Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

BACKGROUND Early in the coronavirus disease 2019(COVID-19)pandemic,there was a significant impact on routine medical care in the United States,including in fields of transplantation and oncology.AIM To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation(LT)for hepatocellular carcinoma(HCC)in the United States.METHODS WHO declared COVID-19 as a pandemic on March 11,2020.We retrospectively analyzed data from the United Network for Organ Sharing(UNOS)database regarding adult LT with confirmed HCC on explant in 2019 and 2020.We defined pre-COVID period from March 11 to September 11,2019,and early-COVID period as from March 11 to September 11,2020.RESULTS Overall,23.5%fewer LT for HCC were performed during the COVID period(518 vs 675,P<0.05).This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July 2020.Among LT recipients for HCC,concurrent diagnosis of non-alcoholic steatohepatitis significantly increased(23 vs 16%)and alcoholic liver disease(ALD)significantly decreased(18 vs 22%)during the COVID period.Recipient age,gender,BMI,and MELD score were statistically similar between two groups,while waiting list time decreased during the COVID period(279 days vs 300 days,P=0.041).Among pathological characteristics of HCC,vascular invasion was more prominent during COVID period(P<0.01),while other features were the same.While the donor age and other characteristics remained same,the distance between donor and recipient hospitals was significantly increased(P<0.01)and donor risk index was significantly higher(1.68 vs 1.59,P<0.01)during COVID period.Among outcomes,90-day overall and graft survival were the same,but 180-day overall and graft were significantly inferior during COVID period(94.7 vs 97.0%,P=0.048).On multivariable Coxhazard regression analysis,COVID period emerged as a significant risk factor of post-transplant mortality(Hazard ratio 1.85;95%CI:1.28-2.68,P=0.001).CONCLUSION During COVID period,there was a significant decrease in LTs performed for HCC.While early postoperative outcomes of LT for HCC were same,the overall and graft survival of LTs for HCC after 180 days were significantly inferior.

Impact of utilization of hepatitis C positive organs in liver transplant:Analysis of united network for organ sharing database

BACKGROUND The utility of hepatitis C virus(HCV)organs has increased after the Food and Drug Administration approval of direct acting anti-viral(DAA)medications for the HCV treatment.The efficacy of DAA in treating HCV is nearly 100%.AIM To analyze the United Network for Organ Sharing(UNOS)database to compare the survival rates between the hepatitis C positive donors and negative recipients and hepatitis C negative donors and recipients.METHODS We analyzed the adult patients in UNOS database who underwent deceased donor liver transplant from January 2014 to December 2017.The primary endpoint was to compare the survival rates among the four groups with different hepatitis C donor and recipient status:(Group 1)Both donor and recipient negative for HCV(Group 2)Negative donor and positive recipient for HCV(Group 3)Positive donor and negative recipient for HCV(Group 4)Both positive donor and recipient for HCV.SAS 9.4 software was used for the data analysis.Kaplan Meier log rank test was used to analyze the estimated survival rates among the four groups.RESULTS A total of 24512 patients were included:Group 1:16436,Group 2:6174,Group 3:253 and Group 4:1649.The 1-year(Group 1:91.8%,Group 2:92.12%,Group 3:87%,Group 4:92.8%),2-year(Group 1:88.4%,Group 2:88.1%,Group 3:84.3%,Group 4:87.5%),3-year(Group 1:84.9%,Group 2:84.3%,Group 3:75.9%,Group 4:83.2%)survival rates showed no statistical significance among the four groups.Kaplan Meier log rank test did not show any statistical significance difference in the estimated survival rates between Group 3 vs all the other groups.CONCLUSION The survival rates in hepatitis C positive donors and negative recipients are similar as compared to both hepatitis C negative donors and recipients.This could be due to the use of DAA therapy with cure rates of nearly 100%.This study supports the use of hepatitis C positive organs in the selected group of recipients with and without HCV infection.Further long-term studies are needed to further validate these findings.

Equality Testing for Soil Grid Unit Resolutions to Polygon Unit Scales with DNDC Modeling of Regional SOC Pools

Matching soil grid unit resolutions with polygon unit map scales is important to minimize the uncertainty of regional soil organic carbon(SOC) pool simulation due to their strong influences on the modeling.A series of soil grid units at varying cell sizes was derived from soil polygon units at six map scales,namely,1:50 000(C5),1:200 000(D2),1:500 000(P5),1:1 000 000(N1),1:4 000 000(N4) and 1:14 000 000(N14),in the Taihu Region of China.Both soil unit formats were used for regional SOC pool simulation with a De Nitrification-DeC omposition(DNDC) process-based model,which spans the time period from 1982 to 2000 at the six map scales.Four indices,namely,soil type number(STN),area(AREA),average SOC density(ASOCD) and total SOC stocks(SOCS) of surface paddy soils that were simulated by the DNDC,were distinguished from all these soil polygon and grid units.Subjecting to the four index values(IV) from the parent polygon units,the variations in an index value(VIV,%) from the grid units were used to assess its dataset accuracy and redundancy,which reflects the uncertainty in the simulation of SOC pools.Optimal soil grid unit resolutions were generated and suggested for the DNDC simulation of regional SOC pools,matching their respective soil polygon unit map scales.With these optimal raster resolutions,the soil grid units datasets can have the same accuracy as their parent polygon units datasets without any redundancy,when VIV < 1% was assumed to be a criterion for all four indices.A quadratic curve regression model,namely,y = – 0.80 × 10^(–6)x^2 + 0.0228 x + 0.0211(R^2 = 0.9994,P < 0.05),and a power function model R? = 10.394?^(0.2153)(R^2 = 0.9759,P < 0.05) were revealed,which describe the relationship between the optimal soil grid unit resolution(y,km) and soil polygon unit map scale(1:10 000x),the ratio(R?,%) of the optimal soil grid size to average polygon patch size(?,km^2) and the ?,with the highest R^2 among different mathematical regressions,respectively.This knowledge may facilitate the grid partitioning of regions during the investigation and simulation of SOC pool dynamics at a certain map scale,and be referenced to other landscape polygon patches' mesh partition.

Integrating Sustainable Development into Global Institutions:Reforming the United Nations

This article will briefly outline the origins,structure and functions of United Nations Environment Program and the Commission on Sustainable Development in the context of the goals of ecologically sustainable development(ESD).Economic development,social development and environmental protection form the three interconnected parts of ESD.The achievements of the key UN environmental institutions and programs in opening up the global system to civil society,the private sector and a diversity of actors and interests,promoting the role of poverty alleviation as part of ESD through the Millennium Development Goals,and facilitating important Multilateral Environmental Agreements should be recognized.However,with these notable exceptions,organizations such as United Nations Environment Program and the Commission on Sustainable Development have become weak in scientific and technical leadership,global policy,co-ordination(inside and outside the UN) and has few achievements in the international and national implementation of obligations and standards in Global Environmental Governance-including enforcement,compliance and effectiveness.This article will outline the key reasons for this inadequacy.Attention will also be focused on the way forward through of a new United Nations Environment Organization.This will require a clarification of purpose and function(within the UN system and as part of global governance structures) as well as consideration of whether it depends on system-wide UN reform.It is recommended that medium and long term strategies for reform are necessary.

Layered(C_(5)H_(6)ON)_(2)[Sb_(2)O(C_(2)O_(4))_(3)]with a large birefringence derived from the uniform arrangement of π-conjugated units

An organic-inorganic hybrid antimony(Ⅲ)oxalate(C_(5)H_(6)ON)_(2)[Sb_(2)O(C_(2)O_(4))_(3)]has been successfully obtained by simultaneous combination of a-conjugated 4-hydroxypyridine and(C_(2)O_(4))^(2-)group with stereochemical active Sb(Ⅲ)cation.The compound features a layered structure,and the equatorial planes of SbO6 units,π-conjugated(C_(2)O_(4))^(2-)and(C5H6ON)+groups are closer to a planar arrangement,representing strong structural anisotropy that favors a large birefringence.As expected,(C_(5)H_(6)ON)_(2)[Sb_(2)O(C_(2)O_(4))_(3)]exhibits a large birefringence of 0.279 at 546 nm.Structural and theoretical analyses indicate that the combination of multipleπ-conjugated units is a feasible approach for designing and exploring new superior birefringent materials.

Analysis of hepatitis C virus-positive organs in liver transplantation

The authors of this study note that in liver transplantation(LT),the survival rates of hepatitis C virus(HCV)-positive donors and HCV-negative receivers are compa-rable to those of HCV-negative donors and recipients.Direct-acting antiviral(DAA)therapies have nearly 100%effectiveness in treating HCV.Between 2006 and 2016,the percentages of HCV-positive patients on the waiting list and HCVpositive LT recipients fell by 8.2 percent and 7.6 percent,respectively.Records from April 1,2014,in which the donor and receiver were both at least 18 years old and had a positive HCV status,were the only ones eligible for the study.The analysis for this study was restricted to the first transplant recorded for each patient using a data element that documented the number of prior transplants for each recipient,although some recipients appeared multiple times in the data set.HCV-positive recipients or people with fulminant hepatic failure were the main beneficiaries of primary biliary cirrhosis among HCV-positive donors.However,there is still a reticence to use HCV-positive donor organs in HCV recipients due to clinical and ethical considerations.Similar survival rates between HCV-positive donors and recipients and HCV-negative donors and receivers illustrate the efficacy of these DAA regimens.

Molecular uniting set identified characteristic(MUSIC): a promising strategy for purely organic RTP luminogens

The room temperature phosphorescences（RTP）are of growing interest owing to their promising applications in material science and bioimaging.To date,the lumiogens showing persistent RTP effect mainly contain the noble metals which have the shortcomings such as high cost,potential toxicity.The exploration of metal free luminogens,i.e.,purely organic RTP luminogens,is thus of great importance for the community.