Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

Extended criteria brain-dead organ donors:Prevalence and impact on the utilisation of livers for transplantation in Brazil

BACKGROUND Despite its association with higher postoperative morbidity and mortality,the use of extended criteria donor(ECD)livers for transplantation has increased globally due to the high demand for the procedure.AIM To investigate the prevalence of ECD in donation after brain death(DBD)and its impact on organ acceptance for transplantation.METHODS Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre.The incidence of the Eurotransplant risk factors to define an ECD(ET-ECD)among DBD donors and the likelihood of organ acceptance over the years were analysed.The relationship between organ refusal for transplantation,the occurrence,and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.RESULTS A total of 1619 organ donors were evaluated.Of these,78.31%(n=1268)had at least one ET-ECD criterion.There was an increase in the acceptance of ECD DBD organs for transplantation(1 criterion:from 23.40%to 31.60%;2 criteria:from 13.10%to 27.70%;3 criteria:From 6.30%to 13.60%).For each addition of one ETECD variable,the estimated chance of organ refusal was 64.4%higher(OR 1.644,95%CI 1.469-1.839,P<0.001).Except for the donor serum sodium>165 mmol/L(P=0.310),all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.CONCLUSION A high prevalence of ECD DBD was observed.Despite the increase in their utilisation,the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.

Superior aggregation, morphology and photovoltaic performance enabled by fine tuning of fused electron-deficient units in polymer donors

Copolymerization of an electron-rich donor(D)unit with an electron-deficient acceptor(A)unit to construct efficient D-π-A-πtype donors is an effective strategy for organic solar cell applications.The electron-deficient unit fusion,endows extendedπ-conjugation plane and insures excellent photoelectronic property,has great advantages to build A moiety and gradually receives considerable attention.In this work,we adopt benzo[2,1-b:3,4-b’]dithiophene and benzopyrazine(BP),benzothiadiazole(BT)and benzoselenadiazole(BS)to cleverly construct a series of fused A units with different electrondeficient ability,and further synthesize three polymer donors PBDP-BP,PBDP-BT,and PBDP-BS,respectively.The relationships between structure and performance were systematically investigated.PBDPBT shows a moderate aggregation behavior in both solution and film,and the highest hole mobility among the three polymers.After blending with Y6,the PBDP-BT:Y6-based film has the strongest absorption,favorable compatibility,superior crystallinity,and uniform phase separation morphology compared with PBDP-BP or PBDP-BS based blend films.Thus,the device based on PBDP-BT:Y6 has the highest and balanced charge mobility,suppressive recombination,reduced energy loss and achieves an outstanding PCE of 15.14%,which is superior to PBDP-BP:Y6(8.55%)and PBDP-BS:Y6(6.85%).These results provide learnable guidelines for future fused electron-deficient unit-based donor design for photovoltaic application.

Liver transplantation using organs from deceased organ donors: a single organ transplant center experience

BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.

Renal allograft procurement from living unrelated donors in Iran: What falls under the eclipse

Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.

Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time?

Liver transplantation(LT)provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma.Despite the increasing number of liver transplants performed each year,the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality.Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates.Nevertheless,further strategies can be implemented to increase the pool of potential donors in deceased donor LT,such as reducing the rate of organ discards.Utilizing hepatitis C virus(HCV)seropositive liver grafts is one of the expanded donor organ criteria.A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients.Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation.The American Society of Transplantation advises against performing transplants from HCV-infected liver donors(D+)into HCV-negative recipient(R-)unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants.Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is im-portant.National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.

Can adequate hemodynamic management of brain-dead donors improve donor organ procurement?

There is increasing evidence that adequate donor management with a goal of optimization of organ function is essential to maximize the number of organs that can be procured.Therefore,identification of the cause of hemodynamic instability is crucial in order to direct the right therapy.Several donor management goals for better hemodynamic management including serial echocardiography can guide hemodynamic management in potential donors to increase both number and quality of donor hearts.

Generativity of Self-Organizing Processes and Their Correlative Description in Terms of a Formal Language of Meta-Ordinal Generative Nature, in the Light of the Maximum Ordinality Principle and the Explicit Solution to the “Three-Body Problem”

The main objective of this paper is to demonstrate that the internal processes of Self-Organizing Systems represent a unique and singular process, characterized by their specific generativity. This process can be modeled using the Maximum Ordinality Principle and its associated formal language, known as the “Incipient” Differential Calculus (IDC).

Semicrystalline Unfused Polymer Donors with Backbone Halogenation toward Cost-Effective Organic Solar Cells

Developing novel unfused building blocks with simple synthesis and low cost is essential to advance and enrich cost-effective poly-mer donors;however,it remains a challenge due to the lack of efficient molecular strategies.Herein,a class of low-cost and fully unfused polymer donors with precisely regulated backbone planarity via halogenation was designed and synthesized,namely PDTBTBz-2H,PDTBTBz-2F,and PDTBTBz-2Cl.These polymer donors possess a four-step synthesis route with over 80%yield from cheap raw chemicals comparable to existing low-cost polymer donors,such as PTQ10.Benefitting from the planar backbone via in-corporating the F…S non-covalent interactions,PDTBTBz-2F exhibits more robust J-type aggregation in solution and a long-ranged molecular stacking in film relative to PDTBTBz-2H and PDTBTBz-2Cl.Moreover,the systematical study of PDTBTBz-based organic so-lar cells(OSCs)reveals the close relationship between optimized molecular self-assembly and charge separation/transport regarding backbone halogenation when paired with the non-fullerene acceptor(Y6-BO-4F).As a result,the photovoltaic devices based on semicrystalline PDTBTBz-2F achieved a promising power conversion efficiency(PCE)of 12.37%.Our work highlighted the influence of backbone halogenation on the molecular self-assembly properties and a potential unfused backbone motif for further developing cost-effective OSCs.

Chlorinated Thiazole-Based Low-Cost Polymer Donors for High Efficiency Binary and Ternary Organic Solar Cells

In this work,novel D-A alternating polymers(PJ-1,PJ-2,and PJ-3)with chlorinated benzodithiophene and chlorinated thiazole units were synthesized via gradual chlorination.These polymers could be obtained readily through a few concise synthesis steps.Among them,PJ-1 displayed desirable properties including energy levels,crystallinity,and charge transport capabilities.The binary and ternary organic solar cells(OSCs)fabricated based on PJ-1 displayed significant power conversion efficiency(PCE)of 15.02%and 19.12%,respectively,placing them among the highest reported for ternary OSCs.Notably,the PJ1-based devices also showcased one of the highest figure-of-merit values,indicating their promising potential for future applications.This study offers valuable insights and supports the development of costeffective and high-performance polymer donors for the generation of OSCs.

Living donor liver transplantation with body-weight more or less than 10 kilograms

AIM: To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation.METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation between June 1994 and February 2011 were reviewed retrospectively.The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1(G1; n =101), while those with body weights of more than 10 kg were included in group 2(G2; n = 95). For each group, the patients' ages, body weights, heights,pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively.RESULTS: The general medical conditions of the G1patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z-scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients,including leukocyte poor red blood cell transfusions,5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However,the one-year survival rates(95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates(94.9% and 94.6% for G1 and G2, respectively) for both groups were similar.CONCLUSION: Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg.

High-performance asymmetric small molecular donor materials based on indenothiophene for solution-processed organic solar cells

Two novel asymmetric organic small molecules of IT(2FBT-T3Cz)_2and IT(2FBT-TT3Cz)_2with an indenothiophene(IT)central donor core,fluorinated benzothiadiazole(2FBT)as acceptor and 3-carbazole(Cz)unit as terminal group were designed and synthesized as the donor materials in organic solar cells(OSCs).The thermal,optical absorption,electrochemical property,hole–electron mobility,film morphology were thoroughly studied.Using PC_(71)BM as an electron acceptor,without any additive and thermal annealing(TA)treatment,the IT(2FBT-T3Cz)_2-based cells showed a promising power conversion efficiency(PCE)of5.81%and the IT(2FBT-TT3Cz)_2-based cells exhibited a PCE of 4.39%.Our results demonstrate that the IT-based asymmetric small molecules can be developed as a promising class of donor materials for highperformance OSCs.

Healthy ranges of serum alanine aminotransferase levels in Iranian blood donors

AIM: The healthy ranges for serum alanine aminotransferase(ALT) levels are less well studied. The aim of this study was to define the upper limit of normal (ULN) for serum ALT levels, and to assess factors associated with serum ALT activity in apparently healthy blood donors. METHODS: A total of 1 939 blood donors were included.ALT measurements were performed for all cases using the same laboratory method. Healthy ranges for ALT levels werecomputed from the population at the lowest risk for liver disease. Univariate and multivariate analyses were performed to evaluate associations between clinical factors and ALT levels.RESULTS: Serum ALT activity was independently associated with body mass index (BMI) and male gender, but not associated with age. Association of ALT with BMI was more prominent in males than in females. Upper limit of normal for non-overweight women (BMI of less than 25) was 34 U/L,and for non-overweight men was 40 U/L.CONCLUSION: Serum ALT is strongly associated with sex and BMI. The normal range of ALT should be defined for male and female separately.

Kidney transplant from donors with hepatitis B: A challenging treatment option

Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation.However,the risk of hepatitis B virus(HBV)transmission remains a challenge that undermines the chance of organs being used.This is particularly true with hepatitis B surface antigen(HBsAg)positive donors despite the comparable long-term outcomes when compared with standard donors.To reduce the risk of HBV transmission,a comprehensive approach is needed.This includes assessment of donor risk,optimal allocation to the proper recipient,appropriate immunosuppressive regimen,optimizing the prophylactic therapy,and post-transplant monitoring.This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment.The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening,optimal recipient selection,importance of hepatitis B immunity,role of nucleos(t)ide analogues,and hepatitis B immunoglobulin.A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.

Standard liver weight model in adult deceased donors with fatty liver: A prospective cohort study

BACKGROUND Standard liver weight(SLW)is frequently used in deceased donor liver transplantation to avoid size mismatches with the recipient.However,some deceased donors(DDs)have fatty liver(FL).A few studies have reported that FL could impact liver size.To the best of our knowledge,there are no relevant SLW models for predicting liver size.AIM To demonstrate the relationship between FL and total liver weight(TLW)in detail and present a related SLW formula.METHODS We prospectively enrolled 212 adult DDs from West China Hospital of Sichuan University from June 2019 to February 2021,recorded their basic information,such as sex,age,body height(BH)and body weight(BW),and performed abdominal ultrasound(US)and pathological biopsy(PB).The chi-square test and kappa consistency score were used to assess the consistency in terms of FL diagnosed by US relative to PB.Simple linear regression analysis was used to explore the variables related to TLW.Multiple linear regression analysis was used to formulate SLW models,and the root mean standard error and interclass correlation coefficient were used to test the fitting efficiency and accuracy of the model,respectively.Furthermore,the optimal formula was compared with previous formulas.RESULTS Approximately 28.8%of DDs had FL.US had a high diagnostic ability(sensitivity and specificity were 86.2%and 92.9%,respectively;kappa value was 0.70,P<0.001)for livers with more than a 5%fatty change.Simple linear regression analysis showed that sex(R2,0.226;P<0.001),BH(R2,0.241;P<0.001),BW(R2,0.441;P<0.001),BMI(R2,0.224;P<0.001),BSA(R2,0.454;P<0.001)and FL(R2,0.130;P<0.001)significantly impacted TLW.In addition,multiple linear regression analysis showed that there was no significant difference in liver weight between the DDs with no steatosis and those with steatosis within 5%.Furthermore,in the context of hepatic steatosis,TLW increased positively(nonlinear);compared with the TLW of the non-FL group,the TLW of the groups with hepatic steatosis within 5%,between 5%and 20%and more than 20%increased by 0 g,90 g,and 340 g,respectively.A novel formula,namely,-348.6+(110.7 x Sex[0=Female,1=Male])+958.0 x BSA+(179.8 x FLUS[0=No,1=Yes]),where FL was diagnosed by US,was more convenient and accurate than any other formula for predicting SLW.CONCLUSION FL is positively correlated with TLW.The novel formula deduced using sex,BSA and FLUS is the optimal formula for predicting SLW in adult DDs.

The Planning, Organization and Management of Post-disaster Reconstruction of the Lushan Earthquake Based on the Local as the Main Body

A new organization and management mechanism with the local government as the main body was created during the post-disaster reconstruction of the "4. 20 " Lushan earthquake,in which the experiences and lessons were drawn from the "5. 12"Wenchuan earthquake. Correspondingly, the local government conducted an exploration of the organization and management mode in the field of planning and construction. The effective experiences have been accumulated, including working out a full coverage planning,taking the leading part in the urban-rural planning,and exercising whole space control over the disaster area. An innovation management mode named as "Five Generals Pattern"was implemented in the construction projects. In view that the rural housing reconstruction was a weak link, a new approach to improving the construction management was investigated,by means of strengthening on-site supervision,establishing a technical platform,and bolstering public participation.

Marginal donor liver versus standard donor liver: A single-center observational study

Background:The effectiveness and safety of marginal donor livers remain controversial.This study aimed to investigate the clinical efficacy of marginal donor livers in patients with liver transplantation(LT).Methods:This study included 199 liver donors(including 16 split donors)and 206 liver recipients from January 1,2018 to January 27,2020,with case follow-up until July 31,2021.Clinical data of donors and recipients were retrospectively analyzed and were divided into the marginal donor and standard donor groups according to the criteria of marginal donor livers.Indices of liver and kidney functions,complications,and survival curves of the two groups were compared.Results:Compared with the standard donor group,the blood creatinine levels were significantly higher in the marginal donor group in the first week after operation(P<0.05);there were no significant differences in alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels after LT(all P>0.05);there was no significant difference in the incidence of complications after LT(P>0.05);there was also no significant difference in the survival curve(P=0.335).Conclusions:There were no significant differences in liver and kidney function and survival curve between the standard donor and marginal donor groups.The marginal donor liver appears safe and reliable for LT and may be an important strategy to expand the donor pool and solve the shortage of organs.

Unsymmetrical donor—acceptor—donor—acceptor type indoline based organic semiconductors with benzothiadiazole cores for solution-processed bulk heterojunction solar cells

Bulk heterojunction(BHJ) solar cells based on small molecules have attracted potential attention due to their promise of conveniently defined structures, high absorption coefficients, solution process-ability and easy fabrication. Three D—A—D—A type organic semiconductors(WS-31,WS-32 and WS-52) are synthesized, based on the indoline donor and benzotriazole auxiliary acceptor core, along with either bare thiophene or rigid cyclopentadithiophene as π bridge, rhodanine or carbonocyanidate as end-group. Their HOMO orbitals are delocalized throughout the whole molecules. Whereas the LUMOs are mainly localized on the acceptor part of structure, which reach up to benzothiadiazole, but no distribution on indoline donor. The first excitations for WS-31 and WS-32 are mainly originated by electron transition from HOMO to LUMO level, while for WS-52, partly related to transition between HOMO and LUMO+1 level. The small organic molecules are applied as donor components in bulk heterojunction(BHJ) organic solar cells, using PC_(61)BM as acceptor material to check their photovoltaic performances. The BHJ solar cells based on blended layer of WS-31:PC_(61)BM and WS-32:PC_(61)BM processed with chloroform show overall photoelectric conversion efficiency(PCE) of 0.56% and 1.02%, respectively. WS-32 based BHJ solar cells show a higher current density originated by its relatively larger driving force of photo-induced carrier in photo-active layer to LUMO of PC_(61)BM.

Small molecule donors with different conjugated π linking bridges: Synthesis and photovoltaic properties

Three small molecule(SM)donors,namely B-T-CN,B-TT-CN and B-DTT-CN,with differentπconjugated bridges were synthesized in this research.Interestingly,with the conjugated fused rings of theπlinking bridge increasing,the SM HOMO levels exhibit a decline tendency with–5.27 eV for B-T-CN,–5.31 eV for B-TT-CN and–5.40 eV for B-DTT-CN.After blending the SM donors with the fullerene acceptor PC71BM,the all SM organic solar cells(OSCs)achieved high Vocs of 0.90 to 0.96 V.However,the phase separation morphology and molecule stacking are also unexpectedly changed together with the enhancement of conjugated degree ofπbridges,resulting in a lower power conversion efficiency(PCE)for the B-DTT-CN:PC71BM device.Our results demonstrate and provide a useful way to enhance OSC Voc and the morphology needs to be further optimized.

A Thiazole-Based Polymer Donor for Efficient Organic Solar Cells

The development of new materials plays a critical role in improving the efficiency of organic solar cells(OSCs).At present,the relatively high-lying highest occupied molecular orbital(HOMO)level of the high-efficiency polymer donor is regarded as one of the main reasons for the low open-circuit voltage(V_(OC)).In this work,we introduced the strong electron-withdrawing thiazole unit into the construction of a polymer donor.We designed and prepared an alternating donor-acceptor material,namely PSZ,by copolymerizing 4-methyl thiazole with an electron-donating benzodithiophene unit and studied its application in high-efficiency OSCs.The optical and electrical properties of the new material were characterized by UV-Vis absorption spectroscopy and electrochemical cyclic voltammetry.Results show that PSZ is a typical wide-bandgap material with a high optical bandgap of 2.0 eV and a deep HOMO level of-5.70 eV.When a non-fullerene BTP-eC9 was selected as the acceptor material,V_(OC) reached 0.88 V in the resulting device,and the corresponding power conversion efficiency(PCE)was8.15%.In addition,when PSZ was added as the third component to the binary photoactive combination with PBDB-TF as the donor and BTP-eC9 as the acceptor,V_(OC) of the cell device could be increased,thereby obtaining a high PCE of 17.4%.These results indicated that introducing thiazole units into polymer donors can remarkably reduce the HOMO levels and improve V_(OC) and PCE in OSCs.