Management of ectopic intestinal variceal bleeding following pancreatic transplant: Two cases.

Ectopic variceal bleeding is a potentially under recognized source of gastrointestinal (GI) hemorrhage. While vascular complications following pancreatic transplant are relatively common, the development of symptomatic ectopic venous varices has rarely been reported. We report two patients with a remote history of simultaneous kidney pancreas transplant (SPK) presenting two decades after transplant with an occult GI bleed. In both cases, a lengthy diagnostic course was required. The varices were treated with coil embolization via transhepatic approach. Our findings add to the limited literature on this topic and aid in the recognition, diagnosis, and management of this unusual presentation.

Particulates, unregulated and regulated emissions and catalytic converter efficiency evaluation of methanol (M15) fuelled BS-VI compliant light-duty spark-ignition engine.

Methanol adaptation in the transport sector is being encouraged worldwide. Methanol, a high-octane fuel, is emerging as a strong fuel candidate for powering spark-ignition (SI) engines and it can be indigenously produced from low-value agricultural biomass waste and high-ash coal. This study investigated particulates and unregulated and regulated emissions from M15 (15 % v/v methanol, 82 % v/v gasoline, 3 % v/v propanol) fueled Bharat Stage-VI (BS-VI) 2020 compliant light-duty SI engine equipped with a multipoint port fuel injection system and compared it with baseline gasoline fueled engine. The catalytic conversion efficiency for controlling regulated and unregulated emission species are also discussed for both test fuels. The experimental results showed a reduction in carbonaceous emissions from M15 fueled engine. Hydrocarbons (HC), carbon monoxide (CO) and particulate emissions reduced, while oxides of nitrogen (NOx) emissions were comparable to baseline gasoline-fueled engine. The catalytic conversion of CO emission was higher for M15 but lower for HC and NOx emissions. Various unregulated trace emission components such as formaldehyde, acetaldehyde, methane, ethene and propene reduced with methanol addition to gasoline. Considerable reductions in benzene and toluene trace emissions were observed for M15, but methanol and ethane trace emissions were higher. The catalytic conversion of all unregulated trace emission components was comparable for both test fuels except alcohols, where M15 exhibited increased trace emission values. The study reflected that M15 could easily replace gasoline in BS-VI-compliant light-duty SI transportation engines. However, verification of all regulatory emission compliances, diagnostics and durability compliances need be ascertained before large-scale implemetation.

Donor-derived Transmission of Hepatitis A Virus Following Kidney Transplantation: Clinical Course of Two Cases From One Donor.

Donor-derived transmission of infections is a rare complication of kidney transplant. Hepatitis A virus (HAV) is a common cause of acute viral hepatitis worldwide, but donor-derived transmission to organ recipients has been reported in the literature only twice previously. The timeline for HAV incubation and clearance in transplant recipients is not well understood. Methods: In 2018, 2 kidneys and a liver were procured from a deceased donor resident of Kentucky, one of many states that was experiencing an HAV outbreak associated with person-to-person transmission through close contact, primarily among people who reported drug use. Both kidney recipients, residents of Virginia, subsequently developed acute HAV infections. We report the results of an investigation to determine the source of transmission and describe the clinical course of HAV infection in the infected kidney recipients. Results: The liver recipient had evidence of immunity to HAV and did not become infected. The donor and both kidney recipients were found to have a genetically identical strain of HAV using a next-generation sequencing-based cyber molecular assay (Global Hepatitis Outbreak Surveillance Technology), confirming donor-derived HAV infections in kidney recipients. At least 1 kidney recipient experienced delayed development of detectable hepatitis A anti-IgM antibodies. By 383 and 198 d posttransplant, HAV RNA was no longer detectable in stool specimens from the left and right kidney recipients, respectively. Conclusions: Adherence to current guidance for hepatitis A vaccination may prevent future morbidity due to HAV among organ recipients. http://links.lww.com/TXD/A548.

Early and Effective Diagnosis of Sepsis Using Flow Cytometry.

Objective Sepsis is a major global health issue due to its high death and morbidity rates. To avoid the negative effects of sepsis and decrease mortality, it is vital to diagnose and treat it as soon as possible. Blood cultures can take up to 2 days to give result, and they are not always reliable. According to recent studies, neutrophil CD64 expression might be a sensitive and specific option for assessing sepsis. This study aimed to evaluate the diagnostic performance of a flow cytometry analysis for the expression of neutrophil CD64 in sepsis and its comparison with other standard tests in a tertiary care center. Materials and Methods Prospective analysis on 40 blood samples from suspected sepsis patients admitted to intensive care units with criteria for the systemic inflammatory response syndrome on presentation was performed for expression of neutrophil CD64, C-reactive protein, procalcitonin, and complete blood count. Ten healthy volunteers were also enrolled in this prospective study. The laboratory results were compared in different groups. Results The neutrophil CD64 had the highest diagnostic value to differentiate between patients of sepsis and nonsepsis groups with a sensitivity of 100% (95% confidence interval [CI]: 77.19-100%) and 100% (95% CI: 55.32-86.83%); specificity of 90.00% (95% CI: 59.58-99.49%) and 87.24% (95% CI: 66.69-99.61%); and likelihood ratio of 10.00 and 7.84, respectively. Conclusion The neutrophil CD64 expression provides a more sensitive, specific, and novel marker for the early detection of sepsis in critically ill patients.

Weissella confusa Causing Vancomycin-Resistant Septicemia Infection in a Pediatric Patient: A Case Report From a University Teaching Hospital in North India.

Weissella confusa is a Gram-positive coccus usually found in the microbiota of humans and the environment. Different studies quote that it has caused infections in humans under unfavourable conditions. A case report causing septicemia in an 11-year-old male patient diagnosed with acute pancreatitis and having acute respiratory distress syndrome (ARDS) is presented. The patient was successfully treated with ceftazidime and a piperacillin-tazobactam combination after confirmation of bacteria by matrix-assisted laser desorption and ionisation-time of flight (MALDI-TOF-MS) and antimicrobial sensitivity testing (AST) performed as per the latest Clinical and Laboratory Standard Institute (CLSI) guidelines. The patient was discharged asymptomatically after drainage of fluid and was managed conservatively. Correct identification by the automated method is important for this species and also to find its mode of infection. Because of its similarities to other vancomycin-resistant cocci, isolates of this species might be difficult to identify, leading to drug resistance. A literature review in tabulated form is summarised.

Characterisation of particulates and trace metals emitted by a dimethyl ether-fuelled genset engine prototype.

Diesel-fuelled CI engines are the primary sources of particulate matter (PM) emissions which harm human health and the urban environment. Elevated PM emission levels can cause respiratory diseases and deteriorate urban air quality and atmospheric visibility. DME, a carbon-neutral and oxygenated fuel, is fast merging as a strong alternative to diesel to reduce PM emissions. The absence of a direct carbon-carbon bond in the molecular structure of DME improves combustion and reduces PM emissions to negligible levels. DME and baseline diesel are experimentally evaluated in a single-cylinder CI genset engine prototype to find the particulate number-size, surface area-size and mass-size distributions. In addition, total particulate number (TPN), total particulate mass (TPM), count mean diameter (CMD) of particulates, particulate morphology and trace metals were assessed. DME genset engine emitted higher numbers of smaller diameter particles, with lower surface area and mass distribution than baseline diesel. For DME, total PM mass emission and CMD of particulates were lower due to particles being finer. Morphological analysis of particulates showed the presence of larger particles from diesel and less bunched agglomerates of nucleation mode particles from the DME genset engine prototype. The trace metal analysis of particulates showed higher presence of trace metals such as Si, Ca, and Na in DME-fuelled engine than in diesel. As an alternative to diesel, DME can reduce PM emissions from genset engines, significantly enhance urban air quality, and minimise the threat of respiratory diseases.

Dosimetric Evaluation of the Treatment Plan on Indigenous Heterogeneous Phantoms using Analytical Anisotropic Algorithm and Acuros-XB Algorithm for Different Photon Energies.

Background: Modern radiotherapy techniques are using advanced algorithms; however, phantoms used for quality assurance have homogeneous density; accordingly, the development of heterogeneous phantom mimicking human body sites is imperative to examine variation between planned and delivered doses. Objective: This study aimed to analyze the accuracy of planned dose by different algorithms using indigenously developed heterogeneous thoracic phantom (HT). Material and Methods: In this experimental study, computed tomography (CT) of HT was done, and the density of different parts was measured. The plan was generated on CT images of HCP with 6 and 15 Megavoltage (MV) photon beams using different treatment techniques, including three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Plans were delivered by the linear accelerator, and the dose was measured using the ion chamber (IC) placed in HT; planned and measured doses were compared. Results: Density patterns for different parts of the fabricated phantom, including rib, spine, scapula, lung, chest wall, and heart were 1.849, 1.976, 1.983, 0.173, 0.855, and 0.833 g/cc, respectively. Variation between planned and IC estimated doses with the tolerance (±5%) for all photon energies using different techniques. Acuros-XB (AXB) showed a slightly higher variation between computed and IC estimated doses using HCP compared to the analytical anisotropic algorithm (AAA). Conclusion: The indigenous heterogeneous phantom can accurately simulate the dosimetric scenario for different algorithms (AXB or AAA) and be also utilized for routine patient-specific QA.

Electrifying passenger road transport in India requires near-term electricity grid decarbonisation.

Battery-electric vehicles (BEV) have emerged as a favoured technology solution to mitigate transport greenhouse gas (GHG) emissions in many non-Annex 1 countries, including India. GHG mitigation potentials of electric 4-wheelers in India depend critically on when and where they are charged: 40% reduction in the north-eastern states and more than 15% increase in the eastern/western regions today, with higher overall GHGs emitted when charged overnight and in the summer. Self-charging gasoline-electric hybrids can lead to 33% GHG reductions, though they haven't been fully considered a mitigation option in India. Electric 2-wheelers can already enable a 20% reduction in GHG emissions given their small battery size and superior efficiency. India's electrification plan demands up to 125GWh of annual battery capacities by 2030, nearly 10% of projected worldwide productions. India requires a phased electrification with a near-term focus on 2-wheelers and a clear trajectory to phase-out coal-power for an organised mobility transition.

Impact of Portable Normothermic Blood-Based Machine Perfusion on Outcomes of Liver Transplant: The OCS Liver PROTECT Randomized Clinical Trial.

IMPORTANCE: Ischemic cold storage (ICS) of livers for transplant is associated with serious posttransplant complications and underuse of liver allografts. OBJECTIVE: To determine whether portable normothermic machine perfusion preservation of livers obtained from deceased donors using the Organ Care System (OCS) Liver ameliorates early allograft dysfunction (EAD) and ischemic biliary complications (IBCs). DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial (International Randomized Trial to Evaluate the Effectiveness of the Portable Organ Care System Liver for Preserving and Assessing Donor Livers for Transplantation) was conducted between November 2016 and October 2019 at 20 US liver transplant programs. The trial compared outcomes for 300 recipients of livers preserved using either OCS (n = 153) or ICS (n = 147). Participants were actively listed for liver transplant on the United Network of Organ Sharing national waiting list. INTERVENTIONS: Transplants were performed for recipients randomly assigned to receive donor livers preserved by either conventional ICS or the OCS Liver initiated at the donor hospital. MAIN OUTCOMES AND MEASURES: The primary effectiveness end point was incidence of EAD. Secondary end points included OCS Liver ex vivo assessment capability of donor allografts, extent of reperfusion syndrome, incidence of IBC at 6 and 12 months, and overall recipient survival after transplant. The primary safety end point was the number of liver graft-related severe adverse events within 30 days after transplant. RESULTS: Of 293 patients in the per-protocol population, the primary analysis population for effectiveness, 151 were in the OCS Liver group (mean [SD] age, 57.1 [10.3] years; 102 [67%] men), and 142 were in the ICS group (mean SD age, 58.6 [10.0] years; 100 [68%] men). The primary effectiveness end point was met by a significant decrease in EAD (27 of 150 [18%] vs 44 of 141 [31%]; P = .01). The OCS Liver preserved livers had significant reduction in histopathologic evidence of ischemia-reperfusion injury after reperfusion (eg, less moderate to severe lobular inflammation: 9 of 150 [6%] for OCS Liver vs 18 of 141 [13%] for ICS; P = .004). The OCS Liver resulted in significantly higher use of livers from donors after cardiac death (28 of 55 [51%] for the OCS Liver vs 13 of 51 [26%] for ICS; P = .007). The OCS Liver was also associated with significant reduction in incidence of IBC 6 months (1.3% vs 8.5%; P = .02) and 12 months (2.6% vs 9.9%; P = .02) after transplant. CONCLUSIONS AND RELEVANCE: This multicenter randomized clinical trial provides the first indication, to our knowledge, that normothermic machine perfusion preservation of deceased donor livers reduces both posttransplant EAD and IBC. Use of the OCS Liver also resulted in increased use of livers from donors after cardiac death. Together these findings indicate that OCS Liver preservation is associated with superior posttransplant outcomes and increased donor liver use. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02522871.

Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers.

OBJECTIVE: On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS: Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS: Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS: Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status.

Elizabethkingia anophelis Infections: A Case Series From a Tertiary Care Hospital in Uttar Pradesh.

Elizabethkingia anophelis is a gram-negative, aerobic, non-motile rod belonging to the ​​​​​Flavobacteriaceae family. Elizabethkingia is a genus of bacteria commonly found in the environment worldwide and has been detected in soil, river, water, and reservoirs. Over the period, it has emerged as an opportunistic human pathogen involved in neonatal meningitis and sepsis, as well as nosocomial outbreaks in adults with underlying medical conditions, including malignancies, diabetes, and chronic obstructive pulmonary disease. Here, we present a series of three cases of infection of E. anophelis in different clinical samples. These three cases were referred from different departments of King George's Medical University (KGMU), Lucknow, India to the Critical Care Medicine Department of KGMU, and finally succumbed to the infection.

National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.

BACKGROUND: Organ transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV-positive donors is critical for safety. METHODS: We performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors. RESULTS: Between March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL <400 copies/mL. The median CD4 T-cell count (interquartile range) was 194/µL (77-331/µL), and the median CD4 T-cell percentage was 27.0% (16.8%-36.1%). Major HIV DRMs were detected in 42%, including nonnucleoside reverse-transcriptase inhibitors (33%), integrase strand transfer inhibitors (4%), and multiclass (13%). Serum ART was detected in 46% and matched ART by history. CONCLUSION: The use of HIV-positive donor organs is increasing. HIV DRMs are common, yet resistance that would compromise integrase strand transfer inhibitor-based regimens is rare, which is reassuring regarding safety.

Conversion from Calcineurin Inhibitor- to Belatacept-Based Maintenance Immunosuppression in Renal Transplant Recipients: A Randomized Phase 3b Trial.

BACKGROUND: Calcineurin inhibitors (CNIs) are standard of care after kidney transplantation, but they are associated with nephrotoxicity and reduced long-term graft survival. Belatacept, a selective T cell costimulation blocker, is approved for the prophylaxis of kidney transplant rejection. This phase 3 trial evaluated the efficacy and safety of conversion from CNI-based to belatacept-based maintenance immunosuppression in kidney transplant recipients. METHODS: Stable adult kidney transplant recipients 6-60 months post-transplantation under CNI-based immunosuppression were randomized (1:1) to switch to belatacept or continue treatment with their established CNI. The primary end point was the percentage of patients surviving with a functioning graft at 24 months. RESULTS: Overall, 446 renal transplant recipients were randomized to belatacept conversion ( n =223) or CNI continuation ( n =223). The 24-month rates of survival with graft function were 98% and 97% in the belatacept and CNI groups, respectively (adjusted difference, 0.8; 95.1% CI, -2.1 to 3.7). In the belatacept conversion versus CNI continuation groups, 8% versus 4% of patients experienced biopsy-proven acute rejection (BPAR), respectively, and 1% versus 7% developed de novo donor-specific antibodies (dnDSAs), respectively. The 24-month eGFR was higher with belatacept (55.5 versus 48.5 ml/min per 1.73 m 2 with CNI). Both groups had similar rates of serious adverse events, infections, and discontinuations, with no unexpected adverse events. One patient in the belatacept group had post-transplant lymphoproliferative disorder. CONCLUSIONS: Switching stable renal transplant recipients from CNI-based to belatacept-based immunosuppression was associated with a similar rate of death or graft loss, improved renal function, and a numerically higher BPAR rate but a lower incidence of dnDSA.Clinical Trial registry name and registration number: A Study in Maintenance Kidney Transplant Recipients Following Conversion to Nulojix® (Belatacept)-Based, NCT01820572.

A cleaner route of biodiesel production from waste frying oil using novel potassium tin oxide catalyst: A smart liquid-waste management.

The valorization of waste frying oil (WFO) to biodiesel has been carried out via solid base catalyzed transesterification reaction. A novel potassium tin oxide (KSO) catalyst was synthesized via polymer precursor auto combustion method. The catalyst showed the best physicochemical properties when it was calcined at 800 °C. Using KSO 800 catalyst, the highest FAME conversion (99.5%) of WFO found at moderated reaction condition within very short time (35 min); moreover, no leaching of K-species was observed in reusability test upto 5th cycle. Kinetics proved that the above catalytic reaction followed pseudo-first-order kinetics and the rate of the reaction was doubled with increasing 10 °C reaction temperature. The reaction activation energy, enthalpy of activation, entropy of activation, and Gibb's free energy of activation of the reaction were found to be 66.52 kJ/mol, 62.95 kJ/mol, -74.07 J/mol/K and 88 kJ/mol respectively. Evaluation of the green parameters revealed that KSO 800 catalyzed transesterification process approached a cleaner route with excellent efficacy in terms of turnover frequency and yield. KSO 800 helped to produce high quality biodiesel from WFO adopting faster and greener reaction pathway. Thus, KSO 800 was considered as a potential and green catalyst for transforming waste oil into biofuel.

Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India.

INTRODUCTION: Ventilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide. MATERIAL AND METHODS: Endotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes. RESULTS: VAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes. CONCLUSION: The blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.

Robot-assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end-stage renal disease.

BACKGROUND: Many centres deny obese patients with a body mass index (BMI) >35 access to kidney transplantation due to increased intraoperative and postoperative complications. METHODS: From August 2017 to December 2019, 73 consecutive cases of kidney transplantation in morbidly obese patients were enrolled at a single university at the initiation of a robotic transplant surgery program. Outcomes of patients who underwent robotic assisted kidney transplant (RAKT) were compared to frequency-matched patients undergoing open kidney transplant (OKT). RESULTS: A total of 24 morbidly obese patients successfully underwent RAKT, and 49 obese patients received an OKT. The RAKT group developed fewer surgical site infections (SSI) than the OKT group. Graft function, creatinine, and glomerular filtration rate (GFR) were similar between groups 1 year after surgery. Graft and patient survival were 100% for both groups. CONCLUSIONS: RAKT offers a safe alternative for morbidly obese patients, who may otherwise be denied access to OKT.

Transplant of a Kidney from a Hepatitis C Viremic Donor to a Naïve Recipient without Viral Transmission: A Case Report.

BACKGROUND Kidneys from deceased donors who were positive for hepatitis C virus (HCV) on a nucleic acid amplification test (NAT) are not given to anti-HCV antibody-negative recipients. This is because of the high risk of HCV transmission, combined with the lack of effective antiviral treatment. Several studies have demonstrated rates of transmission of HCV from anti-HCV-positive/HCV NAT-positive donors to anti-HCV-negative recipients of 100%. Ours is the first report of transplantation of a kidney from an anti-HCV antibody-positive/HCV NAT-positive donor into an anti-HCV antibody-negative recipient who remains anti-HCV antibody-negative at 3 months after transplant with no treatment. CASE REPORT A 49-year-old man had a history of end-stage renal disease that was presumed to be secondary to type ll diabetes. He received a kidney from a deceased donor who was HCV antibody-positive/NAT-negative. The patient's HCV antibody status was checked prior to transplant and he was found to be negative and nonreactive. Since the transplant, his HCV viral load has been checked 5 times, on postoperative days 15, 23, 44, 62, and 64; each time, it has been undetectable. Furthermore, the patient's HCV antibody status was rechecked 1 month after transplant and it remained negative and nonreactive. CONCLUSIONS Further research is required on the accuracy of polymerase chain reaction as an indicator of donor HCV infection when the quantity of the viral load is not reported.

Particulate characteristics of low-temperature combustion (PCCI and RCCI) strategies in single cylinder research engine for developing sustainable and cleaner transportation solution.

In this experimental study, particulate matter (PM) characterizations of different low-temperature combustion (LTC) strategies have been compared with conventional compression ignition (CI) combustion for finding out a sustainable and cleaner transport solution. LTC strategies included premixed charge compression ignition (PCCI) and reactivity-controlled compression ignition (RCCI) combustion. Particulate sampling and characterization were carried out in a single-cylinder diesel engine. All engine tests were performed at 1, 2, 3, 4 bar brake mean effective pressure (BMEP) at 1500 rpm. CI and PCCI combustion experiments were performed using mineral diesel as the test fuel. However, mineral diesel and methanol were used as high reactivity fuel (HRF) and low reactivity fuel (LRF), respectively in the RCCI combustion strategy. For all combustion strategies, fuel injection pressure (FIP) was kept constant at 500 bar. However, the number of injections and start of injection (SoI) timings were varied to optimize the engine performance. Results showed that the RCCI combustion strategy emitted a relatively lower concentration of particles than the other two strategies (PCCI and CI). A relatively higher number concentration of accumulation mode particles (AMP) compared to nucleation mode particles (NMP) in the exhaust of the RCCI combustion strategy was an important finding of this study. Number-size and mass-size distributions of particles emitted from different strategies also exhibited the dominant concentration of particles in the CI combustion strategy. PM bound trace metal analysis was yet another critical aspect of this study, which showed that both RCCI and PCCI strategies emitted a relatively lower concentration of trace metals than the conventional CI combustion strategy. Parametric analysis of different PM characteristics and NOx-PM trade-off analysis also demonstrated the importance of LTC strategies over the conventional CI combustion strategy. Overall, this study demonstrated that all LTC strategies could be used for PM and NOx reduction; however, the RCCI combustion strategy was more dominant in NOx and PM reduction, in addition to having an excellent capability of using alternative fuel in the quest for developing sustainable transport solution.

Specialized metabolites contributing to colour and scent volatiles in Uvaria hamiltonii flowers.

The present study focuses on the emitted and endogenous scent profiles of Uvaria hamiltonii flowers. Among the 34 compounds identified, sesquiterpenoids were found to dominate the floral volatiles composition. Profiles from endogenous scent volatiles showed higher number of compounds than the emitted ones. The anthocyanin pigment responsible for the flower colour was also explored. It was found that a single anthocyanin compound, cyanidin-3-O-glucoside, was principally responsible for petal colour. Total phenolic content was evaluated and antioxidant capacities were studied with the help of DPPH, FRAP and ABTS assays. The total phenolic content and the antioxidant capacity were higher in methanolic extract as compared to aqueous, petroleum ether and ethyl acetate extracts of U. hamiltonii flowers.

A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action.

HIV-positive donor to HIV-positive recipient (HIV D+/R+) transplantation is permitted in the United States under the HIV Organ Policy Equity Act. To explore safety and the risk attributable to an HIV+ donor, we performed a prospective multicenter pilot study comparing HIV D+/R+ vs HIV-negative donor to HIV+ recipient (HIV D-/R+) kidney transplantation (KT). From 3/2016 to 7/2019 at 14 centers, there were 75 HIV+ KTs: 25 D+ and 50 D- (22 recipients from D- with false positive HIV tests). Median follow-up was 1.7 years. There were no deaths nor differences in 1-year graft survival (91% D+ vs 92% D-, P = .9), 1-year mean estimated glomerular filtration rate (63 mL/min D+ vs 57 mL/min D-, P = .31), HIV breakthrough (4% D+ vs 6% D-, P > .99), infectious hospitalizations (28% vs 26%, P = .85), or opportunistic infections (16% vs 12%, P = .72). One-year rejection was higher for D+ recipients (50% vs 29%, HR: 1.83, 95% CI 0.84-3.95, P = .13) but did not reach statistical significance; rejection was lower with lymphocyte-depleting induction (21% vs 44%, HR: 0.33, 95% CI 0.21-0.87, P = .03). In this multicenter pilot study directly comparing HIV D+/R+ with HIV D-/R+ KT, overall transplant and HIV outcomes were excellent; a trend toward higher rejection with D+ raises concerns that merit further investigation.