Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce

BACKGROUND: Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience. METHODS: Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated. RESULTS: From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant\u27s rank list, and proportion of unfilled fellowship positions (each, p \u3c 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs. CONCLUSIONS: Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates

A population of proinflammatory T cells coexpresses αβ and γδ T cell receptors in mice and humans

T cells are classically recognized as distinct subsets that express αβ or γδ TCRs. We identify a novel population of T cells that coexpress αβ and γδ TCRs in mice and humans. These hybrid αβ-γδ T cells arose in the murine fetal thymus by day 16 of ontogeny, underwent αβ TCR–mediated positive selection into CD4+ or CD8+ thymocytes, and constituted up to 10% of TCRδ+ cells in lymphoid organs. They expressed high levels of IL-1R1 and IL-23R and secreted IFN-γ, IL-17, and GM-CSF in response to canonically restricted peptide antigens or stimulation with IL-1β and IL-23. Hybrid αβ-γδ T cells were transcriptomically distinct from conventional γδ T cells and displayed a hyperinflammatory phenotype enriched for chemokine receptors and homing molecules that facilitate migration to sites of inflammation. These proinflammatory T cells promoted bacterial clearance after infection with Staphylococcus aureus and, by licensing encephalitogenic Th17 cells, played a key role in the development of autoimmune disease in the central nervous system

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Hepatic alterations are accompanied by changes to bile acid transporter-expressing neurons in the hypothalamus after traumatic brain injury

Annually, there are over 2 million incidents of traumatic brain injury (TBI) and treatment options are non-existent. While many TBI studies have focused on the brain, peripheral contributions involving the digestive and immune systems are emerging as factors involved in the various symptomology associated with TBI. We hypothesized that TBI would alter hepatic function, including bile acid system machinery in the liver and brain. The results show activation of the hepatic acute phase response by 2 hours after TBI, hepatic inflammation by 6 hours after TBI and a decrease in hepatic transcription factors, Gli 1, Gli 2, Gli 3 at 2 and 24 hrs after TBI. Bile acid receptors and transporters were decreased as early as 2 hrs after TBI until at least 24 hrs after TBI. Quantification of bile acid transporter, ASBT-expressing neurons in the hypothalamus, revealed a significant decrease following TBI. These results are the first to show such changes following a TBI, and are compatible with previous studies of the bile acid system in stroke models. The data support the emerging idea of a systemic influence to neurological disorders and point to the need for future studies to better define specific mechanisms of action

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

A study on the implementation requirements of an integrated quality, environmental, safety and health management systems for the Philippine Rice Research Institute

The Philippine Rice Research Institute or PhilRice is the current partner of the Philippine government in enhancing the rice harvest in the country today. With its mandate to conduct rice research and development, it has proven and establish a lot in rice science and technology locally and globally. The specific services of PhilRice are detailed from research and development on rice-related science demands, conduct of specialized training courses on rice production and other related specifics, farm equipment loan for farmers and farm cooperatives, and selling of seeds, rice foods and beverages, selected scientific and extensioncommunication materials (print and video) on rice science and technology. In catering these services and products, the PhilRice utilizes laboratories, fields, equipments, chemicals, methods or procedures, which emit air, water, land, and noise pollutants. These discharges which range from wastewater from laboratory and shop works, releases of nitrogen fumes from chloroform, ETOH, isopropanol, trizol, phenol, merchapethanol, used oils, excess chemicals from both field and laboratory, and heat emission from operating equipments, could be hazardous and fatal to employees as well as to other stakeholders who are engaged in such emissions of PhilRice. Thus, the PhilRice made the initiative of implementing ISO 14001:1996 the international standard requirements for an Environmental Management System (EMS). This was made as the solution to eliminate or at least mitigate the impacts of its function to the environment. This Practicum Project was a part of this initiative as it worked with the PhilRice EMS Team in assuring the conformance of its ISO 14001 implementation with the standard. As PhilRice moved on with the transition, it had seen and realized the greater need for an OHSAS 18001:1999, the international standard for health and safetymanagement system, which will safeguard the health and safety of its manpower. PhilRice also envisioned to adopt the principles of ISO 9001:2000, the international standard for quality management system, in order to upgrade its quality of services and products to its clientele as well as to smoothen the adoption of the two former standards. As a result, PhilRice came up with the concept of adopting an Integrated Quality, Environmental, Safety and Health Management Systems (QESHMS). Integrated QESHMS is an integrated performance of the three management systems that is in conformance with the standards of ISO 9001, ISO 14001 and OHSAS 18001. This study had developed the set-up requirements for the QESHMS integration of PhilRice. This paper also studied and compiled on this project the vital references that could be used by PhilRice in its QESHMS Integration. Gap analysis was prepared so as to define the requirements, which are still needed to be implemented. Results of the Gap Analysis showed that 33% from the ISO 14001 implementation and 67% from the output of this practicum project contributed to the 33% accomplishment of the requirements of an Integrated QESHMS for PhilRice. Conversion, which is done by building upon an existing system the other management systems requirements that are to be integrated, is the best method of integration for PhilRice. This would fit to the condition and existing set-ups that PhilRice has. Anticipating the certification of its ISO 14001, integration of quality and safety and health management systems to the existing should just be carried out by building on the ISO 14001 preparations. Finally, the benefits of an integrated QESHMS to PhilRice and any other industry who wishes to have the same set-up would be a comprehensive and programmed means of managing their organization’s processes. This also develops an atmosphere of proactive identification and reaction to different problems. In effect, confidence and trust of involved parties and other stakeholders on the organization’s performance is achieved voluntarily. Integrated QESHMS is also a big initiative in getting a worldwide recognition

Vision-based golf ball locator (VBGL)

Current applications of vision based robotic systems item recognition thru color, size and shape, lane following, and item sorting. The problems mostly encountered with these vision systems are their strict requirements such as constant lighting condition and non-occlusion of target objects. The Vision-Based Golf Ball Locator seeks to improve these systems by giving them adaptability on certain changes in lighting and partial occlusions. The VBGL is designed as a prototype system to aid in the collection of golf balls in a driving range. The use of such a system is expected to reduce if not prevent hazards encountered by people working in golf driving ranges. The VBGL is designed for the detection and collection of golf balls. It uses photoelectric sensors to guide its path and to detect if an object is within the path of the system. It uses a mounted camera for its vision, taking a snapshot of the image if an object is in its path. It uses a personal computer for controlling the movement and image processing. With the aid of these components, the robot was able to detect golf balls with an accuracy of 100% provided that golf balls are within camera range, lighting conditions remain favorable and partial occlusions do not exceed 50%. Retrieval accuracy was also 100%, as long as the retrieval mechanism remains unobstructed during retrieval