Posttransplant renal replacement therapy is an alarm signal for survival outcomes in pediatric liver transplantation.

BACKGROUND: The impact of renal replacement therapy (RRT) on the long-term survival outcomes of pediatric liver recipients remains controversial. METHODS: A total of 224 patients aged <18 years, who underwent liver transplantation (LT), were divided into two groups: patients who underwent renal replacement therapy (RRT) (group R, n = 25, 11.2%) and those who did not (group N, n = 199, 88.8%). The posttransplant patient survival outcomes according to RRT use constituted the primary end-point. RRT was initiated preoperatively in 12 patients (48.0%) and postoperatively in 13 [early: <6 months after LT (n = 5, 20.0%) and late: ≥6 months after LT (n = 8, 32.0%)]. The indications for RRT included liver disease involving the kidney (44.0%) and hepatorenal syndrome (56.0%). RESULTS: The age at the time of LT (71.6 vs. 19.1 months) was higher, the pediatric end-stage liver disease score was lower (9.9 vs. 21.2), and the duration of hospitalization posttransplantation (41.0 vs. 27.0 days) was longer, while the rates of hepatic artery thrombosis (8.0% vs. 3.5%) were higher in group R (p < .05). The number of patients (60.0% vs. 93.0%; p < .001) and graft survival rates (68.0% vs. 93.0%; p < .001) were significantly lower in group R. Multivariate analysis revealed that posttransplant RRT and hepatic artery complications were risk factors for patient survival outcomes. Renal function was recovered in 7 patients (28.0%) in group R, and 9 (36.0%) eventually underwent kidney transplantation. CONCLUSION: The survival outcomes of children requiring posttransplant RRT were significantly worse than those of children, who did not undergo RRT. Physicians should pay meticulous attention to patients requiring post-LT RRT.

Association between childhood obesity and familial salt intake: analysis of data from Korean National Health and Nutrition Examination Survey, 2014-2017.

High salt intake is known as a risk factor of childhood obesity. As family members share not only genes but also their diet habit, parents' salt intake may affect to their children's obesity. In this study, we investigated correlations between childhood obesity and parents' or children's sodium intakes based on a nationwide survey data. From the Korean National Health and Nutrition Examination Survey data from 2014 to 2017, 802 boys and 657 girls aged 10-18 years, and their parents were included. BMI z-score and 24-hour urinary sodium excretion, which is estimated through Tanaka's equation, were used to examine associations between obesity and sodium intakes. The BMI status and the prevalence of obesity between children and their parents showed strong positive correlations in both sexes (all p < 0.001). The urinary sodium excretion between children and their parents showed positive correlations in both sexes (all p < 0.05). Children with higher urinary sodium excretion showed higher BMI (in both sexes, p < 0.001) and higher parental obesity compared to those with lower urinary sodium excretion, however, statistical significances of the latter relationship were varied by sex. In conclusion, our study suggests close relationship between childhood obesity and their sodium intakes, which also correlate well with parental BMIs and diet behavior. Therefore, parental education and active participation could be crucial in regulating childhood obesity.

Myocardial injury in a pediatric patient with diabetic ketoacidosis: A case report.

RATIONALE: Diabetic ketoacidosis (DKA) can cause several complications. Among them, cardiac complications are the most fatal and difficult to detect. Cardiac markers are prognostic factors for morbidity and mortality in adult patients with DKA. But, there have been very few discussed cases in pediatrics. We report a case of severe DKA in child with elevated cardiac enzymes and prolonged QT interval. PATIENT CONCERNS: A 12-year-old girl admitted by nausea, vomiting, and lethargy for 1 day. DIAGNOSES: Her blood sugar level was initially undetectable by the capillary blood glucose meter, and blood gas analysis showed severe DKA with elevated cardiac enzymes and prolonged QT interval. INTERVENTIONS: The patient was admitted to hospital and intensive intravenous fluid and regular insulin infusion were administered. OUTCOMES: After 5 days of supportive care, the patient was fully recovered, discharged, and followed up in an outpatient clinic. LESSONS: Since the relationship between DKA and myocardial injury has not been clearly elucidated, pediatricians and emergency physicians should remain careful throughout the recovery time as it can lead to life-threatening conditions in various courses.

Tissue inhibitor of metalloproteinase proteins inhibit teratoma growth in mice transplanted with pluripotent stem cells.

Pluripotent stem cells (PSCs) can serve as an unlimited cell source for transplantation therapies for treating various devastating diseases, such as cardiovascular diseases, diabetes, and Parkinson's disease. However, PSC transplantation has some associated risks, including teratoma formation from the remaining undifferentiated PSCs. Thus, for successful clinical application, it is essential to ablate the proliferative PSCs before or after transplantation. In this study, neural stem cell-derived conditioned medium (NSC-CM) inhibited the proliferation of PSCs and PSC-derived neural precursor (NP) cells without influencing the potential of PSC-NP cells to differentiate into neurons in vitro and prevented teratoma growth in vivo. Moreover, we found that the NSC-CM remarkably decreased the expression levels of Oct4 and cyclin D1 that Oct4 directly binds to and increased the cleaved-caspase 3-positive cell death through the DNA damage response in PSCs and PSC-NPs. Interestingly, we found that NSCs distinctly secreted the tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 proteins. These proteins suppressed not only the proliferation of PSCs in cell culture but also teratoma growth in mice transplanted with PSCs through inhibition of matrix metalloproteinase (MMP)-2 and MMP-9 activity. Taken together, these results suggest that the TIMP proteins may improve the efficacy and safety of the PSC-based transplantation therapy.

Defect-free surface modification methods for solubility-tunable carbon nanotubes.

Although carbon nanotubes (CNTs) have outstanding physical properties, there are still challenging issues such as poor dispersibility and miscibility between organic polymers and CNTs for polymer nanocomposites. Chemical modifications (e.g., strong acid based oxidation, carboxylation, etc.) can improve dispersion properties and compatibility, but such surface modification methods often lead to damage to the pristine CNT structure and also deteriorate the mechanical properties of CNTs. Here we demonstrate a simple, defect-free and scalable method for well-dispersed CNTs in common organic solvents, using dopamine and amine-terminated polyethylene glycol derivatives. This method makes it possible to prepare solubility-tunable CNTs without any severe structural deformation. As-modified CNTs were successfully characterized by thermal gravimetric analysis (TGA), Fourier-transformed infrared spectroscope (FT-IR), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and transmission electron microscope (TEM). The surface modified-CNTs were well-dispersed in polar and/or non-polar common solvents. The well-dispersed CNTs can be used in a nanofiller in commercial polymers such as thermoplastic polyurethane (TPU) polymer. The CNT/TPU composite showed improved tensile strength without sacrificing elongation at break relative to those of pristine TPU.

Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved <50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving <50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

High-performance CO2-philic graphene oxide membranes under wet-conditions.

Ultrathin graphene oxide (GO) (<5 nm) membranes were prepared by spin-casting onto microporous polymeric support membranes. GO membranes exhibited a highly CO2 permeable character, which is suitable for CO2 separation. In the presence of water vapour, high CO2 selectivity (e.g., CO2/H2, CO2/N2, and CO2/CH4) was achieved by enhanced CO2 sorption.

Selective gas transport through few-layered graphene and graphene oxide membranes.

Graphene is a distinct two-dimensional material that offers a wide range of opportunities for membrane applications because of ultimate thinness, flexibility, chemical stability, and mechanical strength. We demonstrate that few- and several-layered graphene and graphene oxide (GO) sheets can be engineered to exhibit the desired gas separation characteristics. Selective gas diffusion can be achieved by controlling gas flow channels and pores via different stacking methods. For layered (3- to 10-nanometer) GO membranes, tunable gas transport behavior was strongly dependent on the degree of interlocking within the GO stacking structure. High carbon dioxide/nitrogen selectivity was achieved by well-interlocked GO membranes in high relative humidity, which is most suitable for postcombustion carbon dioxide capture processes, including a humidified feed stream.