Our institution explored using allografts from donors with Hepatitis C virus (HCV) for elderly renal transplantation (RT). Thirteen HCV– elderly recipients were transplanted with HCV+ allografts ...(eD+/R–) between January 2003 and April 2009. Ninety HCV– elderly recipients of HCV– allografts (eD–/R–), eight HCV+ recipients of HCV+ allografts (D+/R+) and thirteen HCV+ recipients of HCV– allografts (D–/R+) were also transplanted. Median follow-up was 1.5 (range 0.8–5) years. Seven eD+/R– developed a positive HCV viral load and six had elevated liver transaminases with evidence of hepatitis on biopsy. Overall, eD+/R– survival was 46% while the eD–/R– survival was 85% ( P = 0.003). Seven eD+/R– died during follow-up. Causes included multi-organ failure and sepsis ( n = 4), cancer ( n = 1), failure-to-thrive ( n = 1) and surgical complications ( n = 1). One eD+/R– died from causes directly related to HCV infection. In conclusion, multiple eD+/R– quickly developed HCV-related liver disease and infections were a frequent cause of morbidity and mortality.
Therapeutic hypothermia reduces death and disability after moderate or severe neonatal encephalopathy in high-income countries and is used as standard therapy in these settings. However, the safety ...and efficacy of cooling therapy in low- and middle-income countries (LMICs), where 99% of the disease burden occurs, remains unclear. We will examine whether whole body cooling reduces death or neurodisability at 18-22 months after neonatal encephalopathy, in LMICs.
We will randomly allocate 408 term or near-term babies (aged ≤ 6 h) with moderate or severe neonatal encephalopathy admitted to public sector neonatal units in LMIC countries (India, Bangladesh or Sri Lanka), to either usual care alone or whole-body cooling with usual care. Babies allocated to the cooling arm will have core body temperature maintained at 33.5 °C using a servo-controlled cooling device for 72 h, followed by re-warming at 0.5 °C per hour. All babies will have detailed infection screening at the time of recruitment and 3 Telsa cerebral magnetic resonance imaging and spectroscopy at 1-2 weeks after birth. Our primary endpoint is death or moderate or severe disability at the age of 18 months.
Upon completion, HELIX will be the largest cooling trial in neonatal encephalopathy and will provide a definitive answer regarding the safety and efficacy of cooling therapy for neonatal encephalopathy in LMICs. The trial will also provide important data about the influence of co-existent perinatal infection on the efficacy of hypothermic neuroprotection.
ClinicalTrials.gov, NCT02387385 . Registered on 27 February 2015.
Identification of different factors that affect emissions of gasses, including volatile organic compounds (VOCs) is necessary to develop emission abatement technology. The objectives of this research ...were to quantify and study temporal variation of gas emissions from a model pig house under varying ventilation rates. The used model was a 1:12.5 scale of a section of a commercial finishing pig house. The VOC concentrations at inlet, outlet, and slurry pit of the model space were measured using Proton-Transfer-Reaction Mass Spectrometry (PTR-MS). PTR-MS can measure the temporal variations of odor compounds' emission from the slurry pit in real time. The emissions of H
2S and 14 VOCs were lower compared to real pig buildings except for ammonia, which indicated possible other sources of those compounds than the slurry in the slurry pit. The ventilation rate affected significantly on ammonia and trimethylamine emission (p
<
0.05). The hydrogen sulfide (H
2S) emission was independent of the ventilation rate. VFAs' emission dependency on ventilation rate increased with the increase of carbon chain. Phenols, indoles and ketones showed the positive correlation with ventilation rate to some extent. Generally, compounds with high solubility (low Henry's constant) showed stronger correlation with ventilation rates than the compounds with high Henry's constant.
► Proton-Transfer-Reaction Mass Spectrometry was used to measure odorants in real time. ► Ammonia, hydrogen sulfide and 14 volatile organic compounds (VOCs) were measured from pig slurry. ► Temporal variations of odorants were explained by four factors. ► The factors were surface pH, dry matter enrichment, depletion, and oxidation. ► Complex relations between ventilation rate and odorants' emissions were observed.
The parasites of genera Haemoproteus, Plasmodium, and Leucocytozoon are well-known avian haematozoa and can cause declined productivity and high mortality in wild birds. The objective of the study ...was to record the prevalence of haematozoan parasites in a wide range of wetland birds in Bangladesh. Six species of Haemoproteus, seven species of Plasmodium, one unidentified species of Leucocytozoon, and one unidentified microfilaria of the genus Paronchocerca were found. Data on the morphology, size, hosts, prevalence, and infection intensity of the parasites are provided. The overall prevalence among the birds was 29.5% (95 out of 322 birds). Of those, 13.2% (42 of 319) of birds were infected with Haemoproteus spp., 15.1% with Plasmodium spp. (48 of 319) and 0.6% with Leucocytozoon spp. (2 of 319). Two birds were positive for both Haemoproteus sp. and Plasmodium sp. A single resident bird, Ardeola grayii, was found positive for an unidentified microfilaria. Prevalence of infection varied significantly among different bird families. Wild birds of Bangladesh carry several types of haematozoan parasites. Further investigation with a larger sample size is necessary to estimate more accurately the prevalence of haematozoan parasites among wild birds as well as domestic ducks for better understanding of the disease ecology.
Adult living donor liver transplant (LDLT) recipients have a higher incidence of biliary complications than deceased donor liver transplant (DDLT) recipients. Our objective was to define the ...intensity of intervention and time to resolution after diagnosis of biliary complications after liver transplantation. We analyzed the management and resolution of post-transplant biliary complications and investigated the comparative effectiveness of interventions in LDLT and DDLT recipients. Analysis of biliary complications (leak or stricture) used a retrospective cohort of liver transplant recipients at 8 centers between 1998–2006 (median follow-up was 4.7 years from onset). Number, procedure types, and time to resolution were compared between LDLT and DDLT recipients. Post-transplant biliary complications occurred among 47/189 25% DDLT recipients and 141/356 40% of LDLT recipients. Biliary leaks comprised 38% (n=18) of post-DDLT and 65% (n=91) of post-LDLT biliary complications. Median times to first biliary complication were similar (DDLT vs. LDLT: leak: 11 vs. 14 days, p=0.6; stricture: 69 vs. 107 days, p=0.3, respectively). There were 1225 diagnostic and therapeutic procedures performed, including re-operation and retransplant (mean: 6.5±5.4 per recipient; DDLT: 5.4±3.6 vs. LDLT: 6.8±5.8, p=0.5). The median number of months to resolution of a biliary complication (tube/stent/drain-free) was not significantly different between DDLT and LDLT for leaks (DDLT: 2.3; LDLT: 1.3; p=0.3) or strictures (DDLT: 4.9; LDLT: 2.3; p=0.6). Although the incidence of biliary complications after LDLT is higher than after DDLT, treatment requirements and time to resolution after development of a biliary complication are similar in LDLT and DDLT recipients.
We tested 1149 ruminant sera conveniently collected from three districts of Bangladesh to identify the serological evidence of Coxiella burnetii infection in cattle and goats by enzyme-linked ...immunosorbent assay. We found that 0.7% (8/1149) of ruminants had detectable immunoglobulin G for C. burnetii: 0.65% (4/620) in cattle and 0.76% (4/529) in goats. A sub-set of ruminant samples was retested and confirmed by immunofluorescence assay (18/112). Although we cannot rule out false-positive reactions, our study suggests the presence of C. burnetii in cattle and goats in Bangladesh. Further studies are required to estimate disease burden at the population level and identify risk factors for Q fever in ruminants in Bangladesh.
BACKGROUNDIn the US, 5% of adult liver transplant recipients receive a graft donated after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse ...intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes.
METHODSRetrospective de-identified data collected between 2005 and 2013 were entered electronically by 10 centers via a REDCap database. Our primary outcome was development of intra-hepatic biliary strictures consistent with IC.
RESULTSWithin 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intra-hepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly (p=0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (versus duct-to-duct), OR3.06, 95% CI1.52-6.16, p=0.002. Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (OR for IC3.36, 95% CI1.95-5.79).
CONCLUSIONSThis first report of the large combined experience with DCDD from the IDOL consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies.
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