Search

Living donor kidneys with two arteries can be revascularized using various techniques depending on anatomy. We hypothesized that the revascularization technique could impact long-term outcomes. We retrospectively analyzed 1714 living donor renal transplants at our institution between 1999 and 2015. Three hundred and eleven kidneys had dual arteries, and these were categorized into 5 groups; end-to-side (n = 18), inferior epigastric artery (n = 21), direct anastomosis (n = 65), side-to-side (n = 126) and ligated (n = 81). We then compared the outcomes with that of a control group (single artery, n = 1403) using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted by age, sex and race/ethnicity of donor and recipient, side of kidney, transplant period and recipient surgeon. Compared to the control group, the end-to-side group had increased all-cause graft loss (10 years: 77.2% vs 24.5%, adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.30–7.03, p = 0.010) and death-censored graft loss (10 years: 82.0% vs 55.9%, aHR 4.17, 95% CI 1.63–10.68, p = 0.003), whereas the other groups did not. Our study shows that 10-year overall survival and death-censored graft survival were significantly worse for end-to-side arterial reconstruction than for other techniques. Alternative techniques to the end-to-side method should be used for accessory arteries that require revascularization.

Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long-term insulin independence in selected patients with T1D.

For solid organ transplant (SOT) donors, nucleic acid-amplification testing (NAT) may reduce human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission over antibody (Ab) testing given its shorter detection window period. We compared SOT donor NAT + Ab versus Ab alone using decision models to estimate incremental cost-effectiveness ratios (ICERs; cost per quality-adjusted life year [QALY] gained) from the societal perspective across a range of HIV/HCV prevalence values and NAT costs. The cost per QALY gained was calculated for two scenarios: (1) favorable: low cost ($150/donor)/high prevalence (HIV: 1.5%; HCV: 18.2%) and (2) unfavorable: high cost ($500/donor)/low prevalence (HIV: 0.1%; HCV: 1.5%). In the favorable scenario, adding NAT screening cost $161 013 per QALY gained for HIV was less costly) for HCV, and cost $86 653 per QALY gained for HIV/HCV combined. For the unfavorable scenario, the costs were $15 568 484, $221 006 and $10 077 599 per QALY gained, respectively. Universal HCV NAT + Ab for donors appears cost-effective to reduce infection transmission from SOT donors, while HIV NAT + Ab is not, except where HIV NAT is ≤$150/donor and prevalence is ≥1.5%. Our analyses provide important data to facilitate the decision to implement HIV and HCV NAT for deceased SOT donors and shape national policy regarding how to reduce infection transmission in SOT.

An embedded curve in a symplectic surface Σ⊂X$\Sigma \subset X$ defines a smooth deformation space B$\mathcal {B}$ of nearby embedded curves. A key idea of Kontsevich and Soibelman is to equip the symplectic surface X$X$ with a foliation in order to study the deformation space B$\mathcal {B}$. The foliation, together with a vector space VΣ$V_\Sigma$ of meromorphic differentials on Σ$\Sigma$, endows an embedded curve Σ$\Sigma$ with the structure of the initial data of topological recursion, which defines a collection of symmetric tensors on VΣ$V_\Sigma$. Kontsevich and Soibelman define an Airy structure on VΣ$V_\Sigma$ to be a formal quadratic Lagrangian L⊂T∗(VΣ∗)$\mathcal {L}\subset T^*(V_\Sigma ^*)$ which leads to an alternative construction of the tensors of topological recursion. In this paper, we produce a formal series θ$\theta$ on B$\mathcal {B}$ which takes it values in L$\mathcal {L}$, and use this to produce the Donagi–Markman cubic from a natural cubic tensor on VΣ$V_\Sigma$, giving a generalisation of a result of Baraglia and Huang. [ABSTRACT FROM AUTHOR]

The most common congenital diseases in children is congenital heart disease. Factors such as environment, genetic, old maternal age during pregnancy, maternal disease and using medicine in pregnancy, prematuritiy, and specific seasons are significant in the prevalence of disease."nMaterials and Methods: A cross sectional study was conducted to investigate the status of children with congenital heart diseases, among 665 child that refereed to Children's hospital medical center, Tehran University of Medical Sciences and Health Services, during 1 year (2000 tO 2001). The researchers due to the lack of existing appropriate tools developed the instrument for the study. The questionnaire was 15 items, nominal, ordinal and interval scale. All items were verified using major authoritative pediatric cardiologists references and were subjected to face and content validation by three experts. Convenient sampling was utilized for collecting data. All subjects were examined in cardiology department and echocardiography was done for them."nResults: From a total of 665 children with congenital heart defects, 56.2 percent were male and 43.8 percent were female. 32.6 percent were born in autumn. Septal defects were predominant lesions, which account for 36.1 percent of lesions. 89.8 percent of children have never extracardiac defects. Children of mothers age 20-35 years had a percentage of 86.2 percent of developing congenital heart disease, Percentage of children who their birth weight less than 2500 gram was quite small, at 24.1 per cent overall. There was no significant relationship between selected variables and congenital heart diseases."nConclusion: With regard to the prevalence of disease and preventing therapeutic costs, parents and teachers education have an important role in preventing congenital heart disease. Therefore, the formation of a learning curriculum model for a life free of congenital heart disease and congenital heart diseases registration is essential.

A descriptive cross-sectional survey design was performed among medical and paramedical students. This study was conducted to assess evaluation of teaching quality of teachers from students' point of view, using a questionnaire administered by interviewers to 21171 students randomly selected among target population. 650 subjects were recorded during the year 1996-1997. The questionnaire was a 14 item, Likert scale designed to measure teaching quality of teachers. The possible score range on the questionnaire was 14 to 70, so the mean score was 42. The scores equal or more than 42 were suggested as "Good teaching quality" and the scores less than 42 considered as "Poor teaching quality". Findings indicated that the mean score and standard deviation on total faculties were, 54.6 and 12.2 respectively. 79.3% have positive point of view of quality teaching. Analysis of variance (ANOVA) was used to determine the influence of faculties on subjects' scores on the questionnaire. A significant main effect of faculties on mean score (F=44.29: P

A survey was carried out in 1998-99 among 20 selected primary schools in the north, south, east and west regions of Tehran to determine the level of teachers’ knowledge of asthma. 387 (96.7%) of 400 questionnaires were completed and evaluated. Five items were investigated: “general knowledge”, “symptoms and triggers”, exercise”, treatment” and “individual experience”. Statistical analysis was performed by using counting statistics. For the correlation of items, Spearman correlation coefficients and willcoxon’s test were used. The teachers in primary schools showed a good basic knowledge of asthma and trigger factors of asthma; 40.6% teachers knew that asthma could not be transmitted by virus. There was no statistically significant effect of teaching experience in terms of years, level of education and contact with asthmatic child on the knowledge score. 24% of teachers felt they had the average information about asthma. We suggest that teachers at primary school receive further instructions in this regard.