The current landscape of in situ and ex-situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US.

Donation after circulatory death (DCD) is driving the increase in deceased organ donors in the United States. Normothermic regional perfusion (NRP) and ex-situ machine perfusion (es-MP) have been instrumental in improving liver transplant outcomes and graft utilization. This study examines the current landscape of liver utilization from cardiac DCD donors in the US. Using the UNOS STAR file, all adult (≥ 18 years old) DCD donors in the US in which the heart was used for transplantation from October 1, 2020, to September 30, 2023, were compared using procurement technique (NRP versus super rapid recovery [SRR]) and storage strategy (es-MP versus static cold storage [SCS]). 188 livers were transplanted from 309 TA-NRP donors (61% utilization) versus 305 (56%) liver transplants from 544 SRR donors. Es-MP was used in 20% (n= 38) of NRP cases versus 32% (98) of SRR cases. 281 (59%) of liver grafts were exposed to NRP, es-MP, or both. While there is widespread utilization of machine perfusion, more research is needed to determine optimal graft management strategies, particularly concerning the use of multiple technologies in complementary ways. More complete data collection is necessary at a national level to address these important research questions.

Variation in intention-to-treat survival by MELD subtypes: all models created for end-stage liver disease are not equal.

BACKGROUND & AIMS: Kidney dysfunction is a major determinant of prognosis in patients with decompensated cirrhosis awaiting transplantation. We hypothesized that for identical MELD scores at listing, outcomes before and after liver transplantation may vary if the predominant driver of the MELD score is serum creatinine versus serum bilirubin or INR. METHODS: We evaluated all adult patients registered for liver transplantation (LT) between 2016 - 2020 and excluded patients receiving MELD exceptions or undergoing dual organ transplantation. Using K-Means clustering analysis, we classified each patient as MELD-Br, MELD-INR or MELD-Cr depending on the dominant variable for their MELD score. The primary outcome was intent-to-treat survival, defined as survival within 1 year from listing with or without LT. RESULTS: MELD scores of LT waitlist registrants clustered into 3 subtypes: MELD-Br (n=13,658), MELD-INR (n=13,809), and MELD-Cr (n=12,412). One-year ITT survival was 78% (MELD-Br), 75% (MELD-INR), and 65% (MELD-Cr), p<0.01. ITT survival was lower for each MELD subtype for females compared to males (e.g. MELD Cr 63% females vs 67% males, p<0.0001). MELD-Cr subtype had the highest MELD at listing (MELD Cr 23.4 vs MELD-Br 19.2 vs MELD INR 21.0) and the largest decline in MELD over 3 months (23% vs. 12% vs 21%). In adjusted analyses including MELD Na, MELD-Cr compared to the other subtypes was associated with higher WL mortality (HR 1.339, 95% CI 1.279-1.402) and lower LT rates (HR 0.688, 95% CI 0.664-0.713). CONCLUSIONS: For equivalent listing practices, registrants with MELD-Cr subtype have lower ITT survival. MELD subtype may serve as a more sophisticated variable for dynamic assessment of risk of mortality, to inform models for organ allocation. IMPACT AND IMPLICATIONS: The MELD score is an excellent predictor of waitlist mortality; however, our work highlights that the driver of a patient's score MELD score matters and particularly those driven by elevated creatinine have a lower 1-year ITT mortality. The 1-year ITT mortality is also lower for women compared to men within the Cr-dominant subtype. These results are important for physicians and patients undergoing LT evaluation as creatinine may serve as a marker of prognosis and even if the creatinine improves the prognosis remains poor, necessitating discussion about alternative pathways for transplant. Our work also highlights that the type of kidney injury matters, in that those AKI were more likely to die or remain on the waitlist compared to those with CKD within the creatinine dominant subtype.

Exploring Divergent Views: A Comparative Study of Uterus Transplantation Perceptions among Transplant and Obstetrics/Gynecology Providers.

Background: Uterus transplantation (UTx) provides women with absolute uterine-factor infertility (AUFI) the opportunity to carry their own pregnancy and deliver a child. There are multiple ethical and medical concerns associated with UTx. Since the last survey of US provider perceptions of UTx in 2018, there have been additional reports of successful transplantations and pregnancies. This study aimed to identify the perception of UTx among providers involved in the diagnosis of AUFI and on the transplant team to help us understand knowledge gaps and determine what barriers must be overcome for UTx to be used in general clinical practice. Methods: We administered REDCap surveys to conference attendees at the 2023 American College of Obstetricians and Gynecologists (ACOG) conference and 2023 American Transplant Congress (ATC). Participants were recruited by medical student volunteers. Results: Two hundred ACOG and ATC attendees completed the survey. Medical concerns related to UTx were reported by 42% of providers from ACOG compared to 22% of providers from ATC. Overall, 76% of participants agreed that UTx should be an option for patients with congenital AUFI. Lastly, 68% of participants agreed that the procedure should be presented as an option for transgender women. Conclusions: This study further elucidates the perception of UTx among obstetricians/gynecologists and transplant physicians. We found greater support for the procedure than in previous studies. This study also demonstrates provider support for presenting this procedure as an option for transgender women.

Study on multiscale structures and digestibility of cassava starch and medium-chain fatty acids complexes using molecular simulation techniques.

Effect of complexation of three medium-chain fatty acids (octanoic, decylic and lauric acid, OA, DA and LA, respectively) on structural characteristics, physicochemical properties and digestion behaviors of cassava starch (CS) was investigated. Current study indicated that LA was more easily to combine with CS (complex index 88.9%), followed by DA (80.9%), which was also consistent with their corresponding complexed lipids content. Following the investigation of morphology, short-range ordered structure, helical structure, crystalline/amorphous region and fractal dimension of the various complexes, all cassava starch-fatty acids complexes (CS-FAs) were characterized with a flaked morphology rather than a round morphology in native starch (control CS). X-ray diffraction demonstrated that all CS-FAs had a V-type crystalline structure, and nuclear magnetic resonance spectroscopy confirmed that the complexes made from different fatty acids displayed similar V6 or V7 type polymorphs. Interestingly, small-angle X-ray scattering analysis revealed that α value became greater following increased carbon chain length of fatty acids, indicating the formation of a more ordered fractal structure in the aggregates. Changes in rheological parameters G' and G'' indicated that starch complexed with fatty acids was more likely to form a gel network, but difference among three CS-FAs complexes was significant, which might be contributed to their corresponding hydrophobicity and hydrophilicity raised from individual fatty acids. Importantly, digestion indicated that CS-LA complexes had the lowest hydrolysis degree, followed by the greatest RS content, indicating the importance of chain length of fatty acids for manipulating the fine structure and functionality of the complexes.

The separate and joint effects of recent interpersonal abuse and cannabis use on psychotic experiences: findings from students in higher education in the United States.

BACKGROUND: Various forms of interpersonal abuse (e.g., physical, emotional, sexual) and cannabis use across the lifespan have both been known to increase odds of psychotic experiences; however, there have been few studies examining their separate and joint effects in the United States. METHODS: We analyzed data from the Healthy Minds Study (2020-2021) and used multivariable logistic regression and interaction contrast ratios to assess separate and joint effects of interpersonal abuse (past 12 months) and cannabis use (past 30 days) on psychotic experiences (past 12 months). RESULTS: Students who only used cannabis had significantly greater odds of psychotic experiences (aOR: 1.70; 95% CI 1.58-1.82), as well as those who only experienced interpersonal abuse (aOR: 2.40; 95% CI 2.25-2.56). However, those who reported both cannabis use and interpersonal abuse had the greatest odds, exceeding the sum of these individual effects (the combined effect aOR: 3.46; 95% CI 3.19-3.76). CONCLUSIONS: Recent interpersonal abuse and recent cannabis use both separately and jointly increase odds of having recent psychotic experiences. Future research should continue to examine the potential interactive and additive impact of multiple known exposures to better inform primary and secondary prevention efforts.

Mental health differences between multiracial and monoracial college students in the United States: Emerging racial disparities.

BACKGROUND: Multiracial individuals appear to be at higher risk for mental health problems; however, more research is needed to confirm these racial disparities among young adult college populations. METHODS: We analyzed data from the Health Minds Study (N = 99728 young adult college students aged 18-34), collected online across 140 college campuses from September 2020 to June 2021. We used multivariable logistic regression to examine associations between multiracial identity and several mental health outcomes, including mental and behavioral health (depression, anxiety, languishing, perceived need, loneliness), self-injurious behaviors (non-suicidal self-injury, suicidal ideation, suicide plan, suicide attempt), and history of lifetime psychiatric disorders, adjusting for age and gender. RESULTS: Almost a tenth of the weighted sample were multiracial. Multiracial students had greater odds of all mental and behavioral health outcomes, self-injurious behaviors (though only marginally significant for suicide attempt), and most lifetime psychiatric disorders. CONCLUSION: Multiracial young adult college students were more likely to have mental health problems than their monoracial counterparts, calling for targeted preventive interventions on college campuses to address these mental health disparities.

Food Insecurity and Substance Use Among Young Adult College Students in the United States.

BACKGROUND: Food insecurity is prevalent among college students in the United States and has been associated with substance use. We sought to provide updated prevalence estimates and associations between food insecurity and a broad range of substances during the SARS-CoV-2 pandemic. METHODS: Using cross-sectional data from the Health Minds Study (N = 94,722; September 2020-June 2021), we used multivariable logistic regression to examine associations between food insecurity and several substances, adjusting for age, gender, race/ethnicity, hours worked, and residence. We then added a block of adjustments consisting of mental health factors (depression, anxiety, loneliness, financial stress). RESULTS: Food insecurity was associated with significantly greater odds of having used most individual substances, including greater odds of binge drinking (adjusted odds ratio [aOR], 1.21; 95% confidence interval [CI], 1.13-1.30), cigarette use (aOR, 1.91; 95% CI, 1.73-2.10), vaping (aOR, 1.74; 95% CI, 1.62-1.87), and a range of illicit or prescription drugs (using any illicit/prescription drug; aOR, 1.43; 95% CI, 1.32-1.55) These associations attenuated and many lost significance after adjusting for mental health factors. CONCLUSIONS: This study found evidence to suggest that food insecurity is related to substance use in a large sample of young adult college students in the United States, calling for targeted interventions.

Catalytic pyrolysis of lignocellulosic biomass for bio-oil production: A review.

Catalytic pyrolysis has been widely explored for bio-oil production from lignocellulosic biomass owing to its high feasibility and large-scale production potential. The aim of this review was to summarize recent findings on bio-oil production through catalytic pyrolysis using lignocellulosic biomass as feedstock. Lignocellulosic biomass, structural components and fundamentals of biomass catalytic pyrolysis were explored and summarized. The current status of bio-oil yield and quality from catalytic fast pyrolysis was reviewed and presented in the current review. The potential effects of pyrolysis process parameters, including catalysts, pyrolysis conditions, reactor types and reaction modes on bio-oil production are also presented. Techno-economic analysis of full-scale commercialization of bio-oil production through the catalytic pyrolysis pathway was reviewed. Further, limitations associated with current practices and future prospects of catalytic pyrolysis for production of high-quality bio-oils were summarized. This review summarizes the process of bio-oil production from catalytic pyrolysis and provides a general scientific reference for further studies.

Food insecurity and mental health among young adult college students in the United States.

BACKGROUND: Food insecurity is prevalent among college students in the United States and has been associated with mental health problems. However, the literature is not entirely consistent and is missing key aspects of mental health. METHODS: Using cross-sectional data from the Health Minds Study (N = 96,379; September 2020-June 2021), we used multivariable logistic regression to examine associations between food insecurity and several aspects of mental health (i.e., depression, anxiety, languishing, perceived need, loneliness, self-injurious behaviors), adjusting for age, gender, race/ethnicity, financial distress, and parental education. RESULTS: Food insecurity was associated with greater odds of having depression, anxiety, languishing, perceived need for help, loneliness, and self-injurious behaviors, adjusting for sociodemographic characteristics and markers of socioeconomic status. CONCLUSION: This study found evidence to suggest that food insecurity is related to poor mental health in a large sample of young adult college students in the United States, calling for targeted interventions.

Clinical observation of 60 cases of treating cognitive disorder after cerebral injury in combination with scalp acupuncture and cognitive training.

To observe the clinical effect of scalp acupuncture combined with cognitive training on cognitive disorder after cerebral injury.Around 60 cases of cerebral injury patients for hospitalization in rehabilitation department of Chongqing Three Gorges Central Hospital from July in 2015 to June in 2017 are divided into control group and treatment group of 30 cases for each at random. The control group received routine treatment and cognitive rehabilitation training for 12 weeks. The treatment group received conventional treatment, cognitive rehabilitation training, and scalp acupuncture. Acupuncture with a scalp acupuncture is provided for the treatment group besides adopting above conventional treatment and rehabilitation training method.Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score of both groups increases obviously after treatment compared with that before treatment, and there is difference (P < .01) through contrast. And LOTCA score of treatment group is higher than that of control group (P < .05) after treatment.Scalp acupuncture in combination with cognitive training can effectively improve cognitive disorder degree of patients with cerebral injury, and the effect is more significant compared with simple cognitive rehabilitation training, thus it is worth of research and application.

Generalized shift-rotation absolute measurement method for high-numerical-aperture spherical surfaces with global optimized wavefront reconstruction algorithm.

In this paper, a generalized shift-rotation absolute measurement method is proposed to measure the absolute surface shape of high-numerical-aperture spherical surfaces. Based on the wavefront difference method, the high order misalignment aberrations can be removed from the measurements. Our generalized shift-rotation absolute measurement process only needs one rotational measurement position and one translational measurement position. A wavefront reconstruction method based on the self-adaptive differential evolution algorithm is proposed to calculate the Zernike polynomials coefficient ai of the absolute surface shape Wtest(x,y), the rotation angle Δθ, the translation δx along the x axis, and the translation δy along the y axis. The translation error and rotation error in other absolute measurement methods are avoided using our generalized shift-rotation absolute measurement method. Experimental absolute results of the test surface and reference surface are given and the difference of reference surface shapes between two testings in experiments is 0.12 nm root mean square.