proper operations, the proposed technique works without such explicit information. The discriminant uses a predetermined threshold value, which is chosen to effectively eliminate the undesirable outliers in the 8-element uniform array. Simulations show that the RMSE reduces to the close level of LS-Prony characteristics, while some of the estimation results are discarded by the discriminant test.

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.

The interfacial properties and water-in-CO

Aim Graft-versus-host disease (GVHD) following liver transplantation is rare but fatal. Therefore, it is important to identify possible risk factors before transplantation. Although it has been suggested that donor-dominant one-way human leukocyte antigen (HLA) matching of three loci (HLA-A/B/DR) is associated with the occurrence of GVHD, the precise significance of HLA matching including HLA-C/DQ/DP remains unclear. Methods We retrospectively analyzed the impact of donor-dominant one-way HLA matching at six HLA loci at the allele level on GVHD using clinical registry data from 1759 cases who underwent living donor liver transplantation between June 1990 and June 2019. We extracted cases with donor-dominant one-way HLA matching at the antigen level and reconfirmed them at the allele level using preserved DNA samples. Results Three of four cases (75%) who developed GVHD showed donor-dominant one-way HLA matching at three HLA-A/B/DR loci. These cases also showed donor-dominant one-way HLA matching at HLA-C/DQ/DP. Three of six cases (50%) with donor-dominant one-way HLA matching at three loci of HLA-A/B/DR developed GVHD. Notably, none of the cases with donor-dominant one-way HLA matching at one or two HLA-A/B/DR loci developed GVHD, irrespective of matching status at HLA-C/DQ/DP. The HLA matching status at the antigen level was revised in 22 of 56 cases, following reconfirmation at the allele level. Conclusions Pairing of donors and recipients with donor-dominant one-way HLA matching at three HLA-A/B/DR loci should be avoided to prevent GVHD. No impact of HLA-C/DQ/DP on GVHD was identified. For liver transplantation, HLA genotypes should be determined at the allele level.

To facilitate potential applications of water-in-supercritical CO

A Japanese man in his 60s presented with complaints of epigastric pain and weight loss. A gastrointestinal endoscopy revealed multiple gastric ulcers and an irregular mound located on the wall of the lower gastric body along the greater curvature, which was suspected to be cancerous. A biopsy revealed that it was a Group 2 tumor even though the biopsy was repeated 4 times. He was referred to our hospital and 3 biopsies were performed. The final result classified the tumor as Group 4. The patient underwent surgery and the pathological examination revealed an extremely well-differentiated adenocarcinoma( EWDA). An EWDA is characterized by a well-formed mucinous gland with little or no nuclear atypia, which makes preoperative biopsy diagnosis difficult.

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.

Preoperative anemia was reportedly associated with increased morbidity and mortality after various types of surgeries. However, its impact on the outcomes after liver transplantation has not been thoroughly investigated. We retrospectively investigated the clinical outcome of 216 consecutive adult patients who underwent living donor liver transplantation at our institute between January 2010 and June 2017 and stratified them according to the hemoglobin level before transplant. Risk factors for 90-day patient mortality, especially infection-related mortality and early graft loss, were evaluated. We found that patients with preoperative hemoglobin below 10 g/dl required more intraoperative packed red blood cell transfusions (p = 0.002) and had significantly higher early 90-day postoperative mortality rate (p = 0.007), particularly infection-related mortality (p = 0.002), lower overall graft, and patient survival rates (p = 0.007, p = 0.013, respectively). Preoperative hemoglobin below 10 g/dl was an independent risk factor for increased post-transplant 90-day patient mortality (OR 2.92, p = 0.02), infection-related mortality (OR 6.81, p = 0.02), and early graft loss (OR 3.26, p = 0.01). Preoperative hemoglobin level below 10 g/dl is associated with poorer short-term outcomes after liver transplantation and should be corrected preoperatively if possible through safe and effective treatment modalities.

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.