Potential Recipients Research Articles

Therapeutic strategies to improve liver regeneration after hepatectomy.

Chronic liver disease is one of the most common diseases worldwide, and its prevalence is particularly high among adults aged 40-60 years; it takes a toll on productivity and causes significant economic burden. However, there are still no effective treatments that can fundamentally treat chronic liver disease. Although liver transplantation is considered the only effective treatment for chronic liver disease, it has limitations in that the pool of available donors is vastly insufficient for the number of potential recipients. Even if a patient undergoes liver transplantation, side effects such as immune rejection or bile duct complications could occur. In addition, impaired liver regeneration due to various causes, such as aging and metabolic disorders, may cause liver failure after liver resection, even leading to death. Therefore, further research on the liver regeneration process and therapeutic strategies to improve liver regeneration are needed. In this review, we describe the process of liver regeneration after hepatectomy, focusing on various cytokines and signaling pathways. In addition, we review treatment strategies that have been studied to date to improve liver regeneration, such as promotion of hepatocyte proliferation and metabolism and transplantation of mesenchymal stem cells. This review helps to understand the physiological processes involved in liver regeneration and provides basic knowledge for developing treatments for successful liver regeneration.

Organ donation and transplantation in the Russian Federation in 2022. 15<sup>th</sup> Report from the Registry of the Russian Transplant Society

Objective: to monitor the current trends and developments in organ donation and transplantation in the Russian Federation based on data from the year 2022.Materials and methods. Heads of organ transplant centers were surveyed through questionnaires. Data control was done using the information accounting system of the Russian Ministry of Health. We performed a comparative analysis of data obtained over years from various federal subjects of the Russian Federation and transplant centers.Results. Based on data retrieved from the National Registry in 2022, 46 kidney, 31 liver and 16 heart transplant programs were existing in the Russian Federation as of the year 2022. Organ donation activity in 2022 was 5.2 per million population (p.m.p.), with a 73.7% multi-organ procurement rate and an average of 2.8 organs procured from one effective donor. In 2022, 2,555 organ transplants were performed in the Russian Federation, which included 1,562 kidney, 659 liver and 310 heart transplants. Same year, the number of transplant surgeries performed in the Russian Federation increased by 10.0% compared to 2021. In Moscow, organ donation activity was 26.3 p.m.p. The city of Moscow and the Moscow Oblast alone had a total of 12 transplant centers, accounting for 52.6% of all kidney transplants and 64.8% of all extrarenal transplants in the country. The number of organ recipients in the Russian Federation exceeds 150 p.m.p.Conclusion. The geographic distribution of transplant centers in the Russian Federation continues to expand. Five new centers were opened in 2022. Over the past year, the number of effective donors and organ transplants increased in the country. The resource potential of medical institutions has not been exhausted and this is set to further increase the number of organ transplants performed. Moscow is the powerhouse of Russian transplantology. However, other regional leaders have since appeared in the Russian Federation, such as in Kemerovo, Kazan, Rostov-on-Don, Tyumen, Irkutsk, and Volzhsky. In the Russian Federation, priority is being given to pediatric transplant care. It is expedient to implement a complex of measures aimed at identifying potential recipients.

Pig-to-human heart xenotransplantation in two recently deceased human recipients.

Genetically modified xenografts are one of the most promising solutions to the discrepancy between the numbers of available human organs for transplantation and potential recipients. To date, a porcine heart has been implanted into only one human recipient. Here, using 10-gene-edited pigs, we transplanted porcine hearts into two brain-dead human recipients and monitored xenograft function, hemodynamics and systemic responses over the course of 66 hours. Although both xenografts demonstrated excellent cardiac function immediately after transplantation and continued to function for the duration of the study, cardiac function declined postoperatively in one case, attributed to a size mismatch between the donor pig and the recipient. For both hearts, we confirmed transgene expression and found no evidence of cellular or antibody-mediated rejection, as assessed using histology, flow cytometry and a cytotoxic crossmatch assay. Moreover, we found no evidence of zoonotic transmission from the donor pigs to the human recipients. While substantial additional work will be needed to advance this technology to human trials, these results indicate that pig-to-human heart xenotransplantation can be performed successfully without hyperacute rejection or zoonosis.

Virtual and Reality: An Analysis of the UCLA Virtual Crossmatch Exchanges.

The "virtual" crossmatch (VXM) has become a critical tool to predict the compatibility between an organ donor and a potential recipient. Yet, nonstandardized laboratory practice can lead to variability in VXM interpretation. Therefore, UCLA's VXM Exchange survey was designed to understand factors that influence the variability of VXM prediction in the presence of HLA donor-specific antibody (DSA). Thirty-six donor blood samples and 72 HLA reference sera were sent to 35 participating laboratories to perform HLA antibody testing, flow crossmatch (FXM), and VXM from 2014 to 2019, consisting of 144 T/B-cell FXM pairs and 112 T/B-cell VXM pairs. In the FXM survey, 86% T-cell FXM and 84% B-cell FXM achieved >80% concordance among laboratories. In the VXM survey, 81% T-cell VXM and 80% VXM achieved >80% concordance. The concordance between FXM and VXM was 79% for T cell and 87% for B cell. The consensus between VXM and FXM was high with strong DSA. However, significant variability was observed in sera with (1) very high titer antibodies that exit prozone effect; (2) weak-to-moderate DSA, particularly in the presence of multiple weak DSAs; and (3) DSA against lowly expressed antigens. With the increasing use the VXM, standardization and continuous learning via exchange surveys will provide better understanding and quality controls for VXM to improve accuracy across all centers.

Percutaneous left ventricular assist device as a short-term mechanical circulatory support before heart transplantation in patients with high pre-transplant pulmonary hypertension (series of clinical cases)

Federation In certain categories of patients with end-stage heart failure (HF), short-term mechanical circulatory support (MSC) is successfully used as a mechanical «bridge» to heart transplantation (HTx). In predominantly left-ventricular (LV) dysfunction, the use of isolated coronary artery bypass, especially amidst high pulmonary hypertension (PH), seems to be a more physiological method of short-term MSC.Objective: to present the results of a series of clinical cases of the use of percutaneous left ventricular assist device (pLVAD) before HTx in potential recipients with predominantly LV dysfunction and concomitant high PH.Materials and methods. Three potential heart recipients with predominantly left-sided HF and high pre-transplant PH (pulmonary vascular resistance, PVR, 4.7–6.6 Wood units) who required MSC due to progression of hemodynamic disorders were included in the study. A standard venous extracorporeal membrane oxygenation (ECMO) cannula (26 F) was used for percutaneous left atrial-femoral artery (LA–FA) bypass. The cannula was passed from the transfemoral route through the interatrial septum into the left atrial cavity. A paracorporeal centrifugal pump provided blood injection through a standard arterial ECMO cannula (15 F).Results. pLVAD unloaded the left ventricle effectively (PCWP reduced from 27–32 to 15–20 mmHg), reduced pre-transplant PH (mean pulmonary artery pressure (mPAP) reduced from 45–53 to 28–33 mmHg) and improved systemic hemodynamics (cardiac index (CI) increased from 1.8–1.9 to 2.1–2.6 l/min/m2 and mean arterial pressure (mAP) from 56–59 to 70–75 mmHg). All these created the prerequisites for subsequent successful HTx. Against the background of pLVAD, transpulmonary pressure gradient (TPG) decreased from 15–25 to 13–15 mmHg, and PVR decreased from 4.7–6.6 to 2.7–3.4 Wood units. pLVAD flow rate was 2.9–3.8 L/min or 1.38–1.83 L/min/m2 at 4700–7100 rpm. pLVAD duration ranged from 4 (n = 1) to 7 (n = 2) days. All patients underwent successful HTx.Conclusion. pLVAD is a highly effective method of short-term MSC in potential recipients with predominantly LV dysfunction and concomitant high PH, leading to rapid regression of the dysfunction against the background of left ventricular unloading. This short-term MSC technique can be successfully realized using standard ECMO cannulas and centrifugal pumps of any modification, without requiring additional special equipment.

Application of the WP and SAW Methods in the Decision Support System for Recipients of Free Electricity Installation Assistance

The main factors causing inequality and poverty in Indonesia are education, welfare, and access to essential systems such as clean water, sterilization, and of course electricity as the main energy supplier in human daily activities. Therefore, to reduce poverty in Indonesia, the main responsibility of the government is to close the gap between groups of people by providing access to various facilities such as electricity. One of the programs initiated by the government to increase access to electricity for the poor is the free electricity installation assistance scheme. However, when providing such assistance, potential recipients must be evaluated or qualified to ensure that aid funds are distributed effectively and efficiently. And in its implementation, problems often occur related to the selection of beneficiaries which are still subjective and less objective. This can have an impact on not being on target and misappropriating aid, so that aid programs do not reach their targets. A decision support system that can help evaluate the eligibility of beneficiaries in a more objective and transparent manner is needed to resolve this issue. One strategy that can be used is the Weighted Product (WP) and Simple Additive Weighting (SAW) methods. In using a combination of the WP method, it can give weight to each criterion in determining the choice of free electricity installation assistance and the SAW method is ablei to determine the data ranking of free electricity installation assistance options. The results of this study can assist in selecting beneficiaries of free electricity installation assistance in an objective and effective way.

Nutrition, frailty assessment, and interventions for the liver transplant candidate.

Nutrition, frailty assessment, and interventions for the liver transplant candidate.

Implementasi Metode SAW Untuk Menentukan Program Bantuan Bedah Rumah Di Kabupaten Pandeglang

The home surgery assistance program is one of the programs of the Department of housing and settlements, where this program is intended to help ease the burden on the poor. Of the many peoply , there are still many resident whosw economic level is very low(poor). The problem in this study is that the housing and settlement office of Pandeglang regency in term of determining the house surgery assistance program is still subjective so that sometime it is not target , as well as the frequent exchange of application document and the lack of transparency of the result of grant recipients. Therefore, a decision support system is needed that ains to make I easier for the housing and settlement office to determine potential recipient of the this method works by finding the weight value for each alternative, then a calculation processs is carried out to obtain an optimal alternative, to determine to potential recipients of the home surgery program. The results of this study with the SAW method yielded a ranking of 0,654 rank 5 on behalf of Inik, rank 4 with a value of 0,7535 on behalf of Toton, rank 3 with a value of 0,886 on behalf of irman, rank 2 with a value of 0,911 on behalf of Tedi, rank 1 with a 1 point on behalf of Enong. Those who are entitled to receive a house renovation program grant in the name of Enong with a value of 1.

Maximizing utility of nondirected living liver donor grafts using machine learning.

There is an unmet need for optimizing hepatic allograft allocation from nondirected living liver donors (ND-LLD). Using OPTN living donor liver transplant (LDLT) data (1/1/2000-12/31/2019), we identified 6328 LDLTs (4621 right, 644 left, 1063 left-lateral grafts). Random forest survival models were constructed to predict 10-year graft survival for each of the 3 graft types. Donor-to-recipient body surface area ratio was an important predictor in all 3 models. Other predictors in all 3 models were: malignant diagnosis, medical location at LDLT (inpatient/ICU), and moderate ascites. Biliary atresia was important in left and left-lateral graft models. Re-transplant was important in right graft models. C-index for 10-year graft survival predictions for the 3 models were: 0.70 (left-lateral); 0.63 (left); 0.61 (right). Similar C-indices were found for 1-, 3-, and 5-year graft survivals. Comparison of model predictions to actual 10-year graft survivals demonstrated that the predicted upper quartile survival group in each model had significantly better actual 10-year graft survival compared to the lower quartiles (p<0.005). When applied in clinical context, our models assist with the identification and stratification of potential recipients for hepatic grafts from ND-LLD based on predicted graft survivals, while accounting for complex donor-recipient interactions. These analyses highlight the unmet need for granular data collection and machine learning modeling to identify potential recipients who have the best predicted transplant outcomes with ND-LLD grafts.

Unemployment of parents — one of the poverty causes in families with children

Families with children in Russia are at high risk of poverty. The economic consequences of the coronavirus pandemic and the sanctions imposed in spring 2022 make social policy a priority. It is necessary to pay a stronger attention to groups of population at higher risk of poverty. In recent years the support for families with children has been strengthened and the circle of potential recipients of assistance expanded (raising the age of children, lifting restrictions on the type of family). Additional support measures provided to families with children to reduce the negative effects of the crisis helped to alleviate the severity of poverty but did not change the position of families with children on the welfare scale, they are still the largest group of the poor (according to Rosstat they make 80% of all poor households). It seems important to identify the main factors of poverty of families with children, which include, not least, the limited employment of parents. The main purpose of the study is to show, using the data of the statistical survey (HBS-2019), the scale of unemployment and its impact on families with children as well as gender characteristics of the phenomenon of unemployment. Financial assistance to families with children should be combined with work to activate the actions of families for self-sufficiency.

Results of studying the diabetic retinopathy course in potential kidney and pancreatic recipients while on hemodialysis

Introduction. Kidney and pancreas transplantation is a surgical method for the treatment of patients with diabetes mellitus and terminal diabetic nephropathy. While waiting for surgical treatment, potential recipients receive maintenance hemodialysis. Dialysis initiates the loss of body fluid, which in turn can affect the state of the intraocular structures. Aim. To study the effect of long-term hemodialysis therapy on ophthalmic parameters in patients with terminal diabetic nephropathy. Material and methods. Sixty patients (120 eyes) were examined: group A included 30 patients with end-stage renal failure as a result of diabetic nephropathy, group B included 30 people without systemic and ocular pathologies. The ophthalmological status of group A was assessed at the stage of planned preparation for renal replacement therapy, at 3 and 6 months after the initiation of dialysis. Ophthalmological examination consisted of the use of traditional and special diagnostic methods (microperimetry, photorecording of the fundus, optical coherence tomography angiography). Results. Within 6 months of hemodialysis courses, the following was recorded: a decrease in the thickness of the retina (Me: from 348.5 to 306.1 µm; p &lt;0.05) and choroid (Me: from 330.3 to 294.9 µm; p &lt;0.05), the improvement of retinal perfusion in eyes with diabetic macular edema (Me in the superficial capillary plexus: from 10.6 to 15.8% in the fovea, from 19.7 to 25.4% in the parafovea; in the deep capillary plexus: from 15.4 to 20.9% in the fovea, from 27.5 to 33.5% in the parafovea; p &lt;0.05), a decrease in choroidal hemoperfusion (Me in the layer of choriocapillaries: from 59.0 to 54.2% in the fovea, from 59.3 to 54.7% in the parafovea; in the deep layer of the choroids: from 55.5 to 50.7% in the fovea, from 55.3 to 50.7% in the parafovea; p&lt;0.05),an improvement in retinal photosensitivity (Me: from 16.7 to 20.3 dB in eyes with diabetic macular edema; from 21.1 to 24.2 dB in eyes without diabetic macular edema; p&lt;0.05) and increased visual acuity in eyes with macular edema (Me: 0.1 to 0.3; p&lt;0.05). Conclusions. Against the background of maintenance hemodialysis hemodialysis in patients with terminal diabetic nephropathy, along with a decrease in hyperazotemia, there is an improvement in architectonics, hemodynamics of the retina and visual functions.

Assessing uncertainty in genomic offset forecasts from landscape genomic models (and implications for restoration and assisted migration)

IntroductionEcological genomic models are increasingly used to guide climate-conscious restoration and conservation practices in the light of accelerating environmental change. Genomic offsets that quantify the disruption of existing genotype–environment associations under environmental change are a promising model-based tool to inform such measures. With recent advances, potential applications of genomic offset predictions include but are not restricted to: (1) assessing in situ climate risks, (2) mapping future habitat suitability while accounting for local adaptations, or (3) selecting donor populations and recipient areas that maximize genomic diversity and minimize maladaptation to future environments in assisted migration planning. As for any model-based approach, it is crucial to understand how arbitrary decisions made during the modeling process affect predictions and induce uncertainty.MethodsHere, we present a sensitivity analysis of how various modeling components influence forecasts of genomic offset-based metrics, using red spruce (Picea rubens), a cool-temperate tree species endemic to eastern North America, as a case study. We assess the effects of genomic marker set, climatic predictor set, climate change scenario, and “not-to-exceed” offset threshold and evaluate how uncertainty in predictions varies across space.ResultsClimate change scenario induced by far the largest uncertainty to our forecasts; however, the choice of predictor set was also important in regions of the Southern and Central Appalachians that are of high relevance for conservation and restoration efforts. While much effort is often expended in identifying candidate loci, we found that genomic marker set was of minor importance. The choice of a maximum offset threshold to limit transfers between potential donor and recipient locations in assisted migration programs has mostly affected the magnitude rather than geographic variation in our predictions.DiscussionOverall, our model forecasts suggest high climate change risks across the entire distributional range of red spruce and strongly underscore the potential for assisted migration to help ameliorate these risks. In that regard, populations in the Southern and Central Appalachians as well as along the US and Canadian east coast seem the best candidates for both in situ conservation and relocation.

Timing of antibiotic administration determines the spread of plasmid-encoded antibiotic resistance during microbial range expansion

Plasmids are the main vector by which antibiotic resistance is transferred between bacterial cells within surface-associated communities. In this study, we ask whether there is an optimal time to administer antibiotics to minimize plasmid spread in new bacterial genotypes during community expansion across surfaces. We address this question using consortia of Pseudomonas stutzeri strains, where one is an antibiotic resistance-encoding plasmid donor and the other a potential recipient. We allowed the strains to co-expand across a surface and administered antibiotics at different times. We find that plasmid transfer and transconjugant proliferation have unimodal relationships with the timing of antibiotic administration, where they reach maxima at intermediate times. These unimodal relationships result from the interplay between the probabilities of plasmid transfer and loss. Our study provides mechanistic insights into the transfer and proliferation of antibiotic resistance-encoding plasmids within microbial communities and identifies the timing of antibiotic administration as an important determinant.

Outcomes of childhood, adolescent, and young adult cancer survivors (CAYACS) with solid organ transplants: A population-based study.

10056 Background: Organ toxicity requiring solid organ transplant (SOT) is a rare but serious effect of cancer treatment. Given restricted donor organ supply, teams must assess CAYACS requiring SOT in relation to potential recipients with non-malignant indications; decisions are limited by scant long-term outcome data. We compared long-term outcomes for CAYACS requiring SOT with other SOT recipients. Methods: All Ontario, Canada children &lt; 18 years at cancer diagnosed 1986-2021 at pediatric centres, and AYA aged 15-21 diagnosed at adult centres for acute leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012 were identified using population-based clinical databases. Patients with SOT prior to their primary cancer diagnosis were excluded. SOT was identified through linkage to healthcare databases; patients were matched 1:2 to non-malignant SOT recipients by sex, SOT year and type, and birth year. Post-SOT outcomes including overall survival (OS) and post SOT cancers were compared between CAYACS and SOT controls. Results: Among 16,533 CAYA with cancer, 85 received SOT: 46 liver, 18 kidney, 11 lung, and 10 heart. Among liver recipients, 33 (71.7%) were for primary cancer treatment (e.g. hepatoblastoma) vs. 13 (28.3%) for organ toxicity. Median age at original cancer diagnosis was 4 years [interquartile range (IQR) 1-13] and at SOT was 13 (IQR 3-20). CAYACS with SOT as treatment for long-term toxicity (liver subset plus all renal, lung, heart, N = 52) had a median time from cancer diagnosis to SOT of 9 years (IQR 4-16) and experienced lower 10-year OS from time of SOT [67.7%, 95th confidence interval (95CI) 50.8-79.9] vs. SOT matched controls [86.0% (74.8-92.5); hazard ratio (HR) 3.9; 95CI 1.6-9.7; p = 0.003]. When stratified by SOT type, similar trends were seen but were only statistically significant among lung SOT recipients (Table). The 5-year cumulative incidence of primary cancer relapse from time of SOT among those who received liver SOT for primary cancer therapy was 15.9% (95CI 5.6-30.8). Among CAYACS who require SOT following organ toxicity, 10-year cumulative incidence of second cancers was 8.6%±4.2%; this was similar to the incidence of first cancer among SOT controls (6.4%±2.6%; HR 1.6, 95CI 0.6-4.0; p = 0.34). Conclusions: Though CAYACS requiring SOT have inferior survival compared to other SOT patients, the majority achieve long-term cancer-free survival. These data can inform discussions on the suitability of CAYACS for SOT. [Table: see text]

Anticorps anti-Cw, anti-DP et décision de transplantation rénale : à propos de deux cas

AbstractDue to the harmful impact of preformed anti-HLA-A/B/DR/DQ DSA (Donor Specific Antibody) on kidney transplantation, organ allocation systems take these antibodies into account in the transplant decision. Nevertheless, more and more studies point to the deleterious role of preformed anti-Cw and anti-DP antibodies as well.Indeed, it appears from the literature that the presence of anti-Cw and antiDP DSA adversely affects the survival of the graft.These DSA are incriminated in the occurrence of graft rejection, with a correlation of their MFI (Mean Fluorescence Intensity) thresholds with their pathological potential. However, no consensus has yet been established.We present two cases of patients candidates for kidney transplantation, for whom the presence of anti-Cw and anti-DP DSA hampered access to the transplant.This strategy, which takes these DSAs into account in the renal transplant decision, requires carrying out the HLA-Cw and HLA-DP typings of the donor as soon as the potential recipient presents an anti-Cw and/or anti-DP immunization.

Implementation of the Naive Bayes and Simple Additive Weighting Methods in the Feasibility Selection of Village Cash Assistance Recipients

Village Fund Direct Cash Assistance (VF-DCA) is a direct cash assistance policy in which funds come from the village. The VF-DCA policy is expected to ease the burden on the community, especially those with a low economy. Still, it is undeniable that there are opportunities for misuse of village funds by some VF-DCA organizers, intentionally or unintentionally. Problems that arise in implementing VF-DCA are mistakes in determining the beneficiary communities that are not on target so that the impact of VF can be manipulated for the interests of certain groups in several cases of social assistance programs. The solution to these problems is that this research creates a decision support system in selecting the eligibility of assistance recipients. This research used the Naïve Bayes (NB) method in selecting VF-DCA recipients and the Simple Additive Weighting (SAW) way to determine the order of eligibility scores for each candidate for VF-DCA recipients. In this study, the results of the classification process using the NB method obtained an accuracy rate of 99.36%. Hence, this is simplified in determining potential recipients of VF-DCA using the NB and SAW methods

The Care-Dependent are Less Averse to Care Robots: An Empirical Comparison of Attitudes

A growing gap is emerging between the supply of and demand for professional caregivers, not least because of the ever-increasing average age of the world’s population. One strategy to address this growing gap in many regions is the use of care robots. Although there have been numerous ethical debates about the use of robots in nursing and elderly care, an important question remains unexamined: how do the potential recipients of such care perceive situations with care robots compared to situations with human caregivers? Using a large-scale experimental vignette study, we investigated people’s affective attitudes toward care robots. Specifically, we studied the influence of the caregiver’s nature on participants’ perceived comfort levels when confronted with different care scenarios in nursing homes. Our results show that the care-robot-related views of actual care recipients (i.e., people who are already affected by care dependency) differ substantially from the views of people who are not affected by care dependency. Those who do not (yet) rely on care placed care robots’ value far below that of human caregivers, especially in a service-oriented care scenario. This devaluation was not found among care recipients, whose perceived level of comfort was not influenced by the caregiver’s nature. These findings also proved robust when controlled for people’s gender, age, and general attitudes toward robots.

Simultaneous 3-way Paired Exchange Liver Transplantation Without Nondirected Donation: Novel Strategy to Expand the Donor Pool.

Simultaneous 3-way Paired Exchange Liver Transplantation Without Nondirected Donation: Novel Strategy to Expand the Donor Pool.

Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis.

Active assisted living (AAL) refers to systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. As the population of older adults in Canada grows, there is a pressing need for nonintrusive, continuous, adaptable, and reliable health monitoring tools to support aging in place and reduce health care costs. AAL has great potential to support these efforts with the wide variety of solutions currently available; however, additional work is required to address the concerns of care recipients and their care providers with regard to the integration of AAL into care. This study aims to work closely with stakeholders to ensure that the recommendations for system-service integrations for AAL aligned with the needs and capacity of health care and allied health systems. To this end, an exploratory study was conducted to understand the perceptions of, and concerns with, AAL technology use. A total of 18 semistructured group interviews were conducted with stakeholders, with each group comprising several participants from the same organization. These participant groups were categorized into care organizations, technology development organizations, technology integration organizations, and potential care recipient or patient advocacy groups. The results of the interviews were coded using a thematic analysis to identify future steps and opportunities regarding AAL. The participants discussed how the use of AAL systems may lead to improved support for care recipients through more comprehensive monitoring and alerting, greater confidence in aging in place, and increased care recipient empowerment and access to care. However, they also raised concerns regarding the management and monetization of data emerging from AAL systems as well as general accountability and liability. Finally, the participants discussed potential barriers to the use and implementation of AAL systems, especially addressing the question of whether AAL systems are even worth it considering the investment required and encroachment on privacy. Other barriers raised included issues with the institutional decision-making process and equity. Better definition of roles is needed in terms of who can access the data and who is responsible for acting on the gathered data. It is important for stakeholders to understand the trade-off between using AAL technologies in care settings and the costs of AAL technologies, including the loss of patient privacy and control. Finally, further work is needed to address the gaps, explore the equity in AAL access, and develop a data governance framework for AAL in the continuum of care.

Anatomy of the Superficial Radial Nerve and Its Target Nerves for Targeted Muscle Reinnervation: An Anatomical Cadaver Study.

Targeted muscle reinnervation (TMR) is a surgical procedure for treating symptomatic neuroma, in which the neuroma is removed and the proximal nerve stump is coapted to a donor motor branch innervating a nearby muscle. This study aimed to identify optimal motor targets for TMR of the superficial radial nerve (SRN). Seven cadaveric upper limbs were dissected to describe the course of the SRN in the forearm and motor nerve supply-number, length, diameter, and entry points in muscle of motor branches-for potential recipient muscles. The radial nerve provided three (three of six) motor branches, two (two of six) motor branches, or one (one of six) motor branch to the brachioradialis muscle, entering the muscle 21.7 ± 17.9 to 10.8 ± 15 mm proximal to the lateral epicondyle. One (one of seven), two (three of seven), three (two of seven), or four (one of seven) motor branches innervated the extensor carpi radialis longus muscle, with entry points 13.9 ± 16.2 to 26.3 ± 14.9 mm distal from the lateral epicondyle. In all specimens, the posterior interosseous nerve gave off one motor branch to the extensor carpi radialis brevis, which divided into two or three secondary branches. The distal anterior interosseus nerve was assessed as a potential recipient for TMR coaptation and had a freely transferable length of 56.4 ± 12.7 mm. When considering TMR for neuromas of the SRN in the distal third of the forearm and hand, the distal anterior interosseus nerve is a suitable donor target. For neuromas of the SRN in the proximal two-thirds of the forearm, the motor branches to the extensor carpi radialis longus, extensor carpi radialis brevis, and brachioradialis are potential donor targets.