Current situation of donation after circulatory death in European countries

The aim of the present study was to describe the current situation of donation after circulatory death (DCD) in the Council of Europe, through a dedicated survey. Of 27 participating countries, only 10 confirmed any DCD activity, the highest one being described in Belgium, the Netherlands and the United Kingdom (mainly controlled) and France and Spain (mainly uncontrolled). During 2000–2009, as DCD increased, donation after brain death (DBD) decreased about 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries. The number of organs recovered and transplanted per DCD increased along time, although it remained substantially lower compared with DBD. During 2000–2008, 5004 organs were transplanted from DCD (4261 kidneys, 505 livers, 157 lungs and 81 pancreas). Short‐term outcomes of 2343 kidney recipients from controlled versus 649 from uncontrolled DCD were analyzed: primary non function occurred in 5% vs. 6.4% (P = NS) and delayed graft function in 50.2% vs. 75.7% (P < 0.001). In spite of this, 1 year graft survival was 85.9% vs. 88.9% (P = 0.04), respectively. DCD is increasingly accepted in Europe but still limited to a few countries. Controlled DCD might negatively impact DBD activity. The degree of utilization of DCD is lower compared with DBD. Short‐term results of DCD are promising with differences between kidney recipients transplanted from controlled versus uncontrolled DCD, an observation to be further analyzed.     

Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death

The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heart‐beating deceased ECDs – defined according to the United Network of Organ Sharing definition – were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P = 0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P = 0.04). One‐year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P = 0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1‐year graft survival and function in ECD kidneys. (Current Controlled Trials number: ISRCTN83876362).     

Impact of emerging hepatitis C virus treatments on future needs for liver transplantation in France: A modelling approach

BackgroundIn light of the impact of emerging hepatitis C virus treatments on morbidity and mortality, we sought to determine whether candidates for liver transplantation for hepatocellular carcinoma and decompensated cirrhosis will decrease sufficiently to match liver grafts for hepatitis C virus-infected patients.AimsUsing a Markov model, we quantified future liver graft needs for hepatitis C virus-induced diseases and estimated the impact of current and emerging treatments.MethodsWe simulated progression of yearly-hepatitis-C-virus-infected cohorts from the beginning of the epidemic and calculated 2013–2022 candidates for liver transplantation up until 2022 without and with therapies. We compared these estimated numbers to projected trends in liver grafts for hepatitis C virus.ResultsOverall, current treatment would avoid transplantation of 4425 (4183–4684) potential candidates during the period 2013–2022. It would enable an 88% and 42% reduction in the gap between liver transplantation activity and candidates for hepatocellular carcinoma and decompensated cirrhosis, respectively. Emerging hepatitis C virus treatments would allow adequacy in transplant activities for hepatocellular carcinoma. However, they would not lead to adequacy in decompensated cirrhosis from 2013 to 2022. Results were robust to sensitivity analysis.ConclusionOur study indicates that patients will benefit from public health policies regarding hepatitis C virus screening and therapeutic access to new emerging treatments.     

兰州市农村集中式供水卫生现状调查

目的 为了解兰州市农村集中式供水的卫生现状.方法 于2008-2010年对兰州市农村集中式供水点的基本情况(如水源类型、水处理方式、消毒情况等)进行现场调查,并采集枯水期(3-4月)和丰水期(7-8月)出厂水和末梢水水样进行水质检测分析.结果 共采集水样344件,合格115件,合格率为33.4%(115/344).丰水...     

2009年昆山市集中式区域供水水质现况调查

目的了解昆山市集中式供水（区域供水）的水质现况。方法按照《生活饮用水标准检验方法》（GB/T5750-2006）对2009年昆山市集中式供水单位水源水、出厂水、末梢水进行水质检测、分析。结果 2009年共采集水样258份,合格253份,样品合格率99.2%。共检测5 990个项次,合格项次5 982个,项次合格率99.9%。其中水源水和出厂水样品合格率均为100%,末梢水样品合格率为97.5%。对末梢水不合格项目菌落总数和游离余氯按照监测点级别不同进行方差分析,市级及镇级游离余氯含量较高,菌落总数较低;村级余氯含量较低,菌落总数相对较高,甚至不达标。结论昆山市区域供水水质稳定、合格率高,特别是大大提高了农村饮用水水质状况。但也存在着整个供水管网游离余氯含量分布不均的现象,建议市自来水集团公司根据存在问题及时改进水处理工艺,进一步提高供水水质。     

烟台市牟平区农村生活饮用水卫生学调查及改善对策

目的了解烟台市牟平区农村生活饮用水的卫生状况,为今后农村改水提供依据。方法对城区外所有已安装集中式供水的村庄未梢水,按GB 5750-2006生活饮用水标准检验方法,对感官性状和一般化学指标、毒理指标、微生物指标的19个项目进行检测。结果 420份水样中合格率为41.67%。水样中菌落总数不合格率为24.05%,总大肠菌群不合格率为37.38%,氟化物不合格率为3.33%,硝酸盐不合格率为13.57%,总硬度不合格率为0.71%,肉眼可见物不合格率0.95%,锌不合格率0.48%,锰不合格率0.24%,铁不合格率为0.48%。结论烟台市牟平区农村集中式供水的水源污染严重,水源保护差,缺乏有效的消毒措施,须强化供水村管理,扩大饮水安全宣传,预防性卫生监督到位以改善目前状况。     

2009—2010年无锡市惠山区生活饮用水水质监测结果

目的了解无锡市惠山区生活饮用水水质现状,确保居民饮用水卫生安全,为政府决策提供依据。方法对惠山区4个集中式供水及2个二次供水监测点的水质进行监测,并根据《生活饮用水卫生标准》GB 5749-2006进行分析评价。结果 2009—2010年惠山区生活饮用水的合格率较高,2009年为97.9%（188/192）,2010年为92.0%（127/138）。其中,2009年集中式供水为96.9%（124/128）,二次供水为100%（64/64）,不合格项目均为细菌总数超标。2010年集中式供水为88.0%（81/92）,二次供水为100%（46/46）,不合格项目为余氯含量低于标准,细菌总数超标。结论惠山区饮用水卫生状况较好,但夏秋季仍有不合格现象,应于夏秋等天气炎热季节加大水质监测力度,及时通报供水部门,确保饮用水安全卫生。     

温州市部分酒店集中空调通风系统卫生监测与分析

目的:调查分析温州市部分酒店集中空调通风系统的卫生状况,为卫生管理提供依据,预防和控制由空调细菌污染所带来的呼吸道传染病的传播和流行。方法:选取20家有集中空调通风系统的单位,分别对风管表面的积尘量、真菌总数、细菌总数、β-溶血性链球菌,送风中PM10、细菌和真菌总数,以及冷凝水和冷却水中的嗜肺军团菌进行检测和评价。结果:送风空气PM10合格率为40%(8/20),细菌总数的合格率为100%(20/20),真菌总数合格率为95%(19/20),β-溶血性链球菌等致病菌均未检出;风管表面积尘量合格率为30%(6/20),细菌总数合格率为95%(19/20),真菌总数合格率为50%(10/20),空调冷凝水嗜肺军团菌污染率为5%(1/20),空调冷却水嗜肺军团菌的污染率高达45%(9/20)。结论:温州部分酒店集中空调通风系统存在一定的污染,冷却水中嗜肺军团菌污染情况较为严重,应加强集中空调系统的清洗消毒和卫生监督管理。     

氧气湿化瓶集中化消毒供应的探讨

目的 加强医院氧气湿化瓶的消毒管理。方法 对氧气湿化瓶的清洗、消毒进行集中化处理,由供应科专业人员对氧气湿化瓶进行清洗、消毒、包装。结果 加强医院氧气湿化瓶的消毒管理,细菌培养合格率由集中化处理前的45.6％上升为100％,大大提高了氧气湿化瓶的清洗、消毒质量。结论 通过对氧气湿化瓶进行中心化清洗、消毒,规范化管理,保...     

Transplantation in the patient with hepatitis C

Hepatitis C virus (HCV) infection is the most frequent cause of liver disease after renal transplantation. Its clinical course is irrelevant in the short term, except for rare cases of fibrosing cholestatic hepatitis. However, in the long run, HCV infection can lead to major liver complications. Because interferon (IFN) is generally contraindicated in renal transplant patients, the best approach is to treat patients on dialysis. Until more information with pegylated-IFN is available, the use of alpha-IFN monotherapy is recommended. Most of the patients with sustained virological response remain HCV RNA negative after transplantation. HCV-positive renal transplant patients have a higher risk for proteinuria, chronic rejection, infections and post-transplant diabetes (PTDM). Long-term patient- and graft-survival rates are lower in HCV-positive patients. Mortality is higher, mainly as a result of liver disease and infections. HCV can contribute to the development of certain neoplasias such as post-transplant lymphoproliferative disease (PTLD). HCV infection is also an independent risk factor for graft loss. PTDM, transplant glomerulopathy and HCV-related glomerulonephritis can contribute to graft failure. Despite this, transplantation is the best option for end-stage renal disease in HCV-positive patients. Several measures to minimize the consequences of HCV infection have been recommended. Adjustment of immunosuppression and careful follow up in the outpatient clinic for early detection of HCV-related complications are mandatory.