Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

Adult living donor liver transplantations (ALDLTs) across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins) were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR). Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety

Adoption and Handling Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults

(Background) The use of information communication technology and smartphone application are crucial to individuals’ functional independence of community living. Previous studies did not reveal how older adults’ in applying the information communication technology will affect their aging-in-place in our contemporary community. (Methods) This study aimed at developing the psychometric properties of the instrument named Advanced Instrumental Activities of Daily Living (AIADL), and to explore the adoption and handling information communication technology in instrumental activities of daily living for aging-in-place of older adults. 100 home-living participants who are functionally and socially independent, 100 hostel-living participants who are functionally independent but need social assistance, and 100 care-and-attention home living participants who need environment support and assistance in daily functioning were recruited for this study. (Results) AIADL showed good test-retest reliability and good-to-excellent internal consistency. Exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals’ capability of independent living in the community. (Conclusions) AIADL is a valid and reliable instrument to assess older adults’ ability in handling contemporary instrumental activities in their daily life. This instrument can serve as a reference in measuring individuals’ ability of aging-in-place

Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong

IMPORTANCE: Schools were closed intermittently across Hong Kong to control the COVID-19 outbreak, which led to significant physical and psychosocial problems among children and youths. OBJECTIVE: To compare the clinical characteristics and sources of infection among children and youths with COVID-19 during the 3 waves of outbreaks in Hong Kong in 2020. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study involved children and youths aged 18 years or younger with COVID-19 in the 3 waves of outbreaks from January 23 through December 2, 2020. Data were analyzed from December 2020 through January 2021. MAIN OUTCOMES AND MEASURES: Demographic characteristics, travel and contact histories, lengths of hospital stay, and symptoms were captured through the central electronic database. Individuals who were infected without recent international travel were defined as having domestic infections. RESULTS: Among 397 children and youths confirmed with COVID-19 infections, the mean (SD) age was 9.95 (5.34) years, 220 individuals (55.4%) were male, and 154 individuals (38.8%) were asymptomatic. There were significantly more individuals who were infected without symptoms in the second wave (59 of 118 individuals [50.0%]) and third wave (94 of 265 individuals [35.5%]) than in the first wave (1 of 14 individuals [7.1%]) (P = .001). Significantly fewer individuals who were infected in the second and third waves, compared with the first wave, had fever (first wave: 10 individuals [71.4%]; second wave: 22 individuals [18.5%]; third wave: 98 individuals [37.0%]; P < .001) or cough (first wave: 6 individuals [42.9%]; second wave: 15 individuals [12.7%]; third wave: 52 individuals [19.6%]; P = .02). Among all individuals, 394 individuals (99.2%) had mild illness. One patient developed chilblains (ie, COVID toes), 1 patient developed multisystem inflammatory syndrome in children, and 1 patient developed post–COVID-19 autoimmune hemolytic anemia. In all 3 waves, 204 patients with COVID-19 (51.4%) had domestic infections. Among these individuals, 186 (91.2%) reported having a contact history with another individual with COVID-19, of which most (183 individuals [90.0%]) were family members. In the third wave, 18 individuals with domestic infections had unknown contact histories. Three schoolmates were confirmed with COVID-19 on the same day and were reported to be close contacts. CONCLUSIONS AND RELEVANCE: his cross-sectional study found that nearly all children and youths with COVID-19 in Hong Kong had mild illness. These findings suggest that household transmission was the main source of infection for children and youths with domestic infections and that the risk of being infected at school was small

Adeno-associated virus-mediated heme oxygenase-1 gene transfer suppresses the progression of micronodular cirrhosis in rats

AIM: To test the hypothesis that enhancement of the activity of heme oxygenase can interfere with processes of fibrogenesis associated with recurrent liver injury, we investigated the therapeutic potential of over-expression of heme oxygense-1 in a CCl(4)-induced micronodular cirrhosis model. METHODS: Recombinant adeno-associated viruses carrying rat HO-1 or GFP gene were generated. 1x 10(12) vg of adeno-associated viruses were administered through portal injection at the time of the induction of liver fibrosis. RESULTS: Conditioning the rat liver with over-expression of HO-1 by rAAV/HO-1 significantly increased the HO enzymatic activities in a stable manner. The development of micronodular cirrhosis was significantly inhibited in rAAV/HO-1-transduced animals as compared to controls. Portal hypertension was markedly diminished in rAAV/HO-1-transduced animals as compared to controls, whereas there are no significant changes in systolic blood pressure. This finding was accompanied with improved liver biochemistry, less infiltrating macrophages and less activated hepatic stellate cells (HSCs) in rAAV/HO-1-transduced livers. CONCLUSION: Enhancement of HO activity in the livers suppresses the development of cirrhosis

Comparisons of shoe-length and shoe-width fitness in people with diabetes, diabetes sensory neuropathy and non diabetes

Introduction Ill-fitting footwear is one of the well-known risk factors causing foot ulceration in the diabetic population. Current literature for fitness of foot dimensions is insufficient, especially on foot-shoe length and foot-shoe width measurement in absolute numerical differences. The aims of the study were to compare and identify the footwear fitness in diabetic patients with peripheral sensory neuropathy, diabetic patients without peripheral neuropathy and non diabetes. Materials and Method 　　Diabetes patients were assessed for peripheral sensory neuropathy by two sensory tests, 10-g monofilament test using 10-g Semmes-Weinstein monofilament and vibration perception threshold test using neurotheisometer. Abnormal results of both tests indicated diabetes sensory neuropathy. The dimensions of foot length and foot width were determined by the Brannock device while internal shoe length and internal shoe width were measured by an inside caliper. The mean of internal shoe-length difference and shoe-width difference of three groups were calculated and compared. Reference ranges of 10-15mm of shoe-length difference and 0-7mm were selected from past literature. The values of shoe-length and shoe-width differences were dichotomized into correct and incorrect fit category. Footwear fitness of the three groups was compared. Demographics of patients, information on self foot care, shoe size check and footwear habit were collected for correlation analysis. Results Data was collected from 20 diabetes patients with sensory neuropathy, 60 diabetes patients without neuropathy and 40 non diabetes controls. There were significant difference in shoe-length difference among three groups, with larger shoe-length difference in diabetic neuropathy group (left: 21.9mm, / right: 21.7mm), followed by non neuropathy diabetes (left: 15.2mm, / right: 15.5mm) and controls (left: 13.4mm, / right: 14.5mm) (left p=0.002 / right p=0.008). The shoe-length differences of both diabetes groups exceeded the reference range, indicating long footwear. No significant difference was reported related to shoe-width difference. Analysis of shoe fit category showed around 15-17% of diabetes patients were wearing correctly fit shoes in both length and width. A high prevalence of diabetes patient had ill-fitting footwear while nearly half of them wear shoes with correct width but incorrect length. There is nearly no correlations between shoe-length fit, shoe-width fit and frequency of self foot check, frequency of footwear size check and frequency of diabetic footwear education. Discussion Most diabetes patients wear ill-fitting footwear, especially those with peripheral sensory neuropathy when compared to control group. There is significant difference in shoe-length difference among the three groups, with reference to the 10-15mm range as the gap length allowance. Diabetic patients tend to wear long and loose footwear in this study even they had past foot education and practice proper self foot check regularly. These might imply incomprehensive proper diabetic footwear education and self footwear assessment in current diabetes care pathway. These components are essential in diabetes foot care and people with diabetes are highly recommended to select a pair of good fit footwear. Further research is required to standardize the methodologies of measurement in foot dimensions and footwear fitness as well as investigate on relations of additional foot parameters in shoe fitting.published_or_final_versionOrthopaedics and TraumatologyMasterMaster of Medical Science