Controlled DCD Liver Transplantation Is Not Associated With Increased Hyperfibrinolysis and Blood Loss After Graft Reperfusion

BACKGROUND: The specific effect of donation after circulatory death (DCD) liver grafts on fibrinolysis, blood loss, and transfusion requirements after graft reperfusion is not well known. The aim of this study was to determine whether transplantation of controlled DCD livers is associated with an elevated risk of hyper-fibrinolysis, increased blood loss and higher transfusion requirements upon graft reperfusion, compared to livers donated after brain death (DBD). METHODS: A retrospective single-center analysis of all adult recipients of a primary liver transplantation between 2000 and 2019 was performed (total cohort n= 628). Propensity score matching (PSM) was used to balance baseline characteristics for DCD and DBD liver recipients (PSM cohort n= 218). Intra- and postoperative hemostatic variables between DCD and DBD liver recipients were subsequently compared. Additionally, in vitro plasma analyses were performed to compare the intraoperative fibrinolytic state upon reperfusion. RESULTS: No significant differences in median (interquartile range) postreperfusion blood loss (1.2 L [0.5-2.2] vs 1.3 L (0.6-2.2); P= 0.62), RBC transfusion (2 units [0-4) vs 1.1 units [0-3], P= 0.21), or FFP transfusion requirements (0 units [0-2.2] vs 0 units (0-0.9); P= 0.11) were seen in DCD compared to DBD recipients, respectively. Furthermore, plasma fibrinolytic potential was similar in both groups. CONCLUSIONS: Transplantation of controlled DCD liver grafts does not result in higher intraoperative blood loss or more transfusion requirements, compared to DBD liver transplantation. In accordance to this, no evidence for increased hyper-fibrinolysis upon reperfusion in DCD compared to DBD liver grafts, was found

Periodontal disease status among adults from South Africa - prevalence and effect of smoking

CITATION: Chikte, U., et al. 2019. Periodontal disease status among adults from South Africa - prevalence and effect of smoking. International Journal of Environmental Research and Public Health, 16(19):3662, doi:10.3390/ijerph16193662.The original publication is available at http://www.mdpi.comPublication of this article was funded by the Stellenbosch University Open Access FundPeriodontal diseases are among the six most prevalent non-communicable diseases (NCDs) worldwide, constituting a burden for oral and general health. There is a shortage of epidemiological data on periodontal diseases in Africa. The aim of the present cross-sectional study was to present the periodontal status and cotinine levels of a South African population of adults. This study included individuals living in the Belville South area. Bleeding on probing (BOP) and pocket depth were recorded for each tooth, and clinical attachment loss (CAL) was recorded as the highest score per sextant. Cotinine levels were measured in ng/mL. A total of 951 individuals were included. More than one third of all subjects had BOP. Regarding pocket depth, over 50% of the subjects had shallow pockets (4–5 mm), and almost 6% had deep pockets. CAL ≥ 4 mm was present in 40.1% of the subjects. Males presented worse periodontal conditions than females. In total, 52.7% of the participants had serum cotinine levels of ≥15 ng/mL. Cotinine levels had no effect on periodontal variables. Periodontal diseases were highly prevalent, and periodontal conditions were worse in males. Preventive and restorative public health programs are required to improve oral health in this populationhttps://www.mdpi.com/1660-4601/16/19/3662Publisher's versio

Machine Perfusion of Donor Livers for Transplantation: A Proposal for Standardized Nomenclature and Reporting Guidelines.

With increasing demand for donor organs for transplantation, machine perfusion (MP) promises to be a beneficial alternative preservation method for donor livers, particularly those considered to be of suboptimal quality, also known as extended criteria donor livers. Over the last decade, numerous studies researching MP of donor livers have been published and incredible advances have been made in both experimental and clinical research in this area. With numerous research groups working on MP, various techniques are being explored, often applying different nomenclature. The objective of this review is to catalog the differences observed in the nomenclature used in the current literature to denote various MP techniques and the manner in which methodology is reported. From this analysis, we propose a standardization of nomenclature on liver MP to maximize consistency and to enable reliable comparison and meta-analyses of studies. In addition, we propose a standardized set of guidelines for reporting the methodology of future studies on liver MP that will facilitate comparison as well as clinical implementation of liver MP procedures

Assessment of aflatoxin and fumonisin contamination levels in maize and mycotoxins awareness and risk factors in Rwanda

Mycotoxins are secondary metabolites of fungi that are toxic to humans and animals when consumed in contaminated food and feed. The Rwandan climate conditions like steady temperature and sufficient rainfall favor the growth of fungi leading to high probability of mycotoxins contamination. Mycotoxins get into maize throughout the value chain from the field to processed products. Maize is  promoted in Rwanda under the Crop Intensification Program (CIP), for nutrition and food security. The aim of the study was to evaluate mycotoxins (Aflatoxin and fumonisin) levels in maize and assess awareness and factors associated with mycotoxin contamination in Rwanda. Maize samples (227 kg) from season B 2019 were collected in 15 Districts in five provinces of Rwanda after an interview with a representative of the household or cooperative using a structured questionnaire. The samples were analyzed for aflatoxin and  fumonisin using Reveal Q+ and AccuScan Gold Reader. From the interview, most of the respondents were not aware about aflatoxin (59.7 %) and 99 % did not know the effect of mycotoxins on human health. The average of aflatoxin contamination in surveyed districts was 6.69±13 μg/kg. In general, 90.4 % of samples scored below the limit of aflatoxin level regulated in East Africa/Kenya regulation standards (10 μg/kg). The levels of aflatoxin ranged between 0 and 100.9 μg/kg. The means aflatoxin levels within districts ranged between 1.36±0.5 μg/kg and 13.75±25 μg/kg. Among 9.6 % of the samples containing aflatoxins above the EU and Kenyan regulations standard limit, 5.7 % were above the US standards of 20 μg/kg. Within clusters, the level of aflatoxin more than 10 μg/kg was 5 %, 7 % and 18 % for stores, household and market samples, respectively. From the study, as mechanical damage of grains, moisture content of grains and the temperature of the store house increased, Aflatoxin level also increased. Fumonisin analyzed in maize ranged from 0 to 2.3 μg/g and only one sample from market showed a slightly higher level of fumonisin than the EU and US limit of 2 μg/g. More effort for aflatoxin mitigation is needed at the market level. Farmers need to be aware and taught how they can improve their agricultural system and more knowledge on mycotoxin control is needed. The results point to appropriate measures to recommend for control ofmycotoxins in Rwanda and awareness creation. Key words: AccuScan, Aflatoxin, Fumonisin, Fungal, Maize, Mycotoxins, Reveal Q+, Rwand

Agrarian and Land Reforms in Rwanda: Situation and Perspectives

Rwanda is a landlocked country of Eastern Africa with 26,338 km2. The total arable land in Rwanda is more or less than 1.8 million ha and Rwanda has the highest population density in Africa. A series of policy reforms and agrarian strategic plan have been elaborated to transform the economy now oriented towards subsistence agriculture into a knowledge-based service and market-oriented economy. The research question is who has the right to land ownership for its rational use? The purpose of this article is to contribute to land sharing prospects between agricultural operators and investors in Rwanda for the optimisation of land access in the rural areas. This work is the result of deep literature review related to the situation of land issue prevailing from pre-colonial period to the recent 2004 land policy reforms in Rwanda. Crucial challenges before the beginning of the effective agrarian evolution are widely discussed. Agrarian perspectives show that the foreignization of agrarian reforms put Rwandan peasants in uncomfortable position. The changes in land use and tenure in Rwanda have been stimulated by both outside influence and inside adversary forces. The real land reform policy consists in specialization and exploitation of large-scale farms subsequent to land consolidation of small plots registered by individuals whose property certificates are preserved. Meanwhile, the required registration of land holdings does not entitle the land to definitive appropriation but it only provides the rights of use if rational exploitation is guaranteed. Such a rational system may result in expropriation for the inefficient producers.This article emphasize that in the case of Rwanda were population growth rate is high, the redistribution of land has its limits. The land consolidation should not be a rule either. Any agrarian reform must find a point of balance. This equilibrium consists in reducing the pressure on the property assets and promoting rural entrepreneurship. Agriculture program may improve and diversify the mode of land access and improved input acquisition to feed a growing population whereas non-agriculture population is gradually increasing. It has been found that farmers operating in co-operatives are more secure and have advantage for land access than individual farmers

Hypothermic Machine Perfusion in Liver Transplantation

Dynamic preservation strategies are a promising option to improve graft quality before transplantation, and to extend preservation time for either logistic or treatment reasons. In contrast to normothermic oxygenated perfusion, which intends to mimic physiological conditions in the human body, with subsequent clinical application for up to 24 hrs, hypothermic perfusion is mainly used for a relatively short period with protection of mitochondria and subsequent reduction of oxidative injury upon implantation. The results from two randomized controlled trials, where recruitment has finished are expected this year. Both ex situ perfusion techniques are increasingly applied in clinical transplantation including recent reports on viability assessment, which could open the door for an increased liver utilization in the future

Production of Physiologically Relevant Quantities of Hemostatic Proteins During Ex Situ Normothermic Machine Perfusion of Human Livers

Ex-situ normothermic machine perfusion (NMP) of donor livers is an emerging innovation in liver transplantation that has made its transition to clinical trials. NMP is applied in an effort to overcome ischemia-reperfusion injury associated with static cold storage, to improve the quality of sub-optimally functioning donor organs and to permit viability testing of potentially transplantable livers. The in-vivo physiological conditions maintained during ex-situ NMP necessitate the need for a perfusion fluid that mimics the composition of whole blood. To date, perfusion fluids used in NMP studies are composed of either plasma-based solutions or plasma-free solutions consisting of colloids such as Gelofusine1 . The latter avoids the use of human plasma which is scarce, costly and logistically challenging. This article is protected by copyright. All rights reserved