Novel oxygenation technique for hypothermic machine perfusion of liver grafts: Validation in porcine Donation after Cardiac Death (DCD) liver model.

Background: Hypothermic oxygenated machine perfusion improves outcomes in Liver Transplantation, but application is limited as O is supplied by a stationary circuit. A novel technique of O "pre-charge" in a portable pump would broaden use and further mitigate ischemia damage from organ transport.

Methods: Porcine DCD livers were randomized to static cold storage (SCS, n = 8) or hypothermic machine perfusion (HMP).

The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort.

Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity.

Obstructive sleep apnea as an independent predictor of postoperative delirium and pain: protocol for an observational study of a surgical cohort.

: Postoperative delirium and pain are common complications in adults, and are difficult both to prevent and treat. Obstructive sleep apnea (OSA) is prevalent in surgical patients, and has been suggested to be a risk factor for postoperative delirium and pain. OSA also might impact pain perception, and alter pain medication requirements.

Adequacy of Current State Setbacks for Directional High-Volume Hydraulic Fracturing in the Marcellus, Barnett, and Niobrara Shale Plays.

Background: There is an increasing awareness of the multiple potential pathways leading to human health risks from hydraulic fracturing. Setback distances are a legislative method to mitigate potential risks.

Objectives: We attempted to determine whether legal setback distances between well-pad sites and the public are adequate in three shale plays.

A novel ex-vivo porcine renal xenotransplantation model using a pulsatile machine preservation system.

Background: Animal models to investigate pathophysiology and xenotransplantation require complex techniques and significant animal utilization. The aim of the study was to develop a reliable ex-vivo technique to test xenotransplant interventions.

Material/methods: Miniature Swine being utilized for a nonsurvival study acted as donor animals.

Hypothermic machine preservation attenuates ischemia/reperfusion markers after liver transplantation: preliminary results.

Background: Hypothermic machine perfusion (HMP) has shown significant benefits in renal transplantation but is still in its infancy in liver transplantation. Potential benefits include diminished preservation injury and improved early graft function.

Methods: We analyzed liver tissue and effluent collected during our Phase 1 trial of liver HMP.

Digital imaging of extended criteria donor livers to facilitate placement and utilization.

The disparity between organ supply and demand has necessitated more aggressive use of livers from extended criteria donors. Organ sharing between donor service areas and transplant centers in other regions is common. Confidence in the graft quality is greatly improved with a digital image taken in conjunction with the recovery surgeon's report and biopsy data.

Building a local agenda for dissemination of research into practice.

Across North America and in other parts of the world, there has been a growing recognition that a large gap exists between public health knowledge generated through scientific discovery and its application in individual, community, organizational, and policy innovation. An academic-funder partnership sought to identify potential actions to improve the translation of public health research to practice in Missouri. Concept mapping, a structured conceptualization process, was used to develop information to support a local action planning effort to improve research translation to practice in Missouri.

Ergovaline-induced vasoconstriction in an isolated bovine lateral saphenous vein bioassay.

Ergovaline has been proposed as a toxic component of endophyte-infected tall fescue. As many of the symptoms of fescue toxicosis are a result of compromised circulation, the objective of this study was to examine the vasoconstrictive potentials of ergovaline and a more documented ergopeptine, ergotamine, using a bovine, lateral (cranial branch) saphenous vein bioassay. Segments of the cranial branch of the lateral saphenous vein (2 to 3 cm) were collected from healthy, mixed breed cattle (n = 12 and n = 5 for the ergovaline and ergotamine experiments, respectively) at local abattoirs.

Assessment of vasoconstrictive potential of D-lysergic acid using an isolated bovine lateral saphenous vein bioassay.

Vasoconstriction has been associated with several symptoms of fescue toxicosis thought to be alkaloid induced. Lysergic acid, an ergot alkaloid, has been proposed as a toxic component of endophyte-infected tall fescue. The objective of this study was to examine the vasoconstrictive potential of D-lysergic acid using a bovine lateral (cranial branch) saphenous vein bioassay.

Competency-based healthcare management education: the Saint Louis University experience.

As a follow up to a school-wide initiative to create a common set of competencies for all degree programs in the Saint Louis University School of Public Health, in January 2000 the Department of Health Management and Policy (HMP, renamed from the Department of Health Administration in 2002) began a process to develop a competency-based curriculum for its Master of Health Administration (MHA) degree program with the goal of establishing a foundation for systematically measuring the learning outcomes of its students as they progressed through the program. This article describes how the department developed a set of competencies most appropriate for graduate training in healthcare management, how it incorporated these into its overall MHA program curriculum and content, and how effective this approach has been in measuring student progress in mastering these competencies over the first two years of this initiative. The problems and challenges encountered during this process are discussed, as are the next steps for effectively using competencies to assess healthcare management program learning outcomes.

Hypothermic machine perfusion of liver grafts for transplantation: technical development in human discard and miniature swine models.

Introduction: Cold storage (CS) is the standard preservation technique for liver transplantation (LTx). Hypothermic machine perfusion (HMP) is an alternative preservation technique that provides a continuous supply of substrates and removes waste products. HMP improves early graft function in kidney transplantation, especially for marginal organs: To our knowledge there have been no reports HMP in human LTx.

Measuring a hospital's ability to improve.

The aim of this study was to test whether a recently developed measure of Continuous Quality Improvement (CQI) implementation can provide health care researchers and administrators with a tool to assist in understanding and with developing an appropriate structure for improvement efforts in hospitals. Two hundred respondents from 40 Missouri hospitals completed a 28-item survey addressing 8 domains of CQI. Overall, hospital scores showed low implementation of a structure that supports improvement efforts.

Pushing the envelope in renal preservation; improved results with novel perfusate modifications for pulsatile machine perfusion of cadaver kidneys.

Introduction: Novel preservation techniques may diminish ischemia/reperfusion (I/R) injury. Our preservation laboratory has modified Belzer MPS for machine perfusion (MP) with prostaglandin E1 (PGE 1), nitroglycerin (NTG), and polyethylene glycol-superoxide dismutase (PEG-SOD) to attenuate I/R injury. We reviewed our recent experience using this novel formulation (NF) compared with standard perfusates.

Glutathione supplementation during cold ischemia does not confer early functional advantage in renal transplantation.

Background: Reduced glutathione (GSH), a component of University of Wisconsin (UW) solution, is reported to oxidize during storage. Consequently the commercial manufacturer of UW recommends the supplemental addition of GSH to UW before utilization. We investigated the influence of supplemental GSH during cold ischemia on early renal allograft function.

The influence of pulsatile preservation on renal transplantation in the 1990s.

Background: Unlike simple cold storage (CS), pulsatile machine preservation (MP) of kidneys for transplantation permits pharmacologic manipulation of the perfusate and aids in the pretransplant assessment of the kidney graft. These characteristics of MP may have importance in the era of increasing use of extended criteria donor kidneys. The overall aim of this article is to critically assess practices at our preservation unit with respect to graft function.

Donor treatment with phentolamine mesylate improves machine preservation dynamics and early renal allograft function.

Background: It has been suggested that pharmacologic conditioning of the donor before organ procurement may protect the renal allograft from injuries associated with the cold ischemic period. We compared the administration of two vasoactive agents before organ procurement to: (1) determine their influence on machine perfusion characteristics and (2) determine their impact on delayed graft function (DGF) in transplanted renal allografts.

Methods: Between January 1997 and December 1998, 150 kidneys were procured from heart-beating donors and preserved in our laboratory by machine perfusion (MP) or cold storage (CS).

Calcium ion concentration of machine perfusate predicts early graft function in expanded criteria donor kidneys.

Pulsatile preservation offers the advantage of pretransplant assessment of donor kidneys. Selected electrolyte concentrations of machine perfusate were measured over time in order to: (1) describe electrolyte changes in perfusate during the pulsatile preservation of expanded-criteria donor (ECD) kidneys, and (2) to assess the prognostic significance of these characteristics to early graft function. One hundred and fifty ECD kidneys were preserved in our laboratory between 1 January 1995 and 11 January 1997.

Prostaglandin E1 influences pulsatile preservation characteristics and early graft function in expanded criteria donor kidneys.

Introduction: Unlike simple cold storage, machine preservation allows dynamic assessment and manipulation of the donor organ prior to transplantation. We prospectively compared the effects of five pharmacological agents added to the perfusate during machine preservation of expanded criteria donor (ECD) kidneys in order to (1) describe their influence on perfusion parameters and (2) determine their influence on early graft outcome.

Methods: Two hundred seventy-five consecutive ECD kidneys were preserved in our laboratory between 1/1/94 and 12/31/97 by either machine perfusion (MP) or cold storage (CS).