Integration of photothermal water evaporation with photocatalytic microplastics upcycling via nanofluidic thermal management.

Photothermal heating and photocatalytic treatment are two solar-driven water processing approaches by harnessing NIR and UV-vis light, respectively, which can fully utilize solar energy if integrated. However, it remains a challenge to achieve high performance in both approaches when integrated in a material due to uncontrollable heat diffusion. Here, we report a demonstration of heat confinement on photothermal sites and fluid cooling on photocatalysis sites at the nanoscale, within a well-designed heat and fluid confinement nanofiber reactor. Photothermal and photocatalytic nanostructures were alternatively aligned in electrospun nanofibers for on-demand nanofluidic thermal management as well as easy folding into 3D structures with enhanced light utilization and mass transfer. Such a design showed simultaneously high photothermal evaporation rate (2.59 kg m-2 h-1, exceeding the limit rate) and efficient photocatalytic upcycling of microplastics pollutant into valued products. Enabled by controlled photothermal heating, the valued main product (i.e., methyl acetate) can be evaporated out with 100% selectivity by in situ separation.

Organ donation: what else can be done besides legislature?

With the ongoing organ shortage for transplantation, Singapore has adopted an organ opt-out scheme: Human Organ Transplant Act (HOTA) that presumes consent unless specified otherwise. Likewise, receptivity of doctors and medical students (MS), as future doctors, can positively influence organ donation (OD) rates. We explored the knowledge and attitudes of MS toward OD. MS from all five yr of medical school were recruited using self-administered questionnaires. There were 294 completed questionnaires with 49.3% males and 45.6% pre-clinical students. The MS were generally knowledgeable about organ transplantation, but deficient in the knowledge of some aspects of HOTA. The majority of the MS were receptive toward OD. Traditional values rather than religion were possible barriers toward OD. 50.7% of the MS were concerned that donated organs may be inappropriately used, while 32% had concerns that doctors would prematurely terminate treatment if the patient is a potential organ donor. Fewer clinical students shared such concerns, compared with the pre-clinical students. The MS have a good understanding of basic tenets of OD and are receptive toward OD. Potential barriers for OD advocation are local traditional values and reservations regarding the appropriate use of harvested organs and provision of appropriate care to donor patients. These concerns are areas to address.

Living Donor Liver Transplantation for Acute on Chronic Liver Failure Based on EASL-CLIF Diagnostic Criteria.

BACKGROUND: The European association for the study of the liver and chronic liver failure consortium (EASL-CLIF) recently proposed diagnostic criteria for acute on chronic liver failure (ACLF). There is lack of data regarding liver transplant outcomes in ACLF patients based on these criteria. The objective of this study was to determine outcome following living donor liver transplantation (LDLT) in ACLF patients. METHODS: We retrospectively reviewed patients who underwent LDLT for ACLF based on European association for the study of the liver and chronic liver failure consortium (EASL-CLIF) diagnostic criteria (group 1) (N = 60) and compared them with ACLF patients who did not undergo transplantation (group 2) (N = 59). The primary outcome of interest was 30 day mortality. We also looked at one year survival in these patients. Survival was calculated using Kaplan-Meier curves and Log rank test was used to determine significance between variables. RESULTS: Median MELD scores for group 1 and 2 patients in ACLF grade 1 was 28 (20-38) and 31 (24-36), in ACLF grade 2 was 35 (24-42) and 36 (24-42) and in ACLF grade 3 was 36 (29-42) and 38 (32-52). For group 1 and 2, 30 day mortality in ACLF grade 1, 2 and 3 was 2/43(4.6%) versus 9/15(60%) (P < 0.001), 1/15 (6.6%) versus 13/19 (68.4%), 0/2 (0%) versus 20/25 (80%) (P < 0.001). Actuarial 1 year overall survival was 92% versus 11% (P < 0.001) in patients who underwent transplantation versus those who did not. One year survival in patients with grade 1 and 2 ACLF who received transplant versus medical treatment was 91% versus 13% and 93% versus 15% (P < 0.001) respectively. CONCLUSION: LDLT has excellent outcomes in patients with EASL-CLIF grade 1 and 2 ACLF. Without transplantation, ACLF patients have a very poor prognosis.

Liver Transplantation in India: At the Crossroads.

As the liver transplant journey in India reaches substantial numbers and suggests quality technical expertise, it is time to dispassionately look at the big picture, identify problems, and consider corrective measures for the future. Several features characterize the current scenario. Although the proportion of deceased donor liver transplants is increasing, besides major regional imbalances, the activity is heavily loaded in favor of the private sector and live donor transplants. The high costs of the procedure, the poor participation of public hospitals, the lack of a national registry, and outcomes reporting are issues of concern. Organ sharing protocols currently based on chronology or institutional rotation need to move to a more justiciable severity-based system. Several measures can expand the deceased donor pool. The safety of the living donor continues to need close scrutiny and focus. Multiple medical challenges unique to the Indian situation are also being thrown up. Although many of the deficits demand state intervention and policy changes the transplant community needs to take notice and highlight them. The future of liver transplantation in India should move toward a more accountable, equitable, and accessible form. We owe this to our citizens who have shown tremendous faith in us by volunteering to be living donors as well as consenting for deceased donation.

Living Donor Liver Transplant is a Transparent Activity in India.

Living donor liver transplant (LDLT) has progressed rapidly in India with at least two major centers performing over 200 transplants annually. There have been concerns regarding donor safety as donor deaths have been reported worldwide. In India, there is a possible underreporting of donor complications and mortality leading to the allegation that LDLT is a clandestine activity. Deceased donor liver transplantation activity may be less transparent as there are no national guidelines for retrieval and allocation of organs. LDLT is for a named person and as the activity can only be conducted in major hospitals with involvement of over 100 medical personnel in each operation, it cannot be a clandestine operation. Government regulations require licensing of hospitals following inspection by senior doctors and reporting of transplant activity periodically. About 2500 living donor liver transplants have been conducted in India and there have been 7 donor deaths reported in India. Rather than not being transparent, donor morbidity and mortality has received excessive media attention. Most liver transplant activity in India is well organized with clearance from hepatologists and anesthetists. Unrelated donation needs to be cleared from a State appointed Authorization Committee. Foreigners cannot be transplanted without State clearance and approval of the concerned embassy. The donor risk is discussed and the success of the recipient operation is also explained to all patients. The ever-increasing popularity of the operation in spite of the high cost and the requirement for donation from a family member suggests that many patients are living healthy life after transplantation. Overall LDLT is a transparent activity in India.