Simultaneous Detection of Carbon Quantum Dots as Tracers for Interwell Connectivity Evaluation in a Pattern with Two Injection Wells.

This study aimed to develop and implement a nanotechnology-based alternative to traditional tracers used in the oil and gas industry for assessing interwell connectivity. A simple and rapid hydrothermal protocol for synthesizing carbon quantum dots (CQDs) using agroindustry waste was implemented. Three commercial CQDs were employed (CQDblue, CQDgreen, and CQDred); the fourth was synthesized from orange peel (CQDop). The CQDs from waste and other commercials with spherical morphology, nanometric sizes less than 11 nm in diameter, and surface roughness less than 3.1 nm were used. These tracers demonstrated high colloidal stability with a negative zeta potential, containing carbonyl-type chemical groups and unsaturations in aromatic structures that influenced their optical behavior. All materials presented high colloidal stability with negative values of charge z potential between -17.8 and -49.1. Additionally, individual quantification of these tracers is feasible even in scenarios where multiple CQDs are present in the effluent with a maximum percentage of interference of 15.5% for CQDop in the presence of the other three nanotracers. The CQDs were injected into the field once the technology was insured under laboratory conditions. Monitoring the effluents allowed the determination of connectivity for five first-line producer wells. This study enables the application of CQDs in the industry, particularly in fields where the arrangement of injector and producer wells is intricate, requiring the use of multiple tracers for a comprehensive description of the system.

Efecto aditivo in vitro de Chlorella sorokiniana en combinación con Vincristina sobre la inhibición del crecimiento de células de cáncer de colon HT-29 / In vitro additive effect of Chlorella sorokiniana in combination withVincristine on HT-29 colon cancer cells growth inhibition

Objetivo: Evaluar el efecto in vitro de la combinación deChlorella sorokiniana con Vincristina contra el crecimiento decélulas de cáncer de colon HT-29.Material y método:Chlorella sorokiniana se cultivó enmedio López-Chuken. El efecto inhibitorio de la microalga solay en combinación con Vincristina en el crecimiento tumoral seevaluó mediante la técnica de MTT, contra células de cáncerde colon humano HT-29, y se analizó mediante el softwareSynergyFinder 2.0.Resultados: El crecimiento Chlorella sorokiniana fue cons-tante al día 28 a una temperatura de 34 oC ± 3 oC. El efectoinhibitorio de Vincristina sobre células HT-29 fue del 60% apartir de 0.0037μg/mL. La inhibición por Chlorella sorokinianafue del 60% al 80% a las concentraciones de 106-108.Además, la combinación de Vincristina/Chlorella inhibió el cre-cimiento tumoral entre 70% y 90%, siendo la concentraciónmenor de Chlorella la que mostró un mejor efecto en combi-nación con Vincristina. El análisis de los resultados enSynergyFinder mostró un score de -0.708, determinando unefecto aditivo. Conclusión:Chlorella sorokiniana presenta un efecto adi-tivo en combinación con Vincristina contra la línea de cáncerde colon humano HT-29. La suplementación de C. sorokinianaen la dieta de pacientes con cáncer de colon podría mejorarsu tratamiento y por consecuencia su recuperación (AU)

Objective:To evaluate in vitro the effect of the combina-tion of Chlorella sorokiniana with vincristine on HT-29 coloncancer cells.Material and method:Chlorella sorokininana growth wasconstant on day 28 at a temperature of 34 oC ± 3 oC. Chlorellasorokiniana was cultured in López-Chuken medium. HT-29 cellsgrowth inhibition by the microalga alone or in combination withvincristine was evaluated by the colorimetric reduction MTT as-say, and analyzed using the SynergyFinder 2.0 software. Results:The inhibitory effect of Vincristine on HT-29 cellswas 60% from 0.0037μg/mL. Tumor cells growth inhibition by106 to 108 Chlorella sorokiniana cells ranged from 60% to80%. The combination of vincristine and Chlorella inhibitedtumor cells growth from 70% to 90%, being the lower con-centration of Chlorella the one that showed a better effect incombination with vincristine. The analysis of the results inSynergyFinder showed a score of -0.708, determining an ad-ditive effect.Conclusion: Chlorella sorokiniana has an additive effect incombination with vincristine against the human colon cancerline HT-29. Supplementation of C. sorokiniana in the diet ofpatients with colon cancer may improve their treatment andrecovery (AU)

Sex Steroid Hormone Receptor Content of Medial Preoptic Efferents to the Ventral Tegmental Area Is Sexually Dimorphic: Implications for Sex Differences in Mesolimbic Reward Processing.

INTRODUCTION: The medial preoptic area (mPOA) is an important regulator of natural and drug-induced reward. However, despite the mPOA being implicated in sexually dimorphic reward responses, sex differences in medial preoptic efferents to the ventral tegmental area (VTA) have not been fully investigated. METHODS: Two cohorts of male and female rats received unilateral injections of the tract-tracer Fluoro-Gold (FLG) into the VTA. Immunohistochemical staining was used to quantify co-labeled FLG-positive neurons with γ-aminobutyric acid (GABA), estrogen receptor α (ERα), and androgen receptors (AR). RESULTS: Results revealed a pattern of VTA innervation that was comparable between males and females; more efferents emerged from the rostrocentral portions of the mPOA than caudal portions. Results also indicated that males and females had the same percentage of GABAergic mPOA-VTA projections. Differences emerged when investigating the hormone receptor profile of projections to the VTA, where females had a greater percentage of efferents expressing ERα and males had a greater percentage of efferents expressing AR, in the central portion of the mPOA. Lastly, FLG-positive cells were colocalized with GABA and ERα in cohort 1 and GABA and AR in cohort 2. The majority of AR-expressing cells colocalized with GABAergic efferents to the VTA, but only a portion of ERα-expressing cells colocalized with GABAergic efferents to the VTA. CONCLUSION: Results indicate that sex differences are present in the sex-steroid hormone receptor content of mPOA-VTA projections, particularly among efferents arising from the central region of the mPOA. These sexually dimorphic connections may influence a wide range of sex differences in reward responses.

Impact of Recipient Age at Liver Transplant on Long-term Outcomes.

BACKGROUND: The age of a liver transplant (LT) candidate is one of many variables used in the transplant selection process. Most research about the age at transplant has used prespecified age ranges or categories in assessing associations with transplant outcomes. However, there is a lack of knowledge about the age at transplant and survival. This study aimed to examine associations of age at transplant as a continuous variable, in conjunction with other patient and disease-related factors, with patient and graft survival after LT. METHODS: We used the Standard Transplant Analysis and Research data to identify LT recipients between January 2002 and June 2018. Cox regression models with a restricted cubic spline term for age examined associations with graft and patient survival after LT. We assessed the interactions of age with recipients' sex, race/ethnicity, region, indication for transplant, body mass index, model for end-stage liver disease score, diabetes, functional status at transplant, and donor risk index. RESULTS: Age at the time of LT showed a nonlinear association with both graft and patient survival. Each demographic, clinical, transplant-related, and donor-related factor influenced these relationships differently. CONCLUSIONS: Our results suggest that some older LT candidates may be better than some younger candidates and that clinicians should not exclusively use age to determine who receives LT.

Morphological and molecular characterization of three new species of Gyrodactylus (Monogenea: Gyrodactylidae) infecting Sicydium salvini (Teleostei: Gobiidae) in Mexican rivers draining into the Pacific Ocean.

The genus Gyrodactylus von Nordmann, 1832 is one of the most diverse within the class Monogenea; it contains mainly parasites of freshwater and marine teleost fishes. Around 40 species of Gyrodactylus have been described from gobiid fishes; mainly in Europe, as only two species are known from the Americas. In this study, we describe three new gyrodactylids from the body surface and fins of the goby Sicydium salvini (Gobiidae, Sycydiinae), which has a wide distribution on the Pacific coast, from Mexico to Panama. We describe Gyrodactylus oaxacae n. sp., G. atoyacensis n. sp. and G. salvini n. sp. collected from rivers draining to the eastern Pacific in the state of Oaxaca, Mexico. Morphologically, G. atoyacensis n. sp. and G. salvini n. sp. are very similar, and both are easily differentiated from G. oaxacae n. sp. Phylogenetic hypotheses based on sequences of the Internal Transcribed Spacers (ITS1-5.8S-ITS2 rDNA) and the D2 + D3 domains of the large ribosomal subunit (28S rDNA) support the erection of the three new taxa; and suggest that G. atoyacensis n. sp. and G. salvini n. sp. are sister species. These gyrodactylids are the first monogeneans described from gobies of the genus Sicydium in Mexico.

The medial preoptic area and acute cocaine's stimulant effects in rats: Potential influences of estradiol and biological sex.

The medial preoptic area (mPOA) in the hypothalamus is an important integrator of neuroendocrine signaling and a key regulator of both natural and drug-induced reward. Although the mPOA modulates sex differences in other behaviors, whether it also modulates sex differences in cocaine response remains unclear. To help us better understand the mPOA's role in sex differences associated with cocaine response, we examined cocaine-induced changes in locomotion and neural activity in the mPOA of male and female rats. In addition, neural activity in the striatum, a brain area known to be involved in cocaine response, was examined for comparison purposes. Fos, the protein product of the immediate early gene c-fos, was used as the marker of neural activity. Locomotion chambers were used to measure behavior, radioimmunoassays and vaginal lavages were used to determine hormonal status, and immunohistochemical assays were used to quantify Fos. To account for the effects of gonadal hormones, rats were left gonadally intact and categorized as either 'low-estradiol' or 'high-estradiol' based on their hormonal status on test day. Results indicate that high-estradiol females experienced greater cocaine-induced mPOA Fos-immunoreactivity (Fos-ir) and displayed greater cocaine-induced locomotion than low estradiol females. Conversely, high-estradiol males experienced less cocaine-induced mPOA Fos-ir and displayed less cocaine-induced locomotion than low-estradiol males. Cocaine-induced Fos-ir in the mPOA also correlated with cocaine-induced Fos-ir in areas of the striatum already associated with cocaine response. These findings further support the mPOA's role in the endocrine-mediated response to cocaine. It also identifies the mPOA as a contributor to sex differences in cocaine response and potential differences in vulnerability to developing cocaine use disorders.

Substance use screening in transplant populations: Recommendations from a consensus workgroup.

Transplant patients are frequently treated with substances that have dependence potential and/or they may have a history of substance use disorders. The Psychosocial and Ethics Community of Practice of the American Society of Transplantation formed a Drug Testing Workgroup with participation from members of the Pharmacy Community of Practice and members of the Academy of Consultation-Liaison Psychiatry. The workgroup reviewed the literature regarding the following issues: the role of drug testing in patients with substance use disorders, for patients prescribed controlled substances, legal, ethical and prescription drug monitoring issues, financial and insurance issues, and which patients should be tested. We also reviewed current laboratory testing for substances. Group discussions to develop a consensus occurred, and summaries of each topic were reviewed. The workgroup recommends that transplant patients be informed of drug testing and be screened for substances prior to transplant to ensure optimal care and implement ongoing testing if warranted by clinical history. While use of certain substances may not result in the exclusion for transplantation, an awareness of the patient's practices and possible risk from substances is necessary, allowing transplant teams to screen for substance use disorders and ensure the patient is able to manage and minimize risks post-transplant.

Kids With Altitude: Acute Mountain Sickness and Changes in Body Mass and Total Body Water in Children Travelling to 3800 m.

INTRODUCTION: We explored the incidence of acute mountain sickness (AMS) and extravascular lung water (ELW) in children in relation to changes in body composition and peripheral blood oxygenation (SpO2) during 1 week of acclimatization to 3800 m. METHODS: In a prospective cohort study, 10 children (7 female, ages 7-14 y) and 10 sex-matched adults (ages 23-44 y) traveled via automobile from sea level to 3000 m for 2 nights, followed by 4 nights at 3800 m. Each morning, body mass and body water (bioelectrical impedance), SpO2 (pulse oximetry), AMS (Lake Louise Questionnaire), and ELW (transthoracic echocardiography) were measured. RESULTS: No differences were found between children and adults in SpO2 or ELW. At 3800 m 7 of 10 children were AMS+ vs 4 of 10 adults. Among those AMS+ at 3800 m, the severity was greater in children compared to adults (5±1 vs 3 ± 0; P=0.005). Loss of body mass occurred more quickly in children (day 5 vs day 7) and to a greater extent (-7±3% vs -2±2%; P<0.001); these changes were mediated via a larger relative loss in total body water in children than in adults (-6±5% vs -2±2%; P=0.027). CONCLUSIONS: Children demonstrated a higher incidence of AMS than adults, with greater severity among those AMS+. The loss of body water and body mass at high altitude was also greater in children, albeit unrelated to AMS severity. In addition to awareness of AMS, strategies to maintain body weight and hydration in children traveling to high altitudes should be considered.

Morpho-molecular characterization of Gyrodactylus parasites of farmed tilapia and their spillover to native fishes in Mexico.

Translocation of fishes for aquaculture has resulted in the co-introduction of some of their parasites. African cichlid fishes, generically called "tilapias" have been introduced worldwide, along with their monogenean parasites. In a nation-wide survey, we characterised monogeneans of the genus Gyrodactylus infecting farmed "tilapia" throughout Mexico. We also collected native fishes around farms, to look for potential parasite spillover from cultured fishes. Monogeneans were identified taxonomically using morphological and molecular characters. Originally African, pathogenic Gyrodactylus cichlidarum was recorded in every farm surveyed, infecting different "tilapia" varieties, as well as three native cichlid fish species. Previously, we had shown that G. cichlidarum also infects native, non-cichlid fishes in Mexico. We also recorded that Gyrodactylus yacatli is widely distributed in Mexico, infecting cultured "tilapia" and native fishes; and present data indicating that this is a further translocated African parasite. A third, unidentified gyrodactylid infected farmed and native fishes in Chiapas, southern Mexico; we describe the new species as Gyrodactylus shinni n. sp., and provide evidence that this is a third monogenean translocated with African fish. The wide distribution of exotic parasites co-introduced with "tilapia" and their spillover to native fishes may have an important impact on the ichthyofauna in Mexico, one the world's megadiverse countries.

Disruption of the blood-brain barrier in 22q11.2 deletion syndrome.

Neuroimmune dysregulation is implicated in neuropsychiatric disorders including schizophrenia. As the blood-brain barrier is the immunological interface between the brain and the periphery, we investigated whether this vascular phenotype is intrinsically compromised in the most common genetic risk factor for schizophrenia, the 22q11.2 deletion syndrome (22qDS). Blood-brain barrier like endothelium differentiated from human 22qDS+schizophrenia-induced pluripotent stem cells exhibited impaired barrier integrity, a phenotype substantiated in a mouse model of 22qDS. The proinflammatory intercellular adhesion molecule-1 was upregulated in 22qDS+schizophrenia-induced blood-brain barrier and in 22qDS mice, indicating compromise of the blood-brain barrier immune privilege. This immune imbalance resulted in increased migration/activation of leucocytes crossing the 22qDS+schizophrenia blood-brain barrier. We also found heightened astrocyte activation in murine 22qDS, suggesting that the blood-brain barrier promotes astrocyte-mediated neuroinflammation. Finally, we substantiated these findings in post-mortem 22qDS brain tissue. Overall, the barrier-promoting and immune privilege properties of the 22qDS blood-brain barrier are compromised, and this might increase the risk for neuropsychiatric disease.

Species delimitation of Gyrodactylus (Monogenea: Gyrodactylidae) infecting the southernmost cyprinids (Actinopterygii: Cyprinidae) in the New World.

The genus Gyrodactylus von Nordmann, 1832 represents one of the most diverse and widespread taxa within Monogenea, with approximately 500 species described worldwide. Thirty-three species of Gyrodactylus have been recorded in Mexico, and in the last two decades, at least 26 new species have been described mainly from freshwater fish families such as poeciliids, goodeids, profundulids, characids, and cichlids. In this study, we describe two new species of Gyrodactylus infecting freshwater cyprinids based on morphological and molecular characteristics. Gyrodactylus ticuchi n. sp. and Gyrodactylus tobala n. sp. were recovered from Notropis moralesi de Buen and N. imeldae Cortés, respectively, captured in five localities from the State of Oaxaca, Mexico. The new species differ slightly from their congeners in the morphology of the haptoral hard parts and the male copulatory organ. Sequences of the Internal Transcribed Spacers rDNA (ITS1-5.8S-ITS2), cytochrome oxidase subunit I (cox1), and the D2 + D3 domains of the large subunit (28S rDNA) were obtained from multiple specimens and analyzed using Maximum Likelihood (ML) and Bayesian Inference (BI). Phylogenetic hypotheses using ITS rDNA, cox1, and 28S rDNA genes recovered two new species of Gyrodactylus from N. moralesi and N. imeldae; we briefly discuss their phylogenetic relationship with other congeners. These gyrodactylids represent the first species described in species of Notropis from southern Mexico, the cyprinids exhibiting the southernmost distribution in the New World.

Competition from sea to mountain: Interactions and aggregation in low-diversity monogenean and endohelminth communities in twospot livebearer Pseudoxiphophorus bimaculatus (Teleostei: Poeciliidae) populations in a neotropical river.

The role of interspecific interactions in structuring low-diversity helminth communities is a controversial topic in parasite ecology research. Most parasitic communities of fish are species-poor; thus, interspecific interactions are believed to be unimportant in structuring these communities.We explored the factors that might contribute to the richness and coexistence of helminth parasites of a poeciliid fish in a neotropical river.Repeatability of community structure was examined in parasitic communities among 11 populations of twospot livebearer Pseudoxiphophorus bimaculatus in the La Antigua River basin, Veracruz, Mexico. We examined the species saturation of parasitic communities and explored the patterns of species co-occurrence. We also quantified the associations between parasitic species pairs and analyzed the correlations between helminth species abundance to look for repeated patterns among the study populations.Our results suggest that interspecific competition could occur in species-poor communities, aggregation plays a role in determining local richness, and intraspecific aggregation allows the coexistence of species by reducing the overall intensity of interspecific competition.

Two new species of Gyrodactylus von Nordmann, 1832 parasitizing Cnesterodon decemmaculatus (Poeciliidae) from the southern limit of the family in the Neotropical region.

In this study, we followed an integrative taxonomy approach to describe two new species of Gyrodactylus von Nordmann, 1832, and to identify specimens of G. breviradix Vega, Razzolini, Arbetman, and Viozzi, 2019, all three collected from ten spotted live-bearer Cnesterodon decemmaculatus (Jenyns, 1842), an endemic and widespread poeciliid from the Pampean region, which is the southernmost occurring species of the Poeciliidae in the Americas. Gyrodactylids were first characterized morphologically and mophometrically, and when possible, sequences of the Internal Transcribed Spacers (ITS1-5.8S-ITS2) and the cytochrome oxidase II (COII) were used to delimit species. Gyrodactylus breviradix, Gyrodactylus marplatensis n. sp., and Gyrodactylus pampeanus n. sp. were found on the fins and body surface of C. decemmaculatus in La Tapera Creek, Mar del Plata, Buenos Aires province, Argentina. A phylogenetic analysis combining newly generated sequences of one of the new species, G. marplatensis n. sp., and of G. breviradix, along with those available in GenBank for a further 36 species of Gyrodactylus, revealed that G. marplatensis n. sp. is a sister taxon of Gyrodactylus decemmaculati Vega, Razzolini, Arbetman, and Viozzi, 2019. Genetic distances for the ITS and COII gene were estimated among Gyrodactylus spp. and further supported the validity of the new species. Overall, morphometric and molecular data coincided in delimiting the new taxa, thus demonstrating the value of integrative taxonomy for the erection of new species of Gyrodactylus and species identification.

New Species of Gyrodactylus von Nordmann, 1832 from Native Fish from Chiapas, Mexico, Studied by Morphology and Molecular Analyses.

BACKGROUND: Three new species of Gyrodactylus von Nordmann, 1832 are described from Poeciliopsis hnilickai and Tlaloc labialis (syn. Profundulus candalarius and Profundulus labialis) from the state of Chiapas, Mexico. Gyrodactylus chiapaneco n. sp. is described from T. labialis. Gyrodactylus guatopotei n. sp. was found to infect P. hnilickai. Gyrodactylus tlaloci n. sp. is described from T. labialis. The new species were characterised morphologically (haptoral hooks) and molecularly (sequences of the Internal Transcribed Spacer region (ITS1-5.8S-ITS2) of rDNA). PURPOSE: During a survey in March 2017 in the state of Chiapas, individuals of Tlaloc labialis were collected by electrofishing from Arroyo Ojo de Agua and from Río Hondo, Ixtapa, Río Las Lajas and Poeciliopsis hnilickai from Río Hondo, Ixtapa and Río Cacao. Three new species of Gyrodactylus were found and are described herein based on morphological and genetic analysis. METHODS: Attachment hooks were excised and partially digested with a proteolytic solution to remove tissue enclosing the haptoral armature. Measurements and pictures of the haptoral hard structures were taken and were compared with other Gyrodactylus species found on poeciliids and profundulids. The bodies from which haptoral hook were removed were stored individually in 95% ethanol at - 20 °C for molecular analyses. Sequences of the Internal Transcribed Spacer region of rDNA were obtained for each species and were compared with 26 Gyrodactylus spp. The genetic divergence among species of Gyrodactylus was estimated using uncorrected "p" distances with the program MEGA. RESULTS: The haptoral hook of Gyrodactylus chiapaneco n. sp. are similar to G. poeciliae from Venezuela; those from Gyrodactylus guatopotei n. sp. resemble the sclerites of G. turnbulli from Singapore and G. pictae from Trinidad, and the haptoral hooks of Gyrodactylus tlaloci n. sp. are comparable to those of G. pseudobullatarudis and G. zapoteco from Mexico; most of these parasites were described from poeciliid fishes, except G. zapoteco which was recently described from Profundulus oxacae from Oxaca, Mexico. The sequences of the three new species were aligned with sequences of 26 other Gyrodactylus spp. Maximum likelihood and Bayesian inference analyses indicated that the three new taxa are members with well-supported lineages-the new taxa are the first species of Gyrodactylus to be described from Poeciliopsis hnilickai and Tlaloc labialis from Chiapas. CONCLUSION: Gyrodactylus chiapaneco n. sp., Gyrodactylus guatopotei n. sp. and Gyrodactylus tlaloci n. sp. are described based on morphological and molecular analyses. Two of the three new species of Gyrodactylus described here, and both roughly fall morphologically and molecularly into the group of parasites harbouring slender marginal hooks: G. chiapaneco n. sp. and G. tlaloci n. sp. both possess marginal sclerites with slim shafts and group phylogenetically with other gyrodactylids of similar marginal hook morphology. Gyrodactylus guatopotei n. sp. groups with gyrodactylids possessing marginal hooks with quite elongated shafts, most of which have been found infecting poeciliids in the Antilles (e.g. G. pictae and G. turnbulli). Poeciliid, profundulid and goodeid fishes are morphologically and ecologically similar and nowadays live in sympatry or close geographical distance in Mesoamerica.

Chemical Characterization and Antiplatelet Potential of Bioactive Extract from Tomato Pomace (Byproduct of Tomato Paste).

We examined the ability of tomato pomace extract (by-product) to affect platelet aggregation in healthy humans (clinical pilot study). In phase 1 the tolerance of participants (n = 15; 5 per dose level) ingesting tomato pomace extract across three dose levels (1, 2.5, and 10 g) was evaluated. Phase 2 was a single-blind, placebo-controlled, parallel design human (male, n = 99; 33 per group) pilot intervention trial investigating the acute and repeated dose effects (5 days) of different doses of tomato pomace extract (1 g, 2.5 g or placebo) on platelet aggregation ex vivo. Various flavonoids (coumaric acid, floridzin, floretin, procyanidin B2, luteolin-7-O-glucoside, kaempferol, and quercitin) and nucleosides (adenosine, inosine, and guanosine) were identified in the tomato pomace extract. The clinical study showed that the daily consumption of 1 g of aqueous extract of tomato pomace for 5 days exerted an inhibitory activity on platelet aggregation.

Liver Transplant Recipients Older Than 60 Years Show Executive and Memory Function Improvement Comparable to Younger Recipients.

BACKGROUND: Increasing numbers of patients over the age of 60 are undergoing liver transplantation. OBJECTIVE: We sought to determine whether age or clinical morbidities were associated with pre- and post-transplant executive and memory performance using the Brief Test of Adult Cognition by Telephone (BTACT). METHODS: Participants included 36 recipients with n = 20 in the older group (>60 y) and n = 16 in the younger group (≤60 years). The BTACT was administered an average of 3 months before transplant, and at follow-up post-transplant intervals of 3, 6, and 9 months. BTACT composite scores for memory and executive function with age and education norms were obtained. RESULTS: Older recipients were more likely to have hepatocellular carcinoma, a lower biological MELD score at transplant, less cellular rejection, and fewer post-operative hospital days. Older and younger recipients showed comparable pre-transplant executive and memory function and comparable post-transplant improvement. Both older and younger patients showed statistically significant improvement in executive function scores at 3 months post-transplant and maintained improvement at 6 and 9 months. Memory function improved significantly in older patients by 6 months post-transplant but did not improve significantly in the younger group. CONCLUSION: Older liver transplant recipients were more likely to have hepatocellular carcinoma and a lower biological MELD score than younger recipients, but both age groups showed comparable pre-transplant cognitive performance and post-transplant cognitive improvement. Additionally, a normed telephone test can be used to effectively screen and track executive and memory function post-transplant.

Psychosocial Risk Impacts Mortality in Women After Liver Transplantation.

BACKGROUND: Liver transplant candidates undergo psychosocial assessment as a component of their pretransplant evaluation. Global psychosocial assessment scales, including the Psychosocial Assessment of Candidates for Transplantation (PACT), capture and quantify these psychiatric and social variables. OBJECTIVE: Our primary aim was to assess for an association between global PACT score and survival in liver transplant recipients. METHODS: This retrospective cohort study examined records of all liver recipients at one U.S. Transplant Center from 2000 to 2012 with outcomes monitoring until 07/01/2016. We investigated for associations between the following variables and mortality: PACT score, age, gender, marital status, race, alcoholic liver disease (ALD), and body mass index (BMI). Statistical methods included Student's t-test, Wilcoxon rank sum test, chi-square, Fisher's exact test, Kaplan-Meier curve, and Cox proportional hazard models. RESULTS: Of 1040 liver recipients, 538 had a documented PACT score. Among these, PACT score was not associated with mortality. In women, a lower PACT score was associated with mortality (p = 0.003) even after adjustments for age, marital status, and BMI. Women with ALD had a 2-fold increased hazard of death (p = 0.012). Increasing age was associated with increased risk of death for the cohort as a whole (p = 0.019) and for men (p = 0.014). In men, being married and BMI were marginally protective (p = 0.10 and p = 0.13, respectively). CONCLUSIONS: Transplant psychosocial screening scales, specifically the PACT, identify psychosocial burden and may predict post-transplant outcomes in certain populations. In female liver recipients, lower PACT scores and ALD were associated with a greater risk of post-transplant mortality.

Psychosocial Risk Predicts New Episode Depression After Heart Transplant.

BACKGROUND: Psychosocial assessment is an essential component of the pretransplant evaluation. Many individuals have significant psychosocial problems, and they are either denied for transplantation or deferred from listing and transplant until the psychosocial issues are addressed. OBJECTIVE: The primary aim of this study was to evaluate the outcomes of patients who initially had significant psychosocial problems, but who addressed them and received a heart transplant. METHODS: This retrospective study included heart transplant recipients from 1/1/2000 to 12/31/2012. Those with initial Psychosocial Assessment of Candidates for Transplantation (PACT) scale score <2 were compared with those whose initial score was ≥2 for the variables new onset depression and anxiety, length of stay, rejection, and survival using logistic and linear regression and Cox proportional hazards modeling. RESULTS: Of 164 heart recipients with pretransplant PACT scores, 46 (28%) were female, 154 (94%) were white, and the mean age was 52.7 years. Only 11 (7%) received an initial PACT score <2; these candidates underwent heart transplantation after their scores increased to ≥2. Initial PACT <2 increased the odds of new depression by 11-fold (p = 0.002), but was not associated with differences in survival, posttransplant length of stay, the occurrence of treated episodes of rejection or new anxiety (p ≥ 0.20 for all). CONCLUSION: Among heart recipients, initially high pretransplant psychosocial risk, as assessed by PACT, was associated with posttransplant new episode depression. However, after addressing the primary psychosocial issues before transplant, posttransplant length of stay, organ rejection, and survival were the same as those without prior psychosocial concerns.

Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients.

OBJECTIVES: This study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death. METHODS: This retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models. RESULTS: Among elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death. CONCLUSION: Six out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.