Pediatric donor heart acceptance practices in the United States: What is really being considered?

BACKGROUND: Recent studies demonstrate high offer decline and organ non-utilization rates are associated with increased pediatric heart transplant waitlist mortality. We sought to determine which donor, candidate, and offer specific variables most importantly influenced these decisions using only data available at the time of each offer. METHODS: Retrospective review of pediatric (<18 years) heart donor offers made to pediatric candidates in the United States between 2010 and 2020. In addition to standard donor, candidate, and offer data available in UNOS, we extracted objective and qualitative valvar and myocardial function data from all available donor echocardiogram reports. RESULTS: During the study period, 5625 pediatric donor hearts produced 30 156 offers to 4905 unique candidates, of which 88.7% of all offers were declined and 39.2% of organs were not utilized by pediatric waitlisted candidates. Of the 60.8% utilized hearts, 89.7% had a 'cumulatively' normal echocardiogram at the time of offer acceptance; 62.9% of hearts not utilized for a pediatric candidate also had a cumulatively normal final echocardiogram. Random forest and logistic regression modeling demonstrated good predictive performance (AUROC ≥0.83) of likelihood to accept when utilizing donor, candidate, and offer specific variables. SHAP variable importance scores demonstrated number of prior offer declines and candidate institution's prior year acceptance rates as the two most important variables influencing offer decisions. CONCLUSIONS: Behavioral economics appear to play a significant role in pediatric heart transplant candidate institutions' acceptance practices, even when considering the arguably healthier pediatric donor population. Removal of prior institution's decisions from DonorNet may help increase donor utilization.

Intrinsic thermalization of the honeycomb optical lattice.

Ultracold atoms confined to optical lattices provide a platform for simulation of phenomena not readily accessible in condensed matter and chemical systems. One area of growing interest is the mechanism by which isolated condensed matter systems can thermalize. The mechanism for thermalization of quantum systems has been directly linked to a transition to chaos in their classical counterpart. Here we show that the broken spatial symmetries of the honeycomb optical lattice leads to a transition to chaos in the single-particle dynamics which, in turn, causes mixing of the energy bands of the quantum honeycomb lattice. For systems with single-particle chaos, "soft" interactions between atoms can cause the system to thermalize (achieve a Fermi-Dirac distribution for fermions or a Bose-Einstein distribution for bosons).

Detection of viruses: atomic force microscopy and surface enhanced Raman spectroscopy.

This paper demonstrates the capability of atomic force microscopy (AFM) and surface enhanced Raman spectroscopy (SERS) to function effectively as ultra-sensitive readout tools for chip-scale platforms designed for pathogen detection in complex biological media. AFM allows direct (i.e., label-free) visualization and quantification of nanometer-sized viruses captured on a smooth, selective surface. AFM readout led to optimization of a capture substrate for feline calicivirus (FCV), and yielded a limit of detection of 3 x 10(6) FCV/mL. SERS-based detection of FCV, carried out in a sandwich-type assay, requires labelling of the substrate-bound FCV with a selective extrinsic Raman label (ERL). These studies yielded a limit of detection of 1 x 10(6) FCV/mL. The prospects of these two readout methods as additions to the arsenal of tools in bioterrorism prevention are briefly discussed.

Effects of feed enzymes on nutritive value of soyabean meal fed to broilers.

1. The effects of two enzyme products on the nutritive value of soyabean meal (SBM) were investigated with the emphasis on changes in composition of non-starch polysaccharides (NSP) along the digestive tract. Enzyme A was a commercially available product containing mainly hemicellulase, pectinase, beta-glucanase and some protease activities and Enzyme B was an experimental product with mainly beta-galactanase activity. 2. Enzymes were added at the recommended dosage (normal) and at 5 times the recommended dosage (high) to a semi-purified diet based on maize with SBM as the sole protein source. 3. The enzymes had no effect on digesta viscosity in the jejunum or ileum. 4. Enzyme A at the high dosage significantly (P<0.05) improved AMEN, reduced excreta moisture content and improved ileal protein digestibility. The addition of the same enzyme at the recommended dosage had no effect on any of the above parameters. 5. Analysis of the monosaccharide composition revealed that Enzyme A tended to reduce the amounts of rhamnose and galactose in the soluble and insoluble NSP fractions in thejejunal and ileal digesta. The reduction was significant (P<0.05) when the same enzyme was added at the high dosage. 6. Enzyme B significantly (P<0.05) improved AMEN of the diet but not the growth or the feed conversion ratio (FCR) of the birds. Enzyme B at the high dosage significantly reduced (P<0.05) ileal protein digestibility. 7. Enzyme B significantly (P<0.05) increased the amount of free sugars in thejejunum and reduced (P<0.05) the concentration of soluble NSP in the ileum. 8. Analysis of the monosaccharide composition in the jejunal and ileal digesta showed that this enzyme was highly effective in releasing galactose from both the soluble and insoluble NSP fractions. 9. It is concluded that glycanases with galactanase and pectinase activities supplemented at appropriate dosages can improve the digestibility of the NSP in SBM and increase the metabolisable energy content of the diet containing high levels of SBM. 10. Furthermore, the addition of Enzyme B at the high dosage significantly (P<0.05) reduced protein digestibility without any measurable reduction in growth performance.

Chemical modification of carbonaceous stationary phases by the reduction of diazonium salts.

This paper describes a new strategy for the creation of chemically modified carbonaceous stationary phases. The strategy exploits the electroreduction of arenediazonium salts as a means for functionalizing the surface of glassy carbon (GC) and porous graphitic carbon (PGC) stationary phases. The one-electron reduction of these salts forms an arene radical which then couples via a carbon-carbon linkage to the carbon framework at the surface of the stationary phase. Two arenediazonium-based modifiers were used in evaluating the potential utility of this strategy: 4-nitrobenzenediazonium tetrafluoroborate for the GC and PGC phases and 4-hexylbenzenediazonium tetrafluoroborate for only the PGC phases. Modifications were carried out by packing the phases into a column used for electrochemically modulated liquid chromatography. The effectiveness of the modifications was assessed by X-ray photoelectron spectroscopy and by comparing the liquid separation of a series of mixtures before and after coating deposition. For the nitrobenzyl-modified GC phase, the test mixture contained both anisole and fluoranthene. The performance of the nitrobenzyl- and hexylbenzyl-modified PGC stationary phases was characterized by the separations of substituted phenols (i.e., nitrophenol and resorcinol) and a few important pharmaceutical agents (i.e., hexobarbital, oxazepam, and nitrazepam). The potential utility of this modification procedure to form stationary phases that are stable upon extended exposure to aggressive mobile phases is discussed and briefly examined.

Electrochemically actuated mercury pump for fluid flow and delivery.

This paper describes the development of a prototype pumping system with the potential for incorporation into miniaturized, fluid-based analytical instruments. The approach exploits the well-established electrocapillarity phenomena at a mercury/electrolyte interface as the mechanism for pump actuation. That is, electrochemically induced changes in the surface tension of mercury result in the pistonlike movement of a mercury column confined within a capillary. We present herein theoretical and experimental assessments of pump performance. The design and construction of the pump are detailed, and the potential attributes of this design, including the generated pumping pressure, flow rate, and power consumption, are discussed. The possible miniaturization of the pump for use as a field-deployable, fluid-delivery device is also briefly examined.

Monoclonal antibody--gold biosensor chips for detection of depurinating carcinogen--DNA adducts by fluorescence line-narrowing spectroscopy.

A new direct readout methodology for detection and quantitation of fluorescent carcinogen-DNA adducts is described. It combines the binding specificity of an immobilized monoclonal antibody (MAb) with high-resolution, low-temperature fluorescence spectroscopy. The MAb, which is covalently bound to a gold surface via a chemisorbed disulfide coupling agent, binds the adduct of interest in an aqueous sample. Laser-induced fluorescence under nonline narrowing (FNLN) and line-narrowing (FLN) conditions was used to detect (benzo[a]pyren-6-yl)guanine (BP-6-N7Gua) bound to immobilized MAb. At room temperature, the BP-6-N7Gua fluorescence was not detected, most likely because of quenching by the gold surface and/or efficient dynamical quenching. However, fluorescence was observed at room temperature when the surface was covered with a thin layer of glycerol, and possible reasons for the fluorescence enhancement are considered. Lowering of the temperature to 77 K led to nearly an order of magnitude increase in fluorescence intensity. Highly structured FLN spectra obtained at 4.2 K allowed for definitive adduct identification. The potential of this methodology for risk assessments of individuals exposed to polycyclic aromatic hydrocarbons is discussed.

Electrochemically modulated liquid chromatography coupled on-line with electrospray mass spectrometry.

Electrochemically modulated liquid chromatography (EMLC) has been coupled to an electrospray mass spectrometer. This combination takes advantage of the ability of EMLC to manipulate retention and enhance separation efficiency solely through changes in the potential applied to a conductive stationary phase, thereby minimizing complications because of possible changes in analyte ionization efficiencies when gradient elution techniques are used. Three examples are presented that demonstrate the attributes of this EMLC/electrospray mass spectrometry (ES-MS) coupling. The first two examples involve the separation of mixtures of corticosteroids or of benzodiazepines, showing the general utility of the union for eluent identification and low-level detection. The ability to identify products from on-column redox transformations is also demonstrated using the benzodiazepine mixture. The third example investigates the electrooxidation of aniline by utilizing an EMLC column as an on-line electrochemical reactor and product separator and ES-MS for detection and product identification.

Immunosensing platforms using spontaneously adsorbed antibody fragments on gold.

This paper describes the construction and characterization of miniaturized antigenic immunosurfaces composed of spontaneously adsorbed Fab'-SH fragments on gold. Rabbit Fab'-SH fragments contain a free sulfhydryl group that forms a thiolate bond with a gold substrate as detailed by X-ray photoelectron spectroscopy. This approach creates surfaces of higher epitope density, a factor critical to the early detection of disease, than surfaces composed of adsorbed whole molecule IgG on gold. The viability and specificity of antigenic Fab'-SH immunosurfaces is demonstrated using atomic force microscopy and confocal fluorescence microscopy, and possible explanations for the larger epitope density are discussed.

Kinetic mechanism of the p38-alpha MAP kinase: phosphoryl transfer to synthetic peptides.

p38 is a member of the mitogen-activated protein (MAP) kinase family. Activation (phosphorylation) of p38 acts as a switch for the transcriptional and translational regulation of a number of proteins, including the proinflammatory cytokines. Investigation of a set of small peptides revealed that, as with protein substrates, p38-alpha behaves as a proline-directed Ser/Thr MAP kinase for a peptide substrate, peptide 4 (IPTSPITTTYFFFKKK). We investigated the steady-state kinetic mechanism of the p38-alpha-catalyzed kinase reaction with EGF receptor peptide, peptide 1, as a substrate. Lineweaver-Burk analysis of the substrate kinetics yielded a family of lines intersecting to the left of the ordinate, with either ATP or peptide 1 as the varied substrate. Kinetic analysis in the presence of ADP yielded a competitive inhibition pattern when ATP was the varied substrate and a noncompetitive pattern if peptide 1 was the varied substrate. At saturating peptide substrate concentrations, inhibition by phosphopeptide product yielded an uncompetitive pattern when ATP was the varied substrate. These data are consistent with ordered binding with ATP as the initial substrate. We provide further evidence of the existence of a productive p38.ATP binary complex in that (a) activated p38-alpha has intrinsic ATPase activity, (b) ATPase and kinase activities are coupled, and (c) inhibitors of ATPase activity also inhibit the kinase activity with a similar inhibition constant. The k(cat) for the kinase reaction was lowered by 1.8-fold when ATP-gamma-S was used. Microviscosity linearly affected the k(cat) values of both the ATP and ATP-gamma-S reactions with a slope of about 0.8. These observations were interpreted to mean that the phosphoryl transfer step is not rate-limiting and that the release of product and/or enzyme isomerization is a possible rate-limiting step(s).

Graphite microparticles as coatings for quartz crystal microbalance-based gas sensors.

The use of graphite particles (1-2 microm) as coatings on quartz crystal microbalances (QCMs) for detection and monitoring of toluene and other volatile organic compounds (VOCs) is described. Unlike the more commonly used polymeric coatings with low glass transition temperatures (Tg), particulate graphitic coatings are not as susceptible to loss of acoustic energy when coating thickness or operational temperature increases. This situation enables the use of relatively thick coatings, which increases the absolute amount of vapor sorbed in the coating and, consequently, lowers the level of detection and enhances operation over a wide temperature range. The use of small size particles also results in a coating with a more porous structure, which facilitates uptake and release of VOCs in comparison to coatings made from high Tg polymers, which have a lower porosity. These attributes, coupled with the inherent stability of graphitic materials, make particulate graphite coatings especially suitable for applications at high temperatures. The advantages of using particulate graphite as a coating on QCMs are demonstrated by comparison to the performance of a few low-Tg polymers [i.e., poly(isobutylene) and poly(diphenoxyphosphazene)] and high-Tg polymers (i.e., polystyrene).

Ultrasound-guided Kopans' needle location and removal of a retained foreign body.

Penetrating injury with retained foreign body is a common problem. Location of the foreign body and surgical excision may be difficult. Ultrasound can be a sensitive and cost-effective tool in both the detection and surgical removal of retained foreign bodies in soft tissue. We report a case in which ultrasound-guided needle localization was used for removal of a wooden foreign body

The effects of enzyme addition to broiler diets containing high concentrations of canola or sunflower meal.

The effects of two commercial enzyme products on the nutritive value of canola meal (CM) and sunflower meal (SFM) were determined in a classical AME bioassay with special emphasis on the utilization of nonstarch polysaccharides (NSP). The enzymes were added to semi-purified broiler grower diets based on corn and casein containing 35% CM or 35% SFM, respectively. Feed intake, growth, and AME of the diets were significantly (P < 0.001) affected by type of oilseed meal included in the diet. Birds fed the SFM-based diets had a significantly (P < 0.001) higher growth rate and AME and a lower feed conversion ratio (FCR) than did birds fed the CM-based diets. The addition of enzymes to either CM- or SFM-based diets had no significant effects on growth performance and AME; however, the addition of enzymes to CM-based diets resulted in a significant reduction in the concentration of soluble NSP in the jejunum (Enzyme A) or a significant reduction of total NSP in the jejunum (Enzyme B). The AMEn was significantly lower in diets containing CM supplemented with Enzyme B. The addition of enzymes to SFM-based diets significantly improved NSP digestion in the jejunum and protein digestion in the ileum. The results of this study indicate that commercial enzyme products had some effects in diets containing high concentrations of CM or SFM. However, these effects could only be seen after detailed analyses of feed and digesta and did not result in significant improvement in growth performance of broilers.

Immunoassay readout method using extrinsic Raman labels adsorbed on immunogold colloids.

An immunoassay readout method based on surface-enhanced Raman scattering (SERS) is described. The method exploits the SERS-derived signal from reporter molecules that are coimmobilized with biospecific species on gold colloids. This concept is demonstrated in a dualanalyte sandwich assay, in which two different antibodies covalently bound to a solid substrate specifically capture two different antigens from an aqueous sample. The captured antigens in turn bind selectively to their corresponding detection antibodies. The detection antibodies are conjugated with gold colloids that are labeled with different Raman reporter molecules, which serve as extrinsic labels for each type of antibody. The presence of a specific antigen is established by the characteristic SERS spectrum of the reporter molecule. A near-infrared diode laser was used to excite efficiently the SERS signal while minimizing fluorescence interference. We show that, by using different labels with little spectral overlap, two different antigenic species can be detected simultaneously. The potential of this concept to function as a readout strategy for multiple analytes is briefly discussed.

A single amino acid substitution makes ERK2 susceptible to pyridinyl imidazole inhibitors of p38 MAP kinase.

Mitogen-activated protein (MAP) kinases are serine/threonine kinases that mediate intracellular signal transduction pathways. Pyridinyl imidazole compounds block pro-inflammatory cytokine production and are specific p38 kinase inhibitors. ERK2 is related to p38 in sequence and structure, but is not inhibited by pyridinyl imidazole inhibitors. Crystal structures of two pyridinyl imidazoles complexed with p38 revealed these compounds bind in the ATP site. Mutagenesis data suggested a single residue difference at threonine 106 between p38 and other MAP kinases is sufficient to confer selectivity of pyridinyl imidazoles. We have changed the equivalent residue in human ERK2, Q105, into threonine and alanine, and substituted four additional ATP binding site residues. The single residue change Q105A in ERK2 enhances the binding of SB202190 at least 25,000-fold compared to wild-type ERK2. We report enzymatic analyses of wild-type ERK2 and the mutant proteins, and the crystal structure of a pyridinyl imidazole, SB203580, bound to an ERK2 pentamutant, I103L, Q105T, D106H, E109G. T110A. These ATP binding site substitutions induce low nanomolar sensitivity to pyridinyl imidazoles. Furthermore, we identified 5-iodotubercidin as a potent ERK2 inhibitor, which may help reveal the role of ERK2 in cell proliferation.