First uterine transplant case at the Royal Prince Alfred Hospital.

Uterine transplantation (UT) is an emerging medical treatment for women affected by absolute uterine factor infertility (AUFI). To date there have been over 90 documented cases of UT performed worldwide, with over 50 live births. UT allows women affected by AUFI the opportunity to carry and deliver a childd. The Royal Prince Alfred Hospital (RPAH) introduced a UT study in 2019; however, due to the impacts of the COVID pandemic the study was placed on hold for two years. In February 2023, RPAH performed the centre's first UT from a living unrelated donor to a 25-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome. The donor and recipient surgeries were uncomplicated and both are recovering well in the early post-operative period.

Hemostasis, coagulation and thrombin in venoarterial and venovenous extracorporeal membrane oxygenation: the HECTIC study.

Extracorporeal membrane oxygenation (ECMO) support has a high incidence of both bleeding and thrombotic complications. Despite clear differences in patient characteristics and pathologies between veno-venous (VV) and veno-arterial (VA) ECMO support, anticoagulation practices are often the same across modalities. Moreover, there is very little data on their respective coagulation profiles and comparisons of thrombin generation in these patients. This study compares the coagulation profile and thrombin generation between patients supported with either VV and VA ECMO. A prospective cohort study of patients undergoing VA and VV ECMO at an Intensive care department of a university hospital and ECMO referral centre. In addition to routine coagulation testing and heparin monitoring per unit protocol, thromboelastography (TEG), multiplate aggregometry (MEA), calibrated automated thrombinography (CAT) and von-Willebrand's activity (antigen and activity ratio) were sampled second-daily for 1 week, then weekly thereafter. VA patients had significantly lower platelets counts, fibrinogen, anti-thrombin and clot strength with higher d-dimer levels than VV patients, consistent with a more pronounced consumptive coagulopathy. Thrombin generation was higher in VA than VV patients, and the heparin dose required to suppress thrombin generation was lower in VA patients. There were no significant differences in total bleeding or thrombotic event rates between VV and VA patients when adjusted for days on extracorporeal support. VA patients received a lower median daily heparin dose 8500 IU [IQR 2500-24000] versus VV 28,800 IU [IQR 17,300-40,800.00]; < 0.001. Twenty-eight patients (72%) survived to hospital discharge; comprising 53% of VA patients and 77% of VV patients. Significant differences between the coagulation profiles of VA and VV patients exist, and anticoagulation strategies for patients of these modalities should be different. Further research into the development of tailored anticoagulation strategies that include the mode of ECMO support need to be completed.

Correlation and agreement between the TEG® 5000 and the TEG® 6s during liver transplant surgery.

The TEG® 5000 and novel TEG® 6s measure the viscoelasticity of whole blood during in vitro clot formation. The two devices measure similar coagulation variables but utilize distinctly different technologies. This study aimed to determine the correlation and agreement between the thrombelastographic parameters obtained by the two devices during liver transplant surgery. We obtained blood samples at six predefined intervals during the surgery of 10 consecutive patients. Two operators proficient in the use of the TEG® 6s and TEG® 5000 systems performed thrombelastographic measurements on each sample: non-citrated TEG® 5000, citrated TEG® 5000 and citrated TEG® 6s. Agreement and correlation were assessed using Bland Altman plots and Lin's concordance correlation. There was considerable inter-device variability for the different parameters measured by the TEG® 5000 and TEG® 6s devices. Acceptable agreement was observed when results were within the normal reference ranges. However, with increasing coagulopathy, agreement was poor and results could not be considered interchangeable. Although each of the three tests appeared reliable for qualitative detection of abnormalities of clot formation during liver transplant surgery, we found their quantitative results were not interchangeable.

Biology of Pentalonia nigronervosa (Hemiptera, Aphididae) on banana using different rearing methods.

The banana aphid, Pentalonia nigronervosa Coquerel, is present worldwide where banana (Musa spp.) is grown. It is the vector of Banana bunchy top virus (Nanoviridae, Babuvirus), the etiological agent of banana bunchy top disease, currently the most important constraint for banana producers in Hawaii. P. nigronervosa is not well studied, and effects of temperature on its growth and reproduction are unknown. We studied the longevity and fecundity of one clone of banana aphid on different types of plant materials to determine an effective method to study the insect in the laboratory. We found that insects performed better unconfined on plantlets, followed by leaf midrib cuttings. We also conducted complete life table studies with P. nigronervosa on banana leaf midrib cuttings at 20, 25, and 30 degrees C, with a photoperiod of 12:12. Intrinsic rate of increase (r), net reproductive rate (R0), doubling time (DT), nymphal mortality, and mean offspring per female all showed maximal rates at 25 degrees C. Population growth was studied on whole banana plantlets as well, and growth rates were also highest at 25 degrees C. We found r to be greater when aphids were reared on intact banana plantlets than on cuttings. Our results show the importance of comparing insect rearing methods for studies such as life tables.

Within-plant distribution and binomial sampling of Pentalonia nigronervosa (Hemiptera: Aphididae) on banana.

The banana aphid, Pentalonia nigronervosa Coquerel (Hemiptera: Aphididae), infests banana (Musa spp.) worldwide. Pentalonia nigronervosa is the vector of Banana bunchy top virus (family Nanoviridae, genus Babuvirus) the etiological agent of Banana bunchy top disease (BBTD). BBTD is currently the most serious problem affecting banana in Hawaii. Despite the importance of this vector species, little is known about its biology or ecology. There are also no sampling plans available for P. nigronervosa. We conducted field surveys to develop a sampling plan for this pest. Ten plots were surveyed on seven commercial banana farms on the island of Oahu, HI, for the presence of P. nigronervosa on banana plantlets. We found aphids more frequently near the base of plants, followed by the newest unfurled leaf at the top of the plant. Aphids were least likely to be located on leaves in between the top and bottom of the plant. Aphid infestation on surveyed plots ranged from 8 to 95%. We developed a sequential binomial sampling plan based on our surveys. We also discovered that the within-plant distribution of P. nigronervosa is an important factor to consider when sampling for this pest. Our sampling plan will assist in the development of sustainable management practices for banana production.