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Background@#In lung transplantation, human leukocyte antigen (HLA) compatibility is not included in the lung allocation score system or considered when placing donor allografts.However, HLA matching may affect the outcomes of lung transplantation. This study evaluated the current assessment status, prevalence, and effects of HLA crossmatching in lung transplantation in Korean patients using nationwide multicenter registry data. @*Methods@#Two hundred and twenty patients who received lung transplantation at six tertiary hospitals in South Korea between March 2015 and December 2019 were retrospectively reviewed. Clinical data, including general demographic characteristics, primary diagnosis, and pretransplant status of the recipients and donors registered by the Korean Organ Transplant Registry, were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method with log-rank tests. @*Results@#Complement-dependent cytotoxic crossmatch (CDC-XM) was performed in 208 patients (94.5%) and flow cytometric crossmatch (flow-XM) was performed in 125 patients (56.8%). Among them, nine patients (4.1%) showed T cell- and/or B cell-positive crossmatches. The incidences of postoperative complications, including primary graft dysfunction, acute rejection, and chronic allograft dysfunction in positively crossmatched patients, were not significant compared with those in patients without mismatches.Moreover, Kaplan-Meier analyses showed poorer 1-year survival in patients with positive crossmatch according to CDC-XM (P < 0.001) and T lymphocyte XM (P = 0.002) than in patients without mismatches. @*Conclusion@#Positive CDC and T lymphocyte crossmatching results should be considered in the allocation of donor lungs. If unavailable, the result should be considered for postoperative management in lung transplantation.
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Background@#The purpose of this study is to investigate the effect of liquefied digestive medicines on the composite resin surface. @*Methods@#Three types of liquefied digestive medicines (Gashwalmyeongsu, Wicheongsu, and Saengrokcheon) were selected as experimental groups, Samdasoo and Chamisul as negative controls, and Trevi as positive controls were selected to measure pH and titratable acidity. The samples filled with resin at acrylic were made total 300, 50 per group. To evaluate the erosion risk of the composite resin, the specimens were immersed in a liquefied medicine for 1, 3, 5, 15, and 30 minutes, and then the surface microhardness was measured using the Vickers Hardness Number, and the surface change was observed with scanning electron microscope (SEM). @*Results@#The average pH of the three liquefied medicine was 3.75±0.30, the Saengrokcheon was the lowest at 3.45±0.01, and the Trevi was 4.66 and Samdasoo and Chamisul were 7.40 and 8.58, respectively. The amount of NaOH reaching pH 5.5 and 7.0 was the lowest in the order of Trevi, Gashwalmyeongsu, Wicheongsu, and Saengrokcheon. The largest surface hardness reduction value was shown in Gashwalmyeongsu (−11.85±3.73), followed by Saengrokcheon (−9.79±3.11) and Wicheongsu (−8.28±2.83), and Samdasoo (−0.84±1.56) and Chamisul (−6.24±0.42) had relatively low surface hardness reduction values. However, Trevi (−16.67±5.41), a positive control group containing carbonic acid, showed a higher decrease in surface hardness than the experimental group. As a result of observation with SEM, experimental group and positive control group, showed rough surfaces and irregular cracks, and negative control groups showed smooth patterns similar to before immersion. @*Conclusion@#The liquefied digestive medicine with low pH could weaken the composite resin surface, and the carbonic acid component could more effect on the physical properties of the composite resin than pH.
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Purpose@#Calcineurin inhibitor (CNI) use has improved lung transplantation outcomes. However, significant perioperative complications in patients receiving CNI can deteriorate the early course of lung transplantation. To date, there is no consensus regarding the optimal agent for the induction regimen after lung transplantation. We aimed to determine the efficacy of basiliximab induction with delayed CNI initiation in the prevention of acute complications without compromising immunosuppression in high-risk patients. @*Materials and Methods@#Between January 2013 and December 2019, 236 patients at a single lung transplant center were retrospectively reviewed. Forty-one patients (17.4%) received basiliximab induction, and 195 patients (82.6%) received a routine triple-drug regimen without induction. The primary endpoint was postoperative acute kidney injury with several other postoperative outcomes as secondary end-points. @*Results@#Preoperatively, the induction group had a higher proportion of patients who were admitted before transplantation (95.1% vs. 47.7%, p<0.001) and received intensive unit care (90.2% vs. 33.8%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (87.8% vs. 20.0%, p<0.001) compared to the non-induction group. No significant differences were observed in the incidence of acute rejection between groups (p=0.657), although lower incidence of postoperative complications, including acute kidney injuries or culture-proven infections, were observed in the induction group. However, the differences were not statistically significant. A subgroup analysis of high-risk and preoperative ECMO support groups showed similar results. @*Conclusion@#Basiliximab induction with delayed CNI initiation for high-risk patients might decrease the incidence of perioperative complications, including acute renal failure, without increasing the risk of acute rejection.
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Abstract: This study aimed to evaluate the effects of a bioabsorbable bone hemostatic agent comprising poly (ethylene glycolpropylene glycol) copolymers (PEG-PPG) on hemostasis and osteogenesis. Bilateral 3 mm diameter calvarial defects were created in 99 male Sprague-Dawley rats. The defects were filled with PEG-PPG or bone wax. The defects of control group were left unfilled.Virtual autopsy was performed to evaluate bioabsorption. The calvaria were subjected to x-ray microtomography (microCT) and histological examination. Bone volume fraction (BV/TV) and bone mineral density (BMD) were measured using microCT;furthermore, white blood cell count and histological examination were performed. After application of PEG-PPG and bone wax, immediate hemostasis was achieved. Autopsy revealed that PEG-PPG disappeared within 48 h at the application site; in contrast, bone wax remained until 12 weeks. The PEG-PPG and control groups showed significantly more osteogenesis than the bone wax group with respect to BV/TV and BMD at 3, 6, and 12 weeks (p < 0.05). Histology revealed that the bone wax group exhibited little bone formation with inflammation. In contrast, PEG-PPG and control groups showed significantly more qualitative osteogenesis than the bone wax group (p < 0.01). In conclusion, PEG-PPG showed immediate hemostasis and was absorbed to allow progressive osteogenesis.
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BACKGROUND: Airway anastomotic complications are a leading cause of mortality after lung transplantation. Among the factors that cause airway complications, preoperative steroid use has been considered to be related with postoperative airway healing. We analyzed the influence of preoperative steroid use on postoperative airway complications. METHODS: The medical records of 66 double-lung transplant recipients from January 2014 to December 2015 were reviewed. Forty patients were prescribed steroids preoperatively. The daily steroid dose was standardized using the patient’s body mass index (BMI). Patients who received preoperative steroids were sub-divided into high-dose (HD) and low-dose (LD) groups (cut-off value, 1.6 mg/BMI/day). RESULTS: Thirteen patients suffered from airway complications postoperatively (bronchopulmonary fistula, 9; bronchial stenosis, 4). There was a tendency for early development of airway complications in the steroid use group compared to the non-steroid use group, but it was not significant (percentage free from airway complications in year 1: non-steroid group, 90.9% vs. steroid group, 79.2%; p=0.43). The percentage of patients in the LD and HD groups who were free from airway complications in year 1 was not significantly different (84.0% vs. 77.8%, p=0.39). CONCLUSION: The airway complication rate did not vary significantly according to steroid use. Additionally, in patients who received preoperative steroids, the dose did not affect the rate of development of airway complications.
Subject(s)
Humans , Body Mass Index , Constriction, Pathologic , Fistula , Lung Transplantation , Lung , Medical Records , Mortality , Steroids , Transplant RecipientsABSTRACT
BACKGROUND: Vitamin D has been associated with sepsis in pediatric and adult patients. The association with neonates is unclear. This systematic review and meta-analysis examined the effect of neonatal and maternal vitamin D levels on neonatal early-onset sepsis. METHODS: We searched studies published up to November 2017 in PubMed/Medline, Embase, and the Cochrane Library databases. All studies that reported 25-hydroxyvitamin D levels in neonates with or without early-onset sepsis were included. Meta-analysis was performed using RevMan 5.3 software. RESULTS: Four studies were eligible. The weighted mean difference of 25-hydroxyvitamin D levels in neonates with early-onset sepsis and controls was −7.27 ng/mL (95% confidence interval = −7.62, −6.92). Maternal vitamin D levels in neonates with early-onset sepsis were significantly lower than those in controls (weighted mean difference −7.24 ng/mL, 95% confidence interval −8.45, −6.03). All neonates with early onset sepsis had vitamin D deficiency (25-hydroxyvitamin D < 20 ng/mL). CONCLUSION: Lower neonatal and maternal 25-hydroxyvitamin D levels were associated with neonatal early-onset sepsis. Vitamin D supplementation during pregnancy may be helpful to prevent neonatal early-onset sepsis. The effects of vitamin D supplementation on early-onset sepsis in neonates warrant further study.
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Spontaneous perforation of the esophagus after forceful vomiting is known as Boerhaave syndrome, a rare and life-threatening condition associated with a high rate of mortality. The management of Boerhaave syndrome is challenging, especially when diagnosed late. Herein, we report the successful management of late-diagnosed Boerhaave syndrome with T-tube drainage in a 55-year-old man. The patient was transferred to our institution 8 days after the onset of symptoms, successfully managed by placing a T-tube, and was discharged on postoperative day 46 without complications.
Subject(s)
Humans , Middle Aged , Delayed Diagnosis , Drainage , Esophagus , Mortality , Rupture , Thoracic Surgery, Video-Assisted , VomitingABSTRACT
Patients with venoarterial extracorporeal membrane oxygenation (ECMO) frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA) decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.