Lower Loss Rate Research Articles

Real-world adoption of left bundle branch area pacing: Insights from the conduction-system pacing Italian network group (C-SING)

Left bundle branch area pacing (LBBAP) is increasingly used for treating bradycardia and heart failure. However, real-world data are limited. The Conduction-System Pacing Italian Network Group (C-SING) collected prospective data on LBBAP procedures in a nationwide context. Observational data from 28 Italian sites were analysed for consecutive LBBAP procedures, comparing outcomes based on operator experience levels. From January 2022 to December 2023, 1250 patients (median age 78, 66.2% male) underwent LBBAP attempt. Most frequent indications were atrioventricular block (40.8%) and heart failure (25.6%). Successful lead implantation was achieved in 1207 procedures (96.6%), with a median fluoroscopy time of 6.2min. Significant QRS duration reduction was observed in patients with interventricular conduction delay (144ms to 120ms, p<0.001). Compared to low-experience operators (0-10 previous cases), high-experience operators (>50 cases) had significantly better outcomes, with reduced fluoroscopy time (5.9min versus 9.0min, p=0.005) and an 86% lower risk of lead implantation failure (adjusted odds ratio 0.14, p=0.002). Periprocedural complications occurred in 6.2% of patients, unaffected by operator experience. Follow-up data for 794 patients over a median of 93days showed stable LBBAP pacing parameters and a 1.3% loss of LBBAP capture. LBBAP is routinely adopted for bradycardia and heart failure indication, with high success and acceptable complication rates, even when performed by less experienced operators. However, procedure outcomes improved significantly as operators gained experience with at least 50 prior cases. Electrical parameters remained stable with a low rate of LBBAP loss during short-term follow-up.

The effect of exploiting the public good on climate cooperation: evidence from a collective-social risk dilemma experiment

AbstractReaching ambitious climate targets is challenging, due the individual incentives of countries to free ride and to continue contributing to climate change. This issue of climate change has been analyzed in collective-risk social dilemma (CRSD) experiments, where participants interact in groups and can invest money in a group account over a fixed number of rounds. If the group account is below a threshold after the last round, the group members lose a large proportion of their assets. In the real world, however, agents can not only invest in public goods, but also exploit them. We argue that this possibility reduces the likelihood to reach the threshold. To test this prediction, we introduce the option to also exploit the public good in a CRSD experiment. The results reveal that a take option negatively affects the likelihood of reaching the threshold. Overall, the effect of the existence of a take option is rather small and not statistically significant. However, if participants exert their option to exploit the public good at the beginning, the success rate drops significantly. Consistent with the results of previous studies without the option of exploiting the public good, we find that a lower loss rate makes cooperation less likely, but the effect of heterogeneity is less clear. Our findings indicate that CRSD experiments that do not consider exploitation are likely to overestimate the likelihood of successful cooperation. The key implication for policy is to focus on reducing the incentives of the take option.

Comparative Analysis of Prediction Models for Trawling Grounds of the Argentine Shortfin Squid Illex argentinus in the Southwest Atlantic High Seas Based on Vessel Position and Fishing Log Data.

To evaluate and compare the effectiveness of prediction models for Argentine squid Illex argentinus trawling grounds in the Southwest Atlantic high seas based on vessel position and fishing log data, this study used AIS datasets and fishing log datasets from fishing seasons spanning 2019-2024 (December to June each year). Using a spatial resolution of 0.1° × 0.1° and a monthly temporal resolution, we constructed two datasets-one based on vessel positions and the other on fishing logs. Fishing ground levels were defined according to the density of fishing locations, and combined with oceanographic data (sea surface temperature, 50 m water temperature, sea surface salinity, sea surface height, and mixed layer depth). A CNN-Attention deep learning model was applied to each dataset to develop Illex argentinus trawling ground prediction models. Model accuracy was then compared and potential causes for differences were analyzed. Results showed that the vessel position-based model had a higher accuracy (Accuracy = 0.813) and lower loss rate (Loss = 0.407) than the fishing log-based model (Accuracy = 0.727, Loss = 0.513). The vessel-based model achieved a prediction accuracy of 0.763 on the 2024 test set, while the fishing log-based model reached an accuracy of 0.712, slightly lower than the former, indicating the high accuracy and unique advantages of the vessel position-based model in predicting fishing grounds. Using CPUE from fishing logs as a reference, we found that the vessel position-based model performed well from January to April, whereas the CPUE-based model consistently maintained good accuracy across all months. The 2024 fishing season predictions indicated the formation of primary fishing grounds as early as January 2023, initially near the 46° S line of the Argentine Exclusive Economic Zone, with grounds shifting southeastward from March onward and reaching around 42° S by May and June. This study confirms the reliability of vessel position data in identifying fishing ground information and levels, with higher accuracy in some months compared to the fishing log-based model, thereby reducing the data lag associated with fishing logs, which are typically available a year later. Additionally, national-level fishing log data are often confidential, limiting the ability to fully consider fishing activities across the entire fishing ground region, a limitation effectively addressed by AIS vessel position data. While vessel data reflects daily catch volumes across vessels without distinguishing CPUE by species, log data provide a detailed daily CPUE breakdown by species (e.g., Illex argentinus). This distinction resulted in lower accuracy for vessel-based predictions in December 2023 and May-June 2024, suggesting the need to incorporate fishing log data for more precise assessments of fishing ground levels or resource abundance during those months. Given the near-real-time nature of vessel position data, fishing ground dynamics can be monitored in near real time. The successful development of vessel position-based prediction models aids enterprises in reducing fuel and time costs associated with indiscriminate squid searches, enhancing trawling efficiency. Additionally, such models support quota management in global fisheries by optimizing resource use, reducing fishing time, and consequently lowering carbon emissions and environmental impact, while promoting marine environmental protection in the Southwest Atlantic high seas.

Joint Power and Delay Optimization‐Based Resource Allocation in Mu‐MIMO‐OFDM System: Deep Convolutional Red Piranha Pyramid‐Dilated Neural Network

ABSTRACTIn general, Multi‐User Multiple Input Multiple Output Orthogonal Frequency Division Multiplexing (MU‐MIMO‐OFDM) enables multiple users to simultaneously communicate with a single base station using multiple antennas and OFDM modulation. Nevertheless, resource allocation challenges such as power management and delay optimization arise within MU‐MIMO‐OFDM systems, requiring sophisticated solutions to ensure efficient use of resources and optimal system performance. Thus, joint power and delay optimization‐based resource allocation using a Deep Convolutional Pyramid‐Dilated Neural Network (DCPDNN) with Red piranha optimization and Optimal Delay Scheduling conflict graphs Algorithm (DCPDNN‐RPO‐ODSCGA) in MU‐MIMO‐OFDM system is proposed in this presented research. The proposed mechanism is performed in two stages: power allocation and delay optimization. In the first stage, through a Deep Convolutional Pyramid‐Dilated Neural Network (DCPDNN), which aims to maximize throughput, the network resources are distributed to user equipment (UEs) based on power and transmission rate. To reduce the loss function, Red Piranha Optimization (RPO) is proposed to optimize the layers of DCPDNN. In the second stage, the Optimal Delay Scheduling conflict graphs Algorithm (ODSCGA) is proposed for the optimizing delay in the MU‐MIMO‐OFDM system. The multiracial envelope procedure and service curve for traffic flows in the uplink transmission are used in the ODSCGA approach to estimate the delay‐bound value. Ideas like the maximal weight independent set and optimal conflict graph are also utilized. The simulations of DCPDNN‐RPO‐ODSCGA were conducted using MATLAB software. Thus, the proposed approach has attained higher spectral capacity, higher fairness index, and increased cumulative distribution function (CDF), 29.74%, 32.98%, and 16.46% lower loss rate, 28.05%, 24.09%, and 17.45% improved energy efficiency, 15.09%, 13.78%, and 12.05% lower processing time than other conventional approaches like MPQM‐SCA, Hyb‐BF‐DSA, and SIA‐FDBD methods, respectively.

Surgical outcomes and management of complications of StopLoss Jones tube: a single-center study.

We evaluated the surgical outcomes and management of complications associated with the minimally invasive conjunctivodacryocystorhinostomy using the StopLoss Jones (SLJT) tube of proximal lacrimal canal obstruction. The study retrospectively included 22 eyes of 15 patients who underwent SLJT for proximal canalicular obstruction. Age, gender, follow-up duration, etiology of canalicular obstruction, previous surgery, tube size, complications, and the need for additional surgical intervention were assessed. Standard tube placement was performed with intranasal endoscopic visualization. The mean age (± standard deviation) of the 15 patients included in the study was 59.5 ± 8.34years. The most common etiology was idiopathic (86.4%), and 45.5% of the 22 eyes had no prior surgery. The median follow-up duration was 12.5months, 27% of the eyes had a follow-up duration of more than 2years. The mean time to postoperative complication development was 4.88 ± 3.29months. Complications were observed in 8 eyes: 4 had conjunctivalization with inferior migration, 1 had only inferior migration, 2 had conchal obstruction (one of which had a nasal mucosal plug), 1 had tube fracture, and 1 eye developed a conjunctival ulcer due to suture irritation. No extrusion was observed. SLJT is an effective method for proximal obstructions due to its minimally invasive nature, low rate of tube loss, functionality, and comfort for both patients and surgeons. Although complications are more frequently observed in the early postoperative period and vary depending on the endoscopic approach, tube angle, and regional anatomy, we believe that they can be corrected with early intervention without tube extrusion.

Acceptability and validity of a smartphone‐administered word list learning test, LILA, in cognitively unimpaired adults

AbstractBackgroundThe International Shopping List Test (ISLT) is a rater‐administered verbal list learning test, sensitive to memory dysfunction in early Alzheimer’s disease (AD). This study examined the acceptability of a self‐administered ISLT (called LILA) in cognitively unimpaired (CU) middle‐aged and older adults. The validity of LILA was determined by the nature of ISLT learning curves and from examination of the effects of age.MethodCU adults (n = 113) completed LILA on their own smartphone device in a remote, unsupervised setting (n = 113). The LILA app administered a novel ISLT, where a list of 12 shopping list items was read aurally through the speaker to the participant. Participants were required to recall, into the smartphone, as many words as they could remember. This immediate recall trial was repeated three times (T1‐3). After a 10‐minute delay, participants recalled as many of the 12 words as they could. LILA performance measures included, number of words recalled on each trial, and on the delayed recall trial.Result10% of participants (n = 11) failed to provide a response on at least one learning trial (T1 = 3, T2 = 2, T3 = 4, DR = 2), with this data excluded from subsequent analyses. All participants reported feeling highly (74%) or moderately (26%) confident about using a smartphone, and reported using their phone daily. Improvement in immediate recall, known to occur for the ISLT was observed for LILA (Fig 1). Lower LILA immediate recall scores were associated with older age and higher depressive symptomatology (Table 1), but not sex, education or anxiety symptoms. Lower scores on delayed recall was associated with male sex and lower years of education (Table 1), but not age or mood symptoms.ConclusionThe very low rate of data loss indicates high acceptability of LILA in CU middle‐ and older‐aged adults. Validity of performance was indicated by the learning curves, which were qualitatively similar to those of the rater‐administered ISLT, and the effect of age on the immediate recall outcome. These data provide a strong foundation for future studies of the sensitivity of LILA to memory impairment in AD.

Effects of Peanut Shell Flavonoids on Composite Film Properties and Cherry Tomato Preservation.

This study investigated the effects of varying concentrations of peanut shell flavonoids (PSFs) on the properties of peanut meal extract-tilapia skin protein composite films and their impact on cherry tomatoes preservation. Peanut meal alcohol extract (Pe) and tilapia skin protein (Co) were used as base materials, combined with PSFs to prepare composite films with excellent antioxidant properties. The results demonstrated that the optimized composite films exhibited superior mechanical properties, with a tensile strength of 9.83 MPa and an elongation at break of 204.04%. Increased flavonoid content enhanced the films' antioxidant capacity, achieving superoxide anion and DPPH radical scavenging rates of 15.08% and 21.37%, respectively. The microstructure, IR spectra, and circular dichroism spectra of the composite films are also significantly different with the change of flavonoid content. In the cherry tomato preservation experiment, the PeCo-0.5 composite film treatment group maintained a low weight loss rate (11.18%) and malondialdehyde content (13.33 μmol/g) after 15 days, delayed the peak respiration rate, and significantly reduced the peak respiration intensity (3.43 mgCO2∙ mg-1∙gh-1). At the same time, the activity of polyphenol oxidase in the tissue of Cherry Tomatoes was significantly inhibited, and the decrease rate of Vc content was also significantly decreased, which effectively preserving the bright color, smooth appearance, and good aroma of the cherry tomatoes. This study not only provides new insights into the comprehensive utilization of tilapia skin and peanut by-products but also opens new avenues for the development and application of fruit and vegetable preservation films.

Hybrid adaptation is hampered by Haldane’s sieve

Hybrids between species exhibit plastic genomic architectures that could foster or slow down their adaptation. When challenged to evolve in an environment containing a UV mimetic drug, yeast hybrids have reduced adaptation rates compared to parents. We find that hybrids and their parents converge onto similar molecular mechanisms of adaptation by mutations in pleiotropic transcription factors, but at a different pace. After 100 generations, mutations in these genes tend to be homozygous in the parents but heterozygous in the hybrids. We hypothesize that a lower rate of loss of heterozygosity (LOH) in hybrids could limit fitness gain. Using genome editing, we first demonstrate that mutations display incomplete dominance, requiring homozygosity to show full impact and to entirely circumvent Haldane’s sieve, which favors the fixation of dominant mutations. Second, tracking mutations in earlier generations confirmed a different rate of LOH in hybrids. Together, these findings show that Haldane’s sieve slows down adaptation in hybrids, revealing an intrinsic constraint of hybrid genomic architecture that can limit the role of hybridization in adaptive evolution.

Cost-Effectiveness of Treating Hepatitis C in Clients on Opioid Agonist Therapy in Community Pharmacies Compared to Primary Healthcare in Australia.

Meeting the World Health Organisation 2030 target of treating 80% of people with hepatitis C virus (HCV) in Australia requires accessible testing and treatment services for at-risk populations. Previous clinical trials, including those in Australia, have demonstrated the efficacy of outreach programmes to community pharmacies offering opioid agonist therapy (OAT). This analysis evaluates the potential cost-effectiveness of introducing an outreach programme in community pharmacies. Using a decision analytic model, we estimated the impact of adding a temporary hepatitis C outreach and treatment programme in community pharmacies to the standard treatment pathway available through general practice. We compared the expected number of tests, diagnoses, cures and costs occurring through the addition of this outreach and treatment programme to those expected through general practice alone over a 12-month time horizon. We examined costs from the perspective of the health system and conducted one-way and probabilistic sensitivity analyses to assess uncertainty in model parameters and test key assumptions. In the model adding the outreach programme pathway increased the number of tests from 4178 to 8737, the number of diagnoses from 615 to 1285 and the number of cures from 223 to 777 among people on OAT over a 12-month period. Each additional cure achieved through the addition of the outreach programme was estimated to incur $48,964 (AUD 2023) to the health system, with > 85% of these costs attributable to medication and dispensing expenses. The average cost per cure was estimated to be $49,152 through routine care and $49,018 in the outreach programme. Although outreach models of care incur large upfront costs, they can capture otherwise unreached populations and result in comparable or favourable cost per cure, due to higher levels of engagement and lower rates of loss to follow-up.

The Negative Pressure Wound Therapy for Flap Salvage

Negative Pressure Wound Therapy (NPWT) effectively manages complex wounds by promoting fluid drainage, stabilizing the wound environment, and reducing bacterial load. It aids in granulation tissue formation and modulation of inflammatory reactions. NPWT is increasingly used in reconstructive surgery, particularly in flap procedures, enhancing wound healing and cosmetic outcomes while reducing flap complications. Despite concerns about flap compromise, clinical trials demonstrate low flap loss rates with NPWT. Strategies like observation windows and implantable Doppler devices help overcome monitoring challenges. However, conclusive evidence regarding NPWT's safety and impact on flap vascularity is limited due to scarce studies. The study involved 40 healthy adult patients, mostly male, with soft tissue defects primarily caused by road traffic accidents. They were split into two groups: NPWT (25 patients) and conventional dressing (15 patients). The NPWT group was further categorized into high pressure (8 patients) and low pressure (17 patients) subgroups. Results showed lower flap edema in NPWT groups compared to controls, but high pressure NPWT led to higher flap ischemia and infection rates. Overall, low pressure NPWT yielded the best clinical and aesthetic outcomes with fewer complications. The study suggests a delayed NPWT approach and low-pressure settings for optimal vascular perfusion in Fasciocutaneous flaps, emphasizing the need for further trials to establish its efficacy and determine ideal pressure settings for different flap types.

Design and Testing of an Electric Side-Mounted Cabbage Harvester

To address the limitations of current cabbage harvesters in China, which are often designed for a single variety and lack adaptability to different cabbage varieties, we developed an electric side-mounted cabbage harvester suitable for field operations in the Jiangsu region of China. This design is informed by the statistical analysis of the physical and agronomic parameters of major cabbage varieties. The harvester consists of key components, including an extraction device, a leaf-stripping device, a clamping and conveying device, and a root-cutting device. Powered by a 120 Ah direct current (DC) power source, it is capable of performing cabbage extraction, feeding, clamping, conveying, root cutting, and boxing in a single operation for three hours. Through theoretical analysis of the key components, specific parameters were determined, and field tests were conducted to verify the design. The results of the field experiments indicate that all components of the cabbage harvester operated effectively. Optimal performance was observed when the extraction roller speed was set between 100 and 110 RPM, the conveyor belt speed at 60 RPM, and the cutter speed between 160 and 220 RPM, resulting in a low cabbage harvest loss rate. The harvest loss rates from the three experiments were 11.3%, 13.3%, and 12%, respectively, which meets the mechanical harvesting requirements for cabbage.

Comparative analysis of the quality of the cement mantle in hip hemiarthroplasty after femoral neck fracture between three different surgical approaches: a single-center retrospective observational study.

Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. A non-interventional, retrospective case-control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3days vs 11.3 and 13days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients.

Modular multilayered PVC gel soft actuators for novel lightweight humanoid facial robot

Modular multilayered PVC gel soft actuators for novel lightweight humanoid facial robot

What Free Flaps Are Surgeons Using for Palatal Fistula Repair in Patients with Cleft Palate? A Systematic Review.

Recalcitrant palatal fistulas in patients with cleft palate history sometimes require free flap reconstruction. This study reviews the literature on described flaps and outcomes. A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All study designs were included. Non-English articles were excluded. Patients with a history of cleft palate who underwent free flap reconstruction for a oronasal fistula. Free tissue transfer for a palatal fistula repair. Information regarding defect and flap characteristics were reviewed. Surgical outcomes such as flap loss rates, rates of recurrent fistula formation, and speech outcomes were also obtained. Our search returned 894 articles, of which 23 were included. All studies were retrospective case series and reports. A total of 65 patients were described with an average age of 19.3 (range 3-55) years and a median fistula size of 8.00 cm2 (range 2.54 cm2 - 24 cm2). The most common flap was the radial forearm flap (n = 37). Nine patients (13.8%) had recurrent fistula formation with surgical revision successful in all cases in which the patient returned to the operating room. There were two partial flap losses and no total flap losses. Speech outcomes showed improvement in 27 patients across 10 studies. Palatal fistula repair with free tissue transfer is safe with an acceptable risk profile and low flap loss rate. Early recurrence due to partial flap necrosis and dehiscence are successfully managed with flap readvancement.

Turned stem tension band technique in reverse total shoulder arthroplasty for proximal humeral fracture can achieve high tuberosity healing rates regardless of the vertical sutures

The importance of tuberosity healing in reverse total shoulder arthroplasty for proximal humeral fractures (PHFs) has been recognized. The turned stem tension band (TSTB) technique has been applied to tuberosity repair, and high bone healing and low reduction loss rates have been reported. Vertical sutures were added to the original method to reinforce fixation. We hypothesized that vertical sutures would be unnecessary in case the supraspinatus tendon was resected. This study aimed to compare the TSTB technique with or without vertical suturing for PHFs and evaluate the rates of tuberosity healing and reduction loss. Thirty five patients (vertical suture group: 18 cases and nonvertical suture group: 17 cases) underwent reverse total shoulder arthroplasty for complex PHFs using the TSTB technique. We evaluated the postoperative range of motion, the American Shoulder and Elbow Surgeons score, tuberosity healing rates, and reduction loss. The vertical and nonvertical suture groups showed no significant difference in flexion (119±33° vs. 124±23°, P=.95), abduction (116±35° vs. 115±27°, P=.78), external rotation (27±12° vs. 21±8°, P=.16), internal rotation (6±4° lumbar 3 level vs. 6±4°, lumbar 3 level P=.87), the American Shoulder and Elbow Surgeons (77.3±10.7 vs. 81.6±6.3, P=.59), Numerical Rating Scale scores (1.2±0.9 vs. 0.8±0.9, P=.13), and tuberosity reduction loss (P=.34). The tuberosity healing rate in both groups was 100%. The TSTB technique for PHFs provided high tuberosity healing and low reduction loss rates regardless of vertical sutures.

Constructing Microporous Ion Exchange Membranes via Simple Hypercrosslinking for pH‐Neutral Aqueous Organic Redox Flow Batteries

AbstractIon exchange membranes (IEMs) play a critical role in aqueous organic redox flow batteries (AORFBs). Traditional IEMs that feature microphase‐separated microstructures are well‐developed and easily available but suffer from the conductivity/selectivity tradeoff. The emerging charged microporous polymer membranes show the potential to overcome this tradeoff, yet their commercialization is still hindered by tedious syntheses and demanding conditions. We herein combine the advantages of these two types of membrane materials via simple in situ hypercrosslinking of conventional IEMs into microporous ones. Such a concept is exemplified by the very cheap commercial quaternized polyphenylene oxide membrane. The hypercrosslinking treatment turns poor‐performance membranes into high‐performance ones, as demonstrated by the above 10‐fold selectivity enhancement and much‐improved conductivities that more than doubled. This turn is also confirmed by the effective and stable pH‐neutral AORFB with decreased membrane resistance and at least an order of magnitude lower capacity loss rate. This battery shows advantages over other reported AORFBs in terms of a low capacity loss rate (0.0017 % per cycle) at high current density. This work provides an economically feasible method for designing AORFB‐oriented membranes with microporosity.

Constructing Microporous Ion Exchange Membranes via Simple Hypercrosslinking for pH-Neutral Aqueous Organic Redox Flow Batteries.

Ion exchange membranes (IEMs) play a critical role in aqueous organic redox flow batteries (AORFBs). Traditional IEMs that feature microphase-separated microstructures are well-developed and easily available but suffer from the conductivity/selectivity tradeoff. The emerging charged microporous polymer membranes show the potential to overcome this tradeoff, yet their commercialization is still hindered by tedious syntheses and demanding conditions. We herein combine the advantages of these two types of membrane materials via simple in situ hypercrosslinking of conventional IEMs into microporous ones. Such a concept is exemplified by the very cheap commercial quaternized polyphenylene oxide membrane. The hypercrosslinking treatment turns poor-performance membranes into high-performance ones, as demonstrated by the above 10-fold selectivity enhancement and much-improved conductivities that more than doubled. This turn is also confirmed by the effective and stable pH-neutral AORFB with decreased membrane resistance and at least an order of magnitude lower capacity loss rate. This battery shows advantages over other reported AORFBs in terms of a low capacity loss rate (0.0017 % per cycle) at high current density. This work provides an economically feasible method for designing AORFB-oriented membranes with microporosity.

Understanding typhoon-induced vegetation loss and potential ecosystem disservices from land use zonings perspective in high-density Hong Kong

Understanding typhoon-induced vegetation loss and potential ecosystem disservices from land use zonings perspective in high-density Hong Kong

Laser ablation behavior and mechanisms of 3D carbon fiber reinforced ZrB2-SiC composite

Laser ablation behavior and mechanisms of 3D carbon fiber reinforced ZrB2-SiC composite

Long-term outcomes after hypothermic oxygenated machine perfusion and transplantation of 1,202 donor livers in a real-world setting (HOPE-REAL study)

Despite strong evidence for improved preservation of donor livers by machine perfusion, longer post-transplant follow-up data are urgently needed in an unselected patient population. We aimed to assess long-term outcomes after transplantation of hypothermic oxygenated machine perfusion (HOPE)-treated donor livers based on real-world data (i.e., IDEAL-D stage 4). In this international, multicentre, observational cohort study, we collected data from adult recipients of HOPE-treated livers transplanted between January 2012 and December 2021. Analyses were stratified by donation after brain death (DBD) and donation after circulatory death (DCD), sub-divided by their respective risk categories. The primary outcome was death-censored graft survival. Secondary outcomes included the incidence of primary non-function (PNF) and ischaemic cholangiopathy (IC). We report on 1,202 liver transplantations (64% DBD) performed at 22 European centres. For DBD, a total number of 99 benchmark (8%), 176 standard (15%), and 493 extended-criteria (41%) cases were included. For DCD, 117 transplants were classified as low risk (10%), 186 as high risk (16%), and 131 as futile (11%), with significant risk profile variations among centres. Actuarial 1-, 3-, and 5-year death-censored graft survival rates for DBD and DCD livers were 95%, 92%, and 91%, vs. 92%, 87%, and 81%, respectively (log-rank p= 0.003). Within DBD and DCD strata, death-censored graft survival was similar among risk groups (log-rank p= 0.26, p= 0.99). Graft loss due to PNF or IC was 2.3% and 0.4% (DBD), and 5% and 4.1% (DCD). This study shows excellent 5-year survival after transplantation of HOPE-treated DBD and DCD livers with low rates of graft loss due to PNF or IC, irrespective of their individual risk profile. HOPE treatment has now reached IDEAL-D stage 4, which further supports its implementation in routine clinical practice. ClinicalTrials.gov Identifier: NCT05520320. This study demonstrates the excellent long-term performance of hypothermic oxygenated machine perfusion (HOPE) treatment of donation after circulatory and donation after brain death liver grafts irrespective of their individual risk profile in a real-world setting, outside the evaluation of randomised-controlled trials. While previous studies have established safety, feasibility, and efficacy against the current standard, according to the IDEAL-D evaluation framework, HOPE treatment has now reached the final IDEAL-D stage 4, which further supports its implementation in routine clinical practice.