Modifying the vessel walls in porcine kidneys during machine perfusion

Background

Endothelial glycocalyx regulates the endothelial function and plays an active role in maintaining vascular homeostasis. During ischema and reperfusion, the glycocalyx is rapidly shed into the blood stream. A Corline heparin conjugate (CHC; Corline systems AB, Uppsala, Sweden) consists of 70 heparin molecules that have the capacity to adhere strongly to biological tissues expressing heparin affinity. We hypothesized that CHC could be used to restore disrupted glycocalyx in vivo in kidneys from brain-dead pigs.

Materials and methods

Brain death was induced in male landrace pigs (n = 6) by inflating a balloon catheter in the epidural space until obtaining negative cerebral perfusion. The recovered kidneys (n = 5 + 5) were perfused by hypothermic machine perfusion using two Lifeport kidney transporters (Organ Recovery Systems, Chicago, IL). CHC (50 mg) (including 25 mg biotinylated CHC) or 50 mg unfractionated heparin (control) was added to the perfusion fluid in the respective machines. In one case, the kidneys were used only for dose escalation of CHC with the same procedure.

Results

CHC was detected by immunofluorescence and confocal microscopy in the inner surface of the vessel walls. The binding of CHC in the kidney was confirmed indirectly by consumption of CHC from the perfusion fluid.

Conclusions

In this first attempt, we show that CHC maybe used to coat the vessel walls of perfused kidneys during hypothermic machine perfusion, an approach that could become useful in restoring endothelial glycocalyx of kidneys recovered from deceased donors to protect vascular endothelium and possibly ameliorate ischemia and reperfusion injuries.     

Impact of adverse pancreatic injury at surgical procurement upon islet isolation outcome

The consequence of a pancreas injury during the procurement for islet isolation purpose is unknown. The goal of this work was to assess the injuries of the pancreata procured for islet isolation, and to determine their effect on the islet yield. Between January 2007 and October 2013, we prospectively documented every injury of the pancreata processed in our centre for islet isolation. Injuries involving the main duct were classified as major, the others as minor. Donors’ characteristics and islet yields were compared between the groups of injuries. A pancreas injury was identified in 42 of 452 pancreata received for islet isolation (9.3%). In 15 cases, the injury was major (3.3% of all pancreata). Although a minor injury did not affect the islet yield, a major injury was significantly associated with unfavourable outcomes (postpurification mean islet equivalent of 364 ± 181, 405 ± 190 and 230 ± 115 × 10³ for absence of injury, minor injury and major injury, respectively). A major injury was significantly more prevalent in lean and short donors. We recommend assessing the quality of the pancreas in the islet isolation centre before starting the isolation procedure. Each centre should determine its own policy based on its financial resources and on the wait list.     

常州市第二批国家药品集中采购政策实施效果研究——基于双组间断时间序列分析

目的：我国于2019年12月开展了第二批国家药品集中采购工作,本研究旨在探讨第二批国家集采政策实施效果。方法：使用江苏常州医疗机构2019年1月—2021年3月间36万条药品采购数据,以25种国家集采品种和20种在临床使用中与国家集采品种有替代关系的品种为研究样本,采用描述性统计和双组间断时间序列,分析药品使用频度、采购金额、日均费用、价格指数、仿制药数量替代率及金额替代率6个指标的变化。结果：国家集采政策下集采品种使用频度上涨、日均费用下降、价格指数下降、采购金额下降、仿制药数量和金额替代率均明显提高,替代品种使用频度略有增长、日均费用、价格指数、采购金额略为下降、同时仿制药数量和金额替代率有所增长。但模型运行结果显示,国家集采政策对集采品种影响显著,对替代品种影响不显著。结论：建议推行国家集采政策过程中,应当加强用药监测和合理用药管理,并在考虑临床用药实际情况下将更多品种纳入集采范围,真正实现惠及民生的政策目标。     

中成药集中带量采购分组规则对比研究

目的：系统梳理全国及各省、市(区)中成药集中带量采购(以下简称集采)有关政策文件,对比分析各地集采分组规则和方法,为完善我国中成药集采分组规则提供借鉴。方法：通过文献分析法和比较分析法,对纳入研究的22个政策文本进行深入分析,总结全国及省际联盟中成药集采的进展情况。结果：全国和省际联盟中成药集采按照功能主治、给药途径、市场情况划分采购组,分组规则与药品剂型及质量的关联度不高;根据市场竞争格局划分竞价组别,忽视了部分中成药的创新价值,亦未考虑企业及其产品特有的品牌价值和中医药文化传播能力,分组规则的完备性有待提升。结论：中成药剂型繁多,质量控制指标复杂,现有分组规则沿用化学药集采分组思路,缺乏以中成药价值为导向的顶层设计。建议采取多元分组方式,将现有入围规则中的技术评价“前置”,即在制定分组规则时考虑药品剂型、质量、创新价值、弘扬中医药文化等因素,并对分组规则做进一步完善与细化。     

Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report

The combination of kidney paired donation (KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation (LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of LDKT.     

肝移植供肝切取与修整技术

目的：总结临床肝移植供肝切取与修整技术。方法：采用原位腹主动脉、门静脉双路灌注及肝。肾联合快速切取法切取供肝及。肾40例次，并施行同种异体肝移植40例，其中3例行肝。肾联合移植。结果：全组供肝平均热缺血时间为4min，切取时间为25min，保存时间为6h。全组移植肝均于恢复血流10min内有金黄色胆汁泌出，1周左右肝功能恢复正常。结论：我院开展的供肝、肾的切取与修整技术在临床实际应用中取得满意的效果，为移植手术的成功提供了可靠的保证。     

Analysis of public discourse on heart transplantation in Japan using social network service data

The clarification of public concerns regarding heart transplantation is important for improving low organ donation rates in Japan. In the present study, we used the Twitter data of 4986 tweets (between August 2015 and January 2016) and 1429 tweets (between April 2016 and May 2016) to analyze public discourse on heart transplantation in Japan and identify the reasons for low organ donation rates. We manually categorized all tweets relevant to heart transplantation into nine categories and counted the number of tweets in each category per month. During the study period, the most popular category of tweets was related to the media, followed by money (tweets questioning or even criticizing the high price of fundraising goals to go overseas for heart transplantations), while some tweets were misconceptions. We also conducted a sentiment analysis, which revealed that the most popular negative tweets were related to money, while the most positive tweets were related to reports on the favorable outcomes of recipients. Our results suggest that listening to concerns, providing correct information (particularly for some misconceptions), and emphasizing the outcomes of recipients will facilitate an increase in the number of people contemplating heart transplantation and organ donation.