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Purpose: Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases. Source of Information: To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program’s performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard. Methods: The CTR, which collects HSPs’ data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived. Key Findings: In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhibiting significantly longer CITs compared with intraprovincial transplants, averaging an additional 4.7 hours. Limitations: Our study limitations include first that it is a retrospective registry data analysis with no available short- and long-term clinical outcomes data at this point (patient and graft survival). Second, given the nature of registry data, not all relevant data may have been captured and reporting may not be complete for all patients. Implications: Examination of CTR registry data showed the Canadian HSP Program had a meaningful impact in enabling 1000 HSPs to access transplantation opportunities that may otherwise be unavailable to them.

Background: Kidney transplant recipients with graft failure (KTR-GF) and those with a failing graft are an increasingly prevalent group of patients. Their clinical management is complex, and outcomes are worse than transplant naïve patients on dialysis. In 2023, the Kidney Disease: Improving Global Outcomes (KDIGO) organization reported findings from a controversies conference and identified several clinical practice priorities for KTR-GF. Objective: As an exercise in needs assessment, we aimed to collate and summarize current practices in adult Canadian kidney transplant programs around these KDIGO-identified clinical practice priorities. Design: Environmental scan followed by content analysis. Setting: Canadian adult kidney transplant programs. Measurements: We categorized the themes of our content analysis around 7 clinical practice priorities: (1) determining prognosis and kidney failure trajectory; (2) immunosuppression management; (3) management of medical complications; (4) preparing for return to dialysis; (5) evaluation and listing for re-transplantation; (6) management of psychological effects; and (7) transition to supportive care. Methods: We solicited documents that identified each program’s current care practices for KTR-GF or patients with a failing graft, including policies, procedures, pathways, and protocols. A content analysis of documents and informal correspondence (email or telephone conversations) was done to extract information surrounding the 7 practice priorities. Results: Of the 18 programs contacted, 12 transplant programs participated in this study and a document from a provincial organization (where 2 non-responding programs are located) was procured and included in this analysis. Overall, practice gaps and discrepancies were noted. Many participants highlighted the lack of evidence or consensus to guide the management of KTR-GF as the key reason. Immunosuppression management was the most frequently addressed priority. Six programs and the provincial document recommended a nuanced approach to immunosuppressant management based on clinical factors and re-transplant candidacy. Two programs used the Kidney Failure Risk Equation and eGFR to determine referral trajectories and prepare patients for return to dialysis. Exact processes outlining medical management during the transition were not found except for nephrectomy indications and in 1 program that has a specific transition clinic for KTR-GF. All programs have a formal or informal policy that KTR-GF should be assessed for re-transplantation. Referrals for psychological support and transition to supportive care were made on a case-by-case basis. Limitations: Our environmental scan was at risk of non-response bias and restricted to transplant programs. Kidney clinics and dialysis units may have relevant policies and procedures that were not examined. Conclusion: The findings from our environmental scan suggest gaps in care and potential areas for quality improvement, including a lack of multidisciplinary care, structured dialysis preparation and psychological support. There is also a need to prioritize research that generates evidence to guide the management of KTR-GF and contributes to the aim of developing clinical practice guidelines.

Using potential microbes in biodegradable solid waste management is an emerging science. Microbes play a significant role in recycling of organic solid wastes. Therefore, the present project was carried out to isolate indigenous potential non-phytopathogenic fungi from local relevant decomposed substrates for the purpose of organic waste recycling as bio-organic fertilizer (BOF). A total of thirteen fungal strains were isolated. Seven of them were identified as Trichoderma spp., and the rest were Penicillium spp. Germination of mung bean (Vigna radiata), mustard (Brassica campestris), and wheat (Triticum aestivum) seeds were assessed by application of 13 fungal isolate suspensions. Significant increase of germination percent was achieved in mung bean (98.35%), mustard (96.65%), and wheat (93.35%) by fungal treatments RW-T02, PL-P01, and CD-T01/MSW-T05, respectively, compared to the controls. But radicle and plumule lengths were not promoted by fungal treatments in the majority of cases. Significantly, the longest radicle and plumule lengths of mung bean and mustard were found in control treatments. Conversely, in wheat the longest radicle and plumule length were achieved in treatments MSW-T05 and RW-T03, respectively. Based on superior performances of percent germination and radicle/plumule length, six fungal isolates were selected for compatibility performance in mixed cultures. In the compatibility tests, two fungal combinations (ABF and BCE) presented superior mutual intermingle appearances. Perhaps these combinations may play significant roles in biodegradation of organic wastes.

In this work, numerical results focused on the enhancement of water-air heat exchanger thermal performance are presented. New designs consisting of using diffusers between the front end openings of the vehicle and the first exchanger facing the airflow are suggested. The diffuser will reduce the velocity magnitude but over a larger area through the exchanger. This will reduce the air velocity non-uniformity upstream the exchanger and then increase its thermal performance. An in-house code is established to evaluate the thermal performance of the exchanger based on known parameters; namely, the ratio of the area of the air inlet opening to the area of the exchanger, the distance between the air inlet opening and the first exchanger at its downstream, the angle of the diffuser, and the water and air mass flow rates. It was shown that the thermal performance of the exchanger can be enhanced by up to 67% when the diffuser is present depending on the configuration.

Background: Bone mineral density (BMD) decreases postrenal transplantation. Evidence demonstrating the effects of bisphosphonates on BMD and fracture risk beyond 1-year posttransplant is sparse in existing literature, but remains essential to enhance clinical outcomes in this population. Objective: Our study aimed to systematically review and meta-analyze the current literature on the use of any bisphosphonate in the adult renal transplant population beyond the first year of renal transplant to determine its effect on BMD and fracture incidence. Design: We conducted a systematic review and meta-analysis of primary research literature that included full-text, English-language, original randomized clinical trials (RCTs) and observational studies. Setting: Patient data were primarily captured in an outpatient setting across various studies. Patients: Our population of interest was patients older than 18 years who received deceased/living donor kidney transplantation and any bisphosphonate with a follow-up greater than 12 months posttransplantation. Measurements: The primary outcome was change in BMD from baseline. Secondary outcomes were the incidence of fractures and effects of other confounders on bone health. Methods: We included RCTs and observational studies that satisfied our inclusion criteria. Each study was analyzed for risk of bias and data were extrapolated to analyze for overall statistical significance accounting for heterogeneity of studies. Results: Sixteen studies (N = 1762) were analyzed. The follow-up ranged from 12 to 98 months. There was a nonsignificant improvement in BMD with bisphosphonate treatment persisting into the second and third years posttransplant at the lumbar spine. The calculated standardized mean BMD difference was −0.29 (−0.75 to 0.17), P = .22. Only 5 studies reported a total of 43 new fractures. Prednisone ( P < .01), low body weight ( P < .001), low body mass index ( P < .01), and male gender ( P < .05) correlated with reduced lumbar and femoral BMD. Limitations: Limitations of this review include the use of BMD as a surrogate outcome, the bias of the included studies, and the incomplete reporting data in numerous analyzed studies. Conclusions: We demonstrate no statistically significant benefit of bisphosphonate treatment on BMD beyond the first year postrenal transplantation. Despite heterogeneity of treatment, a differential nonsignificant improvement in lumbar spine BMD was consistent and may be clinically relevant. Trial Registration: PROSPERO CRD42019125593

Stress induced cardiomyopathy complicated by refractory cardiogenic shock is challenging as treatment by inotropes and vasopressors may be ineffective. We present a case of female patient presented with cardiogenic shock after rupture globe operation, patient presented on mega doses of vasopressors and inotropes, peripheral percutaneous VA ECMO was instituted, IABP was put to deload leftventricle, 2 days later patient was shifted to VAV ECMO. After 4 days of ECMO run patient recovered left ventricular function and patient was weaned from all mechanical support devices. But patient developed septic shock refractory to vasopressors therapy and patient died. Keywords: Cardiogenic shock, Stress induced cardiomyopathy, Extracorporeal life support

SUMMARY The vertebrate heart is one of the first organs to form, and its early function and morphogenesis are crucial for continued embryonic development. Here we analyze the effects of loss of Heart adaptor protein 1 (Hadp1), which we show is required for normal function and morphogenesis of the embryonic zebrafish heart. Hadp1 is a pleckstrin homology (PH)-domain-containing protein whose expression is enriched in embryonic cardiomyocytes. Knockdown of hadp1 in zebrafish embryos reduced cardiac contractility and altered late myocyte differentiation. By using optical mapping and submaximal levels of hadp1 knockdown, we observed profound effects on Ca2+ handling and on action potential duration in the absence of morphological defects, suggesting that Hadp1 plays a major role in the regulation of intracellular Ca2+ handling in the heart. Hadp1 interacts with phosphatidylinositol 4-phosphate [PI4P; also known as PtdIns(4)P] derivatives via its PH domain, and its subcellular localization is dependent upon this motif. Pharmacological blockade of the synthesis of PI4P derivatives in vivo phenocopied the loss of hadp1 in zebrafish. Collectively, these results demonstrate that hadp1 is required for normal cardiac function and morphogenesis during embryogenesis, and suggest that hadp1 modulates Ca2+ handling in the heart through its interaction with phosphatidylinositols.

Background and aims The most common identifiable causes for ILD are related to occupational and environmental exposures, especially to inorganic dusts and silica dust in one of the most important occupational respiratory toxins that causes silicosis. Silicosis can occur in chronic, accelerated and acute forms. Occupational exposure to crystalline silica dust in many industrial operations world wide. The reduction of silica dust exposure level in most developed countries during the last century resulted in dramatic decreases in morbidity and mortality from silicosis and silica dust associated tuberculosis but exposure risks can be much greater in underdeveloped countries. Silicosis is disabling, non eversible and sometimes fatal. We believe same of this reports is very rare in the world wide and demonstrate the first fatal outbreak report of advanced silicosis in Iran. Methods All of 17 workers had been exposed to crystalline silica at the workplaces of silica powder production for the periods of 1 to 5 years (the average of exposure was 2.7 years) and because dyspnea and occupational history of silica dust exposure referred or self admitted at Urmia occupational medicine centre. All patients reported no silica exposure before working at the current sites. Compliant symptoms and physical examination findings recorded for each patient. Spirometery.Flow/volume and body plethysmography performed (with a ZAN.300). chest X-ray films were taken for catch person and in those, who had previous chest X radiography films, progression was assessed by pair comparison of the initial and latest chest X-ray film according to ILO classification of pneumoconiosis Results All of 17 patient had previously worked in the silica powder production workplaces. The total of patient were male whose youngest age was 20 and oldest 79 years. 16 (94%) cases were symptomatic and 1 (6%) had any complaint but occupational history and radiographic findings suggest sub clinical accelerated silicosis. most common findings during clinical course weredry cough 15(88%) productive cough 5 (29 %) ,anorexia 11 (65%), weight loss 11 (65%) orthopnea 10 (58%), respiratory distress 9 (53%), dysphagia 5 (30%), fibromyalgia 6(35%), small joints arthragia 1 (6%), rude crackle 14(82%), decreased of pulmonary expansibility 15 (88%), symmetric PIP arthritis 1 (6%), symmetric wrist joints arthritis 1 (6%), and anemia 1 (6%), 11(65%) patients had FVC lower than 50% of predictive measured. 17 (100%) cases had small opacity. Large opacity were find in 14 (82%) , pleural thickening 12 (71%). 9 (52%) patient during last 5 years died due to ARDS Conclusion The findings in this outbreak shows that from 17 patient ,15 (88%) subjects were young adults below 40 years old and dying 9 (53%) persons after 1 to 5 years exposure incision to silica dust suggests overexposure had occurred and led the development of advanced silicosis. This outbreak illustrate the very rare manifestations of chest imaging of severe silicosis in the world wide.

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