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Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity and better patient and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of beta-cell replacement therapy: pancreas or islet transplantation. International variation related to national regulatory policies exists in offering one or both options to suitable candidates and is further affected by pancreas/islet allocation policies and transplant waiting list dynamics. The selection of appropriate candidates depends on patient age, coexistent morbidities, the timing of referral to the transplant center (predialysis versus on dialysis) and availability of living kidney donors. Therefore, early referral (estimated glomerular filtration rate < 30 mL/min/1.73 m(2)) is of the utmost importance to ensure adequate time for informed decision making and thorough pretransplant evaluation. Obesity, cardiovascular disease, peripheral vascular disease, smoking, and frailty are some of the conditions that need to be addressed before acceptance on the transplant list, and ideally before dialysis becoming imminent. This review offers insights into selection of pancreas/islet transplant candidates by transplant centers and an update on posttransplant outcomes, which may have practice implications for referring nephrologists.

Purpose/Objective(s) Radiation-induced sarcoma (RIS) is a rare secondary malignancy resulting from ionizing radiation-related treatment after a long latency period. Despite the unfavorable clinical outcomes, the genomic footprints of ionizing radiation in RIS development remain largely unknown. Hence, this study aimed to characterize RIS genomes and the genomic alterations in them. Materials/Methods We performed whole-genome sequencing (WGS) of 11 cases of RIS matched with normal genomes to identify somatic alterations potentially associated with RIS development. Results The mutation abundance of RIS genomes including one hypermutated genome was variable. Cancer-related genes might show different types of genomic alterations. For instance, NF1, NF2, NOTCH1, NOTCH2, PIK3CA, RB1, and TP53 showed singleton somatic mutations; MYC, CDKN2A, RB1, and NF1 showed recurrent copy number alterations; and NF2, ARID1B, and RAD51B showed recurrent structural variations (SVs). The effects of non-homologous end joining on short insertions-deletions and SVs were substantial in RIS genomes, compared with in spontaneous osteosarcoma genomes, representing the genomic hallmark of RIS genomes. In addition, frequent chromothripsis and predisposing germline variants in DNA damage-repair pathways were identified. Conclusion Taken together, WGS-scale characterization of RIS genomes may pave the way for advanced diagnostic and therapeutic strategies for RIS.

Scedosporium spp. is the most common mold infection in pneumonia resulting from near-drowning. Three fatal scedosporiosis cases developed after solid organ transplantation, probably transmitted from the nearly-drowned donor. One heart transplant recipient and two kidney transplant recipients developed fatal scedosporiosis following deceased donor transplantation from the same donor, a nearly-drowned victim of a suicide attempt. Genotypically, indistinguishable strains of Scedosporium auratiacum were recovered from the three recipients. Two liver transplant recipients from the same donor received prophylactic voriconazole without any subsequent signs of infection. To determine the safety of donation from nearly-drowned donors, a national traceback investigation was also performed of the causes of deaths in all transplant recipients who received organs from drowned donors between 2001 and 2013. Over 13 years, 2600 deceased donor transplants were performed in Korea. Among these 2600 deceased donor transplants, 27 (1%) victims of drowning donated their organs. From these 27 donors, 84 patients received organ transplants and 18 died, including the above three. We found no microbiologic evidence of invasive mold transmission from the nearly-drowned donors to the other 15 recipients. Although disseminated infection in the donor could not be demonstrated by culture, undiagnosed disseminated donor infection and transmission of Scedosporium spp. should be considered in near-drowning events.

Objectives The aim of this study was to investigate the prevalence of hyperuricemia and factors predicting its occurrence, and to establish the relationship over time between serial changes in estimated glomerular filtration rate (eGFR) and uric acid (UR) concentration in kidney transplant (KT) recipients with eGFR >60 mL/min/1.73 m2. Methods Adult patients who underwent KT at the Asan Medical Center between 1990 and 2008 and maintained eGFR >60 mL/min/1.73 m2 were retrospectively assessed. Clinical and laboratory data were obtained from inpatient and outpatient charts and from the hospital electronic database. Results Of 356 patients, 301 (84.55%) had normal UR levels and 55 (15.45%) had hyperuricemia. After multivariate adjustment, transplant duration, male gender, eGFR, diabetes mellitus (DM), and calcium level were associated with higher mean UR levels. Mean UR level increased significantly and mean eGFR decreased significantly during the first year after transplantation, but there were no significant differences over the next 4 years. Serial UR and eGFR levels changed almost simultaneously. Conclusions Transplantation duration, male gender, eGFR level, DM, and serum calcium level were risk factors for hyperuricemia in kidney recipients with intact graft function. Increased uric acid after KT did not significantly affect graft function.

We present a novel multigrid-continuation method for treating parameter-dependent problems. The proposed algorithm which can be flexibly implemented is a generalization of the two-grid discretization schemes [C.-S. Chien, B.-W. Jeng, A two-grid discretization scheme for semilinear elliptic eigenvalue problems, SIAM J. Sci. Comput. 27 (2006) 1287–1304]. That is, approximating points on a solution curve do not necessarily lie on the same fine grid. We apply the algorithm to compute energy levels and superfluid densities of Bose–Einstein condensates (BEC) in a periodic potential. Both positive and negative scattering lengths are considered in our numerical experiments. For positive scattering length, if the chemical potential is large enough, and the domain is properly chosen, the results show that the number of peaks of the first few energy states of the 2D BEC in a periodic potential depends on the wave number of the periodic potential. Moreover, for bright solitons the number of peaks of the ground state solutions is (1d−1)2 and (1d)2, where the periodic potential is expressed in terms of the sine or the cosine functions, respectively. However, these formulae do not hold if the scattering length is negative. The numerical study is extended to the two-component, 1D and 2D BEC in a periodic potential.

Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic distal pancreatic resection (LDPR) with open distal pancreatic resection (ODPR). This study aimed to compare clinical outcomes for LDPR and ODPR performed at a single institution.For this study, 93 patients with benign pancreatic disease underwent LDPR, and 35 patients with benign pancreatic disease underwent ODPR. Patient demographic characteristics, operative times, perioperative complications, length of hospital stay, and return to normal diet were compared retrospectively between the two groups.The LDPR and ODPR groups had the same demographic characteristics. The median operative time was 195 min in the LDPR group and 190 min in the ODPR group (p0.05). The rate of spleen preservation was higher in the LDPR group (40.8%) than in the ODPR group (5.7%) (p0.05) No operative mortality occurred in either group. The overall complication rate was 24.7% in the LDPR group and 29% in the ODPR group (p0.05). The rate of pancreas-related complications was 11.8% in the LDPR group and 17.2% in the ODPR group (p0.05). Pancreatic fistula developed in 8.6% of the LDPR group and in 14.3% of the ODPR group (p0.05). Bowel movement return to normal and resumption of normal diet were achieved 2.8+/-1.3 days after the operation in the LDPR group and 4.5+/-1.6 days after the operation in the ODPR group (p0.05). The median duration of hospital stay was 10 days for the LDPR group, which was significantly shorter than the 16 days for the ODPR group (p0.01).The use of LDPR for benign lesions of the distal pancreas is feasible and safe. The LDPR procedure is associated with operative times and complication rates similar to those for ODPR, but LDPR has the advantages of an earlier return to normal bowel movements and normal diet and shorter hospital stays than ODPR.

Background. Lamivudine has been reported to be able to stabilize liver enzyme and hepatitis B virus (HBV) replication with recurrent hepatitis that has been regarded as a frequent and major risk factor for hepatic dysfunction and chronic liver disease in renal transplant recipients. Because large number of hepatitis antigenemia patients among renal transplant patients experience recurrent hepatic dysfunction with HBV recurrence and permanent histological deterioration, preemptive or primary prophylactic use of lamivudine before transplantation may be more beneficial than a trial for the treatment of advanced hepatic dysfunction. Methods. We conducted a double arm study to compare the efficacy of lamivudine between the preemptive (HBV DNA positive) or prophylactic (HBV DNA negative) trial for the maintenance of stable liver function (n=10) and the trial for the salvage of advanced hepatic dysfunction developed after renal transplantation (n=6) in hepatitis B viremia carrier renal transplant recipients. Results. Hepatic dysfunction with recurrent HBV antigenemia developed in 11 of 36 (30.6%) hepatitis antigenemia patients with a mean duration of 8.4 months (range 5-19.4 months). In six patients treated with lamivudine after hepatic dysfunction from recurrent hepatitis B viremia, serum AST and ALT level normalized within 1 month and HBV-DNA disappeared in all cases. HBV-DNA, however, reappeared in three (50%) without any discontinuation of lamivudine. Liver biopsy revealed recurrent chronic active hepatitis with severe activity of fibrosis in four cases, cholestatic fibrosing hepatitis in one, and permanent cirrhotic change in one. In seven patients who had preemptive lamivudine treatment at 9, 6, 2, 2, 1, 0, 0 month before the transplantation, HBV-DNA had converted to negative with a mean follow up of 1.2 months (range 1-2 month) in all case. Three patients who had prophylactic trials with lamivudine have all remained HBV-DNA negative. The recurrence rate of HBV viremia in the preemptive or prophylactic lamivudine treated group is 10.0% (1/10), which is significantly lower than that (42.3%, 11/25) in the nonlamivudinetreated group. The re-recurrence rate of HBV viremia was significantly higher (3/6, 50.0%) in the reactive lamivudine treated group than in prophylactic or preemptive group (1/10, 10%). Conclusion. Although lamivudine treatment after hepatic dysfunction can be a sound conventional treatment modality, this preliminary study may suggest that preemptive or prophylactic trial of lamivudine before hepatic dysfunction might be a more effective strategy for prevention of permanent histological deterioration and recurrence of hepatitis B viremia.

We describe a way to compress Cs atoms in a MOT to temporarily reach spatial densities of 10 12 atoms/cm 3 . The method entails starting off with more atoms than will ultimately be used, and then changing parameters so the atoms rush toward the trap center. For some time during the compression, collisional losses at the center are more than offset by newly arriving atoms. We monitor the compression with a high intensity fluorescent technique that is well suited to providing accurate number and density measurements for large dimension clouds that are very optically thick.

We have observed Bose-Einstein condensation of large numbers of Rb atoms in a magnetic time-averaged orbiting potential ~TOP! trap. Over 1.5310 atoms are captured in the trap and evaporatively cooled to produce condensates containing up to 2310 atoms. We discuss special considerations relating to the production of large Bose-Einstein condensates in a TOP trap, and present measurements of the condensate fraction for this case. @S1050-2947~98!50806-2#

We report experimental realization of lensless imaging on cold rubidium atoms confined in a magneto-optical trap. This imaging scheme relies on the off-resonant light refraction from the cold atoms and is employed in a phase-tunable Mach–Zehnder interferometer, accompanied with phase-shifting interferometry. With this setup, it allows obtaining the probe light phase distribution in the far field after passing the atoms, from which the near-field phase image of the atomic cloud is retrieved using the Fresnel–Kirchhoff integral. We show the phase images can be effectively reconstructed, and the measured two-dimensional phase distributions are in good agreement with the theory.

General differential equations for dynamic analysis of cable-stayed bridges are established through a continuous treatment of stay action. Equations covering both bending and torsional problems can...

We have experimentally demonstrated a general method to perform high-precision refractive index spectrum measurement using phase-shifting interferometry in a phase-tunable Mach–Zehnder interferometer. We observed coherent amplification on the refractive spectrum, across the Lamb dips of ground hyperfine states in a Doppler-broadened Rb87 vapor. Most importantly, the spectrum still has a large signal-to-noise ratio when the probe power is in the dark light level under which the method using a single interferogram fails. This experimental scheme is efficient for refractive spectrum measurements and could be extended for 2D phase imaging. It provides many potential applications for optical phase measurements in linear, nonlinear, and quantum optics.

Invasive pulmonary aspergillosis (IPA) is an important cause of mortality in transplant recipients and in patients with neutropenia. Although IPA has been studied extensively in neutropenic patients, there are limited data on IPA in recipients of solid organ transplants (SOTs). We compared the clinical features and radiologic findings of 27 SOT recipients with IPA with those of 35 neutropenic patients with IPA. The SOT recipients were more likely than neutropenic patients to show peribronchial consolidation (31% vs. 7%; P=0.03) or ground-glass opacity (38% vs. 7%; P=0.007) and less likely to have fever (22% vs. 80%; P0.001), macro-nodules (35% vs. 67%; P=0.02), mass-like consolidation (27% vs. 67%; P=0.004), halo signs (8% vs. 56%; P0.001), or air-crescent signs (0% vs. 22%; P=0.01).

Objective Tacrolimus has been shown to be an important immunosuppressive agent in organ and bone marrow transplantation. Previously, we reported that there were no statistically significant differences between the pharmacokinetic parameters of the oral formulation of generic tacrolimus (TacroBell) and the conventional formulation (Prograf). This study was designed to evaluate the efficacy and safety of oral capsules of TacroBell in de novo renal transplantation. Methods Ninety-six renal transplant recipients from 9 transplantation centers in South Korea were enrolled between November 2005 and July 2007. De novo renal recipients ranged from 19–65 years old. Ninety-four patients who underwent renal transplantation were administered study drug at least one time in the intent-to-treat (ITT) analysis. This phase 4 clinical trial was a 26-week, open-label, noncomparative, multicenter study. Results An acute rejection episode developed in 10/94 recipients (10.6%, 95% confidence interval, 4.4%–16.9%). There were no patient deaths during the study. The 6-month graft survival rate was 96.8%. Conclusion Based on this study, treatment with TacroBell is considered to be efficient and safe after primary renal transplantation.

We report experimental observation of large group index across the Lamb dips of ground hyperfine states in Doppler-broadened 87Rb vapor. By sweeping the laser frequency through each hyperfine transition we measure the saturated absorption and optical phase shift using a phase-locked Mach-Zehnder interferometer. Our measurements provide a direct demonstration of the theoretical prediction by Agarwal et al. [G. S. Agarwal and T. N. Dey, Phys. Rev. A 68, 063816, (2003)] for the first time. An enhancement factor as large as 1005 in group index was observed for Rb vapor at temperature of 85 °C. The experimental data are in good agreement with the theory.

The wave superposition method is one of the effective methods to simulate the stochastic fluctuating wind field. The simulated wind speed samples with single-indexing frequencies are periodic, with period of T 0 = 2π · N/ω u, in which N → ∞ and ω u being the upper cutoff frequency. While using the double-indexing frequencies, theoretically the samples’ period could increase to nT 0, where n is the number of multivariate. However, in fact, the period is not increased. It still keeps the value of T 0. Two examples using the double-indexing frequencies indicate this problem. In this paper, the reason of this problem is studied in detail. And an improved method to generate wind speed samples with non-periodic characteristics is proposed. Formulation is given. In this formulation, the problem existing is that of the enormous memory consumption and time consuming. Therefore, characteristics for the curves of the factorized power spectral density functions changing with frequencies are further studied. And the cubic uniform B-spline interpolation method and the cut-off part of cosine terms method are utilized to improve the simulation efficiency. An example using proposed methods indicates that the simulation is successful. The simulated stochastic fluctuating wind field has features of non-periodicity. And the algorithm is effective and accurate.

The aim of this study was to investigate the effect of culture at 24 degrees C on cell viability, cellular function, immunogenicity, and cytokine profiles of rat pancreatic islets. Pancreatic islets were isolated from Lewis rats and cultured at either 24 degrees C or 37 degrees C for 14 days. Islet recovery was counted as islet equivalents; islet viability was examined with fluorescent vital staining. Islet function was measured with a glucose stimulation test. Annexin V, and MHC class I and II expression were measured using flow cytometric assay for apoptosis and immunogenicity, respectively. Lymphocyte cell proliferation was examined with WST-1 proliferation assay. Cytokine profiles were analyzed with quantitative real time RT-PCR. All these parameters were measured on 1, 3, 5, 7 and 14 culture days after islet isolation. Islet recovery was higher in islets cultured at 24 degrees C than 37 degrees C without a change in viability. Insulin secretion after glucose stimulation was more effective in 24 degrees C culture conditions. Decreased apoptotic cell death was demonstrated in 24 degrees C cultured islets. Both MHC class I and II expression on islets and lymphocyte proliferation upon coculture with islets were less prominent in 24 degrees C cultured islets. TNF-alpha expression was lower in islets cultured at 24 degrees C than in islets cultured at 37 degrees C. Both IL-1beta and IL-10 cytokine expressions were similar under both culture conditions. This study demonstrated that cell recovery and function are increased in islets cultured at 24 degrees C than those at 37 degrees C with decreased antigenicity and proinflammatory cytokine expression.

Reduction of nonpoint source (NPS) pollution from agricultural lands is a major concern in most countries. One method to reduce NPS pollution is through land retirement programs. This method, however, may result in enormous economic costs especially when large sums of croplands need to be retired. To reduce the cost, effluent trading can be employed to couple with land retirement programs. However, the trading efforts can also become inefficient due to various uncertainties existing in stochastic, interval, and fuzzy formats in agricultural systems. Thus, it is desired to develop improved methods to effectively quantify the efficiency of potential trading efforts by considering those uncertainties. In this respect, this paper presents an inexact fuzzy two-stage stochastic programming model to tackle such problems. The proposed model can facilitate decision-making to implement trading efforts for agricultural NPS pollution reduction through land retirement programs. The applicability of the model is demonstrated through a hypothetical effluent trading program within a subcatchment of the Lake Tai Basin in China. The study results indicate that the efficiency of the trading program is significantly influenced by precipitation amount, agricultural activities, and level of discharge limits of pollutants. The results also show that the trading program will be more effective for low precipitation years and with stricter discharge limits.

Background: We analyzed postoperative tumor recurrence in periampullary cancer on computed tomography (CT). Methods: Forty-six patients with tumor recurrence (16 pancreas head cancers, 19 distal common bile duct cancers, and 11 ampulla of Vater cancers) of 125 patients who underwent surgery for periampullary cancer were enrolled. Recurrence was diagnosed by CT findings plus elevated CA 19-9 (n = 28) or biopsy (n = 18). Two radiologists retrospectively reviewed 156 contrast-enhanced CT scans, with 7-mm slice thickness, obtained in our institution until the initial diagnosis of tumor recurrence. The modes of recurrence were classified as local recurrence, hepatic metastasis, lymph node metastasis, peritoneal carcinomatosis, or extraabdominal metastasis. We evaluated the time of recurrence, the frequency of each mode of recurrence, and the earliest mode of recurrence. The differences in tumor recurrence for the three types of periampullary cancer were evaluated. Results: Half of the recurrences occurred within 6 months after surgery and 87% occurred within 12 months after surgery. Local recurrences (67%), hepatic metastases (72%), and lymph node metastases (61%) were common modes of tumor recurrence. Pancreas head cancers recurred earlier than the other types of periampullary cancer (p < 0.05). Conclusion: Periampullary cancer tends to recur early after surgery, usually as a local recurrence, hepatic metastasis, or lymph node metastasis.

Summary form only given. We have observed a stimulated Raman resonance between free and bound molecular states of atoms in a Bose-condensed gas. In our experiment, we first produce a Bose-condensed cloud containing about 5/spl times/10/sup 5/ /sup 87/Rb 5/sup 2/S/sub 1/2/ (f=1,m/sub f/=-1) atoms in a magnetic TOP trap, with a typical condensate fraction of about 20%. We then illuminate the atoms with a /spl tau/=10 ms duration pulse of light from two laser beams 1 and 2 of frequency /spl nu//sub 1/ and /spl nu//sub 2/, and intensities I/sub 1/=120 W/cm/sup 2/ and I/sub 2/=2.2 W/cm/sup 2/, respectively. We measure the fraction of atoms N(/spl tau/)/N/sub 0/ remaining after the 10 ms pulse with laser-induced fluorescence.

Summary form only given. We report the observation of Bose-Einstein condensation of a very large number of /sup 87/Rb atoms in a time orbiting potential (TOP) trap. We found that for such large samples, efficient cooling in the TOP trap is complicated to some extent by undesired losses of atoms at the orbiting magnetic field zero point, but that these difficulties can be overcome. In our experiments, we first load /sup 87/Rb atoms from a slow beam into a magneto-optic atom trap (MOT). Second, we then compress the atoms with a "forced dark MOT", further cool them with optical molasses, and optically pump them into the desired state.

We describe an experiment in which $3\ifmmode\times\else\texttimes\fi{}{10}^{7} \mathrm{Cs}$ atoms are loaded into a $400 \ensuremath{\mu}\mathrm{m}$ crossed beam far-off-resonant trap (FORT) that is only $2 \ensuremath{\mu}\mathrm{K}$ deep. A high-density sample is prepared in a magneto-optic trap, cooled in a three-dimensional far-off-resonant lattice (FORL), optically pumped into the lowest-energy state, adiabatically released from the FORL, magnetically levitated, and transferred to the final trap with a phase-space density of ${10}^{\ensuremath{-}3}.$ Spontaneous emission in the FORT is negligible, and we have compressed the atoms in the FORT to a spatial density of $2\ifmmode\times\else\texttimes\fi{}{10}^{13} {\mathrm{a}\mathrm{t}\mathrm{o}\mathrm{m}\mathrm{s}/\mathrm{c}\mathrm{m}}^{3}.$ Evaporative cooling under these conditions proceeds rapidly.

The proteinuria in renal allograft recipients has been regarded as a sign of poor prognosis. The causes of post-transplant proteinuria include chronic rejection, chronic transplant glomerulopathy, glomerulonephritis (GN), acute rejection, and cyclosporine nephrotoxicity. Among them, chronic rejection is known to be most frequent. We analyzed the histopathologic findings of renal allograft biopsies in 197 Korean recipients with proteinuria. Among them, 26 patients developed proteinuria over 500 mg/d. All patients received baseline immunosuppression with cyclosporine. From 26 patients with post-transplant proteinuria, 29 biopsies were performed and their histologic diagnoses were immunoglobulin A nephropathy (IgAN) in 17, IgAN combined with chronic allograft nephropathy in 1, focal segmental glomerulosclerosis in 2, crescentic GN in 1, membranous GN in 1, diabetic nephropathy in 1, acute tubulointerstitial nephritis in 1, and chronic rejection in 3 biopsies. The remaining two biopsies showed nonspecific findings. The most common cause of post-transplant proteinuria was IgAN (62% of biopsies). The incidence of chronic rejection was relatively low and predominant cyclosporine-associated changes were not observed. In conclusion, our data suggest that the main causes of post-transplant proteinuria in Korea are primary glomerulonephritides rather than chronic rejection or cyclosporine nephrotoxicity, and the kidney allograft biopsies from patients with proteinuria should be handled as native kidney.

State-selected rubidium-87 molecules were created at rest in a dilute Bose-Einstein condensate of rubidium-87 atoms with coherent free-bound stimulated Raman transitions. The transition rate exhibited a resonance line shape with an extremely narrow width as small as 1.5 kilohertz. The precise shape and position of the resonance are sensitive to the mean-field interactions between the molecules and the atomic condensate. As a result, we were able to measure the molecule-condensate interactions. This method allows molecular binding energies to be determined with unprecedented accuracy and is of interest as a mechanism for the generation of a molecular Bose-Einstein condensate.

We laser cool 5x10(7) Cs atoms to a spin-polarized phase space density of 1/30, the highest ever obtained by laser cooling. It is achieved by compression and polarization gradient cooling in a 3D far-off-resonant optical lattice, followed by 3D Raman sideband cooling optimized at a density of 1.5x10(12) atoms/cm(3), and adiabatic release. In the lattice, 23% of the sites are occupied, 95% of the atoms are in the lowest energy magnetic sublevel, and 37% are in the lowest 3D vibrational state.

We propose a lens-free nondestructive imaging method for cold atomic clouds using a Gaussian beam accompanied with phase shifting interferometry. This scheme requires no imaging lens. Hence, aberrations associated with it are completely eliminated and mechanical focusing can be avoided. Compared with the common single-beam nondestructive means, our proposed scheme lowers the energy per probe pulse delivered to the cold samples by almost three orders of magnitude, due to signal enhancement inherently provided in the two-beam configuration. Moreover, higher image resolution is attainable by magnifying the far-field interference distribution using a divergent Gaussian beam. We examine this novel lensless detection means for in situ imaging on typical cold atomic clouds under experimentally achievable conditions. Our simulations show the cloud position can be precisely determined, depending upon the cloud size and probe parameters, with an uncertainty from a few hundreds of micrometers to only a few micrometers, and the spatial resolution of the retrieved phase image can reach the diffraction limit.