Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion(EVLP),it incu...Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion(EVLP),it incurs high costs and potential immune responses in rat models.In our preliminary research,donor lungs perfused with Steen's solution exhibited significant lung injury post transplantation,likely due to a strong immune response elicited by the high concentration of xenogenic proteins upon reperfusion.This study explores a low-cost and efficient perfusate composition for use in rat EVLP and lung transplant models.The modified perfusate employed in this study uses artificial colloids as the primary component,with an albumin concentration of only 2%,demonstrating comparable physiological parameters,metabolic levels,and pathological changes to those of Steen's solution during EVLP.Moreover,the modified composition exhibited good biocompatibility in transplantation,with minimal lung injury.In summary,the proposed perfusate offers a safer and more economical alternative for establishing rat EVLP and lung transplant models,facilitating the advancement of related research.展开更多
AIM: To optimize the perfusates used for hypothermicmachine perfusion(HMP).METHODS: Sprague-Dawley rats were assigned randomly to three groups(n = 12 per group) that received either saline, University of Wisconsin col...AIM: To optimize the perfusates used for hypothermicmachine perfusion(HMP).METHODS: Sprague-Dawley rats were assigned randomly to three groups(n = 12 per group) that received either saline, University of Wisconsin coldstorage solution(UW) or histidine-tryptophan-ketoglutarate solution(HTK) as the perfusate. Each group was divided into two subgroups: static cold storage(SCS) and HMP(n = 6 per subgroup). The liver graft was retrieved according to the method described by Kamada. For the SCS group, the graft was directly placed into cold perfusate(0-4?℃) for 6 h after liver isolation while the portal vein of the graft was connected to the perfusion machine for the HMP group. Then the perfusates were collected at different time points for analysis of aspartate aminotransferase(AST), alanine transaminase(ALT) and lactate dehydrogenase(LDH) levels. Liver tissues were obtained for evaluation of histology, dry/wet weight(D/W) ratio, and malondialdehyde(MDA) and adenosine-triphosphate(ATP) levels. The portal vein pressure and velocity were monitored in real time in all HMP subgroups.RESULTS: Comparison of HMP and SCS: Regardless of the perfusate, HMP improved the architecture of donor graft in reducing the congestion around sinusoids and central vein and maintaining sinusoid lining in morphology; HMP improved liver function in terms of ALT, AST and LDH, especially during the 3-6 h period(SCS vs HMP using saline: ALT3, 225.00 ± 105.62 vs 49.50 ± 18.50, P = 0.047; LDH3, 1362.17 ± 563.30 vs 325.75 ± 147.43, P = 0.041; UW: LDH6, 2880.14 ± 948.46 vs 2135.00 ± 174.27, P = 0.049; HTK, AST6, 307.50 ± 52.95 vs 185.20 ± 20.46, P = 0.041); HMP decreased MDA level(saline, 2.79 ± 0.30 vs 1.09 ± 0.09, P = 0.008; UW, 3.01 ± 0.77 vs 1.23 ± 0.68, P = 0.005; HTK, 3.30 ± 0.52 vs 1.56 ± 0.22, P = 0.006). Comparison among HMP subgroups: HTK showed less portal vein resistance than UW and saline(vs saline, 3.41 ± 0.49 vs 5.00 ± 0.38, P < 0.001; vs UW, 3.41 ± 0.49 vs 4.52 ± 0.63, P = 0.007); UW reduced edema most efficiently(vs saline, 0.68 ± 0.02 vs 0.79 ± 0.05, P = 0.013), while HTK maintained ATP levels best(vs saline, 622.60 ± 29.11 vs 327.43 ± 44.66, P < 0.001; vs UW, 622.60 ± 29.11 vs 301.80 ± 37.68, P < 0.001).CONCLUSION: HMP is superior to SCS in maintaining both architecture and function of liver grafts. Further, HTK was found to be the optimal perfusate for HMP.展开更多
Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may...Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.展开更多
Background:Delayed graft function(DGF)is the main cause of renal function failure after kidney transplantation.This study aims at investigating the value of hypothermic machine perfusion(HMP)parameters combined with p...Background:Delayed graft function(DGF)is the main cause of renal function failure after kidney transplantation.This study aims at investigating the value of hypothermic machine perfusion(HMP)parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor(DD)kidney transplantation.Methods:HMP parameters,perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1,2019 to August 31,2019 in the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis.Results:In this study,the DGF incidence was 17.7%(20/113);The multivariate logistic regression results showed that terminal resistance(OR:1.879,95%CI 1.145-3.56)and glutathione S-transferase(GST)(OR=1.62,95%CI 1.23-2.46)were risk factors for DGF;The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time(HR=0.823,95%CI 0.735-0.981).The model combining terminal resistance and GST(AUC=0.888,95%CI:0.842-0.933)significantly improved the DGF predictability compared with the use of terminal resistance(AUC=0.756,95%CI 0.693-0.818)or GST alone(AUC=0.729,95%CI 0.591-0.806).Conclusion:According to the factors analyzed in this study,the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.展开更多
There exists significant individual variation in electroacupuncture (EA) induced analgesia.Rats may be classified as high- and low-responders according to their response to EA analgesia. The content of cholecystokinin...There exists significant individual variation in electroacupuncture (EA) induced analgesia.Rats may be classified as high- and low-responders according to their response to EA analgesia. The content of cholecystokinin octapeptide like immunoreactivity (CCK-8-ir) in the spinal perfusate of highresponder (HR) and low-responder (LR) rats was measured with radioimmunoassay. The result showed that the CCK-8-ir content in LR rats was significantly lower than that in HR rats. There exists a negative correlation between the EA effect and the CCK-8-ir content during EA stimulation. It is concluded that the spinal release of CCK-8 may be one of the key factors determining the effect of EA analgesia.展开更多
Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susc...Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susceptible to IRI. Although machine perfusion technology has brought hope to alleviate IRI, this technology is still unable to eradicate IRI-related organ damage. Ischemia-free liver transplantation (IFLT)can completely avoid IRI, thereby improve graft function and recipient outcome, and allow to expand organ pool. This review summarized the latest progresses in IFLT, and speculated the future development of this concept.展开更多
BACKGROUND Ischemic heart disease(IHD)impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally.AIM To compare variations in the parameters of the single-lead electrocardiogram...BACKGROUND Ischemic heart disease(IHD)impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally.AIM To compare variations in the parameters of the single-lead electrocardiogram(ECG)during resting conditions and physical exertion in individuals diagnosed with IHD and those without the condition using vasodilator-induced stress computed tomography(CT)myocardial perfusion imaging as the diagnostic reference standard.METHODS This single center observational study included 80 participants.The participants were aged≥40 years and given an informed written consent to participate in the study.Both groups,G1(n=31)with and G2(n=49)without post stress induced myocardial perfusion defect,passed cardiologist consultation,anthropometric measurements,blood pressure and pulse rate measurement,echocardiography,cardio-ankle vascular index,bicycle ergometry,recording 3-min single-lead ECG(Cardio-Qvark)before and just after bicycle ergometry followed by performing CT myocardial perfusion.The LASSO regression with nested cross-validation was used to find the association between Cardio-Qvark parameters and the existence of the perfusion defect.Statistical processing was performed with the R programming language v4.2,Python v.3.10[^R],and Statistica 12 program.RESULTS Bicycle ergometry yielded an area under the receiver operating characteristic curve of 50.7%[95%confidence interval(CI):0.388-0.625],specificity of 53.1%(95%CI:0.392-0.673),and sensitivity of 48.4%(95%CI:0.306-0.657).In contrast,the Cardio-Qvark test performed notably better with an area under the receiver operating characteristic curve of 67%(95%CI:0.530-0.801),specificity of 75.5%(95%CI:0.628-0.88),and sensitivity of 51.6%(95%CI:0.333-0.695).CONCLUSION The single-lead ECG has a relatively higher diagnostic accuracy compared with bicycle ergometry by using machine learning models,but the difference was not statistically significant.However,further investigations are required to uncover the hidden capabilities of single-lead ECG in IHD diagnosis.展开更多
Bioelectronic interventions,specifically trigeminal nerve st imulat ion(TNS),have attracted considerable attention in conditions where cortical spreading depolarizations(CSDs)accompanied by compromised cerebral perfus...Bioelectronic interventions,specifically trigeminal nerve st imulat ion(TNS),have attracted considerable attention in conditions where cortical spreading depolarizations(CSDs)accompanied by compromised cerebral perfusion may exacerbate neurological damage.While pharmacological interventions have demonstrated initial potential in addressing CSDs,a standardized treatment approach has not yet been established.The objective of this perspective is to explore emerging bioelectronic methodologies for addressing CSDs,particularly emphasizing TNS,and to underscore TNS’s capacity to enhance neurovascular coupling and cerebral perfusion.展开更多
Post-reperfusion syndrome(PRS)in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery.PRS can impact the short-term and long-term patient and graft outcomes.The definit...Post-reperfusion syndrome(PRS)in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery.PRS can impact the short-term and long-term patient and graft outcomes.The definition of PRS has evolved over the years,from changes in arterial blood pressures and heart and/or de-creases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS.However,all that did not reflect on the management of PRS or its impact on the outcomes.In recent years,new scientific techniques and new technology have been in the pipeline to better understand,manage and maybe prevent PRS.These new methods and techniques are still in the infancy,and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes.In this article,we will review the long history of PRS,its definition,etiology,mana-gement and most importantly the new advances in science and technology to prevent and properly manage PRS.展开更多
BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preserv...BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preservation time through the suspension of CIT and normothermic perfusion.As we continue to further expand the donor pool in all aspects of lung transplantation,teams are frequently traveling further distances to procure organs.AIM To determine the effect of CSS or EVLP on donors with extended travel distance[>750 nautical miles(NM)]to recipient.METHODS Lung transplants,whose donor traveled greater than 750 NM,were identified from the United Network for Organ Sharing Database.Recipients were stratified into either:CSS or EVLP,based on preservation method.Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods.A 3:1 propensity match was then created,and same analysis was repeated.RESULTS Prior to matching,those in the EVLP group had significantly increased postoperative morbidity to include dialysis,ventilator use,acute rejection,and treated rejection in the first year(P<0.05 for all).However,there were no significant differences in midterm survival(P=0.18).Following matching,those in the EVLP group again had significantly increased post-operative morbidity to include dialysis,extracorporeal membrane oxygenation use,ventilator use,and treated rejection in the first year(P<0.05 for all).As before,there were no significant differences in midterm survival following matching(P=0.08).CONCLUSION While there was no significant difference in survival,EVLP patients had increased peri-operative morbidity.With the advent of changes in CSS with 10℃storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.展开更多
BACKGROUND Liver transplantation(LT)is the only curative,life-saving option for children and adults with end-stage liver disease.Due to the well-known shortage and heterogeneity of grafts,split LT(SLT)is an attractive...BACKGROUND Liver transplantation(LT)is the only curative,life-saving option for children and adults with end-stage liver disease.Due to the well-known shortage and heterogeneity of grafts,split LT(SLT)is an attractive strategy to expand the donor pool and reduce waitlist times.Given increased risk of cold ischemia time with SLT,machine perfusion represents a promising option to reduce it and optimize transplant logistics and outcomes.The present communication describes various possible combinations of procurement steps to perform SLT facilitated by placing one or both grafts on a normothermic machine perfusion(NMP)closed circuit device.CASE SUMMARY A 19-month-old female with biliary atresia after failed Kasai portoenterostomy and a 42-year-old woman with unresectable intrahepatic cholangiocarcinoma were selected as recipients for a SLT from a 17-year-old male donor.The SLT generated a left lateral segment and a right trisectional graft of appropriate volume for both recipients.After a mixed in-situ and ex-situ split,in order to improve logistics,the right trisectional graft was placed on a closed circuit NMP device,following an appropriate vascular reconstruction.Both grafts were implanted with excellent short-term outcomes.CONCLUSION Use of NMP with SLT for preservation prior to implantation allows not only for graft optimization but also for significant improvement of transplant logistics.We propose various models and standardization of logistic options for combining SLT with NMP to optimize graft availability and outcomes.展开更多
BACKGROUND Contrast-enhanced ultrasonography(CEUS)is utilized to assess the therapeutic efficacy of interventional therapy in liver cancer patients,offering insights into tumor blood flow changes,angiogenesis,and tumo...BACKGROUND Contrast-enhanced ultrasonography(CEUS)is utilized to assess the therapeutic efficacy of interventional therapy in liver cancer patients,offering insights into tumor blood flow changes,angiogenesis,and tumor markers.AIM To evaluate the use of CEUS in examining the effectiveness of interventional therapy for liver cancer,we aim to investigate its diagnostic utility for tumor perfusion patterns,microvessel density,perfusion recovery,blood flow enhancement response,and alterations in tumor markers among patients receiving interventional therapy for liver cancer.METHODS The study involved 124 patients who underwent interventional therapy for liver cancer at Guangzhou First People’s Hospital from January 2022 to February 2024.All patients were examined using CEUS before treatment and at 1 month,3 months,and 6 months,and the concentrations of tumor markers were collected and statistically analyzed using Statistical Package for the Social Sciences 25.0.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of CEUS and analyze its sensitivity,specificity,and correlation with clinical indicators.RESULTS Before treatment,tumor blood flow was primarily enhanced.After treatment,enhanced perfusion declined,while uniform and non-uniform perfusion increased,indicating reduced tumor activity.Enhanced perfusion decreased from 68.25%before treatment to 53.75%at 6 months post-treatment(F=6.123,P=0.016),indicating reduced tumor activity.The microvessel density of the tumors decreased significantly after treatment(P<0.05),and the proportion of low microvessel density increased.After treatment,perfusion recovery in the tumor area improved,the proportion of complete and partial responses gradually increased,and the proportion of stable lesions decreased(P<0.05).The levels of alphafetoprotein,carcinoembryonic antigen,and carbohydrate antigen 19-9 decreased by 68.7%,30.4%,and 41.6%,respectively,at 6 months post-treatment(P<0.05).CEUS showed a sensitivity of 85.72%,specificity of 92.31%,and area under the curve of 0.911(95%CI:0.883–0.939)for evaluating treatment response.ROC curve analysis showed that CEUS had high sensitivity and specificity and could effectively evaluate the efficacy of interventional therapy for liver cancer.CONCLUSION CEUS has high diagnostic value in evaluating therapeutic effects in patients with liver cancer following interventional therapy.It can reflect changes in tumor blood flow,angiogenesis,and tumor marker levels,providing an effective basis for real-time monitoring of treatment outcomes.展开更多
BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine pe...BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.展开更多
Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that analyzes the microvascular system of the eye.By capturing high-speed,repeated scans to detect the movement of red blood cells,OCTA...Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that analyzes the microvascular system of the eye.By capturing high-speed,repeated scans to detect the movement of red blood cells,OCTA visualizes the vascular network,revealing ischemia and reperfusion patterns in retinal vascular diseases.It has become a primary tool for assessing changes in the multilayer microvascular structure of the retina,applicable in conditions such as diabetic retinopathy,age-related macular degeneration,central serous chorioretinopathy,vascular occlusions,and glaucomatous optic neuropathy,among others.Moreover,OCTA is useful in the assessment of central nervous system diseases and is increasingly utilized in routine health examinations and scientific research.Its main advantages include high resolution,rapid,non-invasive scanning,and the ability to analyze microcirculation by observing different vascular layers through tomographic imaging.However,its sensitivity to blood flow velocity and susceptibility to artifacts,such as slow blood flow appearing as non-perfusion,are notable limitations.Overall,OCTA provides a visually intuitive approach for observing retinal blood flow and has significant clinical implications for ocular conditions.展开更多
Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the lef...Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.展开更多
Cardiac tissue engineering aims to efficiently replace or repair injured heart tissue using scaffolds,relevant cells,or their combination.While the combination of scaffolds and relevant cells holds the potential to ra...Cardiac tissue engineering aims to efficiently replace or repair injured heart tissue using scaffolds,relevant cells,or their combination.While the combination of scaffolds and relevant cells holds the potential to rapidly remuscularize the heart,thereby avoiding the slow process of cell recruitment,the proper ex vivo cellularization of a scaffold poses a substantial challenge.First,proper diffusion of nutrients and oxygen should be provided to the cell-seeded scaffold.Second,to generate a functional tissue construct,cells can benefit from physiological-like conditions.To meet these challenges,we developed a modular bioreactor for the dynamic cellularization of full-thickness cardiac scaffolds under synchronized mechanical and electrical stimuli.In this unique bioreactor system,we designed a cyclic mechanical load that mimics the left ventricle volume inflation,thus achieving a steady stimulus,as well as an electrical stimulus with an action potential profile to mirror the cells’microenvironment and electrical stimuli in the heart.These mechanical and electrical stimuli were synchronized according to cardiac physiology and regulated by constant feedback.When applied to a seeded thick porcine cardiac extracellular matrix(pcECM)scaffold,these stimuli improved the proliferation of mesenchymal stem/stromal cells(MSCs)and induced the formation of a dense tissue-like structure near the scaffold’s surface.Most importantly,after 35 d of cultivation,the MSCs presented the early cardiac progenitor markers Connexin-43 andα-actinin,which were absent in the control cells.Overall,this research developed a new bioreactor system for cellularizing cardiac scaffolds under cardiac-like conditions,aiming to restore a sustainable dynamic living tissue that can bear the essential cardiac excitation–contraction coupling.展开更多
Impedance pneumography has a significant advantage for continuous and noninvasive monitoring of respiration,compared with conventional flowmeter-based ventilation measurement technologies.While thoracic impedance is s...Impedance pneumography has a significant advantage for continuous and noninvasive monitoring of respiration,compared with conventional flowmeter-based ventilation measurement technologies.While thoracic impedance is sensitive to pulmonary ventilation,it is also sensitive to physiological activities such as blood flow and cardiomotility,in addition,body movement/posture.This paper explores the possibility of simultaneously monitoring pulmonary ventilation,blood circulation and cardiomotility by bioimpedance measurement.Respiratory,blood perfusion and cardiomotility signals are extracted using the wavelet method from thoracic impedance data measured in breath-holding and tidal breathing statuses,to investigate signal strength and their dependency.This research provides a foundation for the development of bedside devices to monitor various physiological activities.展开更多
BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult...BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.展开更多
BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury...BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.展开更多
BACKGROUND Hyperspectral imaging(HSI)offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs.Up to now,there is no case repor...BACKGROUND Hyperspectral imaging(HSI)offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs.Up to now,there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver.The allocated liver from a 49-year-old female donor(161 cm,70 kg)was perfused with the OrganOx®normothermic machine perfusion system in the recommended way.Organ quality assessment was performed based on laboratory values at defined time points.In addition,the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment.After discarding the organ,biopsies were taken from each segment and correlated with the results of the HSI.CASE SUMMARY The donor liver’s size(29 cm×17 cm×11 cm)and weight of 2180 g posed challenges for adequate placement within the organ container.Baseline biopsy of the liver revealed no evidence of fibrosis,steatosis or inflammation.An hour after perfusion start,measurements of the perfusate indicated a pH of 7.18,a glucose level of 404 mg/dL,and a lactate level of 1.7 mmol/L.Throughout perfusion,a significant decline in glucose levels began at the fourth hour,reaching a nadir of 20 mg/dL after eight hours.Concurrently,lactate levels steadily rose,peaking at 4.9 mmol/L after the total perfusion time of 12 hours.Macroscopic alterations(signs of congestion and reduced blood circulation)on the liver’s surface were noted,particularly pronounced in segments 2,3,and 8.HSI of these areas unveiled significant reduced oxygenation.Consequently,based on all these observations,the decision was made to discard the organ.Histological examination of the altered regions revealed congestion,necrotic changes,and dissociation of CONCLUSION This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver.HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.展开更多
文摘Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion(EVLP),it incurs high costs and potential immune responses in rat models.In our preliminary research,donor lungs perfused with Steen's solution exhibited significant lung injury post transplantation,likely due to a strong immune response elicited by the high concentration of xenogenic proteins upon reperfusion.This study explores a low-cost and efficient perfusate composition for use in rat EVLP and lung transplant models.The modified perfusate employed in this study uses artificial colloids as the primary component,with an albumin concentration of only 2%,demonstrating comparable physiological parameters,metabolic levels,and pathological changes to those of Steen's solution during EVLP.Moreover,the modified composition exhibited good biocompatibility in transplantation,with minimal lung injury.In summary,the proposed perfusate offers a safer and more economical alternative for establishing rat EVLP and lung transplant models,facilitating the advancement of related research.
基金Supported by National Science and Technology Major Project,No.2012ZX10002-017Natural Science Foundation of China for Innovative Research Group,No.81121002+4 种基金National Natural Science Foundation of China,No.81000137 and No.81470891The Qianjiang Talent Program of Zhejiang Province,China,No.2012R10045the Scientific Research Program for the Returned Overseas Chinese Scholars,Ministry of Health,China,No.J20112008National High Technology Research and Development Program of China for Young Scientists(863 Program),No.2015AA020923Ministry of Education,Zhejiang Province,China,No.Y201328095
文摘AIM: To optimize the perfusates used for hypothermicmachine perfusion(HMP).METHODS: Sprague-Dawley rats were assigned randomly to three groups(n = 12 per group) that received either saline, University of Wisconsin coldstorage solution(UW) or histidine-tryptophan-ketoglutarate solution(HTK) as the perfusate. Each group was divided into two subgroups: static cold storage(SCS) and HMP(n = 6 per subgroup). The liver graft was retrieved according to the method described by Kamada. For the SCS group, the graft was directly placed into cold perfusate(0-4?℃) for 6 h after liver isolation while the portal vein of the graft was connected to the perfusion machine for the HMP group. Then the perfusates were collected at different time points for analysis of aspartate aminotransferase(AST), alanine transaminase(ALT) and lactate dehydrogenase(LDH) levels. Liver tissues were obtained for evaluation of histology, dry/wet weight(D/W) ratio, and malondialdehyde(MDA) and adenosine-triphosphate(ATP) levels. The portal vein pressure and velocity were monitored in real time in all HMP subgroups.RESULTS: Comparison of HMP and SCS: Regardless of the perfusate, HMP improved the architecture of donor graft in reducing the congestion around sinusoids and central vein and maintaining sinusoid lining in morphology; HMP improved liver function in terms of ALT, AST and LDH, especially during the 3-6 h period(SCS vs HMP using saline: ALT3, 225.00 ± 105.62 vs 49.50 ± 18.50, P = 0.047; LDH3, 1362.17 ± 563.30 vs 325.75 ± 147.43, P = 0.041; UW: LDH6, 2880.14 ± 948.46 vs 2135.00 ± 174.27, P = 0.049; HTK, AST6, 307.50 ± 52.95 vs 185.20 ± 20.46, P = 0.041); HMP decreased MDA level(saline, 2.79 ± 0.30 vs 1.09 ± 0.09, P = 0.008; UW, 3.01 ± 0.77 vs 1.23 ± 0.68, P = 0.005; HTK, 3.30 ± 0.52 vs 1.56 ± 0.22, P = 0.006). Comparison among HMP subgroups: HTK showed less portal vein resistance than UW and saline(vs saline, 3.41 ± 0.49 vs 5.00 ± 0.38, P < 0.001; vs UW, 3.41 ± 0.49 vs 4.52 ± 0.63, P = 0.007); UW reduced edema most efficiently(vs saline, 0.68 ± 0.02 vs 0.79 ± 0.05, P = 0.013), while HTK maintained ATP levels best(vs saline, 622.60 ± 29.11 vs 327.43 ± 44.66, P < 0.001; vs UW, 622.60 ± 29.11 vs 301.80 ± 37.68, P < 0.001).CONCLUSION: HMP is superior to SCS in maintaining both architecture and function of liver grafts. Further, HTK was found to be the optimal perfusate for HMP.
基金supported partly by the National Natural Science Foundation of China,No.82071332the Chongqing Natural Science Foundation Joint Fund for Innovation and Development,No.CSTB2023NSCQ-LZX0041 (both to ZG)。
文摘Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.
基金This work was supported by the grants from the National Natural Science Foundation of China(Nos.81670681,81760137,81870514,81970668 and 81970670)the Fundamental Research Funds for the Central Universities(No.xjj2018091)+1 种基金the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University(No.XJTU1AF-CRF-2019-008)the Special Supportive Program for Organ Transplantation by COTDF(No.2019JYJH04).
文摘Background:Delayed graft function(DGF)is the main cause of renal function failure after kidney transplantation.This study aims at investigating the value of hypothermic machine perfusion(HMP)parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor(DD)kidney transplantation.Methods:HMP parameters,perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1,2019 to August 31,2019 in the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis.Results:In this study,the DGF incidence was 17.7%(20/113);The multivariate logistic regression results showed that terminal resistance(OR:1.879,95%CI 1.145-3.56)and glutathione S-transferase(GST)(OR=1.62,95%CI 1.23-2.46)were risk factors for DGF;The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time(HR=0.823,95%CI 0.735-0.981).The model combining terminal resistance and GST(AUC=0.888,95%CI:0.842-0.933)significantly improved the DGF predictability compared with the use of terminal resistance(AUC=0.756,95%CI 0.693-0.818)or GST alone(AUC=0.729,95%CI 0.591-0.806).Conclusion:According to the factors analyzed in this study,the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.
文摘There exists significant individual variation in electroacupuncture (EA) induced analgesia.Rats may be classified as high- and low-responders according to their response to EA analgesia. The content of cholecystokinin octapeptide like immunoreactivity (CCK-8-ir) in the spinal perfusate of highresponder (HR) and low-responder (LR) rats was measured with radioimmunoassay. The result showed that the CCK-8-ir content in LR rats was significantly lower than that in HR rats. There exists a negative correlation between the EA effect and the CCK-8-ir content during EA stimulation. It is concluded that the spinal release of CCK-8 may be one of the key factors determining the effect of EA analgesia.
基金supported by a grant from the Guangdong Provincial Key Laboratory of Organ Donation and Transplantation Immunity (K0230015)。
文摘Ischemia-reperfusion injury (IRI) is an inherent issue in organ transplantation. Because of the allograft shortage, more and more extended criteria donor (ECD) organs are used, unfortunately these grafts are more susceptible to IRI. Although machine perfusion technology has brought hope to alleviate IRI, this technology is still unable to eradicate IRI-related organ damage. Ischemia-free liver transplantation (IFLT)can completely avoid IRI, thereby improve graft function and recipient outcome, and allow to expand organ pool. This review summarized the latest progresses in IFLT, and speculated the future development of this concept.
基金Supported by Government Assignment,No.1023022600020-6RSF Grant,No.24-15-00549Ministry of Science and Higher Education of the Russian Federation within the Framework of State Support for the Creation and Development of World-Class Research Center,No.075-15-2022-304.
文摘BACKGROUND Ischemic heart disease(IHD)impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally.AIM To compare variations in the parameters of the single-lead electrocardiogram(ECG)during resting conditions and physical exertion in individuals diagnosed with IHD and those without the condition using vasodilator-induced stress computed tomography(CT)myocardial perfusion imaging as the diagnostic reference standard.METHODS This single center observational study included 80 participants.The participants were aged≥40 years and given an informed written consent to participate in the study.Both groups,G1(n=31)with and G2(n=49)without post stress induced myocardial perfusion defect,passed cardiologist consultation,anthropometric measurements,blood pressure and pulse rate measurement,echocardiography,cardio-ankle vascular index,bicycle ergometry,recording 3-min single-lead ECG(Cardio-Qvark)before and just after bicycle ergometry followed by performing CT myocardial perfusion.The LASSO regression with nested cross-validation was used to find the association between Cardio-Qvark parameters and the existence of the perfusion defect.Statistical processing was performed with the R programming language v4.2,Python v.3.10[^R],and Statistica 12 program.RESULTS Bicycle ergometry yielded an area under the receiver operating characteristic curve of 50.7%[95%confidence interval(CI):0.388-0.625],specificity of 53.1%(95%CI:0.392-0.673),and sensitivity of 48.4%(95%CI:0.306-0.657).In contrast,the Cardio-Qvark test performed notably better with an area under the receiver operating characteristic curve of 67%(95%CI:0.530-0.801),specificity of 75.5%(95%CI:0.628-0.88),and sensitivity of 51.6%(95%CI:0.333-0.695).CONCLUSION The single-lead ECG has a relatively higher diagnostic accuracy compared with bicycle ergometry by using machine learning models,but the difference was not statistically significant.However,further investigations are required to uncover the hidden capabilities of single-lead ECG in IHD diagnosis.
基金supported by National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R21NS114763US Army Medical Research and Materiel Command (USAMRMC) under award#W81XWH-18-1-0773merit-based career enhancement award at the Feinstein Institutes for Medical Research (to CL)
文摘Bioelectronic interventions,specifically trigeminal nerve st imulat ion(TNS),have attracted considerable attention in conditions where cortical spreading depolarizations(CSDs)accompanied by compromised cerebral perfusion may exacerbate neurological damage.While pharmacological interventions have demonstrated initial potential in addressing CSDs,a standardized treatment approach has not yet been established.The objective of this perspective is to explore emerging bioelectronic methodologies for addressing CSDs,particularly emphasizing TNS,and to underscore TNS’s capacity to enhance neurovascular coupling and cerebral perfusion.
文摘Post-reperfusion syndrome(PRS)in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery.PRS can impact the short-term and long-term patient and graft outcomes.The definition of PRS has evolved over the years,from changes in arterial blood pressures and heart and/or de-creases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS.However,all that did not reflect on the management of PRS or its impact on the outcomes.In recent years,new scientific techniques and new technology have been in the pipeline to better understand,manage and maybe prevent PRS.These new methods and techniques are still in the infancy,and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes.In this article,we will review the long history of PRS,its definition,etiology,mana-gement and most importantly the new advances in science and technology to prevent and properly manage PRS.
基金Supported by The Jewel and Frank Benson Family Endowmentand The Jewel and Frank Benson Research Professorship.
文摘BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preservation time through the suspension of CIT and normothermic perfusion.As we continue to further expand the donor pool in all aspects of lung transplantation,teams are frequently traveling further distances to procure organs.AIM To determine the effect of CSS or EVLP on donors with extended travel distance[>750 nautical miles(NM)]to recipient.METHODS Lung transplants,whose donor traveled greater than 750 NM,were identified from the United Network for Organ Sharing Database.Recipients were stratified into either:CSS or EVLP,based on preservation method.Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods.A 3:1 propensity match was then created,and same analysis was repeated.RESULTS Prior to matching,those in the EVLP group had significantly increased postoperative morbidity to include dialysis,ventilator use,acute rejection,and treated rejection in the first year(P<0.05 for all).However,there were no significant differences in midterm survival(P=0.18).Following matching,those in the EVLP group again had significantly increased post-operative morbidity to include dialysis,extracorporeal membrane oxygenation use,ventilator use,and treated rejection in the first year(P<0.05 for all).As before,there were no significant differences in midterm survival following matching(P=0.08).CONCLUSION While there was no significant difference in survival,EVLP patients had increased peri-operative morbidity.With the advent of changes in CSS with 10℃storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.
文摘BACKGROUND Liver transplantation(LT)is the only curative,life-saving option for children and adults with end-stage liver disease.Due to the well-known shortage and heterogeneity of grafts,split LT(SLT)is an attractive strategy to expand the donor pool and reduce waitlist times.Given increased risk of cold ischemia time with SLT,machine perfusion represents a promising option to reduce it and optimize transplant logistics and outcomes.The present communication describes various possible combinations of procurement steps to perform SLT facilitated by placing one or both grafts on a normothermic machine perfusion(NMP)closed circuit device.CASE SUMMARY A 19-month-old female with biliary atresia after failed Kasai portoenterostomy and a 42-year-old woman with unresectable intrahepatic cholangiocarcinoma were selected as recipients for a SLT from a 17-year-old male donor.The SLT generated a left lateral segment and a right trisectional graft of appropriate volume for both recipients.After a mixed in-situ and ex-situ split,in order to improve logistics,the right trisectional graft was placed on a closed circuit NMP device,following an appropriate vascular reconstruction.Both grafts were implanted with excellent short-term outcomes.CONCLUSION Use of NMP with SLT for preservation prior to implantation allows not only for graft optimization but also for significant improvement of transplant logistics.We propose various models and standardization of logistic options for combining SLT with NMP to optimize graft availability and outcomes.
基金Supported by Science and Technology Program of Guangzhou,No.2024A03J1029Science and Technology Program of Chinese Medicine and Integrated Chinese and Western Medicine in Guangzhou,No.20252A010001.
文摘BACKGROUND Contrast-enhanced ultrasonography(CEUS)is utilized to assess the therapeutic efficacy of interventional therapy in liver cancer patients,offering insights into tumor blood flow changes,angiogenesis,and tumor markers.AIM To evaluate the use of CEUS in examining the effectiveness of interventional therapy for liver cancer,we aim to investigate its diagnostic utility for tumor perfusion patterns,microvessel density,perfusion recovery,blood flow enhancement response,and alterations in tumor markers among patients receiving interventional therapy for liver cancer.METHODS The study involved 124 patients who underwent interventional therapy for liver cancer at Guangzhou First People’s Hospital from January 2022 to February 2024.All patients were examined using CEUS before treatment and at 1 month,3 months,and 6 months,and the concentrations of tumor markers were collected and statistically analyzed using Statistical Package for the Social Sciences 25.0.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of CEUS and analyze its sensitivity,specificity,and correlation with clinical indicators.RESULTS Before treatment,tumor blood flow was primarily enhanced.After treatment,enhanced perfusion declined,while uniform and non-uniform perfusion increased,indicating reduced tumor activity.Enhanced perfusion decreased from 68.25%before treatment to 53.75%at 6 months post-treatment(F=6.123,P=0.016),indicating reduced tumor activity.The microvessel density of the tumors decreased significantly after treatment(P<0.05),and the proportion of low microvessel density increased.After treatment,perfusion recovery in the tumor area improved,the proportion of complete and partial responses gradually increased,and the proportion of stable lesions decreased(P<0.05).The levels of alphafetoprotein,carcinoembryonic antigen,and carbohydrate antigen 19-9 decreased by 68.7%,30.4%,and 41.6%,respectively,at 6 months post-treatment(P<0.05).CEUS showed a sensitivity of 85.72%,specificity of 92.31%,and area under the curve of 0.911(95%CI:0.883–0.939)for evaluating treatment response.ROC curve analysis showed that CEUS had high sensitivity and specificity and could effectively evaluate the efficacy of interventional therapy for liver cancer.CONCLUSION CEUS has high diagnostic value in evaluating therapeutic effects in patients with liver cancer following interventional therapy.It can reflect changes in tumor blood flow,angiogenesis,and tumor marker levels,providing an effective basis for real-time monitoring of treatment outcomes.
文摘BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.
文摘Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that analyzes the microvascular system of the eye.By capturing high-speed,repeated scans to detect the movement of red blood cells,OCTA visualizes the vascular network,revealing ischemia and reperfusion patterns in retinal vascular diseases.It has become a primary tool for assessing changes in the multilayer microvascular structure of the retina,applicable in conditions such as diabetic retinopathy,age-related macular degeneration,central serous chorioretinopathy,vascular occlusions,and glaucomatous optic neuropathy,among others.Moreover,OCTA is useful in the assessment of central nervous system diseases and is increasingly utilized in routine health examinations and scientific research.Its main advantages include high resolution,rapid,non-invasive scanning,and the ability to analyze microcirculation by observing different vascular layers through tomographic imaging.However,its sensitivity to blood flow velocity and susceptibility to artifacts,such as slow blood flow appearing as non-perfusion,are notable limitations.Overall,OCTA provides a visually intuitive approach for observing retinal blood flow and has significant clinical implications for ocular conditions.
文摘Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.
基金funded by the Israeli Ministry of Innovation,Science and Technology(Grant No.3-11873)the Israel Science Foundation(Grant No.1563/10)+1 种基金the Randy L.and Melvin R.Berlin Family Research Center for Regenerative Medicinethe Gurwin Family Foundation.
文摘Cardiac tissue engineering aims to efficiently replace or repair injured heart tissue using scaffolds,relevant cells,or their combination.While the combination of scaffolds and relevant cells holds the potential to rapidly remuscularize the heart,thereby avoiding the slow process of cell recruitment,the proper ex vivo cellularization of a scaffold poses a substantial challenge.First,proper diffusion of nutrients and oxygen should be provided to the cell-seeded scaffold.Second,to generate a functional tissue construct,cells can benefit from physiological-like conditions.To meet these challenges,we developed a modular bioreactor for the dynamic cellularization of full-thickness cardiac scaffolds under synchronized mechanical and electrical stimuli.In this unique bioreactor system,we designed a cyclic mechanical load that mimics the left ventricle volume inflation,thus achieving a steady stimulus,as well as an electrical stimulus with an action potential profile to mirror the cells’microenvironment and electrical stimuli in the heart.These mechanical and electrical stimuli were synchronized according to cardiac physiology and regulated by constant feedback.When applied to a seeded thick porcine cardiac extracellular matrix(pcECM)scaffold,these stimuli improved the proliferation of mesenchymal stem/stromal cells(MSCs)and induced the formation of a dense tissue-like structure near the scaffold’s surface.Most importantly,after 35 d of cultivation,the MSCs presented the early cardiac progenitor markers Connexin-43 andα-actinin,which were absent in the control cells.Overall,this research developed a new bioreactor system for cellularizing cardiac scaffolds under cardiac-like conditions,aiming to restore a sustainable dynamic living tissue that can bear the essential cardiac excitation–contraction coupling.
基金the National Natural Science Foundation of China(No.61371017)the Interdisciplinary Program of Shanghai Jiao Tong University(No.YG2021QN37)。
文摘Impedance pneumography has a significant advantage for continuous and noninvasive monitoring of respiration,compared with conventional flowmeter-based ventilation measurement technologies.While thoracic impedance is sensitive to pulmonary ventilation,it is also sensitive to physiological activities such as blood flow and cardiomotility,in addition,body movement/posture.This paper explores the possibility of simultaneously monitoring pulmonary ventilation,blood circulation and cardiomotility by bioimpedance measurement.Respiratory,blood perfusion and cardiomotility signals are extracted using the wavelet method from thoracic impedance data measured in breath-holding and tidal breathing statuses,to investigate signal strength and their dependency.This research provides a foundation for the development of bedside devices to monitor various physiological activities.
文摘BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.
文摘BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.
文摘BACKGROUND Hyperspectral imaging(HSI)offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs.Up to now,there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver.The allocated liver from a 49-year-old female donor(161 cm,70 kg)was perfused with the OrganOx®normothermic machine perfusion system in the recommended way.Organ quality assessment was performed based on laboratory values at defined time points.In addition,the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment.After discarding the organ,biopsies were taken from each segment and correlated with the results of the HSI.CASE SUMMARY The donor liver’s size(29 cm×17 cm×11 cm)and weight of 2180 g posed challenges for adequate placement within the organ container.Baseline biopsy of the liver revealed no evidence of fibrosis,steatosis or inflammation.An hour after perfusion start,measurements of the perfusate indicated a pH of 7.18,a glucose level of 404 mg/dL,and a lactate level of 1.7 mmol/L.Throughout perfusion,a significant decline in glucose levels began at the fourth hour,reaching a nadir of 20 mg/dL after eight hours.Concurrently,lactate levels steadily rose,peaking at 4.9 mmol/L after the total perfusion time of 12 hours.Macroscopic alterations(signs of congestion and reduced blood circulation)on the liver’s surface were noted,particularly pronounced in segments 2,3,and 8.HSI of these areas unveiled significant reduced oxygenation.Consequently,based on all these observations,the decision was made to discard the organ.Histological examination of the altered regions revealed congestion,necrotic changes,and dissociation of CONCLUSION This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver.HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.
