Entropy and Turbulence Structure.

Some new perspectives are offered on the spectral and spatial structure of turbulent flows, in the context of conservation principles and entropy. In recent works, we have shown that the turbulence energy spectra are derivable from the maximum entropy principle, with good agreement with experimental data across the entire wavenumber range. Dissipation can also be attributed to the Reynolds number effect in wall-bounded turbulent flows. Within the global energy and dissipation constraints, the gradients (d/dy+ or d2/dy+2) of the Reynolds stress components neatly fold onto respective curves, so that function prescriptions (dissipation structure functions) can serve as a template to expand to other Reynolds numbers. The Reynolds stresses are fairly well prescribed by the current scaling and dynamical formalism so that the origins of the turbulence structure can be understood and quantified from the entropy perspective.

Maximum Entropy Method for Solving the Turbulent Channel Flow Problem.

There are two components in this work that allow for solutions of the turbulent channel flow problem: One is the Galilean-transformed Navier-Stokes equation which gives a theoretical expression for the Reynolds stress (u'v'); and the second the maximum entropy principle which provides the spatial distribution of turbulent kinetic energy. The first concept transforms the momentum balance for a control volume moving at the local mean velocity, breaking the momentum exchange down to its basic components, u'v', u'2, pressure and viscous forces. The Reynolds stress gradient budget confirms this alternative interpretation of the turbulence momentum balance, as validated with DNS data. The second concept of maximum entropy principle states that turbulent kinetic energy in fully-developed flows will distribute itself until the maximum entropy is attained while conforming to the physical constraints. By equating the maximum entropy state with maximum allowable (viscous) dissipation at a given Reynolds number, along with other constraints, we arrive at function forms (inner and outer) for the turbulent kinetic energy. This allows us to compute the Reynolds stress, then integrate it to obtain the velocity profiles in channel flows. The results agree well with direct numerical simulation (DNS) data at Reτ = 400 and 1000.

Everolimus-Induced Systemic Serositis After Simultaneous Liver and Kidney Transplantation: A Case Report.

Although everolimus, a mammalian target of rapamycin inhibitor, has been used as a potent immunosuppressive agent in organ transplantation, data regarding its adverse effect profile compared with that of sirolimus in clinical circumstances are limited. A 50-year-old man who underwent simultaneous liver and kidney transplantation 14 months previously was admitted with large pleural effusion, pericardial effusion, and ascites. Laboratory findings and cultures for possible infectious causes were all negative. Pericardial window surgery with drainage of the pericardial fluid was performed on day 3. Pleural and pericardial biopsy revealed non-specific inflammation without evidence of malignant cells. Everolimus was discontinued and replaced by mycophenolate mofetil on day 4. Significant clinical improvement was observed after discontinuation of everolimus, and follow-up echocardiography and chest radiography showed no recurrence of the pericardial or pleural effusion after discharge.

Review article: acute severe ulcerative colitis - evidence-based consensus statements.

BACKGROUND: Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis. AIM: To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome. METHODS: Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80% votes in 'complete agreement' or 'agreement with minor reservation'. RESULTS: Key recommendations include that patients with ASUC should be: hospitalised, undergo unprepared flexible sigmoidoscopy to assess severity and to exclude cytomegalovirus colitis, and be provided with venous thromboembolism prophylaxis and intravenous hydrocortisone 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin should be started if insufficient response by day 3, and colectomy considered if no response to 7 days of rescue therapy or earlier if deterioration. With such an approach, it is expected that colectomy rate during admission will be below 30% and mortality less than 1% in specialist centres. CONCLUSION: These evidenced-based consensus statements on acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.

A Promoter Polymorphism in the CD46 Complement Regulatory Protein Gene Is Associated With Acute Renal Allograft Rejection.

OBJECTIVES: CD46 molecule (complement regulatory protein [CD46]), known as a human cell surface receptor, plays an important role in complement and T-cell regulation for organ transplantation. This study was performed to evaluate the association of promoter polymorphism (rs2796267, -496 A/G) of the CD46 gene with acute renal allograft rejection (AR), late acute rejection (LAR), and graft loss (GL) in Korean patients. METHODS: A total of 334 patients with kidney transplants were recruited. Transplantation outcomes were determined in terms of AR, LAR, and GL criteria. The promoter single nucleotide polymorphism (SNP) of CD46 was genotyped by direct sequencing. RESULTS: The rs2796267 SNP exhibited significant differences between the AR group and non-AR group (codominant1 model, P = .012; odds ratio [OR], 0.47 [95% confidence interval, 0.26-0.84]; dominant model, P = .012; OR, 0.50 [95% CI, 0.29-0.86]; and allele distribution, P = .034; OR, 0.64 [95% CI, 0.43-0.94]). In addition, the SNP also exhibited significant associations with LAR (codominant2 model, P = .041; OR, 0.12 [95% CI, 0.02-0.92]; recessive model, P = .005; OR, 0.13 [95% CI, 0.02-0.94]; and allele distribution, P = .038; OR, 0.58 [95% CI, 0.35-0.97]). CONCLUSIONS: This study suggests that the promoter polymorphism (rs2796267, -496 A/G) CD46 gene may be related to susceptibility of AR in Korean kidney transplantation recipients.

Association Interleukin-4 and Interleukin-4 Receptor Gene Polymorphism and Acute Rejection and Graft Dysfunction After Kidney Transplantation.

BACKGROUND: Cytokine genotypes have previously been studied in patients undergoing solid organ transplantation; certain polymorphisms have been implicated in the development of acute rejection (AR) and graft dysfunction (GD). Allograft outcomes determined, in part, by alloimmune responses is mainly mediated by T-cell responses, activated and driven by cytokines. Interleukin-4 (IL-4) is one such cytokine, which exerts its biological effects through binding to the IL-4 receptor (IL-4R) complex on target cells. In the present study, we investigated whether polymorphisms of the IL-4 and/or IL-4R gene were associated with susceptibility to acute AR and GD after kidney transplantation. METHODS: We analyzed 2 single nucleotide polymorphism (SNPs) of IL-4 (rs2243250 and rs2070874) and 3 SNPs of IL-4R (rs1801275, rs2107356, and rs1805010) in 344 kidney transplant recipients. These patients included 62 of whom had developed AR and 215 of whom had GD in 1 year after kidney transplantation. RESULTS: The AR group included 62 patients (45 men and 17 women). There was a statistically significant difference in the male-to-female ratio and the use of tacrolimus in the AR group. The GD group included 215 patients. Patients who developed GD were more likely to be older and have an underlying cause of end-stage renal disease that was unknown compared with patients who did not have GD, the cause of which was typically known. Among the SNPs examined, 1 of the SNPs in the IL-4R gene (ie, rs1801275) showed a statistical association with AR (co-dominant model, P = .061; dominant model, P = .019; and log-addictive model, P = .029). In addition, 1 of the IL-4R SNPs (ie, rs2107356) was statistically associated with GD (dominant model, P = .034). No significant difference in the IL-4 genotype was observed between the AR/GD and non-AR/non-GD subjects. CONCLUSIONS: One IL-4R gene polymorphism (rs1801275) was associated with AR. In addition, a separate IL-4R SNP (rs2107356) was statistically associated with GD after kidney transplantation.

Matrix Metalloproteinase Gene Polymorphisms and New-Onset Diabetes After Kidney Transplantation in Korean Renal Transplant Subjects.

BACKGROUND: New-onset diabetes after transplantation (NODAT) is a serious metabolic complication that may follow renal transplantation. Matrix metalloproteinases (MMPs) contribute to insulin insufficiency and beta-cell dysfunction in a rat model. The MMP-2 concentrations were lower in patients with type 2 diabetes mellitus, and the plasma MMPs levels were related to diabetes. Similar to the pathogenesis of type 2 diabetes mellitus, insulin resistance and insulin secretion dysfunction occur in patients with the development of NODAT. Therefore, we examined the association between NODAT and 11 single-nucleotide polymorphisms (SNPs) located within the 3 genes of MMPs that might be related to NODAT. METHODS: A total of 309 renal transplant recipients without a history of diabetes were included in this study. DNA was extracted from the blood samples of recipients, and we analyzed the association between the development of NODAT and a panel of 11 SNPs within 3 MMP genes (MMP-1, MMP-2, and MMP-3). RESULTS: In terms of allele frequencies, rs243849*C (MMP-2) was significantly higher in patients with NODAT. Two of the 11 (18.1%) SNPs were significantly associated with NODAT development after adjusting for age, sex, and tacrolimus usage: MMP-2 (rs1132896) and MMP-2 (rs243849). In the multiple logistic regression analysis, these 2 SNPs were significantly associated with the development of NODAT in the codominant and recessive or codominant and dominant models. CONCLUSIONS: MMP-2 gene rs1132896 and rs243849 polymorphisms may serve as genetic markers for the development of NODAT. The exact molecular mechanisms still must be clarified.

Needs assessment for master of nursing programmes among Bangladesh nurses.

AIM: This study aimed to assess the intent to enrol in a master of nursing programme among Bangladesh nurses, identify preferred programme options and measure the association among intent to enrol in the programme, clinical competency and job satisfaction. BACKGROUND: Personal and professional aspects of potential students pursuing graduate education are beneficial in devising educational strategies. However, considering the pressing needs for higher nursing education, there are no masters of nursing programmes in Bangladesh. METHODS: This study used a descriptive correlational design. Nurses working in Bangladesh public sector were recruited to participate in a self-administered survey (n = 260). The questionnaire consisted of perception of job satisfaction, clinical competency and the need for educational options, including the intent to enrol in a master of nursing programme, preferred specialty area, curriculum content and career goals after graduation. Data were analysed using descriptive statistics and point-biserial correlation. RESULTS: Ninety per cent of the respondents reported that they intended to enrol in a master of nursing programme. Intention was significantly correlated with clinical competency but not with job satisfaction. The most preferred specialty areas were nursing management and education. Half of the respondents responded that teaching at nursing schools was a career goal after graduation. DISCUSSION: The results of the needs assessment for the programme reflected the unique interest and priorities of the current status of Bangladesh. CONCLUSIONS: The results indicate a strong motivation to enrol in a master of nursing programme, confidence in clinical competence and high demand for programme in nursing management and education. These findings should be considered to design the programme in order to meet the interest of Bangladesh nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Educational needs assessments should take precedence to ensure the best possible educational outcome and to produce competent nurses who will contribute in achieving the Millennium Development Goals of Bangladesh.

Avoidance of Profound Hypothermia During Initial Reperfusion Improves the Functional Recovery of Hearts Donated After Circulatory Death.

The resuscitation of hearts donated after circulatory death (DCD) is gaining widespread interest; however, the method of initial reperfusion (IR) that optimizes functional recovery has not been elucidated. We sought to determine the impact of IR temperature on the recovery of myocardial function during ex vivo heart perfusion (EVHP). Eighteen pigs were anesthetized, mechanical ventilation was discontinued, and cardiac arrest ensued. A 15-min standoff period was observed and then hearts were reperfused for 3 min at three different temperatures (5°C; N = 6, 25°C; N = 5, and 35°C; N = 7) with a normokalemic adenosine-lidocaine crystalloid cardioplegia. Hearts then underwent normothermic EVHP for 6 h during which time myocardial function was assessed in a working mode. We found that IR coronary blood flow differed among treatment groups (5°C = 483 ± 53, 25°C = 722 ± 60, 35°C = 906 ± 36 mL/min, p < 0.01). During subsequent EVHP, less myocardial injury (troponin I: 5°C = 91 ± 6, 25°C = 64 ± 16, 35°C = 57 ± 7 pg/mL/g, p = 0.04) and greater preservation of endothelial cell integrity (electron microscopy injury score: 5°C = 3.2 ± 0.5, 25°C = 1.8 ± 0.2, 35°C = 1.7 ± 0.3, p = 0.01) were evident in hearts initially reperfused at warmer temperatures. IR under profoundly hypothermic conditions impaired the recovery of myocardial function (cardiac index: 5°C = 3.9 ± 0.8, 25°C = 6.2 ± 0.4, 35°C = 6.5 ± 0.6 mL/minute/g, p = 0.03) during EVHP. We conclude that the avoidance of profound hypothermia during IR minimizes injury and improves the functional recovery of DCD hearts.

Implementing standard setting into the Conjoint MAFP/FRACGP Part 1 examination - Process and issues.

BACKGROUND: The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent. OBJECTIVE: This paper discusses the process and issues encountered in implementing standard setting to the Conjoint Part 1 examination. DISCUSSION: Critical to success in standard setting were judges' understanding of the process of the modified Angoff method, defining the borderline candidate's characteristics and the composition of judges. These were overcome by repeated hands-on training, provision of detailed guidelines and careful selection of judges. In December 2013, 16 judges successfully standard set the Part 1 Conjoint examinations, with high inter-rater reliability: Cronbach's alpha coefficient 0.926 (Applied Knowledge Test), 0.921 (Key Feature Problems).

Physiologic Changes in the Heart Following Cessation of Mechanical Ventilation in a Porcine Model of Donation After Circulatory Death: Implications for Cardiac Transplantation.

Hearts donated following circulatory death (DCD) may represent an additional source of organs for transplantation; however, the impact of donor extubation on the DCD heart has not been well characterized. We sought to describe the physiologic changes that occur following withdrawal of life-sustaining therapy (WLST) in a porcine model of DCD. Physiologic changes were monitored continuously for 20 min following WLST. Ventricular pressure, volume, and function were recorded using a conductance catheter placed into the right (N = 8) and left (N = 8) ventricles, and using magnetic resonance imaging (MRI, N = 3). Hypoxic pulmonary vasoconstriction occurred following WLST, and was associated with distension of the right ventricle (RV) and reduced cardiac output. A 120-fold increase in epinephrine was subsequently observed that produced a transient hyperdynamic phase; however, progressive RV distension developed during this time. Circulatory arrest occurred 7.6±0.3 min following WLST, at which time MRI demonstrated an 18±7% increase in RV volume and a 12±9% decrease in left ventricular volume compared to baseline. We conclude that hypoxic pulmonary vasoconstriction and a profound catecholamine surge occur following WLST that result in distension of the RV. These changes have important implications on the resuscitation, preservation, and evaluation of DCD hearts prior to transplantation.

Outcomes following 'mini' percutaneous nephrolithotomy for renal calculi in children. A single-centre study.

INTRODUCTION: This retrospective review was undertaken to identify the postoperative outcomes of children undergoing 'mini' percutaneous nephrolithotomy (MPCNL) at a single institution. OBJECTIVE: Outcomes measured included: percentage of stone clearance, postoperative analgesia requirements, the need for intraoperative or postoperative blood transfusion, length of stay and morbidity. STUDY DESIGN: A total of 46 patients were reviewed over a two-and-a-half-year period; the mean age was 7.3 years (range: 1-16 years). The MPCNL was performed with a radiological-guided peripheral puncture, followed by dilatation of the nephrostomy tract to a maximum Amplatz sheath size of 16-French; an 11-French nephroscope was used. Stone disintegration was achieved either with pneumatic or laser lithotripsy. RESULTS: Complete stone clearance was achieved in 35/46 children (76%). The remaining 11 children had a stone clearance rate of over 80%. No patients required intraoperative/postoperative blood transfusion. A total of 39% of patients were managed on simple/non-opiate based analgesia, with 54% requiring opioid analgesia postoperatively for less than 24 h. There were no procedure-related complications and no mortalities. The mean length of stay was 2.24 days. DISCUSSION: The management of urolithiasis can be challenging in children. The use of percutaneous nephrolithotomy, is becoming increasingly popular in the treatment of paediatric urolithiasis. The stone clearance rate in children undergoing standard PCNL, has been reported to be 50-98% in the literature [1,2,3,4]. Samad et al. [2] in 2006, reported their experience in 188 consecutive PCNLs, using a 17Fr or 26Fr nephroscope. Their largest sub group included children aged >5-16 yrs. Within this group, 57% were treated with a 17Fr nephroscope and 43% with the 26Fr nephroscope, achieving stone clearance of only 47% with PCNL monotherapy. In this group the transfusion rate was 3% [2]. Badawy et al., reported their experience of 60 children in 1999, using a 26 or 28Fr Amplatz sheath. They reported an 83.3% stone clearance with single session PCNL, with only one procedure being abandoned due to intraoperative bleeding requiring blood transfusion [3]. In 2007, Bilen et al. reported their experience and compared the use of 26Fr, 20Fr and 14Fr (mini) PCNL. Stone size, previous surgery and the mean haemoglobin drop postoperatively did not change between the groups, however the blood transfusion rate was higher in the 26Fr and 20Fr Amplatz sheath groups. The stone clearance was highest in the 'mini PCNL' group at 90%, compared to 69.5% in the 26Fr and 80% in the 20Fr group [4]. MPCNL has become increasingly popular over recent years, with stone clearance reported as 80-85% [5-7] following a single session of MPCNL as monotherapy. In 2012, Yan et al. reported 85.2% stone clearance with mini PCNL monotherapy (tract size 14-16Fr), with no children requiring blood transfusion [6]. Zeng et al. reported their experience of 331 renal units in children, with stone clearance rates reaching 80.4% and a blood transfusion rate of 3.1% [8]. In our centre, we do not perform postoperative haemoglobin levels as a matter of routine and any investigations are performed on an intention to treat principle. Bilen et al. reported no blood transfusions being required in their cohort of patients undergoing MPCNL [4] and this is supported by Yan et al. [6]. CONCLUSION: Mini PCNL is an effective and safe procedure for the treatment of paediatric renal stones. In the present series, all children achieved greater than 80% stone clearance, none received a blood transfusion (intra/postoperatively) and there were no mortalities. Postoperative pain was managed with simple analgesia in 39%; however, the majority required opiate analgesia for less than 24 hours.

Resting network is composed of more than one neural pattern: an fMRI study.

In resting state, the dynamics of blood oxygen level-dependent signals recorded by functional magnetic resonance imaging (fMRI) showed reliable modular structures. To explore the network property, previous research used to construct an adjacency matrix by Pearson's correlation and prune it using stringent statistical threshold. However, traditional analyses may lose useful information at middle to moderate high correlation level. This resting fMRI study adopted full connection as a criterion to partition the adjacency matrix into composite sub-matrices (neural patterns) and investigated the associated community organization and network features. Modular consistency across subjects was assessed using scaled inclusivity index. Our results disclosed two neural patterns with reliable modular structures. Concordant with the results of traditional intervention, community detection analysis showed that neural pattern 1, the sub-matrix at highest correlation level, was composed of sensory-motor, visual associative, default mode/midline, temporal limbic and basal ganglia structures. The neural pattern 2 was situated at middle to moderate high correlation level and comprised two larger modules, possibly associated with mental processing of outer world (such as visuo-associative, auditory and sensory-motor networks) and inner homeostasis (such as default-mode, midline and limbic systems). Graph theoretical analyses further demonstrated that the network feature of neural pattern 1 was more local and segregate, whereas that of neural pattern 2 was more global and integrative. Our results suggest that future resting fMRI research may take the neural pattern at middle to moderate high correlation range into consideration, which has long been ignored in extant literature. The variation of neural pattern 2 could be relevant to individual characteristics of self-regulatory functions, and the disruption in its topology may underlie the pathology of several neuropsychiatric illnesses.

Enuresis and more.

We describe Pervasive Refusal Syndrome, an important but rare, debilitating condition that may present to paediatric services. Although previous reports have described improvement seen with care delivered in the mental health setting, we have demonstrated treatment predominately delivered in a paediatric ward environment associated with successful recovery.

TLR9 gene polymorphism (rs187084, rs352140): association with acute rejection and estimated glomerular filtration rate in renal transplant recipients.

The Toll-like receptors (TLRs) are related to innate immunity. TLR9, a member of TLRs, is expressed in immune cell-rich tissues and mediates cellular response. We investigated the association between TLR9 polymorphisms and kidney allograft outcomes. To investigate whether TLR9 polymorphisms are associated with acute rejection after renal transplantation, two single nucleotide polymorphisms (SNPs) of TLR9 gene (rs187084 -1486; rs352140, G2848A) were selected and genotyped by direct sequencing in 342 renal transplant recipients. SNPStats, SNPAnalyzer, Helixtree and Haploview version 4.2 were used to analyse genetic data. Multiple logistic regression models (codominant, dominant, recessive and log-additive) were used to evaluate odds ratios (ORs), 95% confidence intervals (CIs) and P values. Both SNPs, TLR9 rs187084 -1486 and rs352140 G2848A, of recipients were associated with the risk of acute rejection in renal transplantation. C allele of rs187084 -1486 and A allele of rs352140 G2848A were protective genotype for acute rejection (OR 0.6, 95% CI 0.40-0.92; P = 0.018, OR 0.64, 95% CI 0.42-0.98; P = 0.04, respectively). rs187084 -1486 CT and rs352140 G2848A GA genotype were associated with a lower eGFR after a year of renal transplantation. TLR9 polymorphisms, rs187084 and rs352140, of recipients were associated with the risk of acute rejection in renal transplantation. The patients with rs187084 -1486 CT and rs352140 G2848A GA genotype showed a lower eGFR after a year of renal transplantation.

Association of doxycycline use with the development of gastroenteritis, irritable bowel syndrome and inflammatory bowel disease in Australians deployed abroad.

BACKGROUND: The risks are unknown for developing chronic gastrointestinal illness when personnel are relocated short term to other countries and when taking antibiotic prophylaxis in areas where malaria is endemic. AIM: To examine the associations of deployment to developed or developing countries and exposure to doxycycline with the new onset of acute gastroenteritis, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). METHODS: A cross-sectional web-based survey of all current and past members of the Australian Federal Police Association was undertaken. Independent predictors of gastrointestinal illness were examined by logistic regression analysis relative to those not deployed without exposure to doxycycline. RESULTS: Of 1300 respondents (response rate 34%), 133 were excluded due to pre-existing chronic gastrointestinal illness. Five hundred and ninety had episodes of overseas deployment for a median duration of 6.5 (range 0.1-149) months. Eighteen (3%) of those not deployed took doxycycline compared with 171 (30%) of those deployed. The risk of acute gastroenteritis was associated with deployment itself without clear association with doxycycline. Doxycycline exposure was associated with increased onset of IBS in those deployed to developing (odds ratio [OR], 6.99; 95% confidence interval [CI], 3.19-15.31) and developed country (OR, 6.93; 95% CI, 1.40-34.39). New onset of IBD (1.5%) was associated with deployment to developed countries and with doxycycline exposure (OR, 8.75; 95% CI, 1.67-45.86)). CONCLUSIONS: The use of doxycycline is a risk factor for developing IBS and possibly IBD when deployed to developing and developed countries respectively. Doxycycline as a risk factor for chronic gastrointestinal illness warrants a prospective large-scale study.

Value of alpha-foetoprotein for screening of recurrence in hepatocellular carcinoma post resection.

INTRODUCTION: The aim of this study was to establish the value of alpha-foetoprotein (AFP) for the screening of recurrences in hepatocellular carcinoma (HCC) in patients who have undergone curative hepatic resection. METHODS: 72 HCC patients who had curative resection/liver transplant in 2000-2006 were monitored for recurrence by evaluating the three- or six-monthly AFP and computed tomography images. Patients without recurrence were followed up for a mean duration of 7.27 years. RESULTS: Out of the 72 patients, 34 (47.2%) suffered from HCC recurrence. 65.4% of recurrent cases had AFP values showing an upward trend. Patients with recurrence had higher AFP values than those without at last follow-up (119.45 µg/L vs. 3.1 µg/L, p < 0.001). AFP at recurrence was independent of gender, race, history of alcohol consumption and hepatitis C or cirrhosis status. Patient with hepatitis B or those with tumours larger than 5 cm had higher AFP values. The best cut-off AFP indicative of HCC recurrence was 5.45 µg/L (sensitivity 84.4%; specificity 77.1%). High preoperative AFP was associated with high AFP at recurrence (correlation coefficient 0.553, p = 0.01). CONCLUSION: AFP alone is an inadequate screening test for HCC recurrence since only about two-thirds of patients showed upward AFP trend on recurrence. Our study found a relatively low cut-off point for detection of recurrence (5.54 µg/L). Patients with high preoperative AFP tended to have high AFP on recurrence. Imaging is recommended for patients with AFP levels > 5.45 µg/L, especially when AFP shows a rising trend.

Hearts from DCD donors display acceptable biventricular function after heart transplantation in pigs.

Cardiac transplantation is in decline, in contrast to other solid organs where the number of solid organ transplants from donors after circulatory death (DCD) is increasing. Hearts from DCD donors are not currently utilized due to concerns that they may suffer irreversible cardiac injury with resultant poor graft function. Using a large animal model, we tested the hypothesis that hearts from DCD donors would be suitable for transplantation. Donor pigs were subjected to hypoxic cardiac arrest (DCD) followed by 15 min of warm ischemia and resuscitation on cardiopulmonary bypass, or brainstem death (BSD) via intracerebral balloon inflation. Cardiac function was assessed through load-independent measures and magnetic resonance imaging and spectroscopy. After resuscitation, DCD hearts had near normal contractility, although stroke volume was reduced, comparable to BSD hearts. DCD hearts had a significant decline in phosphocreatine and increase in inorganic phosphate during the hypoxic period, with a return to baseline levels after reperfusion. After transplantation, cardiac function was comparable between BSD and DCD groups. Therefore, in a large animal model, the DCD heart maintains viability and recovers function similar to that of the BSD heart and may be suitable for clinical transplantation. Further study is warranted on optimal reperfusion strategies.