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1.
Ann Lab Med ; 42(1): 36-46, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34374347

RESUMO

Background: The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem. Recently, the occurrence of CPE has increased globally, but epidemiological patterns vary across region. We report the trends in the genotypic distribution and antimicrobial susceptibility of CPE isolated from rectal and clinical samples during a four-year period. Methods: Between January 2016 and December 2019, 1,254 nonduplicated CPE isolates were obtained from four university hospitals in Korea. Carbapenemase genotypes were determined by multiplex real-time PCR. Antimicrobial susceptibility was profiled using the Vitek 2 system (bioMérieux, Hazelwood, MO, USA) or MicroScan Walkaway-96 system (Siemens West Sacramento, CA, USA). The proportions of carbapenemase genotypes and nonsusceptibility were analyzed using Pearson's chi-square test. Results: Among the 1,254 CPE isolates, 486 (38.8%), 371 (29.6%), 357 (28.5%), 8 (0.6%), 8 (0.6%), and 24 (1.9%) were Klebsiella pneumoniae carbapenemase (KPC), oxacillinase (OXA)-48-like, New Delhi metallo-ß-lactamase (NDM), imipenemase (IMP), Verona integron-encoded metallo-ß-lactamase (VIM), and multiple producers, respectively. The predominant species was K. pneumoniae (72.6%), followed by Escherichia coli (6.5%). More than 90% of the isolates harboring KPC, NDM, and OXA-48-like were nonsusceptible to cephalosporins, aztreonam, and carbapenems. Conclusions: The impact of CPE is primarily due to KPC-, NDM-, and OXA-48-like-producing K. pneumoniae isolates. Isolates carrying these carbapenemase are mostly multidrug-resistant. Control strategies based on these genotypic distributions and antimicrobial susceptibilities of CPE isolates are required.


Assuntos
Anti-Infecciosos , Enterobacteriáceas Resistentes a Carbapenêmicos , Infecções por Enterobacteriaceae , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Infecções por Enterobacteriaceae/epidemiologia , Genótipo , Hospitais Universitários , Humanos , Klebsiella pneumoniae , Testes de Sensibilidade Microbiana , República da Coreia , beta-Lactamases/genética
2.
Ann Lab Med ; 42(1): 96-99, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34374354

RESUMO

The sensitivity of molecular diagnostics could be affected by nucleotide variants in pathogen genes, and the sites affected by such variants should be monitored. We report a single-nucleotide variant (SNV) in the nucleocapsid (N) gene of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), i.e., G29179T, which impairs the diagnostic sensitivity of the Xpert Xpress SARS-CoV-2 assay (Cepheid, Sunnyvale, CA, USA). We observed significant differences between the threshold cycle (Ct) values for envelope (E) and N genes and confirmed the SNV as the cause of the differences using Sanger sequencing. This SNV, G29179T, is the most prevalent in Korea and is associated with the B.1.497 virus lineage, which is dominant in Korea. Clinical laboratories should be aware of the various SNVs in the SARS-CoV-2 genome and consider their potential effects on the diagnosis of coronavirus disease 2019.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Técnicas de Diagnóstico Molecular , Nasofaringe , Nucleotídeos , Prevalência , República da Coreia , Sensibilidade e Especificidade
3.
J Virol Methods ; 299: 114350, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34748817

RESUMO

A novel porcine circovirus 4 has been recently identified in China and Korea. A sensitive and specific diagnostic method is urgently required to detect the virus in field samples. We developed a loop-mediated isothermal amplification (LAMP) the assay for the visual detection of PCV4 and evaluated its sensitivity, specificity, and applicability in clinical samples. This assay's results can be directly visualized by the naked eye using hydroxynaphthol blue after incubation for 40 min at 64 °C. The assay specifically amplified PCV4 DNA and no other viral nucleic acids. The sensitivity of the assay was <50 DNA copies/reaction, which was 10 times more sensitive than conventional polymerase chain reaction (cPCR) and comparable to real-time PCR (qPCR). Clinical evaluation revealed that the PCV4 detection rate in individual pig samples and at the farm level was 39.3 % (57/145) and 45.7 % (32/70), respectively, which were higher than cPCR (46 samples, 24 farms) and qPCR (52 samples, 29 farms) results. Cumulatively, owing to the advantages of high sensitivity and specificity, direct visual monitoring of the results, no possibility for cross-contamination, and being a low-cost equipment, the developed LAMP assay will be a valuable tool for the detection of the novel PCV4 in clinical samples, even in resource-limited laboratories.

4.
J Affect Disord ; 297: 602-609, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34715157

RESUMO

BACKGROUND: Stress is a well-known risk factor of suicide. However, there is a lack of research on the best psychobiological markers of stress for monitoring and predicting suicidal behaviors in depressed patients. We aimed to investigate the individual and interactive effects of serum cortisol levels and stress-related parameters, including perceived stress and life stressors, on suicidal behavior in depressed patients. METHODS: At baseline, serum cortisol levels were measured and stress-related data, i.e., Perceived Stress Scale (PSS) scores and the number of stressful life events (SLEs), were collected from 1,094 patients with a depressive disorder, of whom 884 were followed up for 1 year. Suicidal behaviors evaluated at baseline included previous suicide attempts and baseline suicidal severity, while those at the 1-year follow-up were increased suicidal severity and fatal/non-fatal suicide attempts. Individual and interactive associations of exposure variables with suicidal outcomes were analyzed using logistic regression models after adjusting for relevant covariates. RESULTS: Higher serum cortisol levels were significantly associated with suicidal outcomes at the 1-year follow-up. In addition, higher PSS scores were significantly associated with higher baseline severity, whereas the number of SLEs was not associated with any suicidal outcomes. A significant interactive effect of cortisol level and PSS score on suicidal outcomes at the 1-year follow-up was observed. Higher cortisol levels and PSS scores were associated with increased suicidal severity and more fatal/non-fatal suicide attempts. CONCLUSIONS: The combination of serum cortisol levels and PSS scores may be useful for monitoring and predicting suicidal behaviors in depressed patients.

5.
Meat Sci ; 183: 108663, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34481233

RESUMO

Carcinogens such as heterocyclic amine (HCA), produced during meat cooking, pose a risk of digestive and reproductive cancers in humans. Nevertheless, the exact mechanisms for HCA formation in meat and the control of HCA formation are not known. In this review, we provide an overview of the main cause of HCA formation in cooked meat, fundamental data on natural materials to inhibit HCA carcinogenicity, and methods to analyze HCA in cooked meat. Related past studies has shown that natural substances contain various components that act as antioxidants, and these antioxidants can prevent HCA and mutagenic factors. Free radicals and DNA adducts produced by HCA metabolism have carcinogenic properties. Antioxidants have been found to inhibit oxidative stress caused by free radicals and DNA adducts. Therefore, we can be hypothesized that various natural materials can inhibit HCA carcinogens and mutagens.


Assuntos
Aminas/efeitos adversos , Carcinógenos/química , Culinária , Compostos Heterocíclicos/efeitos adversos , Carne/análise , Aminas/química , Animais , Antioxidantes , Carcinógenos/análise , Adutos de DNA , Contaminação de Alimentos/prevenção & controle , Radicais Livres , Compostos Heterocíclicos/química , Mutagênicos/análise , Mutagênicos/química
6.
Biol Pharm Bull ; 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732594

RESUMO

Methylglyoxal (MGO), which is produced as a byproduct of glucose metabolism, is the leading to diabetic cardiovascular complications. Salvia miltiorrhiza Bunge (Lamiaceae) has been reported as a potential plant to control diabetes and cardiovascular disease. However, no report exists on the effect of Salvia miltiorrhiza Bunge extract (SME) on MGO-induced glucotoxicity in human umbilical vein endothelial cells (HUVECs).We demonstrated the protective effects of SME (1, 5, and 10 µg/mL) and its components against MGO-induced endothelial dysfunction in HUVECs. Cytotoxicity was evaluated using the several in vitro experiments. Additionally, the protein expression of receptor of advanced glycation end-products (RAGE), mitogen-activated protein kinase (MAPK) pathway and glyoxalase system were measured. Then, the inhibitory effects of SME and its main components on MGO-induced oxidative stress, radical scavenging, formation of MGO-derived advanced glycation end products (AGEs), and MGO-AGEs crosslinking were evaluated.SME (10 µg/mL) strongly prevented expressed levels of RAGE, MGO-induced apoptosis and reduced ROS generation in HUVECs, comparing with 1 mM aminoguanidine. Additionally, SME (5 and 10 µg/mL) reduced the expression of proteins (e.g., p-ERK and p-p38) in the MAPKs pathway and upregulated the glyoxalase system in HUVECs. SME (0.5 - 10 mg/mL), dihydrotanshinone (0.4 mM), and rosmarinic acid (0.4 mM) prevented MGO-AGEs formation and broke the MGO-AGE crosslinking. These results show that S. miltiorrhiza has protective effects against MGO-induced glucotoxicity by regulating the proteins involved in apoptosis, glyoxalase system and antioxidant activity.We expect that S. miltiorrhiza is a potential natural resource for the treatment of MGO-induced vascular endothelial dysfunction.

7.
Am J Vet Res ; : 1-7, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34727068

RESUMO

OBJECTIVE: To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs). ANIMALS: 11 healthy Beagles. PROCEDURES: For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined. RESULTS: SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent. CONCLUSIONS AND CLINICAL RELEVANCE: SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.

8.
Eur J Health Econ ; 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34748114

RESUMO

The US spends two times more than the OECD average in health expenditure but has a much smaller portion of public health spending to total health expenditure than other OECD countries. While it has been suggested that public health and social services spending is crucial to promoting health outcomes, less is known about what drives variations in public health expenditure across regions. This study aims to examine whether political fragmentation in local governance is associated with variations in public health and social services expenditures. Using the US Census of Governments, we constructed a panel dataset of political fragmentation and local government spending patterns (1997-2012) for 792 US counties (population > 60,882, top 25%) and employed Least Squares Dummy Variable (LSDV) and Generalized Estimating Equations (GEE) models. We found that per capita public health spending tended to be smaller in areas where the degree of political fragmentation was higher (Coef: - 0.034; p < 0.01), particularly when general-purpose governments were more fragmented (Coef: - 0.087; p < 0.001). The proportion of public health spending also decreased when local governments were more fragmented (Coef: - 0.012; p < 0.001). Social services expenditures and their proportions to total government expenditure fell with an increase in the degree of political fragmentation. Our findings suggest that fragmented governance settings, in which localities are more likely to face competition with others, may lead to a reduction in public spending essential for population health and that political fragmentation can also have a deterrent effect on broader categories of health-related social services spending.

9.
Sci Rep ; 11(1): 21462, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728736

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease-19 (COVID-19). More than 143 million cases of COVID-19 have been reported to date, with the global death rate at 2.13%. Currently, there are no licensed therapeutics for controlling SARS-CoV-2 infection. The antiviral effects of heme oxygenase-1 (HO-1), a cytoprotective enzyme that inhibits the inflammatory response and reduces oxidative stress, have been investigated in several viral infections. To confirm whether HO-1 suppresses SARS-CoV-2 infection, we assessed the antiviral activity of hemin, an effective and safe HO-1 inducer, in SARS-CoV-2 infection. We found that treatment with hemin efficiently suppressed SARS-CoV-2 replication (selectivity index: 249.7012). Besides, the transient expression of HO-1 using an expression vector also suppressed the growth of the virus in cells. Free iron and biliverdin, which are metabolic byproducts of heme catalysis by HO-1, also suppressed the viral infection. Additionally, hemin indirectly increased the expression of interferon-stimulated proteins known to restrict SARS-CoV-2 replication. Overall, the findings suggested that HO-1, induced by hemin, effectively suppressed SARS-CoV-2 in vitro. Therefore, HO-1 could be potential therapeutic candidate for COVID-19.


Assuntos
Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Heme Oxigenase-1/metabolismo , Hemina/uso terapêutico , Animais , Antivirais/química , Antivirais/farmacologia , COVID-19/virologia , Sobrevivência Celular/efeitos dos fármacos , Chlorocebus aethiops , Heme Oxigenase-1/antagonistas & inibidores , Heme Oxigenase-1/genética , Hemina/química , Hemina/farmacologia , Humanos , Interferência de RNA , RNA Interferente Pequeno/metabolismo , RNA Viral/metabolismo , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/fisiologia , Regulação para Cima/efeitos dos fármacos , Células Vero , Replicação Viral/efeitos dos fármacos
10.
J Neurol ; 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34767067

RESUMO

The integrity of the vestibulo-ocular reflex (VOR) remains to be delineated in patients with parkinsonism. We aimed to define the findings of the VOR using head-impulse tests (HITs) and their differential diagnostic value in patients with Parkinson's disease (PD) and multiple system atrophy (MSA). From December 2019 to January 2021, 30 patients with PD and 23 patients with MSA (17 with cerebellar-type MSA and 6 with parkinsonian-type MSA) had a video-oculographic recording of HITs at two university hospitals in South Korea. Reversed (p = 0.034) and perverted (p = 0.015) catch-up saccades were more frequently observed in MSA than in PD during HITs. The gain difference between the ACs and the PCs were larger in MSA than in PD (p = 0.031), and positively correlated with the disease duration in patients with MSA (Spearman's coefficient = 0.512, p = 0.012). Multivariate logistic regression analysis showed that reversed (p = 0.044) and perverted (p = 0.039) catch-up saccades were more frequently associated with MSA than with PD during HITs. In conclusion, HITs aid in differentiation of MSA from PD, and may serve as a surrogate marker for the clinical decline.

13.
Sensors (Basel) ; 21(21)2021 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-34770359

RESUMO

Non-orthogonal multiple access (NOMA) has a key feature that the cell-center user (CCU) has prior information about the messages of the cell-edge user (CEU) in the same user-pair. It means that CCU can be used for retransmission when the CEU requests retransmission. As ultra-reliability and low-latency communication (URLLC) requires high-reliability constraints (e.g., 99.999%), using CCU for retransmission can be useful to satisfy the reliability constraint. In this study, to ensure the reliability of CEU, cooperative retransmission (CR) scheme for downlink NOMA systems is proposed. And the CR scheme is evaluated with Block error rate (BLER) considering reliability and with packet loss rate (PLR) in terms of reliability and latency constraints. And the evaluation results showed that the proposed CR scheme can satisfy the target BLER for URLLC low SNR compared to the conventional retransmission scheme, and showed the improved PLR compared to the conventional retransmission scheme in low SNRs.


Assuntos
Noma , Comunicação , Redes de Comunicação de Computadores , Humanos , Reprodutibilidade dos Testes , Razão Sinal-Ruído
14.
Materials (Basel) ; 14(21)2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34771809

RESUMO

The purpose of this study was to predict the adhesive behavior of steel and carbon-fiber-reinforced plastic (CFRP) hybrid parts based on the cohesive zone model (CZM). In this study, the steel sheet and CFRP were joined by epoxy resin in the CFRP prepreg during the curing process, which could generate delamination at their interface because of the springback of steel or the thermal contraction of the CFRP. First, double cantilever beam (DCB) and end-notched flexure (ENF) tests were performed to obtain various adhesion properties such as the critical energy release rate of mode I, mode II (GI, GII), and critical stress (σmax). A finite element (FE) simulation was performed to predict delamination using CZM, which was also used to describe the interfacial behavior between the steel sheet and the CFRP. Finally, a U-shape drawing test was performed for the steel/CFRP hybrid parts, and these results were compared with analytical results.

15.
Materials (Basel) ; 14(21)2021 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-34771874

RESUMO

To investigate the growth kinetics of the reaction layer and mechanical strength of joined materials, we joined beryllium and reduced-activation ferritic-martensitic steel (F82H) by plasma sintering under various conditions and characterized the joined region. Scanning electron microscopy revealed that the thickness of the reaction layer increased with an increase in the joining time and temperature. Line analyses and elemental mapping using an electron microprobe analyser showed that the reaction layer consists of Be-Fe intermetallic compounds, including Be12Fe, Be5Fe, and Be2Fe, with small amounts of chromium and tungsten. Owing to the time and temperature dependence of the reaction-layer thickness, the layer growth of Be-Fe intermetallic compounds obeys the parabolic law, and the activation energy for the reaction-layer growth was 116.2 kJ/mol. The bonding strengths of the joined materials varied inversely with the thickness of the reaction layer.

16.
Ann Surg Treat Res ; 101(5): 299-305, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34796146

RESUMO

Purpose: InnoSEAL Plus is an adhesive, coagulant-free hemostatic material that mimics the adhesion mechanism of marine mussels. This study reports on the safety and efficacy of InnoSEAL Plus for patients with hemorrhage after hepatectomy despite first-line hemostasis treatments. Methods: This is a multicenter, prospective, single-blinded, randomized clinical trial involving 96 hepatectomy patients. TachoSil was used as a comparator group. Three-minute and 10-minute hemostatic success rates were monitored. Rebleeding rates were also observed. Safety was assessed by recording all novel undesirable symptoms. Results: InnoSEAL Plus showed a 3-minute hemostasis rate of 100%, while TachoSil had a rate of 98.0% (48 of 49 patients), demonstrating that the 2 had similar hemostatic efficacies. The difference in efficacy between the test and comparator group was 2.04%, and the lower limit of the one-sided 97.5% confidence interval was -1.92%; as this is greater than the noninferiority limit of -23.9%, the 2 treatments were equivalent. Meanwhile, the 10-minute hemostatic success rate was the same in both groups (100%). No rebleeding occurred in either group. In the safety evaluation, 89 patients experienced adverse events (45 in the test group and 44 in the comparator group). The difference between the 2 groups was not significant. No death occurred after application of the test or comparator group product. Conclusion: Given that InnoSEAL Plus is a coagulation factor-free product, the hemostasis results are encouraging, especially considering that TachoSil contains a coagulation factor. InnoSEAL Plus was found to be a safe and effective hemostatic material for control of bleeding in hepatectomy patients.

17.
Cancer Res Treat ; 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34793667

RESUMO

Purpose: To identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC). Materials and Methods: Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients' survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease [SD] or better) and poor-response (progressive disease [PD] or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated. Results: A total of 189 patients were evaluated. Ninety-four and ninety-five patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (PFS; median 2.1 vs. 9.7 months; p < 0.001) and overall survival (OS; median, 5.0 vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment free interval (hazard ratio [HR]: 5.557; 95% confidence interval [CI]: 2.403-12.850), platinum-resistant EOC (HR; 2.367; 95% CI: 1.017-5.510), and non-serous/endometrioid histologic type (HR: 5.045; 95% CI: 1.152-22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor-response groups (p=0.167). Conclusion: Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.

18.
J Geod ; 95(4): 40, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34776650

RESUMO

A long-term drift in polar motion (PM) has been observed for more than a century, and Glacial Isostatic Adjustment (GIA) has been understood as an important cause. However, observed PM includes contributions from other sources, including contemporary climate change and perhaps others associated with Earth's interior dynamics. It has been difficult to separate these effects, because there is considerable scatter among GIA models concerning predicted PM rates. Here we develop a new method to estimate GIA PM using data from the GRACE mission. Changes in GRACE degree 2, order 1 spherical harmonic coefficients are due both to GIA and contemporary surface mass load changes. We estimate the surface mass load contribution to degree 2, order 1 coefficients using GRACE data, relying on higher-degree GRACE coefficients that are dominantly affected by surface loads. Then the GIA PM trend is obtained from the difference between observed PM trend (which includes effects from GIA and surface mass loads) and the estimated PM trend mostly associated with surface mass loads. A previous estimate of the GIA PM trend from PM observations for the period 1900-1978 is toward 79.90° W at a speed of 3.53 mas/year (10.91 cm/year). Our new estimate for the GIA trend is in a direction of 61.77° W at a speed of 2.18 mas/year (6.74 cm/year), similar to the observed PM trend during the early twentieth century. This is consistent with the view that the early twentieth-century trend was dominated by GIA and that more recently there is an increasing contribution from contemporary surface mass load redistribution associated with climate change. Our GIA PM also agrees with the linear mean pole during 1900-2017. Contributions from other solid Earth process such as mantle convection would also produce a linear trend in PM and could be included in our GIA estimate.

19.
Neuroreport ; 32(18): 1423-1427, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34743167

RESUMO

OBJECTIVES: We investigated differences in the ascending reticular activating system (ARAS) between vegetative state (VS) and minimally conscious state (MCS) in patients with traumatic brain injury (TBI) by using diffusion tensor tractography. METHODS: We recruited TBI patients and normal subjects. We reconstructed the lower ARAS and five parts of upper ARAS [prefrontal cortex (PFC), premotor cortex, primary motor cortex, primary somatosensory cortex, and posterior parietal cortex]. RESULTS: Significant differences were observed in the fractional anisotropy (FA) and fiber number (FN) values of the five parts of upper ARAS between the VS and control groups and between the MCS and control groups (P < 0.05), but no differences were detected in the lower ARAS (P > 0.05). The FA and FN values of the PFC in the upper ARAS were significantly different between the VS and MCS groups (P < 0.05). No other significant differences in FA and FN values were detected among the other segments of the upper ARAS or in the lower ARAS (P > 0.05). CONCLUSION: The results indicate that the prefrontal portion of the upper ARAS is the critical area for distinguishing between VS and MCS in patients with TBI.

20.
Transplant Direct ; 7(12): e789, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34805491

RESUMO

Perfusate lactate clearance (LC) is considered one of the useful indicators of liver viability assessment during normothermic machine perfusion (NMP); however, the applicable scope and potential mechanisms of LC remain poorly defined in the setting of liver donation after circulatory death. Methods: The ex situ NMP of end-ischemic human livers was performed using the OrganOx Metra device. We further studied the extracellular signal-regulated kinases (phospho-extracellular signal-regulated kinase1/2 [pERK1/2]) pathway and several clinical parameters of these livers with successful LC (sLC, n = 5) compared with non-sLC (nLC, n = 5) in the perfusate (<2.2 mmol/L at 2 h, n = 5, rapid retrieval without normothermic regional perfusion). Results: We found the pERK1/2 level was substantially higher in the nLC livers than in the sLC livers (n = 5) at 2- and 6-h NMP (P = 0.035 and P = 0.006, respectively). Immunostaining showed that upregulation of pERK1/2 was in both the hepatocytes and cholangiocytes in the nLC livers. Successful LC was associated with a marginally higher glycogen restoration than nLC at 2 h NMP (n = 5, P = 0.065). Furthermore, bile lactate levels in all sLC livers were cleared into the normal range at 6 h NMP, whereas in the nLC group, only 2 livers had lower bile lactate levels, and the other livers had rising bile lactate levels in comparison with the corresponding perfusate lactate levels. The necrosis scores were higher in the nLC than in the sLC livers (n = 5) at 0- and 6-h NMP (P = 0.047 and P = 0.053, respectively). Conclusions: The dual LC in perfusate and bile can be helpful in evaluating the hypoxic injury of hepatocytes and cholangiocytes during the NMP of donation after circulatory death in liver donors.

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