Long-term Medical Outcomes of Living Kidney Donors

Historically, to minimize risks, living kidney donors have been highly selected and healthy. Operative risks are well-defined, yet concern remains about long-term risks. In the general population, even a mild reduction in glomerular filtration rate (GFR) is associated with cardiovascular disease, chronic kidney disease, and end-stage kidney disease (ESKD). However, reduction in GFR in the general population is due to kidney or systemic disease. Retrospective studies comparing donors with matched general population controls have found no increased donor risk. Prospective studies comparing donors with controls (maximum follow-up, 9 years) have reported that donor GFR is stable or increases slightly, whereas GFR decreases in controls. However, these same studies identified metabolic and vascular donor abnormalities. There are a few retrospective studies comparing donors with controls. Each has limitations in selection of the control group, statistical analyses, and/or length of follow-up. One such study reported increased donor mortality; 2 reported a small increase in absolute risk of ESKD. Risk factors for donor ESKD are similar to those in the general population. Postdonation pregnancies are also associated with increased risk of hypertension and preeclampsia. There is a critical need for long-term follow-up studies comparing donors with controls from the same era, geographic area, and socioeconomic status who are healthy, with normal renal function on the date matching the date of donation, and are matched on demographic characteristics with the donors. These data are needed to optimize donor candidate counseling and informed consent.     

Is There a Fundamental 300 Hz Limit to Pulse Rate Discrimination in Cochlear Implants?

Literature often refers to a 300 pps limit for cochlear implant (CI) electrical stimulation, above which pulse rate discrimination deteriorates or above which rate pitch is not perceived to increase. The present study investigated the effect on pulse rate difference limens (PRDLs) when using compound stimuli in which identical pulse trains were applied to multiple electrodes across the length of the electrode array and compared the results to those of single-electrode stimuli. PRDLs of seven CI users were determined in two stimulus pulse phase conditions, one in which the phase delays between pulses on different electrodes were minimised (burst mode) and a second in which they were maximised (spread mode). PRDLs were measured at base rates of 100 to 600 pps in 100 pps intervals, using compound stimuli on one, two, five, nine and 18 electrodes. As smaller PRDLs were expected to reflect improved rate pitch perception, 18-electrode spread mode stimuli were also included in a pitch ranking task. PRDLs improved markedly when multi-electrode compound stimuli were used, with average spread mode PRDLs across listeners between 6 and 8 % of the base rate in the whole range tested (i.e. up to 600 pps). PRDLs continued to improve as more electrodes were included, up to at least nine electrodes in the compound stimulus. Stimulus pulse phase had a significant influence on the results, with PRDLs being smaller in spread mode. Results indicate that pulse rate discrimination may be manipulated with stimulus parameter choice so that previously observed deterioration of PRDLs at 300 pps probably does not reflect a fundamental limitation to rate discrimination. However, rate pitch perception did not improve in the conditions that resulted in smaller PRDLs. This may indicate that listeners used cues other than pitch to perform the rate discrimination task or may reflect limitations in the electrically evoked neural excitation patterns presented to a rate pitch extraction mechanism.     

High Pressure Pneumatic Forming of Ti-3Al-2.5V Titanium Tubes in a Square Cross-Sectional Die

A new high strain rate forming process for titanium alloys is presented and named High Pressure Pneumatic Forming (HPPF), which might be applicable to form certain tubular components with irregular cross sections with high efficiency, both with respect to energy cost and time consumption. HPPF experiments were performed on Ti-3Al-2.5V titanium alloy tubes using a square cross-sectional die with a small corner radius. The effects of forming of pressure and temperature on the corner filling were investigated and the thickness distributions after the HPPF processes at various pressure levels are discussed. At the same time, the stress state, strain and strain rate distribution during the HPPF process were numerically analyzed by the finite element method. Microstructure evolution of the formed tubes was also analyzed by using electron back scattering diffraction (EBSD). Because of different stress states, the strain and strain rate are very different at different areas of the tube during the corner filling process, and consequently the microstructure of the formed component is affected to some degree. The results verified that HPPF is a potential technology to form titanium tubular components with complicated geometrical features with high efficiency.