Clinical Profile of Mucormycosis Patients during Coronavirus Disease 2019 Pandemic: A Retrospective Observational Study.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, an increased incidence of mucormycosis infection was noted globally, the majority being from India. We aimed to study the clinical profile of the mucormycosis patients during the COVID-19 pandemic admitted at tertiary care centers. MATERIALS AND METHODS: This is a retrospective record-based observation study conducted at Gandhi Medical College, Bhopal. All suspected or laboratory-proven mucormycosis patients were included. Detailed data on demography, clinical features, risk factors, laboratory/radiological findings, and outcomes were recorded. RESULTS: A total of 288 patients were enrolled and 121(42%) showed mucormycosis on potassium hydroxide (KOH) mount. The mean age was 51.52 ± 10.88 years, male:female ratio was 2.3:1. Most common symptom was facial swelling/pain and fever. The most common risk factor was COVID-19 infection (78.5%) followed by the presence of diabetes mellitus (DM) (70.8%) out of which 152 (52.8%) patients were previously diagnosed cases and 52 (18%) patients were newly diagnosed, 159 (55.2%) had a history of corticosteroid use, 87 (30.2%) had a history of use of oxygen support and 67 (23.2%) had hypertension. Most patients had invasion limited to sinus (46.5%) but the presence of DM was associated with an increased risk of cerebral invasion. Out of 288 patients admitted with mucormycosis, 31 patients collapsed to death while the remaining 257 patients were discharged from the hospital. CONCLUSION: It is observed that during the COVID-19 pandemic, hyperglycemia and inappropriate use of corticosteroids were associated with an increased risk of development of mucormycosis in patients with or without DM. We conclude that regular blood glucose monitoring, adequate glycemic control, and judicious evidence-based use of corticosteroids and immunosuppressants in COVID-19 are recommended to reduce the emergence of mucormycosis in such circumstances.

Long-term treatment results of conventional and hypofractionation radiotherapy in postmastectomy cancer breast patients: A retrospective study from rural cancer center of Maharashtra, India.

AIM: This study aims to evaluate the long-term treatment outcome of conventional and hypofractionation radiotherapy in postmastectomy cancer breast patients. MATERIAL AND METHODS: A total of 140 postmastectomy breast cancer patients were included in this retrospective study, who were treated from 2012 to 2014 with chemotherapy and various fractionation radiotherapy schedules. Radiotherapy treatment records for study group-I received radiotherapy 4256 cGy in 16 fractions over 3½ weeks, group-II patients received 4005 cGy in 15 fractions over 3 weeks, and conventional radiotherapy group-III received 5000 cGy in 25 fractions over 5 weeks. RESULTS: The median follow-up of patients from all groups was 60 months (range 9 to 111 months). There were 39 cases with disease failure, 13 (26%) in group I (42.56 Gy), 16 (40%) in group II (40.05 Gy), and 10 (20%) in group III (50 Gy). There were 4 locoregional recurrences (LRRs), two isolated, and 11 distant failures in group I, 3 LRRs (1 isolated LRR) and 15 distant failures in group II, and only one LRR and 9 distant failures in group III. The disease-free survival (DFS) were 74%, 60%, and 80%, respectively, in groups I, II, and III (P =0.044). CONCLUSION: The long-term results of this study show that hypofractionation radiotherapy in postmastectomy cases is well tolerated and acute and late side effects are also comparable to conventional fractionation. In our study, locoregional and distant failure seems slightly higher with hypofractionation schedules than in other studies, highlighting the need for more studies with long-term follow-up in postmastectomy patients.

Preference for imperfect produce: The influence of political ideology and openness to experience.

Food waste is a critical global issue, posing substantial environmental, social, and financial challenges, even as millions continue to face uncertainty regarding their next meal source. The seriousness of this problem necessitates a closer look into ways to reduce food waste. In this investigation, we identify a key factor which contributes to food waste-imperfect fruits and vegetables (FaVs), defined as foods that are non-uniform in shape, color, or texture. Because of their unusual and sometimes ugly appearance, people are often averse to buying them, making it important to understand factors that influence people's acceptance or rejection of imperfect FaVs. Across four online studies (including an exploratory study) with nearly 1400 U.S. respondents and using varied designs, we test political ideology as a moderator of this aversion to imperfect FaVs. Our findings indicate that politically conservative people are less likely to purchase imperfect FaVs (vs. perfect FaVs) compared to politically liberal people. The last study also uncovers the psychological mechanism underlying this greater aversion to FaVs by conservatives: lower openness to experience explains why this segment of population may be less willing to purchase imperfect FaVs. Implications and future research directions are discussed.

Sustaining Livelihoods or Saving Lives? Economic System Justification in the Time of COVID-19.

An ongoing debate in the United States relating to COVID-19 features the purported tension between containing the coronavirus to save lives or opening the economy to sustain livelihoods, with ethical overtones on both sides. Proponents of opening the economy argue that sustaining livelihoods should be prioritized over virus containment, with ethicists asking, "What about the risk to human life?" Defendants of restricting the spread of the virus endorse saving lives through virus containment but contend with the ethical concern "What about people's livelihoods and individual freedoms?" A commonly held belief is that political ideology drives these differential preferences: liberals are more focused on saving lives, whereas conservatives favor sustaining livelihoods with no additional government intervention in the free-market economy. We examine these lay beliefs among US residents in four studies and find that economic system justification (ESJ), an ideology that defends the prevailing economic system when under threat, is a reliable psychological predictor beyond political ideology. Specifically, compared to those who scored low on ESJ, people who scored high on ESJ judged China as more justified in downplaying the spread of virus to protect its interest in the global free-market economy, supported in-person over online learning, viewed shelter in place as less desirable, and perceived the opening of the Texas economy as more legitimate. We also find that multiple psychological mechanisms might be at work-resistance to market interventions, perceived legitimacy of opening the economy, perceived seriousness of the health crisis, and violation of human rights. Supplementary Information: The online version contains supplementary material available at 10.1007/s10551-022-05091-4.

Concurrent chemotherapy with high-dose rate brachytherapy after treatment with chemoradiotherapy in cases of locally advanced carcinoma cervix: A study from rural area of Maharashtra, India.

Aim: This study aims to evaluate the efficacy, feasibility, tolerability, and toxicity of concurrent chemotherapy and brachytherapy for locally advanced cervical carcinoma. Materials and Methods: Forty patients of cervical carcinoma were included in this study. The study period ranges from October 2016 to September 2019. Patients were evaluated and treated as per the protocol: external beam radiotherapy (50 Gy in 25 fractions) and concurrent weekly chemotherapy with injection (Inj.) cisplatin (30 mg/m2) followed by high-dose rate brachytherapy (3 fractions of 7 Gy each) and concurrent chemotherapy Inj. cisplatin (30 mg/m2). Results: Out of 40 patients enrolled in the study, 36 patients completed the treatment (17 Stage II and 19 Stage III). The incidence of Grade I and II skin toxicities were 78% and 10%, respectively. The incidence of genitourinary toxicities with respect to Grade I and II were 72% and 12%, respectively. There were Grade III hematological toxicities in two patients and the brachytherapy treatment was delayed for 4-6 days. The overall complete response was found in 28 (78%) patients, partial response in six (16.7%) patients, and progressive disease in two (5.6%) patients at 3 months of follow-up. On the last follow-up, 21 (58%) patients were disease-free and there was disease failure in seven patients (5 local recurrence and 2 with distant metastasis). Conclusion: Brachytherapy with the addition of concurrent chemotherapy is effective and feasible with acceptable toxicity for advanced stages of carcinoma cervix. This study upholds an interesting approach that can be regarded as feasible and tolerable for cervical cancer patients.

Perceived financial constraints and normative influence: discretionary purchase decisions across cultures.

Five studies examine how perceived financial constraints and abundance determine when consumers will engage in solitary or social purchases. When financially constrained, consumers prefer solitary (vs. social) purchases. We also identify self-construal as a moderator of how consumers spend their discretionary income. While independent consumers prefer solitary (vs. social) purchases, interdependent consumers prefer social (vs. solitary) purchases. Interestingly, when consumers have adequate discretionary income, independent as well as interdependent consumers have similar preferences for solitary and social purchases. In addition, for interdependent consumers, communal norms mediate the preference for social purchases. Finally, for independent consumers, making the communal norm salient reverses their preference for solitary purchases, resulting in a preference for social purchases. Our findings suggest how managers can effectively promote different types of purchases under varying financial resource conditions in their global communication strategy. Supplementary Information: The online version contains supplementary material available at 10.1007/s11747-021-00814-x.

Pandemics and marketing: insights, impacts, and research opportunities.

Pandemics have been an unfortunate but consistent facet of human existence over centuries, threatening lives as well as livelihoods globally. Disconcertingly, their frequency persists, with four "major" pandemics disrupting the planet in the last 65 years and more expected in the future. While many of the economic and health consequences of pandemics are well-documented, their marketing implications are less understood. Addressing this gap, we develop a broad, conceptual framework to highlight the characteristics and impacts of pandemics as they relate to marketing. We first identify four macro-level forces that characterize pandemics and highlight their marketing implications. Next, using the 7P marketing mix model as the organizing structure, we discuss these implications at a micro-level and identify a set of research questions to stimulate further inquiry, not only to generate deeper insights pertaining to pandemics' marketing implications but also to envision new developments in these areas. Finally, we identify pandemics' disproportionate impacts on and implications for some industry sectors, including healthcare, retail, education, hospitality, and tourism.

Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India.

BACKGROUND: Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome. OBJECTIVES: This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India. MATERIALS AND METHODS: Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study. RESULTS AND CONCLUSIONS: Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.

Subcutaneous Injection of Botulinum Toxin in Patients with Post Herpetic Neuralgia. A Preliminary Study.

BACKGROUND: Post Herpetic neuralgia (PHN) is neuropathic pain that occurs after herpes zoster infection. Several treatments have been suggested in the management of PHN. This study evaluates the efficacy of subcutaneous injection of botulinum toxin in patients suffering from PHN. METHODS: Nineteen patients suffering from PHN for more than 2 months were enrolled in the study. The severity of pain was assessed by visual analog scale (VAS). A total dose 500 units of BTX-A was injected around the site of pain. This was administered in about 25 sub-cutaneous injection around the site, delivering approximately 20U/ml of BTX-A per injection. The patients were followed at 1,2, 3,4,12 and 16 weeks after the administration of the drug. RESULTS: The mean age was 56 years (age range 36 to 63) for non-pregnant patients. The two pregnant patients of age 28 and 32 year old who were in their 28 and 30 weeks of gestation were also included. The mean duration of PHN was 4.78 wks. At each visit VAS was used to evaluate the degree of pain (0: painless; 10: maximum pain). There was a significant reduction in the severity of pain after the injection. CONCLUSIONS: Botulinum toxin significantly decreases the severity of pain in PHN patients and last for 4-6 month of the period. This decrease is less prominent by passing time.

Overall treatment duration with multimodality treatment approach and outcome results in oral cavity carcinoma: A study from an institute from central India.

OBJECTIVE OF THE STUDY: To see the different age groups, gender, sites, disease stage, treatment outcome of various oral cavity sites carcinoma by combined modalities and the overall treatment duration. MATERIALS AND METHODS: A total of 212 oral cavity carcinoma patients (169 males and 43 females) with complete records (from September 2009 to December 2012) were analyzed for age, sex, histopathology, associated medical illnesses, various subsites with disease stage, various treatment modalities with the duration and follow-up records for disease control as well as disease failure at local, nodal, local + nodal, and distant metastasis. RESULTS: The most common site in oral cavity cancer was buccal mucosa 81 (38.20%). 149 (69%) patients reported were in advanced Stages III and IV of the disease. The majority of patients 149 (70.28%) were given chemotherapy + radiotherapy postoperatively (S-CRT group). The mean follow-up for all patients was 41 months (range = 21-59 months). In terms of overall disease control and metastases-free survival, the best results were (80%) for Stage I in all oral cavity sites. Irrespective of disease stage best results (59.57%) were in alveolar ridge subsite of oral cavity carcinoma. CONCLUSION: Challenges are still lie ahead in treating head and neck carcinoma, as in spite of using multimodality treatment approach and biological and molecular research, the overall survival percentage has not changed much. In India as oral cavity carcinoma is in increasing trend in younger individuals massive health promotion and awareness programs targeting the risk population along with financial support for those already affected are required.

Effect of vitamin D level on the immunogenicity to hepatitis B vaccination in dialysis patients.

We undertook this study to assess the response of hepatitis B vaccination in dialysis patients and the effect of vitamin D level on the immunogenicity to hepatitis B vaccination. It was an observational study, which included 60 patients of end-stage renal disease on maintenance dialysis. Patients with anti-HBs antibody positive at baseline were excluded. All received intramuscular recombinant hepatitis B vaccination at 0, 1, 2, and 6 months 20 µg on each deltoid muscle bilateral. Anti-HBs antibody titers were measured at 4 and 7 months of vaccination and the titer ≥10 mIU/mL was considered as "positive". Vitamin D levels were measured at baseline before starting the vaccination. The mean vitamin D level was 15.0 ± 7.8 ng/mL. The vitamin D level <10 and <20 were 23.3% and 83.3%, respectively. The patients on hemodialysis had relatively higher vitamin D level than on peritoneal dialysis patients, i.e. 16.3 ± 8.5 and 11.5 ± 3.1 ng/mL, respectively (p = 0.03). Overall, 38 patients responded to the immunization (63.3%) and 11 patients were non-responders (36.7%) at 4 months. Difference of vitamin D level in responder (16.6 ± 9.1 ng/mL) and non-responder (12.4 ± 4.1 ng/mL) was not significant (p = 0.16). At 7 months (1 month after completion of vaccination) 61.9% were responders and 38.1% were non-responders. The vitamin D level in responders and non-responders were statistically not significant (p = 0.11). In responder, titer ≥100 mIU/mL was seen in 30% at 4 months and in 42.9% at 7 months (p = 0.05). In the good and weak responders at 7 months, vitamin D levels were 21.5 ± 10.8 and 10.1 ± 3.7 ng/mL, respectively (p = 0.37). The association of vitamin D level and anti-HBs antibody titer were not significant (r = 0.03 and 95% CI was -0.43 to 0.48, p = 0.89) in those who responded. Most patients on dialysis were vitamin D deficient. Vitamin D levels did not differ between responding and non-responding dialysis patients.

Significance of ovoid separation with various applications of high-dose-rate-intracavitary radiotherapy in carcinoma of uterine cervix: a study from rural centre of Maharashtra, India.

AIMS: To analyze the differences in dose distribution, with ovoid separation in various applications, by different radiotherapists in the same patient of carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary Radio therapy (ICRT). SETTINGS: Pravara Rural Hospital and Rural Medical College. DESIGN: Retrospective study. MATERIALS AND METHODS: Retrospective analysis of six cases of carcinoma uterine cervix, randomly chosen in the period from January 2004 and December 2007. Three selected radiotherapists performed the applicator placement for ICRT on the aforementioned patients in a consistent pattern-three consecutive ICRT treatments separated by weekly intervals. Ovoid separation was categorized into three groups: < 25 mm, 26-35 mm and > 36 mm. Prescribed point 'A' isodose lines with maximum separation laterally in right and left parametrium and antero-posteriorly in lateral plane was calculated for all 36 isodose charts for the 18 ICRT applications. RESULTS: In this study, there proves to be a significant difference in the ovoid separation between the applications of the different radiotherapists in the same patient with multiple fractions of HDR-ICRT. The applications done by 'A' radiotherapist resulted in an ovoid separation of < 25 mm more often, 'B' radiotherapist of > 36 mm while, 'C' radiotherapist fell in between the two. DISCUSSION AND CONCLUSION: With more ovoid separation, lateral dose to parametrium was improved; however, antero-posterior dose was not significantly affected. In order to determine the best dose distribution, as evident in the dose charts of 'C' radiotherapist, it is recommended to choose the optimum ovoid separation in accordance to the patient's anatomy.

Improved preservation of warm ischemic livers by hypothermic machine perfusion with supplemented University of Wisconsin solution.

Hypothermic machine perfusion (HMP) has the potential to improve recovery and preservation of Donation after Cardiac Death (DCD) livers, including uncontrolled DCD livers. However, current perfusion solutions lack the needed substrates to improve energy recovery and minimize hepatic injury, if warm ischemic time (WIT) is extended. This proof-of-concept study tested the hypothesis that the University of Wisconsin (UW) solution supplemented with anaplerotic substrates, calcium chloride, thromboxane A2 inhibitor, and antioxidants could improve HMP preservation and minimize reperfusion injury of warm ischemic livers. Preflushed rat livers subjected to 60 min WIT were preserved for 5 h with standard UW or supplemented UW (SUW) solution. Post preservation hepatic functions and viability were assessed during isolated perfusion with Krebs-Henseleit solution. Livers preserved with SUW showed significantly (p < .001) improved recovery of tissue ATP levels (micromol/g liver), 2.06 +/- 0.10 (mean +/- SE), as compared to the UW group, 0.70 +/- 0.10, and the level was 80% of that of fresh control livers (2.60 +/- 0.13). At the end of 1 h of rewarming, lactate dehydrogenase (U/L) in the perfusate was significantly (p < .05) lower in the SUW group (429 +/- 58) as compared to ischemia-reperfusion (IR) (781 +/- 12) and the UW group (1151 +/- 83). Bile production (microg/min/g liver) was significantly (p < .05) higher in the SUW group (280 +/- 13) as compared to the IR (224 +/- 24) and the UW group (114 +/- 14). The tissue edema formation assessed by tissue wet-dry ratio was significantly (p < .05) higher in UW group. Histology showed well-preserved hepatic structure in the SUW group. In conclusion, this study suggests that HMP with SUW solution has the potential to restore and preserve livers with extended WIT.

High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: a study from rural centre of Maharashatra, India.

AIM: To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary brachytherapy (ICBT). MATERIALS AND METHODS: Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C). The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups--less then 80% (< 80%), 80-100% and above 100% (>100%). A total of 180 applications for 60 patients were calculated for the above analyses. RESULTS: There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by 'A' radiotherapist were within the limits in the self as well as in the shared groups more number of times, by 'B' radiotherapist was more times exceeding the limit and by 'C' radiotherapist doses were in between the A and B. DISCUSSION AND CONCLUSION: For the rectal and bladder doses most important factors are patient's age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

Radical radiotherapy treatment (EBRT + HDR-ICRT) of carcinoma of the uterine cervix: outcome in patients treated at a rural center in India.

AIM: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary radiotherapy (ICRT). MATERIALS AND METHODS: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO) staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT) and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. RESULTS: There were 7 (3.27%), 88 (41.1%), 101 (47.1%), and 18 (8.4%) patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months) and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months). The overall treatment time (OTT) ranged from 52 to 73 days (median 61 days). The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97%) cases with local residual disease, 35 (16.3%) developed local recurrence/distant metastases, 17 (7.9%) developed distant metastases, and 9 (4.2%) had local recurrence as well. DISCUSSION AND CONCLUSION: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.

Selective assessment and positivity bias in environmental valuation.

The need to determine the value of environmental entities has generated substantial research regarding optimal methods for obtaining valuations from survey respondents. The literature suggests the importance of providing clear, complete descriptions of the entity being valued prior to respondents indicating their valuations. The target entity's attributes are often presented in isolation or in greater detail compared with other entities. Two experiments were conducted to explore whether selective exposure to and assessment of an environmental entity can bias survey respondents' judgments. This article adds to the environmental valuation literature by demonstrating a new process that leads to value overestimates. Specifically, the article shows that (a) when an environmental entity is the focus of assessment in a survey, positively biased evaluations often result; (b) positivity bias in evaluation translates to real monetary allocation decisions; and (c) selective information processing contributes to these effects.

Ex-vivo study of flow dynamics and endothelial cell structure during extended hypothermic machine perfusion preservation of livers.

Liver transplantation is often the only effective treatment for end stage liver diseases resulting from cirrhosis, hepatitis, progressive jaundice, and biliary atresia. Hypothermic machine perfusion (HMP) preservation may enhance donor pool by extending preservation time and reclaiming marginal donor livers including those from non-heart beating donors (NHBD), as demonstrated in the kidney. However, current HMP protocols have not been successful in improving extended preservation of livers and the major cause of preservation injury remains unknown. An intravital microscopy study was conducted to understand the flow dynamics of sinusoidal perfusion during 24h HMP with cold modified University of Wisconsin (UW) solution. Fluorescein isothiocynate (FITC) labeled albumin was utilized to visualize microvascular space and FITC labeled red blood cells (RBCs) were used to visualize flow dynamics during HMP. A heterogeneous flow pattern with regions of red cell stasis was observed after 24-h HMP. To examine the cause of red cell stasis, intravital and confocal microscopy studies of endothelial cells (ECs) structure labeled with DiI acetylated low-density lipoprotein (DiI acLDL) were conducted. These studies suggest that morphological changes in EC structures occurred during 24h HMP, which may cause obstruction to the sinusoidal flow. Histological findings confirm these results. As a result, heterogeneous flow pattern, red cell stasis, and edema occur, which may lead to the failure of these tissues following extended HMP.

Survival transplantation of preserved non-heart-beating donor rat livers: preservation by hypothermic machine perfusion.

BACKGROUND: Non-heart-beating donor (NHBD) livers are an untapped source with the potential to provide relief to the current donor shortage problem. Hypothermic machine perfusion (MP) has the potential to reclaim and preserve these marginal donor organs. METHODS: This study compared 5-day survival in a rat NHBD liver transplantation model with simple cold storage (SCS) and MP-preserved tissues that had experienced 30 min of warm ischemia followed by a 5-hr preservation period with the University of Wisconsin solution. Total release of lactate dehydrogenase (LDH) and alanine aminotransferase (ALT) were determined at major time points. Bilirubin levels and histology were examined after 5-day survival. RESULTS: Six of seven control livers and five of six MP livers survived, whereas SCS tissues had survival in zero of seven. The results showed that MP livers had reduced release of LDH and ALT after 5 hr of storage, 5.07+/-1.42 and 2.02+/-0.69 U (mean+/-SE), respectively, compared with SCS, 15.54+/-0.81 and 3.41.3+/-0.73 U, respectively. Bilirubin values after 5-day survival of MP livers (1.17+/-0.49 mg/dL) were comparable to controls (0.91+/-0.36 mg/dL). Histology confirms that SCS displayed increased necrosis and MP tissue showed regions of near normal hepatic structure. CONCLUSIONS: These results suggest that MP for 5 hr improves survival and reduces cellular damage of liver tissue that has experienced 30 min of warm ischemia when compared with SCS tissues. Further studies need to be conducted, but this study suggests that MP preservation has the potential to reclaim and preserve NHBD liver tissues.