Protecting the Kidney in Liver Transplant Recipients: Practice‐Based Recommendations From the American Society of Transplantation Liver and Intestine Community of Practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134132/1/ajt13765_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134132/2/ajt13765.pd

Effect of the clinical course of acute-on-chronic liver failure prior to liver transplantation on post-transplant survival

BACKGROUND & AIMS: Patients with acute-on-chronic liver failure (ACLF) can be listed for liver transplantation (LT) because LT is the only curative treatment option. We evaluated whether the clinical course of ACLF, particularly ACLF-3, between the time of listing and LT affects 1-year post-transplant survival. METHODS: We identified patients from the United Network for Organ Sharing database who were transplanted within 28 days of listing and categorized them by ACLF grade at waitlist registration and LT, according to the EASL-CLIF definition. RESULTS: A total of 3,636 patients listed with ACLF-3 underwent LT within 28 days. Among those transplanted, 892 (24.5%) recovered to no ACLF or ACLF grade 1 or 2 (ACLF 0–2) and 2,744 (75.5%) had ACLF-3 at transplantation. One-year survival was 82.0% among those transplanted with ACLF-3 vs. 88.2% among those improving to ACLF 0–2 (p 60 years of age, 1-year survival was significantly higher among those who improved from ACLF-3 to ACLF 0–2 than among those who did not. CONCLUSIONS: Improvement from ACLF-3 at listing to ACLF 0–2 at transplantation enhances post-LT survival, particularly in those who recovered from circulatory or brain failure, or were removed from the mechanical ventilator. The beneficial effect of improved ACLF on post-LT survival was also observed among patients >60 years of age. LAY SUMMARY: Liver transplantation (LT) for patients with acute-on-chronic liver failure grade 3 (ACLF-3) significantly improves survival, but 1-year survival probability after LT remains lower than the expected outcomes for transplant centers. Our study reveals that among patients transplanted within 28 days of waitlist registration, improvement of ACLF-3 at listing to a lower grade of ACLF at transplantation significantly enhances post-transplant survival, even among patients aged 60 years or older. Subgroup analysis further demonstrates that improvement in circulatory failure, brain failure, or removal from mechanical ventilation have the strongest impact on post-transplant survival

Dynamics of spin correlations in the spin-1/2 isotropic XY chain in a transverse field

Dynamic xx spin pair correlation functions for the isotropic spin-1/2 XY chain are calculated numerically for long open chains in the presence of a transverse magnetic field at finite temperature. As an application we discuss the temperature dependence of the spin-spin relaxation time in PrCl_3.Comment: 2 pages, latex, 2 figures, abstract of the paper presented at Ampere Summer School ``Applications of Magnetic Resonance in Novel Materials'' Nafplion, Greece, 3-9 September, 2000, partially published in J. Phys. A: Math. Gen. 33, 3063 (2000

Распространенный аппендикулярный перитонит: лапароскопический или открытый доступ — критический анализ

The perforative acute appendicitis with the development of diffuse peritonitis increases the incidence of postoperative complications to 47%, and mortality to 3%. Mortality in the case of the development of diffuse purulent peritonitis makes 4.5-58%, and it can exceed 70% in severe forms of diffuse peritonitis with the development of infectious-toxic shock and multiple organ failure. National Clinical Guidelines for acute appendicitis with diffuse peritonitis allow for appendectomy from both the median and laparoscopic access in the absence of general contraindications to the creation of pneumoperitoneum. However, despite the proven advantages of laparoscopic appendectomy, there are opponents of its use in diffuse forms of appendicular peritonitis. An increased number of postoperative abscesses with a minimally invasive approach has been reported in literature; however, recent randomized studies refute this fact. There is also evidence that the laparoscopic method for appendicular peritonitis often leads to a lengthening of the operation time and higher operating costs, but at the same time there is a decrease in postoperative pain syndrome, a reduction in the length of inpatient treatment and early social and labor rehabilitation, which leads to an overall decrease in hospital costs. Thus, to date, there is no generally accepted opinion about the advisability of laparoscopic access for appendicular peritonitis. At the moment, the presence of diffuse peritonitis is the most common intraoperative reason for refusing a minimally invasive surgical treatment. However, there is a tendency to trying to standardize indications and contraindications, which was the objective of our literature review.Острый аппендицит является наиболее распространенным острым хирургическим заболеванием и, несмотря на то что имеется значительное сокращение его доли в практике врача-хирурга (40,3% — 2000, 24,8% — 2019), он все равно занимает первое место по встречаемости и оперативной активности.Перфоративная форма острого аппендицита с развитием распространенного перитонита увеличивает частоту послеоперационных осложнений до 47%, а летальность — до 3%. Летальность в случае развития разлитого гнойного перитонита составляет 4,5–58%, а при тяжелых формах распространенного перитонита с развитием инфекционно-токсического шока и полиорганной недостаточности может превышать 70%.Национальные клинические рекомендации при остром аппендиците с распространенным перитонитом допускают выполнение аппендэктомии как из срединного, так и из лапароскопического доступа при отсутствии общих противопоказаний к созданию пневмоперитонеума. Однако несмотря на доказанные преимущества лапароскопической аппендэктомии, имеются противники ее использования при распространенных формах аппендикулярного перитонита.В литературе отмечено увеличение количества послеоперационных абсцессов при минимально инвазивном доступе, однако последние рандромизированные исследования опровергают данный факт. Также имеются данные, что лапароскопический метод при аппендикулярном перитоните часто приводит к удлинению времени операции и более высоким операционным затратам, но при этом происходит уменьшение болевого послеоперационного синдрома, сокращение сроков стационарного лечения и ранняя социально-трудовая реабилитация, что приводит к общему снижению расходов больницы.Таким образом, на сегодняшний день нет общепринятого мнения о целесообразности лапаро­скопического доступа при аппендикулярном перитоните. На данный момент наиболее частая интраоперационная причина отказа от минимально инвазивного метода хирургического лечения — наличие распространенного перитонита. Однако прослеживается тенденция к попытке стандартизировать показания и противопоказания, что и явилось целью нашего литературного обзора

Constant regulation for stable CD8 T-cell functional avidity and its possible implications for cancer immunotherapy.

The functional avidity (FA) of cytotoxic CD8 T cells impacts strongly on their functional capabilities and correlates with protection from infection and cancer. FA depends on TCR affinity, downstream signaling strength, and TCR affinity-independent parameters of the immune synapse, such as costimulatory and inhibitory receptors. The functional impact of coreceptors on FA remains to be fully elucidated. Despite its importance, FA is infrequently assessed and incompletely understood. There is currently no consensus as to whether FA can be enhanced by optimized vaccine dose or boosting schedule. Recent findings suggest that FA is remarkably stable in vivo, possibly due to continued signaling modulation of critical receptors in the immune synapse. In this review, we provide an overview of the current knowledge and hypothesize that in vivo, codominant T cells constantly "equalize" their FA for similar function. We present a new model of constant FA regulation, and discuss practical implications for T-cell-based cancer immunotherapy

Evaluation of cleaning efficiency of ultrafiltration membranes fouled by BSA using FTIR–ATR as a tool

The goal of this paper was to study the cleaning of two polyethersulfone (PES) membranes of different molecular weight and fouled with BSA solution. Ultrafiltration (UF) membranes were tested in a flat sheet module. Fouling experiments were carried out at a transmembrane pressure of 2 bar and cross flow velocity of 2 m/s during 2 h. Cleaning experiments were performed at 1 bar and 2.2 m/s. To compare the efficiency of different cleaning solutions (NaOH and P3-Ultrasil 115), quantification of residual pro-teins on the membrane was carried out by FTIR ATR. To have a better understanding of the cleaning pro-cess, characteristics of the feed solution and of the membranes were considered and contact angle of the membranes before and after the cleaning was measured. Membrane resistances were also calculated at the different stages. Results from resistances showed that reversible fouling prevail over irreversible fouling for both membranes. P3-Ultrasil 115 was a better cleaning agent than NaOH solution since cleaning efficiencies (CE) of 100% for both membranes were achieved for P3-Ultrasil 115 solution. Residual pro-teins on the membrane after the cleaning were measured both by FTIR ATR and Pierce-BCA method. Results showed that 100% of permeability recovery did not imply the complete BSA removal from the membrane. However, these measurements corroborated that P3-Ultrasil 115 had removed a higher amount of proteins than NaOH solution.This work was supported by the Spanish Ministry of Science and Innovation (CTM 2010-20.186).Luján Facundo, MJ.; Mendoza Roca, JA.; Cuartas Uribe, BE.; Alvarez Blanco, S. (2015). Evaluation of cleaning efficiency of ultrafiltration membranes fouled by BSA using FTIR–ATR as a tool. Journal of Food Engineering. 163:1-8. https://doi.org/10.1016/j.jfoodeng.2015.04.015S1816

Observation of narrow baryon resonance decaying into pKs0pK^0_s in pA-interactions at 70GeV/c70 GeV/c with SVD-2 setup

SVD-2 experiment data have been analyzed to search for an exotic baryon state, the $\Theta^+$-baryon, in a $pK^0_s$ decay mode at $70 GeV/c$ on IHEP accelerator. The reaction $pA \to pK^0_s+X$ with a limited multiplicity was used in the analysis. The $pK^0_s$ invariant mass spectrum shows a resonant structure with $M=1526\pm3(stat.)\pm 3(syst.) MeV/c^2$ and $\Gamma < 24 MeV/c^2$. The statistical significance of this peak was estimated to be of $5.6 \sigma$. The mass and width of the resonance is compatible with the recently reported $\Theta^+$- baryon with positive strangeness which was predicted as an exotic pentaquark ($uudd\bar{s}$) baryon state. The total cross section for $\Theta^+$ production in pN-interactions for $X_F\ge 0$ was estimated to be $(30\div120) \mu b$ and no essential deviation from A-dependence for inelastic events $(\sim A^{0.7})$ was found.Comment: 8 pages, 7 figures, To be submitted to Yadernaya Fizika. v3-v5 - Some references added, minor typos correcte

Effective transcription factor binding site prediction using a combination of optimization, a genetic algorithm and discriminant analysis to capture distant interactions

<p>Abstract</p> <p>Background</p> <p>Reliable transcription factor binding site (TFBS) prediction methods are essential for computer annotation of large amount of genome sequence data. However, current methods to predict TFBSs are hampered by the high false-positive rates that occur when only sequence conservation at the core binding-sites is considered.</p> <p>Results</p> <p>To improve this situation, we have quantified the performance of several Position Weight Matrix (PWM) algorithms, using exhaustive approaches to find their optimal length and position. We applied these approaches to bio-medically important TFBSs involved in the regulation of cell growth and proliferation as well as in inflammatory, immune, and antiviral responses (NF-κB, ISGF3, IRF1, STAT1), obesity and lipid metabolism (PPAR, SREBP, HNF4), regulation of the steroidogenic (SF-1) and cell cycle (E2F) genes expression. We have also gained extra specificity using a method, entitled SiteGA, which takes into account structural interactions within TFBS core and flanking regions, using a genetic algorithm (GA) with a discriminant function of locally positioned dinucleotide (LPD) frequencies.</p> <p>To ensure a higher confidence in our approach, we applied resampling-jackknife and bootstrap tests for the comparison, it appears that, optimized PWM and SiteGA have shown similar recognition performances. Then we applied SiteGA and optimized PWMs (both separately and together) to sequences in the Eukaryotic Promoter Database (EPD). The resulting SiteGA recognition models can now be used to search sequences for BSs using the web tool, SiteGA.</p> <p>Analysis of dependencies between close and distant LPDs revealed by SiteGA models has shown that the most significant correlations are between close LPDs, and are generally located in the core (footprint) region. A greater number of less significant correlations are mainly between distant LPDs, which spanned both core and flanking regions. When SiteGA and optimized PWM models were applied together, this substantially reduced false positives at least at higher stringencies.</p> <p>Conclusion</p> <p>Based on this analysis, SiteGA adds substantial specificity even to optimized PWMs and may be considered for large-scale genome analysis. It adds to the range of techniques available for TFBS prediction, and EPD analysis has led to a list of genes which appear to be regulated by the above TFs.</p