ABSTRACT
Transplant surgeons have historically traveled to donor hospitals, performing complex, time-sensitive procedures with unfamiliar personnel. This often involves air travel, significant delays, and frequently occurs overnight.In 2001, we established the nation's first organ recovery center. The goal was to increase efficiency,reduce costs and reduce surgeon travel. Liver donors and recipients, donor costs, surgeon hours and travel time, from April 1,2001 through December 31,2011 were analyzed. Nine hundred and fifteen liver transplants performed at our center were analyzed based on procurement location (living donors and donation after cardiac death donors were excluded). In year 1, 36% (9/25) of donor procurements occurred at the organ procurement organization (OPO) facility, rising to 93%(56/60) in the last year of analysis. Travel time was reduced from 8 to 2.7 h (p<0.0001), with a reduction of surgeon fly outs by 93% (14/15) in 2011. Liver organ donor charges generated by the donor were reduced by37% overall for donors recovered at the OPO facility versus acute care hospital. Organs recovered in this novel facility resulted in significantly reduced surgeon hours, air travel and cost. This practice has major implications for cost containment and OPO national policy and could become the standard of care.
Subject(s)
Graft Survival/physiology , Health Facilities , Liver Diseases/surgery , Liver Transplantation , Living Donors , Tissue and Organ Procurement , Costs and Cost Analysis , Hospitals , Humans , Prognosis , TravelABSTRACT
Hydroxycinnamate decarboxylase (HCDC) activity has been evaluated in several commercial yeast strains. The combined effect of using cinnamyl esterases (CE) and HCDC+ Saccharomyces cerevisiae strains has been studied in the formation of vinylphenolic pyranoanthocyanins (VPAs) during fermentation, analysing the kind and concentration of pigments formed according to the yeast strain used. Wines fermented with yeasts HCDC+ were contaminated with Dekkera bruxellensis and afterwards analysed to evaluate the formation of ethylphenols (EPs). The musts treated with CE and later fermented with HCDC+ yeast strains showed lower contents of 4-ethylphenol than those fermented with HCDC- strains. This reduction in the EP content is due to the transformation of hydroxycinnamic acids in stable VPAs pigments. The associated use of CEs and HCDC+ Saccharomyces strains is a natural strategy to reduce the formation of EPs in wines contaminated by Dekkera/Brettanomyces.
Subject(s)
Carboxy-Lyases/metabolism , Carboxylic Ester Hydrolases/metabolism , Phenols/metabolism , Saccharomyces cerevisiae/enzymology , Wine/microbiology , Anthocyanins/analysis , Brettanomyces/metabolism , Color , Coumaric Acids/metabolism , Dekkera/metabolism , Gas Chromatography-Mass Spectrometry , Propionates , Wine/analysisABSTRACT
The authors investigated the real contribution of low-field MR imaging in the follow-up of pneumonectomized patients. Literature on the subject is surprisingly poor, even though MR diagnostic capabilities seem to be great in these patients. Because of the peculiar anatomical features of pneumonectomized patients, low-field MR imaging yields high-quality images. The operated hemithorax, with the postpneumonectomy space full of fluid, in the absence of respiratory movements is free of movement artifacts. The latter are known to worsen image quality in thoracic MR imaging, especially without respiratory gating. In the study of mediastinum and operated hemithorax MR imaging provides the highest diagnostic contribution. In the mediastinum MR images demonstrate enlarged lymph nodes and tumor recurrences and is superior to CT especially when great vessels are involved. In the study of the operated hemithorax, MR imaging is preferable to CT to identify parietal lesions, because of its higher spatial resolution. Moreover, MR imaging allows tumor recurrences to be differentiated from normal muscular tissue and from fibrous tissue on the basis of their different signal intensities as observed on the various pulse sequences.