bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved treatment response with basiliximab immunoprophylaxis after liver transplantation: Results from a double-blind randomized placebo-controlled trial
Authors: Neuhaus Peter , Clavien Pierre-Alain , Kittur Dilip , Salizzoni Mauro , Rimola Antoni , Abeywickrama Kamal , Ortmann Elke , Chodoff Lawrence , Hall Michael , Korn Alexander , Nashan Björn
Published: August 2002

Basiliximab, a high-affinity chimeric monoclonal antibody, is effective in reducing acute rejection episodes in renal allograft recipients. We assessed the ability of this antibody to similarly improve the outcome in liver transplant recipients. Adult recipients of a primary cadaveric liver transplant were randomized to treatment, stratified by hepatitis C virus (HCV) seropositivity. Patients were administered 40 mg of basiliximab (n = 188) or placebo (n = 193) as two 20-mg bolus injections days 0 and 4, plus cyclosporine and steroids. Primary efficacy variables were biopsy-confirmed acute rejection and its composite end point, including death or graft loss, and were assessed at 6 and 12 months and by HCV cohort. Because of differential efficacy responses between HCV-positive and HCV-negative cohorts, an additional analysis incorporating HCV recurrence as a component of treatment failure, termed problem-free transplant, was introduced. Safety and tolerability were monitored over the 12 months of the study. All 381 patients were assessable, and no meaningful differences in background characteristics were apparent between treatment groups. Biopsy-confirmed acute rejection rates 6 months after transplantation were 35.1% in the basiliximab group versus 43.5% in the placebo group. For death, graft loss, or first biopsy-confirmed acute rejection, rates were 44.1% versus 52.8%, respectively. The reduction in rejection episodes was concentrated in the HCV-negative cohort (14.5% relative to placebo; P = .034), with a much smaller difference (2.9%) in the HCV-positive cohort. For HCV-positive patients, problem-free transplant was shown at 12 months in 26.6% of the basiliximab group versus 11.6% in the placebo group (P = .020) and for all patients at 12 months in 39.7% of the basiliximab group versus 30.1% in the placebo group (P = .035). The incidence of infection and other adverse events was similar across the two treatment groups. There were 56 deaths (25 deaths, basiliximab group; 31 deaths, placebo group) over the 12-month study. The intravenous bolus injection was well tolerated. Immunoprophylaxis with 40 mg of basiliximab, in combination with cyclosporine and steroids, reduces the incidence of acute rejection episodes with no clinically relevant safety or tolerability concerns. The influence of HCV recurrence on efficacy results can be accounted for in future trials by using the concept of problem-free transplant, incorporating recurrence as a component of treatment failure.
Right-lobe living related liver transplantation: Evaluation of a comprehensive magnetic resonance imaging protocol for assessing potential donors
Authors: Goyen Mathias , Barkhausen Jörg , Debatin Jörg F. , Kühl Hilmar , Bosk Silke , Testa Giuliano , Malago Massimo , Ruehm Stefan G.
Published: August 2002

The purpose of this study was to determine the practicability and diagnostic accuracy of a magnetic resonance (MR) protocol capable of replacing computed tomography, catheter angiography, and endoscopic retrograde cholangiopancreatography for the presurgical evaluation of potential liver donors before right hepatectomy. MR imaging (MRI) was performed on a 1.5 T scanner using a phased-array torso surface coil for signal reception. The following image sets were collected: axial two-dimensional (2D) T1-weighted fast low angle shot (FLASH), axial 2D T2-weighted half-Fourier acquisition single-shot turbo-spin-echo (HASTE) with fat saturation, coronal MR cholangio-pancreatography (MRCP) based on 2D multisection HASTE and single-section single-shot rapid acquisition with relaxation enhancement (RARE) imaging, dynamic contrast-enhanced three-dimensional (3D) FLASH, and contrast-enhanced T1-weighted FLASH. 3D FLASH data sets were collected before and after an intravenous administration of Multihance (gadobenate dimeglumine, Gd-BOPTA; Bracco, Milano, Italy), 0.2 mmol/kg of body weight. Thirty-eight potential liver donors were assessed by means of MRI. Twenty patients also underwent digital subtraction angiography (DSA). Of these, 16 patients underwent liver harvesting. MR angiography (MRA) data sets correlated with DSA results, and MRCP results correlated with intraoperative findings. Patients were excluded as potential donors based on insufficient liver mass of the left hepatic lobe (n = 5) or presence of hepatic pathological states (n = 9) seen at MRI, such as hemangiomas, focal nodular hyperplasias, or hepatic steatosis. MRCP showed the biliary system to the level of the first hepatic side branch. Dilated ducts were present in 4 patients. MRA depiction of hepatic arterial morphological characteristics correlated with catheter angiography results in all 20 patients: Three left hepatic arteries originating from the left gastric artery, three aberrant right hepatic arteries originating from the superior mesenteric artery, and two aberrant origins of both hepatic arteries and one common hepatic artery originating from the superior mesenteric artery were correctly identified on MRA. Similarly, the portal venous system was fully assessed on MRA. A comprehensive assessment of the hepatic parenchyma, biliary and pancreatic ductal system, and hepatic arterial, portal, and venous systems can be accomplished using the outlined protocol.
Effects of portal vein arterialization on liver regeneration after partial hepatectomy in the rat
Authors: Fan Ye-Dong , Praet Marleen , Van Huysse Jacques , Lelie Bart , De Hemptinne Bernard
Published: August 2002

Although portal venous supply is considered essential to preserve hepatic integrity, in this study, effects of portal arterialization on liver regeneration were evaluated in a rat model of partial hepatectomy (PH). Ninety-six Lewis rats were randomly assigned to four groups of 24 rats each: PH only (group 1), PH with either venous or arterialized portal supply (groups 2 and 3, respectively), and PH without portal supply (group 4). Liver regeneration rate (LRR), 5-bromo-2-deoxyuridine (BrdU) labeling index, and liver biological characteristics were assessed on days 1, 2, 3, and 7. Compared with group 1, all tested rats had a marked body weight loss after surgery, and only rats in group 4 showed no signs of recovery on day 7. With maintained portal inflow (groups 1, 2, and 3), LRRs increased steadily to day-7 values of 89.2% ± 11.8%, 81.4% ± 8%, and 77.4% ± 9.4%, respectively (P = not significant), and 24-hour peak values of BrdU labeling index were 159 ± 26, 157 ± 42, and 149 ± 48, respectively (P = not significant). Conversely, rats deprived of portal supply (group 4) showed profound inhibition of these two parameters (14 ± 13; P < .01;32.1% ± 7.7%; P < .001, respectively). These results indicate that proper portal blood supply is essential to initiate and maintain liver regeneration after PH. With an equivalent portal inflow rate of either venous or arterial source, the hepatic regeneration response can be sustained.
A pilot study of the tolerability and efficacy of antiviral therapy in hepatitis C virus-infected patients awaiting liver transplantation
Authors: Crippin Jeffrey S. , McCashland Tim , Terrault Norah , Sheiner Patricia , Charlton Michael R.
Published: August 2002

Decompensated liver disease associated with chronic hepatitis C virus (HCV) infection is the most common indication for liver transplantation. It was shown previously that greater pretransplantation HCV titers are associated with relatively poor patient and graft survival. The tolerability and efficacy of antiviral therapy in patients with decompensated liver disease are not known. We conducted a pilot study to determine the likely tolerability and efficacy of pretransplantation antiviral therapy with interferon alfa-2b, with or without ribavirin. HCV RNA-positive patients at or near the top of their respective waiting lists were randomly assigned to one of three treatment regimens until the time of liver transplantation: (1) group A, interferon alfa-2b, 1 × 106 U/d; (2) group B, interferon alfa-2b, 3 × 106 U three times weekly; or (3) group C, interferon alfa-2b, 1 × 106 U/d, plus ribavirin, 400 mg twice daily. Less than half the patients screened met entry criteria, with thrombocytopenia and leukopenia the most common reasons for exclusion. Fifteen patients were administered antiviral therapy; three patients in group A and six patients each in groups B and C. Loss of detectable HCV RNA was seen in 33% of patients, whereas 55% had a decrease in viral titers on therapy. Twenty-three adverse events occurred, including 20 serious adverse events. Thrombocytopenia was the most common adverse event. Two infectious complications occurred; one of these had a fatal outcome. We conclude that although pretransplantation antiviral therapy may reduce HCV titers in a minority of patients who meet treatment initiation criteria, adverse events associated with therapy are frequent and often severe in patients with Child’s class B and C cirrhosis.
Predicting the probability of progression-free survival in patients with small hepatocellular carcinoma
Authors: Cheng Steve J. , Freeman Richard B. , Wong John B.
Published: August 2002

Allocation of cadaveric livers to patients based on such objective medical urgency data as the Model for End-Stage Liver Disease (MELD) score may not benefit patients with small hepatocellular carcinomas (HCCs). To ensure that these patients have a fair opportunity of receiving a cadaveric organ, the risk for death caused by HCC and tumor progression beyond 5 cm should be considered. Using a Markov model, two hypothetical cohorts of patients with small hepatomas were assumed to have either (1) Gompertzian tumor growth, in which initial exponential growth decreases as tumor size increases; or (2) rapid exponential growth. The model tracked the number of patients who either died or had tumor progression beyond 5 cm. These results were used to back-calculate an equivalent MELD score for patients with small HCCs. All probabilities in the model were varied simultaneously using a Monte Carlo simulation. The Gompertzian growth model predicted that patients with a 1- and 4-cm tumor have 1-year progression-free survival rates of 70% (HCC-specific MELD score 6) and 66% (HCC-specific MELD score 8), respectively. When assuming rapid exponential growth, patients with a 1- and 4-cm tumor have progression-free survival rates of 69% (HCC-specific MELD score 6) and 12% (HCC-specific MELD score 24), respectively. Our model predicted that the risk for death caused by HCC or tumor progression beyond 5 cm should increase with larger initial tumor size in patients with small hepatomas. To ensure that these patients have a fair opportunity to receive a cadaveric organ, HCC-specific scores predicted by our model could be added to MELD scores of patients with HCC.
Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C
Authors: Burak Kelly W. , Kremers Walter K. , Batts Kenneth P. , Wiesner Russell H. , Rosen Charles B. , Razonable Raymund R. , Paya Carlos V. , Charlton Michael R.
Published: August 2002

Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is almost universal. However, variables that hasten the progression of allograft injury have not been fully defined. Cytomegalovirus (CMV) is a common infection post-LT, and its impact on the course of post-LT HCV infection remains unclear. We investigated the impact of CMV infection on patient and graft outcomes in 93 consecutive HCV-infected liver transplant recipients. Data were collected prospectively, with surveillance cultures for CMV and protocol liver biopsies. CMV infection (defined as isolation of CMV from blood and treatment with ganciclovir) occurred in 25 patients (26.9%). Graft failure (defined as cirrhosis, relisting for LT, re-LT, or death) was significantly more common in CMV-positive compared with CMV-negative patients (52% v 19.1%; P = .002). Fibrosis stage 2 or greater on the 4-month liver biopsy specimen was more common in CMV-infected patients (45% v 16.4%; P = .01). Patients who underwent LT in more recent years had an increased risk for graft failure. Donor and recipient age, CMV infection, and mycophenolate mofetil use were significantly associated with graft failure in a stepwise multivariate analysis. CMV infection occurs in approximately one quarter of HCV-infected liver transplant recipients and is an independent risk factor for graft failure in these patients. Whether CMV mediates this by inducing increased immunosuppression or directly enhancing HCV replication requires further study.
Identification of patients best suited for combined liver-kidney transplantation: Part II
Authors: Davis Connie L. , Gonwa Thomas A. , Wilkinson Alan H.
Published: August 2002

Liver-kidney transplantation (LKT) should be reserved for those recipients with primary disease affecting both organs. However, increasing transplant list waiting times have increased the development and duration of acute renal failure before liver transplantation. Furthermore, the need for posttransplant calcineurin inhibitors can render healing from acute renal failure difficult. Because of the increasing requests for and controversy over the topic of a kidney with a liver transplant (OLT) when complete failure of the kidney is not known, the following article will review the impact of renal failure on liver transplant outcome, treatment of peri-OLT renal failure, rejection rates after LKT, survival after LKT, and information on renal histology and progression of disease into the beginnings of an algorithm for making a decision about combined LKT.
Pretransplantation pre-S2 and S protein heterogeneity predisposes to hepatitis B virus recurrence after liver transplantation
Authors: Grottola Antonella , Buttafoco Paola , Del Buono Maria Grazia , Cremonini Claudia , Colantoni Alessandra , Gelmini Roberta , Morelli Cristina , Masetti Michele , Jovine Elio , Fruet Fiorenza , Pinna Antonio , Manenti Federico , Villa Erica
Published: August 2002

Liver transplantation (LT) in patients with hepatitis B virus (HBV) infection often is complicated by recurrence of infection despite immunoglobulin treatment. To evaluate whether variability in HBV genomic sequences and the target of antibody to hepatitis B surface antigen action in pre-LT samples may be associated with a high recurrence rate, HBV pre-S/S regions of 14 HBV-positive candidates for LT (in 9 of these patients, HBV infection subsequently recurred) were amplified and sequenced. Two hundred ninety-one mutations in 1,167 sequenced nucleotides (24.9%) were found. Of these, 120 mutations (10.2%) led to an amino-acid change. The only significant difference between patients with and without recurrent disease was in the number of mutations in the pre-S2 region (total mutations, P = .042; missense mutations, P = .012) of pre-LT HBV DNA. In addition, a difference in amino-acid level was present in the pre-S2 region (P = .030). The delay in HBV infection recurrence was proportional to the number of pre-LT HBV mutations in the pre-S2 and S genes: the higher the number, the longer the interval between LT and recurrence of infection (pre-S2, P = .0124; S, P = .0060; total number of mutations in S protein, P = .0421). In conclusion, pre-LT determination of pre-S/S gene sequence variability showed that heterogeneity of the pre-S2 and, to a lesser extent, S genes was associated with a greater chance for HBV recurrence. Modification of B-cell epitopes of S, but especially of pre-S2, protein leading to conformational changes and alterations in the viral encapsidation and secretion process may facilitate HBV recurrence and contribute to the failure of immune globulin therapy.
Incidence and recurrence of autoimmune/alloimmune hepatitis in liver transplant recipients
Authors: Molmenti Ernesto P. , Netto George J. , Murray Natalie G. , Smith Douglas M. , Molmenti Hebe , Crippin Jeffrey S. , Hoover Tyrone C. , Jung Ghapjoong , Marubashi Shigeru , Sanchez Edmund Q. , Gogel Brian , Levy Marlon F. , Goldstein Robert M. , Fasola Carlos G. , Gonwa Thomas A. , Klintmalm Goran B.
Published: August 2002

We prospectively collected data on 1,429 liver transplant recipients between December 1984 and December 1998. Fifty-five patients (3.8%; 10 men, 45 women; median age, 44.5 ± 13 [SD] years) with autoimmune hepatitis (AIH) underwent orthotopic liver transplantation (OLT). Transplant recipients with AIH were younger, more likely to be women, and had a greater likelihood of rejection in the first 3, 6, and 12 months. There was no difference in patient survival or graft survival. There were 11 biopsy-proven recurrences (1 man, 10 women) of AIH after OLT. Almost half the episodes occurred within the first year after OLT. No patient required re-OLT because of recurrent disease. AIH has an incidence of 4% and a recurrence rate of 20% in OLT. Transplant recipients are more likely to be young women and have an increased incidence of acute cellular rejection (ACR) during the first post-OLT year. Recurrence should be suspected in those with abnormal liver function test results in the absence of ACR, especially during the first year after OLT. We cannot establish with certainty whether the observed process represents recurrence of the original autoimmune disease, an alloimmune phenomenon, or allograft dysfunction mimicking AIH.
Evaluation of the splanchnic circulation with indocyanine green pharmacokinetics in liver transplant patients
Authors: Niemann Claus U. , Yost Spencer C. , Mandell Susan , Henthorn Thomas K.
Published: August 2002

Although indocyanine green (ICG) can be used to estimate cardiac output (CO) and blood volume independently, a recirculatory multicompartmental ICG model enables description of these and additional intravascular factors. This model was used to describe the effect of end-stage liver disease (ESLD) on systemic and splanchnic hemodynamics in patients undergoing orthotopic liver transplantation. ICG disposition was determined during the dissection phase in six patients with ESLD undergoing orthotopic liver transplantation and six healthy adult living liver donors. After injecting ICG, plasma concentrations were obtained for approximately 10 to 12 minutes by noninvasive pulse dye densitometry. The recirculatory model characterizes three distinct intravascular circuits: lumped parallel fast (presumably nonsplanchnic circulation) and slow peripheral (splanchnic) circuits and a central circuit (central blood volume). Mean transit time (MTT) in the fast peripheral circuit was not different in patients with ESLD and controls. However, ESLD resulted in a significant decrease in MTT in the central (0.11 ± 0.028 [SD] v 0.24 ± 0.094 minutes in controls; P < .001) and slow peripheral circuit (0.67 ± 0.41 v 1.37 ± 0.37 minutes in controls; P < .001) because of increased flows to the central and slow peripheral circuits. These findings are consistent with the described hyperdynamic systemic and splanchnic circulations in patients with ESLD. In conclusion, the ICG model is able to derive estimates of not only blood volume and CO, but also splanchnic hemodynamics under different physiological conditions. This model can be a useful tool to evaluate the effect of pharmacological manipulation of splanchnic hemodynamics.
Cytokine gene polymorphisms and acute human liver graft rejection
Authors: Warlé Michiel C. , Farhan Ayar , Metselaar Herold J. , Hop Wim C.J. , Perrey Chris , Zondervan Pieter E. , Kap Marcel , de Rave Sjoerd , Kwekkeboom Jaap , IJzermans Jan N.M. , Tilanus Hugo W. , Pravica Vera , Hutchinson Ian V. , Bouma Gerda J.
Published: August 2002

Interindividual differences exist in the capacity to produce cytokines. It has been reported that levels of in vitro cytokine production measured after stimulated cell culture are associated with polymorphisms in cytokine genes. Moreover, a correlation between heart, kidney, liver, and lung graft rejection or survival with cytokine gene polymorphisms has been described. In the present study, we analyzed the association of gene polymorphisms in T helper subtype 1 (TH1-), TH2-, and regulatory-type cytokines with human liver allograft rejection. Patients who received a primary liver graft from 1992 onward and were seen at the transplant outpatient clinic since then were included on this study (n = 89). Patients were HLA typed routinely. Biopsy-proven acute rejection occurred in 41 of 89 patients. After informed consent, blood was collected and DNA was obtained. Using amplification-refractory mutation system polymerase chain reaction, the following cytokine gene polymorphisms were determined: IL-2+166, IL-2-330, IL-15+13689, IL-15-80, TNF-A-308, TNFd3, IFN-G+874 (TH1-type cytokines), IL-4+33, IL-4-590, IL-6-174, IL-10-592, IL-10-819, IL-10-1082, IL-13+2043, IL-13-1055 (TH2 type cytokines), TGF-B1+869, and TGF-B1+915 (regulatory-type cytokines). Univariate analysis showed that polymorphisms of IL-10-1082, TGF-B1+869, and HLA-DR6 were significantly related to liver graft rejection. Multiple logistic regression analysis was used to assess which variables remained significantly predictive of acute rejection. Multivariate analysis showed that TGF-B1+869 and HLA-DR6 were independently associated with the occurrence of acute rejection. These findings suggest a role for the regulatory-type cytokine transforming growth factor-β1 in human liver graft rejection.
Spectral electroencephalogram analysis in hepatic encephalopathy and liver transplantation
Authors: Ciancio Alessia , Marchet Alberto , Saracco Giorgio , Carucci Patrizia , Lavezzo Bruna , Leotta Daniela , Capellero Barbara , Nobili Marcello , Smedile Antonina , Rizzetto Mario
Published: August 2002

The aim of this study is to evaluate the role of spectral electroencephalogram (EEG) analysis (SEEG) in quantitating brain dysfunction in cirrhotic patients, showing conditions of minimal hepatic encephalopathy (HE), and determining the impact of orthotopic liver transplantation (OLT) on its correction. SEEG was compared with visual EEG (VEEG) in 44 cirrhotic patients waiting for OLT and 44 healthy controls. Eighteen patients had overt HE, and 26 patients had no apparent HE. Twenty-one transplant recipients were reexamined 6 months after OLT. Computerized SEEG was performed by mean dominant frequency (MDF) and the occipital alpha-theta ratio, expressed as its logarithmic transformation (LogR). All patients underwent psychometric assessment. MDF and LogR correlated significantly with Child-Pugh score (P < .05) and the presence of HE (P < .0001). SEEG and VEEG determined minimal HE in 8 (31%) and 6 (23%) of 26 patients without overt HE, respectively. SEEG did not correlate with age, sex, cause of liver disease, portal hypertension, or psychometric test results. MDF and LogR improved in many transplant recipients. LogR was significantly lower in OLT candidates who died before OLT compared with OLT survivors. In conclusion, SEEG provides reliable quantitative information to evaluate the degree of HE and appears more sensitive than VEEG to discriminate a subclinical stage of HE. The improvement in SEEG results observed in transplant recipients confirms the reversibility of bioelectric brain dysfunction with restoration of liver functions.
Cardiac function after orthotopic liver transplantation and the effects of immunosuppression: A prospective randomized trial comparing cyclosporin (Neoral) and tacrolimus
Authors: Therapondos George , Flapan Andrew D. , Dollinger Matthias M. , Garden James O. , Plevris John N. , Hayes Peter C.
Published: August 2002

There are several case reports in the literature that describe cardiac complications in the first few weeks after orthotopic liver transplantation (OLT) in patients receiving tacrolimus as their primary immunosuppressive therapy. In this study, we investigated the cardiac function of patients on tacrolimus (T) compared with those on cyclosporin (C) (Neoral; Novartis, Basel, Switzerland) immunosuppression, after OLT, in a prospective randomized trial. We randomized 40 adult patients with cirrhosis to either T or C with azathioprine and prednisolone immunosuppression and followed up on them for 3 months after OLT. All had detailed clinical, biochemical, electrocardiographic and echocardiographic assessments at regular intervals. Abnormalities in cardiac function were common after OLT and significant deterioration in left ventricular diastolic function was demonstrable up to 3 months in both patient groups. Cardiac function was similar in the T and C arms and no significant electrocardiographic differences were observed, although reduced heart rate variability (HRV) and higher mean serum brain natriuretic peptide (BNP) levels were identified in the T group. The percentage increase in posterior wall thickness was higher in the T group. Cardiac dysfunction as shown by worsening echocardiographic measures of left ventricular diastolic function and by clinical cardiac events is common in the first 3 months after OLT in patients with cirrhosis. HRV and BNP values in the T group were worse than in the C group, but this was not translated to an increase in cardiac clinical events in this study.
Intractable diarrhea after liver transplantation for Byler’s disease: Successful treatment with bile adsorptive resin
Authors: Egawa Hiroto , Yorifuji Tohru , Sumazaki Ryo , Kimura Akihiko , Hasegawa Makoto , Tanaka Koichi
Published: August 2002

Intractable diarrhea and prolonged growth retardation after liver transplantation for Byler’s disease are serious complications limiting the ultimate outcome of liver transplantation for this disease. However, details of these complications have not been documented thoroughly. Six patients with Byler’s disease developed intractable diarrhea after living donor liver transplantation. Because of high bile acid concentrations in stool, four patients were treated with bile acid adsorptive resin for bile acid diarrhea, and all showed improved bowel movements. Four of these patients who were followed up for 1 year registered a significant height gain. Also, the cause of postoperative diarrhea and growth retardation in patients with Byler’s disease after liver transplantation is discussed.
Redrawing organ distribution boundaries: Results of a computer-simulated analysis for liver transplantation
Authors: Freeman Richard B. , Harper Ann M. , Edwards Erick B.
Published: August 2002

For several years, the Organ Procurement and Transplantation Network/United Network for Organ Sharing (UNOS) Liver and Intestinal Transplantation Committee has been examining effects of changes and proposed changes to the liver allocation system. The Institute of Medicine recently recommended that the size of liver distribution units be increased to improve the organ distribution system. Methods to achieve this and the potential impact on patients and transplant centers of such a change are evaluated in this study. In hypothetical scenarios, we combined geographically contiguous organ procurement organizations (OPOs) in seven different configurations to increase the size of liver distribution units to cover populations greater than 9 million persons. Using the UNOS Liver Allocation Model (ULAM), we examined the effect of 17 different organ allocation sequences in these proposed realignments and compared them with those predicted by ULAM for the current liver distribution system by using the following primary outcome variables: number of primary liver transplantations performed, total number of deaths, and total number of life-years saved. Every proposed new liver distribution unit plan resulted in fewer primary transplantations. Many policies increased the total number of deaths and reduced total life-years saved compared with the current system. Most of the proposed plans reduced interregional variation compared with the current plan, but no one plan consistently reduced variation for all outcome variables, and all reductions in variations were relatively small. All new liver distribution unit plans led to significant shifts in the number of transplantations performed in individual OPOs compared with the current system. The ULAM predicts that changing liver distribution units to larger geographic areas has little positive impact on overall results of liver transplantation in the United States compared with the current plan. Enlarging liver distribution units likely will result in significant shifts in organs across current OPO boundaries, which will have a significant impact on the activity of many transplant centers.
Pressure Overload Induces Heterologous Expression of the Atrial Natriuretic Factor (ANF) Gene
Authors: Dosch J. C. , Szwerc M. F. , Lin J. C. , Magovern J. A. , Edwards J. G.
Published: August 2002

Several investigations have demonstrated the regional heterogeneity of myocardial phenotype, and hypertrophy may also induce regionally disparate changes. We have utilized the direct DNA injection technique to study regional variations in overload‐induced ANF expression. Pressure overload was induced by stenosis of the ascending aorta in canines. ANF promoter reporters were injected into the left ventricle; in different regions including the base, the midwall region, and the apex. Injections were made at different depths to include the epicardial and endocardial layers. The animals were sacrificed 7 days following surgery and the left ventricle harvested for tissue analysis. Under normotensive conditions, ANF reporter expression was similar throughout the heart. PO increased ANF expression and the increases were greater in the endocardium than in the epicaridium. PO also significantly increased expression in the midwall and base regions, but not in the apex. It is unknown from these experiments, whether the greater increases in midwall expression are a function of greater wall stress, metabolic demand, or phenotypic differences in the midwall myocytes. These findings do indicate that regional differences in overload‐induced changes in gene expression are evident and may be functionally important in determining myocardial response to increased functional demand.
Misunderstood misunderstanding: social identities and public uptake of science
Authors: Wynne Brian
Published: August 2002

This paper draws general insights into the public reception of scientific knowledge from a case study of Cumbrian sheep farmers' responses to scientific advice about the restrictions introduced after the Chernobyl radioactive fallout. The analysis identifies several substantive factors which influence the credibility of scientific communication. Starting from the now-accepted point that public uptake of science depends primarily upon the trust and credibility public groups are prepared to invest in scientific institutions and representatives, the paper observes that these are contingent upon the social relationships and identities which people feel to be affected by scientific knowledge, which never comes free of social interests or implications. The case study shows laypeople capable of extensive informal reflection upon their social relationships towards scientific experts, and on the epistemological status of their own `local' knowledge in relation to `outside' knowledge. Public uptake of science might be improved if scientific institutions expressed an equivalent reflexive discourse in the public domain.
Perspectives in the selective synthesis of phthalocyanines and related compounds
Authors: TORRES TOMÁS
Published: August 2002

The main aim of this paper is to describe the state of the art and the key problems of the selective synthesis of phthalocyanines and related compounds. This non-exhaustive overview comments on the synthesis of isomerically pure, unsymmetrically substituted and non-centrosymmetric phthalocyanines as well as intrinsically unsymmetric phthalocyanine-related compounds.
Thermodynamics of porphyrin sublimation
Authors: PERLOVICH GERMAN L. , GOLUBCHIKOV OLEG A. , KLUEVA MARIJA E.
Published: August 2002

The saturated vapor pressures of tetraphenylporphyrin H 2 TPP , its four-coordinated metallo-complexes MTPP ( M ≡ Ni , Cu , Zn , Pd , Ag , Cd ) and some phenyl-substituted derivatives H 2 T ( R ) PP ( R ≡ 2-, 3-, 4- CH 3; 2-, 4- F ; 2-, 3-, 4- Cl ; 3-, 4- Br ; 3,5- C ( CH 3)3) have been measured using the inert gas flow method. The values of sublimation enthalpy Δ sub H m and entropy Δ sub S m are calculated. On the basis of the kinetic vapor pressure dependence, the start temperatures of thermal destruction of the investigated porphyrins are determined. The temperatures of melting of the tetraphenylporphyrin metallo-complexes measured by the DSC method are in linear correlation with the Δ sub H m values. The correlation between the thermodynamic functions of porphyrin sublimation (Δ sub H m , Δ sub S m , Δ sub G m ) and the literature data on the crystal structure of the compounds is considered. The Δ sub H m values obtained by some authors by different methods are compared with the results of our investigations. Possible reasons for discrepancies in the results are discussed.
Phthalocyanine dimer with a direct Si—Si linkage: A response to a recent work
Authors: LI JUNZHONG , SUBRAMANIAN L. R. , HANACK MICHAEL
Published: August 2002

The product from the reaction of Si 2 Cl 6 with substituted diiminoisoindolines has been asserted as a triazatetrabenzcorrole disclaiming a proposed phthalocyanine structure with an Si – Si bond.
Factor structure of the Expagg and Revised Expagg: Failure to replicate using confirmatory factor analysis
Authors: Forrest Sarah , Shevlin Mark , Eatough Virginia , Gregson Mick , Davies Mark N.O.
Published: August 2002

This paper reports tests of the factor structure of the original and Revised Expagg scales using a confirmatory factor analytic approach. Current evidence regarding the dimensionality of the Expagg scale [Campbell A et al. 1992. Aggr Behav 18:95–108] proposes that the scale measures a single bipolar instrumental‐expressive social representation of aggression factor. In contrast, evidence on the Revised Expagg scale [Archer J and Haigh AM. 1997. Brit J Soc Psychol 36:83–105] suggests two unidimensional factors of instrumental and expressive aggressive beliefs. Furthermore, Campbell et al. [1999. Aggr Behav 25:435–444] claim that there is equal evidence for the Revised Expagg being either one‐ or two‐dimensional. They also suggest a short modified version of the Revised Expagg. Current evidence, however, is based on traditional and flawed exploratory factor analytic methods of scale assessment. This paper addresses the limitations of the previous psychometric assessment of these measures by implementing confirmatory factor analytic methods in the assessment of construct validity. It thereby evaluates the previous claims regarding the factor structure of these measures. The results suggest that none of the a priori specifications of the Expagg and Revised Expagg adequately explain the sample data. The results are discussed in terms of the significance of demonstrating sufficient construct validity of measurement instruments in psychological research.Aggr. Behav. 28:11–20, 2002. © 2002 Wiley‐Liss, Inc.
Violence and race in professional baseball: Getting better or getting worse?
Authors: Timmerman Thomas A.
Published: August 2002

The purpose of this study was to examine the relationship between race and violence in the context of professional baseball. Specifically, I used the number of times a batter was hit by a pitch (per plate appearance) as an indicator of being the victim of an indirect violent act. Archival data were gathered from 4,273 players from 1950 to 1997, yielding 27,022 individual records. Even after controlling for player ability and league rules, race was a significant predictor of being hit. Specifically, from 1950 to 1997, the rate at which Blacks were hit was approximately 7.5% greater than the rate for Whites. The rate at which Hispanics were hit was approximately 7.6% greater than the rate for Whites. Testing year as a moderator revealed that the Black‐White difference was much greater in the 1950s and 1960s. From 1970 to 1989, race was not a significant predictor of being hit. Contrary to the hypotheses, from 1990 to 1997, Whites and Hispanics were hit at a significantly higher rate than Blacks (23.0% and 29.0%, respectively). Additional analyses revealed no relationship between pitcher race and batter race in hit‐by‐pitch events from 1997 to 1999. The findings are discussed with respect to group threat theory and the distinction between covert and overt aggression. Aggr. Behav. 28:109–116, 2002. © 2002 Wiley‐Liss, Inc.
Aggression and psychopathology in adolescents with a preference for violent electronic games
Authors: Funk Jeanne B. , Hagan Jill , Schimming Jackie , Bullock Wesley A. , Buchman Debra D. , Myers Melissa
Published: August 2002

Associations between a preference for violent electronic games and adolescents’ self‐perceptions of problem behaviors and emotions were examined. It was predicted that a preference for violent games would be associated with negative externalizing characteristics, in particular aggressive emotions and behaviors, on the Youth Self‐Report (YSR), a standardized self‐report measure of adolescent problem behaviors. Thirty‐two 11‐ through 15‐year‐olds (17 girls) listed and categorized favorite electronic games into one of six predetermined categories and completed the YSR. MANOVA revealed significant relationships between a preference for violent games and the Thought Problems subscale (P < .01) and YSR Total Score (P < .05), with trends noted for the Internalizing (P < .06) and Anxious‐Depressed (P < .08) subscales. Expected relationships with externalizing behaviors, including aggression, were not found. However, across all YSR subscales, children with higher preference for violent games had more clinically significant elevations than those with low preference for violent games. On the Total Problems subscale, of the eight children receiving scores in the clinically significant range, six were in the High preference group (three boys and three girls). The failure to find the expected relationships between a preference for violent games and aggressive, externalizing behaviors is puzzling. It is possible that individuals with a preference for violent games may have high exposure to all forms of media violence. Their perceptions of their own behavior, in comparison, may not seem sufficiently aggressive to justify endorsement of problems in this area. Or, playing violent electronic games may promote a disconnection between the emotions normally associated with violence and violent acts. These explanations are consistent with a desensitization model where exposure to media violence decreases sensitivity to aggression. Aggr. Behav. 28:134–144, 2002. © 2002 Wiley‐Liss, Inc.
γ‐Radiation–induced emulsion graft copolymerization of MMA onto jute fiber
Authors: Khan F. , Ahmad S. R. , Kronfli E.
Published: August 2002

Graft copolymerization of methyl methacrylate (MMA) onto jute substrate was carried out using gamma radiation (60Co) both by the preirradiation and “simultaneous irradiation and grafting” methods in an aqueous emulsion system. The variation of graft weight with radiation dose, intensity of radiation, and irradiation environment was investigated. In the case of the preirradiation method, irradiation in air produced up to 30% graft weight compared to only 20% obtained when the irradiation was conducted in nitrogen environment. In this method the graft copolymerization reaction was initiated by reactive species having different life times, some of which were very long. In simultaneous irradiation and grafting method, the graft weight passes through a maximum value (∼15%) with radiation dose and graft weight limited due to excessive homopolymerization. A comparative study on the mechanical properties of samples grafted by both preirradiation and simultaneous irradiation and grafting methods was carried out. The results showed that the method of grafting has significant influence on the mechanical properties of grafted jute. © 2002 Wiley Periodicals, Inc. Adv Polym Techn 21: 132–140, 2002; Published online in Wiley Interscience (www.interscience.wiley.com). DOI 10.1002/adv.10016
Product diffusion and the demand for new food products
Authors: Duval Yann , Biere Arlo
Published: August 2002

This paper extends the theory of product diffusion associated with consumer demand for new products. New food products encompass both truly new branded or value‐added products and nontraditional food and agricultural products introduced from another region or culture. Bass's new‐product diffusion theory is integrated with economic demand models to develop simple diffusion–demand models to account, simultaneously, for the diffusion process and for the traditional effects of price and income. Models are tested using widely available aggregate trade data on nontraditional fruits consumed in Indonesia, Malaysia, Singapore, France, and England. Dynamic diffusion–demand models outperform both the standard diffusion model and the static double‐log demand model—in and out of sample—and produced parameter estimates for price and income that differ from those obtained with models without a diffusion process. [Econ‐Lit citations: L660, C200, C530]. © 2002 Wiley Periodicals, Inc.
Extracellular accumulation of bioactive substances during preparation and storage of various platelet concentrates
Authors: Edvardsen Lisbeth , Taaning Ellen , Dreier Bettina , Dalh Christensen Lisa , Mynster Tommie , Nielsen Hans Jørgen
Published: August 2002

Background

Side effects of platelet transfusion may be associated with infusion of bioactive substances. We therefore studied extracellular accumulation of histamine, plasminogen activator inhibitor (PAI)‐1, vascular endothelial growth factor (VEGF), and interleukin (IL)‐6 during preparation and storage of various platelet concentrates.

Methods

Twenty buffy‐coat‐derived platelet pools (BCPC) were prepared and stored in platelet additive solutions (PAS). Twelve apheresis platelet (APC) units were prepared using the COBE Spectra LRS, and 14 were prepared using the Fenwal Amicus Separator. After preparation half of the content was drawn from each APC unit. The normal ranges of the substances were determined in plasma from all donors, and the extracellular concentrations of the substances were determined in supernatants collected on days 0, 1, 3, 5, and 7 of storage from all platelet preparations.

Results

The platelet counts were not significantly different in BCPC units and APC units. The BCPC units had a significantly higher white cell count than the APC units (P < 0.0001), but the count was significantly higher in the Amicus APC units than in the COBE APC units (P < 0.0001). The extracellular histamine concentration was significantly (P < 0.001) increased in BCPC units after preparation and without further increase during storage, while there was no accumulation of histamine in APC units. After preparation the PAI‐1 concentration was significantly (P < 0.02) higher in BCPC units than in APC units, but during storage PAI‐1 increased significantly (P < 0.05) more in APC units than in BCPC units. Similarly, VEGF concentration was significantly (P < 0.05) higher in BCPC units than in APC units after preparation. During storage, however, VEGF increased more in BCPC units compared with COBE Spectra APC units (P < 0.05), but compared with Amicus Separator APC units only for the first 3 days of storage. At days 5 and 7 of storage the VEGF concentration was significantly higher in the Amicus APC units than in the COBE APC units (P < 0.05). IL‐6 was not detectable in any of the concentrates after preparation or during storage.

Conclusion

Platelet concentrates prepared by the apheresis method may contain less white cell derived bioactive substances than platelet concentrates prepared by the buffy‐coat method. However, a substantial storage time dependent platelet derived bioactive substance accumulation takes place in all platelet concentrates tested, presumably due to platelet disintegration. Am. J. Hematol. 67:157–162, 2001. © 2001 Wiley‐Liss, Inc.
Molecular characterization of hemoglobin C in Thailand
Authors: Sanchaisuriya Kanokwan , Fucharoen Goonnapa , Sae‐ung Nattaya , Siriratmanawong Nirut , Surapot Sutja , Fucharoen Supan
Published: August 2002

We describe hematologic and DNA characterization of 12 hemoglobin C heterozygotes and three compound heterozygotes for hemoglobin C and hemoglobin E found in Thailand. Amplification and DNA analysis of genomic DNA by the polymerase chain reaction procedure permitted the identification of the βC mutation at codon 6 of β‐globin gene (β 6; GAG–AAG). β‐Globin gene haplotype analysis demonstrated that all βC globin genes detected in these Thai individuals were associated with the haplotype (+ − − − − − +), indicating a non‐African origin of this abnormal hemoglobin in Thailand. On routine hemoglobin typing, hemoglobin C is usually mistakenly identified as hemoglobin E because of theirs similar mobilities on cellulose acetate electrophoresis. The simple DNA assay for hemoglobin C based on an allele‐specific polymerase chain reaction for accurate diagnosis of hemoglobin C was therefore developed. Am. J. Hematol. 67:189–193, 2001. © 2001 Wiley‐Liss, Inc.
Influences of chorion type on measurements of the corpus callosum in adult monozygotic male twins?
Authors: Reed Terry , Pfefferbaum Adolf , Sullivan Edith V. , Carmelli Dorit
Published: August 2002

MRI imaging was used to estimate volumes of corpus callosum structure in 45 pairs of identical (monozygotic, MZ) twins from the National Heart, Lung, and Blood Institute (NHLBI) twin study. Age range of the study subjects was from 68–78 years. Finger, palm, and footprint data (dermatoglyphics) collected at previous examinations of the NHLBI twin study were available for 39 pairs. The dermatoglyphics were scored for an index to retrospectively assess chorion type in MZ twin‐pairs. The results indicated an association between variability in various structures of the corpus callosum with some of these dermatoglyphic traits, suggesting greater structural variation within pairs with dichorionic placentas. In contrast, total intracranial volume, which has similar heritability estimates as a result of shared genetic effects with the corpus callosum, was unrelated to the dermatoglyphic traits. The results provide indirect evidence that the intrauterine environment may influence twin‐pair similarity of corpus callosum measures in adults. Am. J. Hum. Biol. 14:338–346, 2002. © 2002 Wiley‐Liss, Inc.
New STR at the D5S373 locus and its relevance in human population studies
Authors: Luis J.R. , Dios S. , Carril J.C. , Herrera R. , Caeiro B.
Published: August 2002

The genetic analysis of a new trinucleotide repeat (D5S373) was carried out with a view to its application in both individual genetic profiling and human population genetics. In a screening analysis from seven world populations (n = 706) and after nucleotide sequence analysis, up to nine alleles were found corresponding to 8–13 repetitions of a TAA motif. This analysis shows He values ranging between 0.689–0.762. D5S373 reveals interpopulational variability which leads to specific frequency profiles in the major human groups, with alleles 8, 11, l2, and 13 being particularly informative, which suggests the that this marker may be of interest in the biological study of human populations. Am. J. Hum. Biol. 14:347–350, 2002. © 2002 Wiley‐Liss, Inc.