Outcome of Brain Lymphoma in a High Epstein-Barr Virus-Prevalence Country After Kidney Transplantation.

BACKGROUND: The incidence of post-transplant lymphoproliferative disorder (PTLD) in adult kidney transplant (KTx) recipients is less common in Taiwan. In our institute, we observed that brain lymphoma was the most notorious type. METHODS: The study describes the clinical, histologic, and radiological features of primary central nervous lymphoma (PCNSL) and the outcomes and associations with Epstein-Barr virus (EBV) infection in our center. RESULTS: Among 1470 KTx recipients, 5 patients had tissue-proven brain lymphoma (0.34%). The brain pathology disclosed diffuse large B-cell lymphoma in all patients. EBV was detected through in situ hybridization for Epstein-Barr encoding region (EBER) to disclose the EBV inclusion in the nuclei of lymphoma cells. The first treatment step was the reduction of immunosuppressants; 4 patients received whole-brain radiotherapy after complete resection of PCNSL, and 1 received concurrent chemoradiotherapy. Only one patient had poor performance status at the time of diagnosis and had a poor response to treatment with steroids. Four patients survived (mean 36.5 months, range 8.6 to 57.6 months), but one died after rapid neurologic deterioration. CONCLUSION: Epstein-Barr virus inclusion was found in PCNSL in our patients; however, the role of EBV in PCNSL remains to be clarified. Post-transplant lymphoproliferative disorder is a rare malignancy after KTx with a predilection of brain involvement in Taiwan. We report a successful care experience in a patient with primary CNS lymphoma with better survival.

A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center.

BACKGROUND: Operating room (OR) inefficiency drives up cost, decreases revenue, and leads to surgeon, staff, and patient dissatisfaction. Given a low mean first-case start rate in our tertiary academic medical center, we developed a process to improve first-case start rates in an effort to increase OR efficiency. METHODS: A working group of the OR Executive Committee was constituted to develop and implement a multistep operational plan. This plan was predicated on a sensible staggered start framework, coordination of stakeholder responsibilities, a visual preoperative Stop/Go checklist tool, real-time measurement, and feedback. RESULTS: Within 11 days of implementation, 95% of first-start OR cases were tracked to start on time. Throughout the observation period (May 2015-July 2016), the goal of a daily mean 80% on-time start rate was either met or exceeded. CONCLUSIONS: Implementation of an organized collaborative effort led to dramatic improvements in first OR case on-time rates. Such improvement in OR utilization may lead to an increase in staff and patient satisfaction and cost reduction.

High-Performance Photo-Modulated Thin-Film Transistor Based on Quantum dots/Reduced Graphene Oxide Fragment-Decorated ZnO Nanowires.

In this paper, a photo-modulated transistor based on the thin-film transistor structure was fabricated on the flexible substrate by spin-coating and magnetron sputtering. A novel hybrid material that composed of CdSe quantum dots and reduced graphene oxide (RGO) fragment-decorated ZnO nanowires was synthesized to overcome the narrow optical sensitive waveband and enhance the photo-responsivity. Due to the enrichment of the interface and heterostructure by RGO fragments being utilized, the photo-responsivity of the transistor was improved to 2000 A W-1 and the photo-sensitive wavelength was extended from ultraviolet to visible. In addition, a positive back-gate voltage was employed to reduce the Schottky barrier width of RGO fragments and ZnO nanowires. As a result, the amount of carriers was increased by 10 folds via the modulation of back-gate voltage. With these inherent properties, such as integrated circuit capability and wide optical sensitive waveband, the transistor will manifest great potential in the future applications in photodetectors.