Notes

Violent limited component style applied for blood flow formula in arterial bifurcation.
Recurrence of hepatocellular carcinoma (HCC) is an important predictor of survival after liver transplantation (LT). find more Recent studies show that early diagnosis, aggressive treatment, and surveillance may improve outcomes after HCC recurrence. We sought to determine the current practices and policies regarding surveillance for HCC recurrence after LT.
We conducted a web-based national survey of adult liver transplant centers in the United States to capture center-specific details of HCC surveillance post-LT. Responses were analyzed to generate numerical and graphical summaries.

Of 101 eligible adult liver transplant centers, 48 (48%) centers across the United States responded to the survey. Among the participating centers, 79% stratified transplant recipients for HCC recurrence risk, while 19% did not have any risk stratification protocol. Explant microvascular invasion (mVI) was the most common factor used in risk stratification. Use of pretransplant serum biomarkers such as alpha-fetoprotein (AFP) was variable, with only 48% of the participating centers reporting specific "cutoff" values. While a majority of centers (88%) reported having a routine imaging protocol for HCC recurrence surveillance, there was considerable heterogeneity in terms of frequency and duration of such surveillance. Of the centers that did risk stratify patients to identify those at higher risk of HCC recurrence, about 50% did not change their surveillance protocol.

Our study affirms significant variability in center practices, and our results reflect the need for high-quality studies to guide risk stratification and surveillance for HCC recurrence.
Our study affirms significant variability in center practices, and our results reflect the need for high-quality studies to guide risk stratification and surveillance for HCC recurrence.Risk factors for cytomegalovirus (CMV) viremia in CMV seropositive liver transplant recipients are incompletely defined and have focused primarily on recipient factors. We hypothesized that active CMV replication (CMV viremia) in seropositive donors might increase the risk for CMV viremia in recipients, as reported for other viruses in organ transplantation.
From January 3, 2009, to July 27, 2015, stored plasma from consecutive CMV seropositive liver donors was retrospectively tested for CMV viremia by PCR. From April 20, 2012, to July 27, 2015, CMV seropositive recipients of a liver transplant from the donors during this time period received preemptive therapy for CMV prevention (valganciclovir therapy for CMV viremia ≥250 IU/mL). The association of recipient factors and donor CMV viremia with viremia in recipients was assessed.

Among 317 CMV-seropositive donors, CMV viremia was detected in 11 (3.5%) and was associated with longer time to collection after admission and bacteremia. Among 115 CMV-seropositiransplant settings.Stopping immunosuppression in a transplant patient with donor-derived malignancy offers the theoretical benefit that reconstitution of the patient's immune system will allow "rejection" of the malignancy, as the malignancy also originates from allogeneic tissue. However, this option exists with the caveat that the patient's allograft(s) will likely be rejected too. In simultaneous pancreas-kidney (SPK) recipients, the normal continued functioning and possible absence of malignancy in either the unaffected kidney or pancreas further complicate this decision.
The charts of 3 patients with donor-derived metastatic malignancies after SPK were retrospectively reviewed in detail. We provide treatment and management recommendations based on successful outcomes and a review of the existing literature.

Consistent with a broad review of the literature, in all 3 cases, complete immunosuppression cessation, removal of both grafts, and in 1 case treatment with an immune checkpoint inhibitor to augment the immune response was successful. One patient is doing well 1 year after successfully undergoing kidney retransplantation, while a second patient is active on the waitlist for SPK retransplantation after no evidence of metastatic disease for 2 years.

The successful management of metastatic donor-derived malignancies requires allograft removal, immunosuppression cessation, and adjuvant therapy that includes occasional use of checkpoint inhibitors to augment the immune response.
The successful management of metastatic donor-derived malignancies requires allograft removal, immunosuppression cessation, and adjuvant therapy that includes occasional use of checkpoint inhibitors to augment the immune response.Direct-acting antivirals (DAA) are highly effective for the treatment of hepatitis C (HCV), although there are limited data on the safety and efficacy of DAA therapy in hepatitis C-positive individuals awaiting liver transplantation for hepatocellular carcinoma (HCC).
We conducted a retrospective cohort study of HCV-positive patients who underwent liver transplantation for HCC at 3 liver transplant centers across the United States from 2014 to 2017 with follow-up to July 2018. Transplant recipients who received DAA before transplant were compared with those who did not (DAA naive) for posttransplant HCC recurrence rate, sustained virological response (SVR), allograft failure, and death using Kaplan-Meier analysis and Cox proportional hazard models.

A total of 171 HCV-HCC transplant recipients (99 pretransplant DAA; 72 DAA naive controls) were included, with a median follow-up of 24 months. The overall posttransplant HCC recurrence rate was 9% (15/171). Pretransplant DAA was not associated with HCC recurrence (5% versus 14%;
 = 0.07), graft failure (7% versus 3%;
 = 0.21), or death (12% versus 19%;
 = 0.19) as compared with DAA naive patients. SVR rates were significantly lower (
 < 0.01) with pretransplant DAA (75%, 39/52) than posttransplant DAA (97%, 59/61) therapies. Those who received pretransplant DAA and those who did not were not statistically different in age, gender, alpha fetal protein levels, model for end-stage liver disease scores, or transplant wait time.

Pretransplant DAA for HCV was not associated with an increased risk of posttransplant HCC recurrence, though pretransplant DAA had lower efficacy than posttransplant DAA in HCV-HCC transplant recipients.
Pretransplant DAA for HCV was not associated with an increased risk of posttransplant HCC recurrence, though pretransplant DAA had lower efficacy than posttransplant DAA in HCV-HCC transplant recipients.Objective The objective of this study is to determine the factors associated with time spent performing housework/childcare by fathers of children under 12 years of age (preschool and elementary school children) in Japan. Methods An online survey of employees and employers was conducted in 2017. Of the 7,796 total responses to the survey, those of 621 fathers of children aged 0-12 years were analyzed. Participants were divided into two groups fathers of children aged 0-6 years, and fathers of children aged 7-12 years. Multiple logistic regression analysis was performed on the items for which there was a significant intergroup difference, setting time spent performing housework as the dependent variable and the survey items as the independent variables. Results For fathers of children aged 0-6 years, working 40 hours or less per week and commuting for one hour or less were associated with more time spent performing housework/childcare. For fathers of children aged 7-12 years, working less than 40 hours a week, working from home more than once a week, and having spouses with full-time jobs were associated with more time spent performing housework/childcare. Conclusion This study revealed the factors associated with the time spent by fathers of children under 12 in performing housework/childcare. As several of these factors cannot be altered by the fathers' efforts alone, companies and society in general must endeavor to improve work styles to better suit the habits and preferences of fathers. This will promote work-life balance and create better family relationships.Efforts to improve women's health and to reduce maternal mortality worldwide have led to a notable reduction in the global maternal mortality ratio (MMR) over the past two decades. However, it is clear that maternal health outcomes are not equitable, especially when analyzing the scope of maternal health disparities across "developed" and "underdeveloped" nations. This study evaluates recent MMR scholarship with a particular focus on the racial and ethnic divisions that impact on maternal health outcomes. The study contributes to MMR research by analyzing the racial and ethnic disparities that exist in the US, especially among Asian and Pacific Islander (API) subgroups. link2 The study applies exclusionary criteria to 710 articles and subsequently identified various maternal health issues that disproportionately affect API women living in the US. In applying PRISMA review guidelines, the study produced 22 peer-reviewed articles that met inclusionary and exclusionary criteria for this review. The data analysis identified several maternal health foci obstetric outcomes, environmental exposure, obstetric care and quality measures, and pregnancy-related measures. Only eight of the 22 reviewed studies disaggregated API populations by focusing on specific subgroups of APIs, which signals a need to reconceptualize marginalized API communities' inclusion in health care systems, to promote their equitable access to care, and to dissolve health disparities among racial and ethnic divides. Several short- and long-term initiatives are recommended to develop and implement targeted health interventions for API groups, and thus provide the groundwork for future empirically driven research among specific API subgroups in the US.Purpose The effects of breastfeeding on postpartum depression symptoms and stress using physiological measures require investigation. Background Breastfeeding suppresses the secretion of cortisol. Oxytocin levels correlate negatively with symptoms of postpartum depression. Aim To investigate the effects of breastfeeding on stress and postpartum depression. Methods We examined 79 breastfeeding women using the Edinburgh Postnatal Depression Scale, the Perceived Stress Scale-10, and the Breastfeeding Self-Efficacy Scale, and measured the salivary cortisol levels before and after breastfeeding. Findings There was a negative correlation between the duration of suckling and changes in salivary cortisol levels following breastfeeding (rs = -0.333, p less then 0.05). Salivary cortisol levels immediately following breastfeeding were significantly lower compared to mothers who used mixed feeding methods (p less then 0.001). link3 Breastfeeding mothers had lower perceived stress than mothers using mixed feeding methods (β = -0.260, p less then 0.05). There was no association between breastfeeding and postpartum depression; however, there was an association between postpartum depression and perceived stress (β = 0.526, p less then 0.001). Conclusion Salivary cortisol levels significantly decreased following breastfeeding, with longer suckling times correlating with lower cortisol levels. Breastfeeding reduced stress and increased breastfeeding self-efficacy.
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