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Namme JN, Reza HM, Bepari AK. Computational analysis and molecular dynamics simulation of high-risk single nucleotide polymorphisms of the ADAM10 gene. J Biomol Struct Dyn 2024; 42:412-424. [PMID: 36995110 DOI: 10.1080/07391102.2023.2192890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
Polymorphisms of the disintegrin and metalloproteinase domain-containing protein 10 (ADAM10) are linked to pathophysiological changes in lung inflammation, cancer, Alzheimer's disease (AD), encephalopathy, liver fibrosis, and cardiovascular diseases. In this study, we predicted the pathogenicity of ADAM10 non-synonymous single nucleotide polymorphisms (nsSNPs) in a wide array of mutation analyzing bioinformatics tools. We retrieved 423 nsSNPs from dbSNP-NCBI for the analysis, and 13 were predicted deleterious by each of the ten tools: SIFT, PROVEAN, CONDEL, PANTHER-PSEP, SNAP2, SuSPect, PolyPhen-2, Meta-SNP, Mutation Assessor and Predict-SNP. Further assessment of amino acid sequences, homology models, conservation profiles, and inter-atomic interactions identified C222G, G361E and C639Y as the most pathogenic mutations. We validated this prediction through structural stability analysis using DUET, I-Mutant Suite, SNPeffect and Dynamut. Molecular dynamics simulations and principal component analysis also indicated considerable instability of the C222G, G361E and C639Y variants. Therefore, these ADAM10 nsSNPs could be candidates for diagnostic genetic screening and therapeutic molecular targeting.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Jannatun Nayem Namme
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Asim Kumar Bepari
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
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Angelico R, Sensi B, Quaranta C, Orsi M, Parente A, Schlegel A, Tisone G, Manzia TM. The impact of center volume on the utilization and outcomes of machine perfusion technology in liver transplantation: An international survey. Artif Organs 2023; 47:1773-1785. [PMID: 37635420 DOI: 10.1111/aor.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Machine perfusion (MP) was developed to expand the donor pool and improve liver transplantation (LT) outcomes. Despite optimal results in clinical trials, the real-world MP benefit in centers with low-/mid-volume activity (LVCs) is still being determined. METHODS Online survey on MP for LT, distributed to worldwide LT-centers representatives. Variables of interest included logistics, technicalities, and outcomes. Responders were grouped into high-volume centers (HVCs) (>60 LTs/year) and LVCs and results compared. RESULTS Sixty-seven centers were included, 36 HVCs and 31 LVCs. Significant differences in MP regarded: (I) existence of an established program (80.6% vs. 41.9%; p = 0.02), (II) presence of a dedicated perfusionist (58.3% vs. 22.6%; p = 0.006), (III) duration (>4 h: 47.2% vs. 16.1%; p = 0.01), (IV) routine use (20%-40% vs. 5%-20%; p = 0.002), (V) graft utilization (>50%: 75% vs. 51.6%; p = 0.009), (VI) 90-day patient-survival (90%-100% vs. 50%-90%; p = 0.001) and (VII) subjectively perceived benefit (always vs. only in selected ECD; p = 0.009). Concordance was found for indications, type, viability tests, graft-salvage, 90-day graft-loss, and major-complications. CONCLUSIONS This study captured a picture of MP in real-world LT-practice. Significant disparities have surfaced between LVCs and HVCs regarding logistics, utilization, and results. To close this gap, efforts should be made to more efficiently deliver dedicated support, training and mentoring to LVC teams adopting MP technology.
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Affiliation(s)
- Roberta Angelico
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
| | - Bruno Sensi
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Quaranta
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
| | - Michela Orsi
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Parente
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of medicine, Seoul, Korea
| | - Andrea Schlegel
- Centre of Preclinical Research, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuseppe Tisone
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
| | - Tommaso M Manzia
- Department of Surgery Sciences, Transplant and HPB Unit, University of Rome Tor Vergata, Rome, Italy
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Benton M. Experience and Impact of COVID-19 on a Newly Formed Rural University Medical Office: Survey Study. JMIR Form Res 2023; 7:e48299. [PMID: 37676708 PMCID: PMC10514764 DOI: 10.2196/48299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had large social effects, particularly in the fields of medicine and medical education. Medical organizations in the United States operate in overlapping contexts with interrelated goals inside multiple organizations, and the context of work strongly influenced how organizations were able to respond to COVID-19 restrictions. OBJECTIVE This research examines the experience and impact of COVID-19 on the implementation of a Health Resources and Services Administration grant in a newly formed university medical office with the interrelated goals of health policy, health outreach, and medical education. The goal is to understand how COVID-19 created different experiences and challenges for leaders and their collaborators working in medical education compared to those working in public health outreach or health policy. METHODS A survey about COVID-19 opportunities and challenges was administered to work unit leaders and their project collaborators. The most common experiences and challenges are shown, direct educational and other respondents' experiences and challenges are compared, and open-ended comment segments are analyzed. RESULTS Helping others adjust to digital work, remoteness, and coordination were common experiences during COVID-19. Common challenges include coordination and an inability to make comparisons to previous program years. On average, respondents had 11.3 (SD 7.8) experiences and 8.3 (SD 6.9) challenges considered in the survey. While all units were influenced by COVID-19 restrictions, medical education units had more experiences and challenges. Those involved directly in medical education experienced 69% (18.6/27) of their possible experiences and 54% (14.7/27) of their possible challenges on average compared to 35% (7/20) and 21% (4.2/20) among other respondents (P<.001). COVID-19 restrictions increased the complexity of project work and presented challenges, especially in terms of coordinating responses and access to locations. CONCLUSIONS The findings suggest that COVID-19 made the overall administration of programs more complex and drew attention from other medical and public health programs. While remoteness is appropriate for some medical education tasks, it is less appropriate for clinical learning. Remoteness presents an especially large challenge to clinical education. Employees now have expectations for remoteness to be built into programs and workplaces. Program administrators will have to integrate remoteness' benefits and drawbacks into their organization for the foreseeable future.
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Affiliation(s)
- Mark Benton
- Center for Health Policy, Department of Public Health, University of Missouri, Columbia, MO, United States
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Yue P, Lv X, You J, Zou Y, Luo J, Lu Z, Cao H, Liu Z, Fan X, Ye Q. Hypothermic oxygenated perfusion attenuates DCD liver ischemia-reperfusion injury by activating the JAK2/STAT3/HAX1 pathway to regulate endoplasmic reticulum stress. Cell Mol Biol Lett 2023; 28:55. [PMID: 37438690 DOI: 10.1186/s11658-023-00466-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Hepatic ischemia-reperfusion injury (IRI) in donation after cardiac death (DCD) donors is a major determinant of transplantation success. Endoplasmic reticulum (ER) stress plays a key role in hepatic IRI, with potential involvement of the Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway and the antiapoptotic protein hematopoietic-lineage substrate-1-associated protein X-1 (HAX1). In this study, we aimed to investigate the effects of hypothermic oxygenated perfusion (HOPE), an organ preservation modality, on ER stress and apoptosis during hepatic IRI in a DCD rat model. METHODS To investigate whether HOPE could improve IRI in DCD livers, levels of different related proteins were examined by western blotting and quantitative real-time polymerase chain reaction. Further expression analyses, immunohistochemical analyses, immunofluorescence staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining, and transmission electron microscopy were conducted to analyze the effects of HOPE on ER stress and apoptosis. To clarify the role of the JAK2/STAT3 pathway and HAX1 in this process, AG490 inhibitor, JAX1 plasmid transfection, co-immunoprecipitation (CO-IP), and flow cytometry analyses were conducted. RESULTS HOPE reduced liver injury and inflammation while alleviating ER stress and apoptosis in the DCD rat model. Mechanistically, HOPE inhibited unfolded protein responses by activating the JAK2/STAT3 pathway, thus reducing ER stress and apoptosis. Moreover, the activated JAK2/STAT3 pathway upregulated HAX1, promoting the interaction between HAX1 and SERCA2b to maintain ER calcium homeostasis. Upregulated HAX1 also modulated ER stress and apoptosis by inhibiting the inositol-requiring enzyme 1 (IRE1) pathway. CONCLUSIONS JAK2/STAT3-mediated upregulation of HAX1 during HOPE alleviates hepatic ER stress and apoptosis, indicating the JAK2/STAT3/HAX1 pathway as a potential target for IRI management during DCD liver transplantation.
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Affiliation(s)
- Pengpeng Yue
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Xiaoyan Lv
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jian You
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Yongkang Zou
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Jun Luo
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Zhongshan Lu
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Hankun Cao
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Zhongzhong Liu
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China
| | - Xiaoli Fan
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China.
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, 430071, Wuhan, China.
- The Third Xiangya Hospital of Central South University, Research Center of National Health Ministry On Transplantation Medicine Engineering and Technology, Changsha, 410013, China.
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Horné F, Drefs M, Schirren MJ, Koch DT, Cepele G, Jacobi SJ, Payani E, Börner N, Werner J, Guba MO, Koliogiannis D. Hypothermic Oxygenated Machine Perfusion ( HOPE) Prior to Liver Transplantation Mitigates Post-Reperfusion Syndrome and Perioperative Electrolyte Shifts. J Clin Med 2022; 11. [PMID: 36555997 DOI: 10.3390/jcm11247381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Post-reperfusion syndrome (PRS) and electrolyte shifts (ES) represent considerable challenges during liver transplantation (LT) being associated with significant morbidity. We aimed to investigate the impact of hypothermic oxygenated machine perfusion (HOPE) on PRS and ES in LT. (2) Methods: In this retrospective study, we compared intraoperative parameters of 100 LTs, with 50 HOPE preconditioned liver grafts and 50 grafts stored in static cold storage (SCS). During reperfusion phase, prospectively registered serum parameters and vasopressor administration were analyzed. (3) Results: Twelve percent of patients developed PRS in the HOPE cohort vs. 42% in the SCS group (p = 0.0013). Total vasopressor demand in the first hour after reperfusion was lower after HOPE pretreatment, with reduced usage of norepinephrine (−26%; p = 0.122) and significant reduction of epinephrine consumption (−52%; p = 0.018). Serum potassium concentration dropped by a mean of 14.1% in transplantations after HOPE, compared to a slight decrease of 1% (p < 0.001) after SCS. The overall incidence of early allograft dysfunction (EAD) was reduced by 44% in the HOPE group (p = 0.04). (4) Conclusions: Pre-transplant graft preconditioning with HOPE results in higher hemodynamic stability during reperfusion and lower incidence of PRS and EAD. HOPE has the potential to mitigate ES by preventing hyperpotassemic complications that need to be addressed in LT with HOPE-pre-treated grafts.
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Ravaioli M, Germinario G, Dajti G, Sessa M, Vasuri F, Siniscalchi A, Morelli MC, Serenari M, Del Gaudio M, Zanfi C, Odaldi F, Bertuzzo VR, Maroni L, Laurenzi A, Cescon M. Hypothermic oxygenated perfusion in extended criteria donor liver transplantation-A randomized clinical trial. Am J Transplant 2022; 22:2401-2408. [PMID: 35671067 PMCID: PMC9796786 DOI: 10.1111/ajt.17115] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 01/25/2023]
Abstract
Hypothermic Oxygenated Perfusion (HOPE) of the liver can reduce the incidence of early allograft dysfunction (EAD) and failure in extended criteria donors (ECD) grafts, although data from prospective studies are very limited. In this monocentric, open-label study, from December 2018 to January 2021, 110 patients undergoing transplantation of an ECD liver graft were randomized to receive a liver after HOPE or after static cold storage (SCS) alone. The primary endpoint was the incidence of EAD. The secondary endpoints included graft and patient survival, the EASE risk score, and the rate of graft or other graft-related complications. Patients in the HOPE group had a significantly lower rate of EAD (13% vs. 35%, p = .007) and were more frequently allocated to the intermediate or higher risk group according to the EASE score (2% vs. 11%, p = .05). The survival analysis confirmed that patients in the HOPE group were associated with higher graft survival one year after LT (p = .03, log-rank test). In addition, patients in the SCS group had a higher re-admission and overall complication rate at six months, in particular cardio-vascular adverse events (p = .04 and p = .03, respectively). HOPE of ECD grafts compared to the traditional SCS preservation method is associated with lower dysfunction rates and better graft survival.
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Affiliation(s)
- Matteo Ravaioli
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Giuliana Germinario
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Gerti Dajti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Maurizio Sessa
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
| | - Francesco Vasuri
- Department of Specialized, Experimental and Diagnostic Medicine, Pathology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Antonio Siniscalchi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Maria Cristina Morelli
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Matteo Serenari
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Massimo Del Gaudio
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Chiara Zanfi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Federica Odaldi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Valentina Rosa Bertuzzo
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Lorenzo Maroni
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Laurenzi
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Matteo Cescon
- Department of General Surgery and TransplantationIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
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Panisello Rosello A, Teixeira da Silva R, Castro C, G. Bardallo R, Calvo M, Folch-Puy E, Carbonell T, Palmeira C, Roselló Catafau J, Adam R. Polyethylene Glycol 35 as a Perfusate Additive for Mitochondrial and Glycocalyx Protection in HOPE Liver Preservation. Int J Mol Sci 2020; 21:E5703. [PMID: 32784882 PMCID: PMC7461048 DOI: 10.3390/ijms21165703] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Organ transplantation is a multifactorial process in which proper graft preservation is a mandatory step for the success of the transplantation. Hypothermic preservation of abdominal organs is mostly based on the use of several commercial solutions, including UW, Celsior, HTK and IGL-1. The presence of the oncotic agents HES (in UW) and PEG35 (in IGL-1) characterize both solution compositions, while HTK and Celsior do not contain any type of oncotic agent. Polyethylene glycols (PEGs) are non-immunogenic, non-toxic and water-soluble polymers, which present a combination of properties of particular interest in the clinical context of ischemia-reperfusion injury (IRI): they limit edema and nitric oxide induction and modulate immunogenicity. Besides static cold storage (SCS), there are other strategies to preserve the organ, such as the use of machine perfusion (MP) in dynamic preservation strategies, which increase graft function and survival as compared to the conventional static hypothermic preservation. Here we report some considerations about using PEG35 as a component of perfusates for MP strategies (such as hypothermic oxygenated perfusion, HOPE) and its benefits for liver graft preservation. Improved liver preservation is closely related to mitochondria integrity, making this organelle a good target to increase graft viability, especially in marginal organs (e.g., steatotic livers). The final goal is to increase the pool of suitable organs, and thereby shorten patient waiting lists, a crucial problem in liver transplantation.
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Affiliation(s)
- Arnau Panisello Rosello
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France; (C.C.); (R.A.)
| | - Rui Teixeira da Silva
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
- Center for Neuroscience and Cell Biology, Universidade Coimbra, 3000-370 Coimbra, Portugal;
| | - Carlos Castro
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France; (C.C.); (R.A.)
| | - Raquel G. Bardallo
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain; (R.G.B.); (T.C.)
| | - Maria Calvo
- Serveis Cientifico Tècnics, 08036-Campus Hospital Clínic, Universitat de Barcelona, 08919 Barcelona, Catalonia, Spain;
| | - Emma Folch-Puy
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain; (R.G.B.); (T.C.)
| | - Carlos Palmeira
- Center for Neuroscience and Cell Biology, Universidade Coimbra, 3000-370 Coimbra, Portugal;
| | - Joan Roselló Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d’Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC)-IDIBAPS, CIBEREHD, 08036 Barcelona, Catalonia, Spain; (A.P.R.); (R.T.d.S.); (E.F.-P.)
| | - René Adam
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France; (C.C.); (R.A.)
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Lai Q, Ruberto F, Pawlik TM, Pugliese F, Rossi M. Use of machine perfusion in livers showing steatosis prior to transplantation: a systematic review. Updates Surg 2020; 72:595-604. [PMID: 32449031 DOI: 10.1007/s13304-020-00797-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of machine perfusion (MP) in the evaluation of liver grafts with macrovesicular steatosis (MaS) remains ill-defined as only a limited number of studies has been reported. The objective of the current study was to provide a systematic review to evaluate the role of MP in the setting of MaS livers. METHODS A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Eligible articles published up to April 2019 were included using the MEDLINE, Scopus, and Google Scholar databases. RESULTS Among the 422 articles screened, only 16 papers met the inclusion criteria. A total of 54 cases of MP use before liver transplantation were included. Sixteen (29.6%) grafts were from donors after circulatory death. In 22 (40.7%) cases, hypothermic machine perfusion was performed. Normothermic machine perfusion was done in the remaining 32 (59.3%) cases. According to the histological results of the donor core biopsy, a MaS value < 30% was observed in 41 (75.9%) cases, whereas 13 (24.1%) patients had moderate-to-severe (≥ 30%) MaS. Following categorization of the pooled population according to the presence of moderate-to-severe (≥ 30%) MaS in the donor graft, no differences were noted in terms of post-transplant death or severe complications following MP. There was no correlation between the proportion of MaS in the donor graft relative to post-transplant peak ALT among patients treated with MP. Among the entire pooled cohort, there was also no correlation between MaS values and ALT peak (R = 0.13; P = 0.42). CONCLUSIONS MP appears to be feasible and safe in MaS livers. Experience to date has been very limited, and the benefit of MP remains not determined. Prospective studies will need to define better the potential effect of "defatting" drugs used during the perfusion process on MaS.
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Affiliation(s)
- Quirino Lai
- Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Franco Ruberto
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Sapienza University of Rome, Rome, Italy
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Francesco Pugliese
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Sapienza University of Rome, Rome, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Czigany Z, Lurje I, Schmelzle M, Schöning W, Öllinger R, Raschzok N, Sauer IM, Tacke F, Strnad P, Trautwein C, Neumann UP, Fronek J, Mehrabi A, Pratschke J, Schlegel A, Lurje G. Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications. J Clin Med 2020; 9:E846. [PMID: 32244972 PMCID: PMC7141496 DOI: 10.3390/jcm9030846] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
Ischemia-reperfusion injury (IRI) constitutes a significant source of morbidity and mortality after orthotopic liver transplantation (OLT). The allograft is metabolically impaired during warm and cold ischemia and is further damaged by a paradox reperfusion injury after revascularization and reoxygenation. Short-term and long-term complications including post-reperfusion syndrome, delayed graft function, and immune activation have been associated with IRI. Due to the current critical organ shortage, extended criteria grafts are increasingly considered for transplantation, however, with an elevated risk to develop significant features of IRI. In recent years, ex vivo machine perfusion (MP) of the donor liver has witnessed significant advancements. Here, we describe the concept of hypothermic (oxygenated) machine perfusion (HMP/HOPE) approaches and highlight which allografts may benefit from this technology. This review also summarizes clinical applications and the main aspects of ongoing randomized controlled trials on hypothermic perfusion. The mechanistic aspects of IRI and hypothermic MP-which include tissue energy replenishment, optimization of mitochondrial function, and the reduction of oxidative and inflammatory damage following reperfusion-will be comprehensively discussed within the context of current preclinical and clinical evidence. Finally, we highlight novel trends and future perspectives in the field of hypothermic MP in the context of recent findings of basic and translational research.
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Affiliation(s)
- Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (Z.C.); (U.P.N.)
| | - Isabella Lurje
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Nathanael Raschzok
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Igor M. Sauer
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Pavel Strnad
- Department of Gastroenterology, Metabolic Disorders and Intensive Care, University Hospital RWTH Aachen, 52074 Aachen, Germany; (P.S.); (C.T.)
| | - Christian Trautwein
- Department of Gastroenterology, Metabolic Disorders and Intensive Care, University Hospital RWTH Aachen, 52074 Aachen, Germany; (P.S.); (C.T.)
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (Z.C.); (U.P.N.)
| | - Jiri Fronek
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic;
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
| | - Andrea Schlegel
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK;
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (Z.C.); (U.P.N.)
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum—Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.L.); (M.S.); (W.S.); (R.Ö.); (N.R.); (I.M.S.); (J.P.)
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10
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Boyd AJ, Reeves GD, Spence HE, Funsten HO, Larsen BA, Skoug RM, Blake JB, Fennell JF, Claudepierre SG, Baker DN, Kanekal SG, Jaynes AN. RBSP-ECT Combined Spin-Averaged Electron Flux Data Product. J Geophys Res Space Phys 2019; 124:9124-9136. [PMID: 32025458 PMCID: PMC6988469 DOI: 10.1029/2019ja026733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
We describe a new data product combining the spin-averaged electron flux measurements from the Radiation Belt Storm Probes (RBSP) Energetic Particle Composition and Thermal Plasma (ECT) suite on the National Aeronautics and Space Administration's Van Allen Probes. We describe the methodology used to combine each of the data sets and produce a consistent set of spectra for September 2013 to the present. Three-minute-averaged flux spectra are provided spanning energies from 15 eV up to 20 MeV. This new data product provides additional utility to the ECT data and offers a consistent cross calibrated data set for researchers interested in examining the dynamics of the inner magnetosphere across a wide range of energies.
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Affiliation(s)
| | - G. D. Reeves
- New Mexico ConsortiumLos AlamosNMUSA
- Los Alamos National LaboratoryLos AlamosNMUSA
| | - H. E. Spence
- Institute for the Study of Earth, Oceans and SpaceUniversity of New HampshireDurhamNHUSA
| | | | - B. A. Larsen
- New Mexico ConsortiumLos AlamosNMUSA
- Los Alamos National LaboratoryLos AlamosNMUSA
| | - R. M. Skoug
- Los Alamos National LaboratoryLos AlamosNMUSA
| | | | | | - S. G. Claudepierre
- The Aerospace CorporationEl SegundoCAUSA
- Department of Atmospheric and Oceanic SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - D. N. Baker
- Laboratory for Atmospheric and Space SciencesUniversity of Colorado BoulderBoulderCOUSA
| | | | - A. N. Jaynes
- Department of Physics and AstronomyUniversity of IowaIowa CityIAUSA
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11
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Rayar M, Maillot B, Bergeat D, Camus C, Houssel-Debry P, Sulpice L, Meunier B, Boudjema K. A Preliminary Clinical Experience Using Hypothermic Oxygenated Machine Perfusion for Rapid Recovery of Octogenarian Liver Grafts. Prog Transplant 2018; 29:97-98. [PMID: 30497334 DOI: 10.1177/1526924818817072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michel Rayar
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France.,Univ Rennes, Rennes, France
| | - Betty Maillot
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | - Damien Bergeat
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Univ Rennes, Rennes, France
| | | | | | - Laurent Sulpice
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France.,Univ Rennes, Rennes, France
| | - Bernard Meunier
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France.,Univ Rennes, Rennes, France
| | - Karim Boudjema
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.,Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France.,Univ Rennes, Rennes, France
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12
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Sandhu JK, Rae IJ, Freeman MP, Forsyth C, Gkioulidou M, Reeves GD, Spence HE, Jackman CM, Lam MM. Energization of the Ring Current by Substorms. J Geophys Res Space Phys 2018; 123:8131-8148. [PMID: 30775195 PMCID: PMC6360953 DOI: 10.1029/2018ja025766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/10/2018] [Accepted: 09/12/2018] [Indexed: 06/01/2023]
Abstract
The substorm process releases large amounts of energy into the magnetospheric system, although where the energy is transferred to and how it is partitioned remains an open question. In this study, we address whether the substorm process contributes a significant amount of energy to the ring current. The ring current is a highly variable region, and understanding the energization processes provides valuable insight into how substorm-ring current coupling may contribute to the generation of storm conditions and provide a source of energy for wave driving. In order to quantify the energy input into the ring current during the substorm process, we analyze Radiation Belt Storm Probes Ion Composition Experiment and Helium Oxygen Proton Electron ion flux measurements for H+, O+, and He+. The energy content of the ring current is estimated and binned spatially for L and magnetic local time. The results are combined with an independently derived substorm event list to perform a statistical analysis of variations in the ring current energy content with substorm phase. We show that the ring current energy is significantly higher in the expansion phase compared to the growth phase, with the energy enhancement persisting into the substorm recovery phase. The characteristics of the energy enhancement suggest the injection of energized ions from the tail plasma sheet following substorm onset. The local time variations indicate a loss of energetic H+ ions in the afternoon sector, likely due to wave-particle interactions. Overall, we find that the average energy input into the ring current is ∼9% of the previously reported energy released during substorms.
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Affiliation(s)
- J. K. Sandhu
- Department of Space and Climate Physics, Mullard Space Science LaboratoryUniversity College LondonLondonUK
| | - I. J. Rae
- Department of Space and Climate Physics, Mullard Space Science LaboratoryUniversity College LondonLondonUK
| | | | - C. Forsyth
- Department of Space and Climate Physics, Mullard Space Science LaboratoryUniversity College LondonLondonUK
| | - M. Gkioulidou
- Applied Physics LaboratoryJohns Hopkins UniversityBaltimoreMDUSA
| | | | - H. E. Spence
- Institute for the Study of Earth, Oceans, and SpaceUniversity of New HampshireDurhamNHUSA
| | - C. M. Jackman
- Department of Physics and AstronomyUniversity of SouthamptonSouthamptonUK
| | - M. M. Lam
- Department of Physics and AstronomyUniversity of SouthamptonSouthamptonUK
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13
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Kleiman MAR, Kilmer B, Hawken A. Desistance mandates compared with treatment mandates in criminal justice populations. Addiction 2017; 112:748-750. [PMID: 27873375 DOI: 10.1111/add.13635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mark A R Kleiman
- Department of Public Policy, Luskin School of Public Affairs, UCLA, Los Angeles, CA, USA
| | - Beau Kilmer
- Drug Policy Research Center, RAND, Santa Monica, CA, USA
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14
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Abstract
The demand of donor livers for transplantation exceeds the supply. In an attempt to maximize the number of potentially usable donor livers, several centers are exploring the role of machine perfusion. This review provides an update on machine perfusion strategies and basic concepts, based on current clinical issues, and discuss challenges, including currently used biomarkers for assessing the quality and viability of perfused organs. The potential benefits of machine perfusion on immunogenicity and the consequences on post-operative immunosuppression management are discussed.
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15
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Sarno-Smith LK, Larsen BA, Skoug RM, Liemohn MW, Breneman A, Wygant JR, Thomsen MF. Spacecraft surface charging within geosynchronous orbit observed by the Van Allen Probes. Space Weather 2016; 14:151-164. [PMID: 27398076 PMCID: PMC4933096 DOI: 10.1002/2015sw001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 06/06/2023]
Abstract
Using the Helium Oxygen Proton Electron (HOPE) and Electric Field and Waves (EFW) instruments from the Van Allen Probes, we explored the relationship between electron energy fluxes in the eV and keV ranges and spacecraft surface charging. We present statistical results on spacecraft charging within geosynchronous orbit by L and MLT. An algorithm to extract the H+ charging line in the HOPE instrument data was developed to better explore intense charging events. Also, this study explored how spacecraft potential relates to electron number density, electron pressure, electron temperature, thermal electron current, and low-energy ion density between 1 and 210 eV. It is demonstrated that it is imperative to use both EFW potential measurements and the HOPE instrument ion charging line for examining times of extreme spacecraft charging of the Van Allen Probes. The results of this study show that elevated electron energy fluxes and high-electron pressures are present during times of spacecraft charging but these same conditions may also occur during noncharging times. We also show noneclipse significant negative charging events on the Van Allen Probes.
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Affiliation(s)
- Lois K Sarno-Smith
- Department of Climate and Space Engineering University of Michigan Ann Arbor Michigan USA
| | - Brian A Larsen
- Los Alamos National Laboratory Los Alamos New Mexico USA
| | - Ruth M Skoug
- Los Alamos National Laboratory Los Alamos New Mexico USA
| | - Michael W Liemohn
- Department of Climate and Space Engineering University of Michigan Ann Arbor Michigan USA
| | - Aaron Breneman
- School of Physics and Astronomy University of Minnesota Minneapolis Minnesota USA
| | - John R Wygant
- School of Physics and Astronomy University of Minnesota Minneapolis Minnesota USA
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16
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Fu X, Cowee MM, Friedel RH, Funsten HO, Gary SP, Hospodarsky GB, Kletzing C, Kurth W, Larsen BA, Liu K, MacDonald EA, Min K, Reeves GD, Skoug RM, Winske D. Whistler anisotropy instabilities as the source of banded chorus: Van Allen Probes observations and particle-in-cell simulations. J Geophys Res Space Phys 2014; 119:8288-8298. [PMID: 26167433 PMCID: PMC4497467 DOI: 10.1002/2014ja020364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/27/2014] [Indexed: 05/17/2023]
Abstract
Magnetospheric banded chorus is enhanced whistler waves with frequencies ωr <Ω e , where Ω e is the electron cyclotron frequency, and a characteristic spectral gap at ωr ≃Ω e /2. This paper uses spacecraft observations and two-dimensional particle-in-cell simulations in a magnetized, homogeneous, collisionless plasma to test the hypothesis that banded chorus is due to local linear growth of two branches of the whistler anisotropy instability excited by two distinct, anisotropic electron components of significantly different temperatures. The electron densities and temperatures are derived from Helium, Oxygen, Proton, and Electron instrument measurements on the Van Allen Probes A satellite during a banded chorus event on 1 November 2012. The observations are consistent with a three-component electron model consisting of a cold (a few tens of eV) population, a warm (a few hundred eV) anisotropic population, and a hot (a few keV) anisotropic population. The simulations use plasma and field parameters as measured from the satellite during this event except for two numbers: the anisotropies of the warm and the hot electron components are enhanced over the measured values in order to obtain relatively rapid instability growth. The simulations show that the warm component drives the quasi-electrostatic upper band chorus and that the hot component drives the electromagnetic lower band chorus; the gap at ∼Ω e /2 is a natural consequence of the growth of two whistler modes with different properties.
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Affiliation(s)
- Xiangrong Fu
- Los Alamos National LaboratoryLos Alamos, New Mexico, USA
| | - Misa M Cowee
- Los Alamos National LaboratoryLos Alamos, New Mexico, USA
| | | | | | | | | | - Craig Kletzing
- Department of Physics and Astronomy, University of IowaIowa City, Iowa, USA
| | - William Kurth
- Department of Physics and Astronomy, University of IowaIowa City, Iowa, USA
| | - Brian A Larsen
- Los Alamos National LaboratoryLos Alamos, New Mexico, USA
| | - Kaijun Liu
- Department of Physics, Auburn UniversityAuburn, Alabama, USA
| | | | - Kyungguk Min
- Department of Physics, Auburn UniversityAuburn, Alabama, USA
| | | | - Ruth M Skoug
- Los Alamos National LaboratoryLos Alamos, New Mexico, USA
| | - Dan Winske
- Los Alamos National LaboratoryLos Alamos, New Mexico, USA
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17
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Abstract
Physical activity (PA) provides numerous physiological and psychosocial benefits. However, lifestyle changes, including reduced PA opportunities in multiple settings, have resulted in an escalation of overweight and obesity and related health problems. Poor physical and mental health, including metabolic and cardiovascular problems is seen in progressively younger ages, and the systematic decline in school PA has contributed to this trend. Of note, the crowded school curriculum with an intense focus on academic achievement, lack of school leadership support, funding and resources, plus poor quality teaching are barriers to PA promotion in schools. The school setting and physical educators in particular, must embrace their role in public health by adopting a comprehensive school PA program. We provide an overview of key issues and challenges in the area plus best bets and recommendations for physical education and PA promotion in the school system moving forward.
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Affiliation(s)
- Andrew P Hills
- Centre for Nutrition and Exercise, Mater Research Institute, The University of Queensland, Brisbane, Australia.
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455; Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455
| | - David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle Callaghan, New South Wales, Australia
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18
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Schlegel A, Graf R, Clavien PA, Dutkowski P. Hypothermic oxygenated perfusion ( HOPE) protects from biliary injury in a rodent model of DCD liver transplantation. J Hepatol 2013; 59:984-91. [PMID: 23820408 DOI: 10.1016/j.jhep.2013.06.022] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/18/2013] [Accepted: 06/23/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS The use of livers from donors after cardiac arrest (DCD) is increasing in many countries to overcome organ shortage. Due to additional warm ischemia before preservation, those grafts are at higher risk of failure and bile duct injury. Several competing rescue strategies by machine perfusion techniques have been developed with, however, unclear effects on biliary injury. We analyze the impact of an end-ischemic Hypothermic Oxygenated PErfusion (HOPE) approach applied only through the portal vein for 1h before graft implantation. METHODS Rat livers were subjected to 30-min in situ warm ischemia, followed by subsequent 4-h cold storage, mimicking DCD-organ procurement and conventional organ transport. Livers in the HOPE group underwent also passive cold storage for 4h, but were subsequently machine perfused for 1h before implantation. Outcome was tested by liver transplantation (LT) at 12h after implantation (n=10 each group) and after 4 weeks (n=10 each group), focusing on early reperfusion injury, immune response, and later intrahepatic biliary injury. RESULTS All animals survived after LT. However, reperfusion injury was significantly decreased by HOPE treatment as tested by hepatocyte injury, Kupffer cell activation, and endothelial cell activation. Recipients receiving non-perfused DCD livers disclosed less body weight gain, increased bilirubin, and severe intrahepatic biliary fibrosis. In contrast, HOPE treated DCD livers were protected from biliary injury, as detected by cholestasis parameter and histology. CONCLUSIONS We demonstrate in a DCD liver transplant model that end-ischemic hypothermic oxygenated perfusion is a powerful strategy for protection against biliary injury.
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Affiliation(s)
- Andrea Schlegel
- Department of Surgery, Laboratory of the Swiss HPB and Liver Transplantation Center, University Hospital Zurich, Switzerland
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19
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Huang JS, Chun S, Sandhu A, Terrones L. Quality improvement in childhood obesity management through the maintenance of certification process. J Pediatr 2013; 163:1313-6.e1. [PMID: 23810127 DOI: 10.1016/j.jpeds.2013.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/08/2013] [Accepted: 05/10/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. STUDY DESIGN Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. RESULTS The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. CONCLUSIONS Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth.
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Affiliation(s)
- Jeannie S Huang
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA.
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