Triple nuclear collisions – a new method to explore the matter properties under new extreme conditions

We suggest to explore an entirely new method to experimentally and theoretically study the phase diagram of strongly interacting matter based on the triple nuclear collisions (TNC).We simulated the TNC using the UrQMD 3.4 model at the beam center of- mass collision energies √SNN = 200 GeV and √SNN = 2.76 TeV. It is found that in the most central and simultaneous TNC the initial baryonic charge density is about 3 times higher than the one achieved in the usual binary nuclear collisions at the same energies. As a consequence, the production of protons and Λ-hyperons is increased by a factor of 2 and 1.5, respectively. Using the MIT Bag model equation we study the evolution of the central cell in TNC and demonstrate that for the top RHIC energy of collision the baryonic chemical potential is 2-2.5 times larger than the one achieved in the binary nuclear collision at the same time of reaction. Based on these estimates, we show that TNC offers an entirely new possibility to study the QCD phase diagram at very high baryonic charge densities.

Kidney transplantation and donation in the transgender population: A single-institution case series

The medical needs of the transgender population are increasingly recognized within the US health care system. Hormone therapy and gender-affirming surgery present distinct anatomic, hormonal, infectious, and psychosocial issues among transgender kidney transplant donors and recipients. We present the first reported experience with kidney transplantation and donation in transgender patients. A single-center case series (January 2014-December 2018) comprising 4 transgender kidney transplant recipients and 2 transgender living donors was constructed and analyzed. Experts in transplant surgery, transplant psychiatry, transplant infectious disease, pharmacy, and endocrinology were consulted to discuss aspects of care for these patients. Four transgender patients identified as male-to-female and 2 as female-to-male. Three of 6 had gender-affirming surgeries prior to transplant surgery, 1 of whom had further procedures posttransplant. Additionally, 4 patients were on hormone therapy. All 6 had psychiatric comorbidities. The 4 grafts have done well, with an average serum creatinine of 1.45 mg/dL at 2 years (range 1.01-1.85 mg/dL). However, patients encountered various postoperative complications, 1 of which was attributable to modified anatomy. Thus, transgender kidney transplant patients can present novel challenges in regard to surgical considerations as well as pre- and posttransplant care. Dedicated expertise is needed to optimize outcomes for this population.

Twelve-Month Outcomes After Transplant of Hepatitis C-Infected Kidneys Into Uninfected Recipients: A Single-Group Trial

BACKGROUND

Organs from hepatitis C virus (HCV)-infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk.

OBJECTIVE

To describe 12-month HCV treatment outcomes, estimated glomerular filtration rate (eGFR), and quality of life for the 10 kidney recipients in THINKER-1 and 6-month data on 10 additional recipients.

DESIGN

Open-label, nonrandomized trial. (ClinicalTrials.gov: NCT02743897).

SETTING

Single center.

PARTICIPANTS

20 HCV-negative transplant candidates.

INTERVENTION

Participants underwent transplant with kidneys infected with genotype 1 HCV and received elbasvir-grazoprevir on posttransplant day 3.

MEASUREMENTS

The primary outcome was HCV cure. Exploratory outcomes included 1) RAND-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) quality-of-life scores at enrollment and after transplant, and 2) posttransplant renal function, which was compared in a 1:5 matched sample with recipients of HCV-negative kidneys.

RESULTS

The mean age of THINKER participants was 56.3 years (SD, 6.7), 70% were male, and 40% were black. All 20 participants achieved HCV cure. Hepatic and renal complications were transient or were successfully managed. Mean PCS and MCS quality-of-life scores decreased at 4 weeks; PCS scores then increased above pretransplant values, whereas MCS scores returned to baseline values. Estimated GFRs were similar between THINKER participants and matched recipients of HCV-negative kidneys at 6 months (median, 67.5 vs. 66.2 mL/min/1.73 m2; 95% CI for between-group difference, -4.2 to 7.5 mL/min/1.73 m2) and 12 months (median, 72.8 vs. 67.2 mL/min/1.73 m2; CI for between-group difference, -7.2 to 9.8 mL/min/1.73 m2).

LIMITATION

Small trial.

CONCLUSION

Twenty HCV-negative recipients of HCV-infected kidneys experienced HCV cure, good quality of life, and excellent renal function. Kidneys from HCV-infected donors may be a valuable transplant resource.

PRIMARY FUNDING SOURCE

Merck.

Three-fluid Hydrodynamics-based Event Simulator Extended by UrQMD final State interactions (THESEUS) for FAIR-NICA-SPSBES/RHIC energies

We present a new event generator based on the three-fluid hydrodynamics (3FH) approach, followed by a particlization at the hydrodynamic decoupling surface and a subsequent UrQMD afterburner stage based on the microscopic UrQMD transport model that accounts for hadronic final state interactions. First results for Au+Au collisions are presented. The following topics are addressed: the directed flow, transversemass spectra, as well as rapidity distributions of protons, pions and kaons for two model equations of state, one with a first-order phase transition, the other with a crossover transition. Preliminary results on the femtoscopy are also discussed.We analyze the accuracy of reproduction of the 3FH results by the new event generator and the effect of the subsequent UrQMD afterburner stage.

Resonance production in high energy collisions from small to big systems

The aim of this paper is to understand resonance production (and more generally particle production) for different collision systems, namely proton-proton (pp), proton-nucleus (pA), and nucleus-nucleus (AA) scattering at the LHC. We will investigate in particular particle yields and ratios versus multiplicity, using the same multiplicity definition for the three different systems, in order to analyse in a compact way the evolution of particle production with the system size and the origin of a very different system size dependence of the different particles.

Final state hadronic rescattering with UrQMD

In this talk we discuss the effects of the hadronic rescattering on final state observables in high energy nuclear collisions. We do so by employing the UrQMD transport model for a realistic description of the hadronic decoupling process. The rescattering of hadrons modifies every hadronic bulk observable. For example apparent multiplicity of resonances is suppressed as compared to a chemical equilibrium freeze-out model. Stable and unstable particles change their momentum distribution by more than 30% through rescattering. The hadronic rescattering also leads to a substantial decorrelation of the conserved charge distributions. These findings show that it is all but trivial to conclude from the final state observables on the properties of the system at an earlier time where it may have been in or close to local equilibrium.

Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

The direct-acting antivirals (DAAs) constitute an emerging group of small molecule inhibitors that effectively treat hepatitis C virus (HCV) infection, a common comorbidity in end-stage renal disease patients. To date, there are no data to guide use of these agents in kidney transplant patients. The authors collected data from 20 consecutive kidney recipients treated with interferon-free treatment regimens for HCV at their center: 88% were infected with genotype 1; 50% had biopsy-proved advanced hepatic fibrosis on their most recent liver biopsy preceding treatment (Metavir stage 3 fibrosis [F3] or F4); and 60% had failed treatment pretransplantation with interferon-based therapy. DAA treatment was initiated a median of 888 days after renal transplantation. All patients cleared the virus while on therapy, and 100% have achieved a sustained virologic response at 12 weeks after completion of DAA therapy. The most commonly used regimen was sofosbuvir 400 mg daily in combination with simeprevir 150 mg daily. However, four different treatment approaches were used, with comparable results. The DAAs were well tolerated, and less than half of patients required calcineurin inhibitor dose adjustment during treatment. Eradication of HCV infection with DAAs is feasible after kidney transplantation with few treatment-related side effects.

Evidence for flow from hydrodynamic simulations of p-Pb collisions at 5.02 TeV from v2 mass splitting

We show that a fluid dynamical scenario, already well tested against identified particle p(t) spectra, describes quantitatively the observed mass splitting of the elliptical flow coefficients v(2) for pions and protons. This provides a strong argument in favor of the existence of a fluid dynamical expansion in p-Pb collisions at 5.02 TeV.

Changes in vitamin D binding protein and vitamin D concentrations associated with liver transplantation

BACKGROUND

Vitamin D deficiency is associated with fractures, infections and death. Liver disease impairs vitamin D and vitamin D binding protein (DBP) metabolism.

AIMS

We aimed to determine the impact of liver transplantation on vitamin D, particularly on DBP and free vitamin D concentrations.

METHODS

Serum 25(OH)D, 1,25(OH)(2) D and DBP concentrations were measured in 202 adults before liver transplantation and 3 months later in 155. Free vitamin D concentrations were estimated from these values. Risk factors for 25(OH)D deficiency (<20 ng/ml) and low 1,25(OH)(2) D (<20 pg/ml) were examined with logistic regression, and changes in concentrations following transplantation with linear regression.

RESULTS

Pretransplant, 84% were 25(OH)D deficient, 13% had 25(OH)D concentrations <2.5 ng/ml, and 77% had low 1,25(OH)(2) D. Model for end-stage liver disease score ≥ 20 (P < 0.005) and hypoalbuminemia (P < 0.005) were associated with low 25(OH)D and 1,25(OH)(2) D concentrations. Following transplantation, 25(OH)D concentrations increased a median of 17.8 ng/ml (P < 0.001). Albumin increased from a median of 2.7 to 3.8 g/dl (P < 0.001) and DBP from 8.6 to 23.8 mg/dl (P < 0.001). Changes in total 25(OH)D were positively and independently associated with changes in DBP (P < 0.05) and albumin (P < 0.001). Free 25(OH)D concentrations rose from 6.0 to 9.7 pg/ml (P < 0.001). In contrast, total 1,25(OH)(2)D concentrations rose only by 4.3 pg/ml (P < 0.001) and free 1,25(OH)(2D concentrations declined (P < 0.001).

CONCLUSIONS

Serum total and free 25(OH)D and DBP concentrations rose substantially following transplantation, while 1,25(OH)(2) D concentrations showed modest changes and free 1,25(OH)(2) D decreased. Studies of the effects of vitamin D status on diverse transplant complications are needed.

Simultaneous liver-kidney transplantation in the MELD era

Impaired kidney function is common in liver transplant candidates and portends heightened risk for both postoperative chronic kidney disease and mortality. The weighting of serum creatinine in the Model of End-stage Liver Disease classification for liver allocation has been accompanied by a proliferation of simultaneous liver-kidney transplants in recent years. In the absence of standardized criteria for allocating kidneys in this setting, there is a wide variation in combined organ transplants across transplant centers. This review discusses the issues surrounding simultaneous liver-kidney transplantation and proposes a strategy for selecting patients to receive both organs.

Kidney transplantation at the University of Pennsylvania: 1998-2008

Kidney transplantation at the University of Pennsylvania has grown substantially over the past 11 years. Although our transplant volume has increased primarily as a consequence of multiorgan transplants as well as the utilization of historically "marginal" allografts, our post-transplantation outcomes remain excellent in both children and adults. We attribute these outcomes to technical improvements in tissue typing and donor-recipient crossmatching, modification of immunosuppression protocols, and rigorous donor and recipient selection. In the next decade, we hope to substantially expand our living donor program and refine our overall donor and recipient selection process such that we maintain excellent post-transplant outcomes in the face of aging and increasingly comorbid donors and recipients. We further predict significant changes in post-transplant management of kidney recipients with respect to immunosuppression regimens. In particular, we anticipate the modulation of immunosuppression regimens in recipients with high titers of donor-specific antibody and the integration of B-cell specific immunosuppression into post-transplant patient care. Only time will tell whether such therapies will 1) improve long-term outcomes, 2) allow us to diminish the degree of non-specific pharmacologic immunosuppression currently in use, 3) or even promote donor-specific tolerance in kidney transplant recipients.

Percutaneous tendo-Achilles lengthening with a large-gauge needle: a modification of the Ponseti technique for correction of idiopathic clubfoot

The Ponseti technique has become standard for the treatment of congenital idiopathic clubfoot. Treatment includes serial manipulations and casting, accompanied by percutaneous tenotomy of the Achilles tendon. In this article, the authors describe a modification in the Achilles tenotomy technique by using a large-gauge hypodermic needle in the outpatient setting.

Novel mechanism of H0 dibaryon production in proton-proton interactions from parton-based Gribov-Regge theory

A novel mechanism of H0 and strangelet production in hadronic interactions within the Gribov-Regge approach is presented. In this approach the H0 is produced by the same mechanism as usual hadrons, namely, by disintegration of the remnant formed by the exchange of pomerons between the two protons. Rapidity and transverse momentum spectra of the observed hadrons are well described in this approach. In contrast to traditional distillation approaches, here the production of multiple (strange) quark bags does not require large baryon densities or a quark gluon plasma. We calculate the rapidity and transverse momentum distributions as well as the 4pi multiplicity of the H0 for sqrt[s]=17 GeV (Super Proton Synchrotron) and 200 GeV (Relativistic Heavy Ion Collider). In both cases the H0, if it exists, should be observable by the present experiments.

Overpopulation of Omega; in pp collisions: a way to distinguish statistical hadronization from string dynamics

The Omega/Omega ratio originating from string decays is predicted to be larger than unity in proton-proton interactions at SPS energies ( E(lab) = 160 GeV). The antiomega dominance increases with decreasing beam energy. This surprising behavior is caused by the combinatorics of quark-antiquark production in small and low-mass strings. Since this behavior is not found in a statistical description of hadron production in proton-proton collisions, it may serve as a key observable to probe the hadronization mechanism in such collisions.

Endogenous production of specific antibodies does not decrease hypocalcemic response to calcitonin in young rabbits

In order to evaluate the potential inhibition of the acute anti-osteoclastic activity of salmon calcitonin (SCT) by specific antibodies (Ab), we compared the SCT-induced hypocalcemic effect in young male rabbits with significant titers of high affinity Ab and in matched animals without Ab. Immunization of rabbits was performed by repetitive s.c. injections of SCT and Freund adjuvant. Ab were present in four-fifths of SCT-treated rabbits (Ab+). Their titer varied from 0.8 x 10(-9) to 30 x 10(-9) M/liter and their constant of affinity from 0.97 x 10(9) to 4.2 x 10(9) L/M. Intravenous injection of 1 IU/kg SCT to Ab+ rabbits induced a significant decrease (P less than 0.01) of ionized serum calcium (Ca2+) after 30 minutes (mean +/- SD: -9 +/- 0.6%) and until the 240th minute of the test (-16.7 +/- 4.7%), with a maximum after 120 minutes (-22.6 +/- 2%). This was not significantly different from the hypocalcemic effect measured after the same procedure performed in matched animals without Ab (Ab-): significant decrease in Ca2+ (P less than 0.01) after 30 minutes (-8.2 +/- 2.2%), maximal after 150 minutes (-23.2 +/- 4.9%), and lasting until 210 minutes (-14.5 +/- 3.7%). We conclude that, in the particular model of the male young rabbit, specific anti-SCT Ab do not block or reduce the acute anti-osteoclastic activity of SCT.

Treatment of primary undifferentiated sarcoma of the liver with surgery and chemotherapy

Primary undifferentiated sarcoma of the liver is a rare tumor with survival reliant on total excision of the tumor. The authors report such a tumor, initially nonresectable, in a 7-year-old girl whose tumor was successfully excised following treatment with cisplatin and Adriamycin (doxorubicin). The light and electron microscopic details of this patient's tumor are presented.

Mucosal proctectomy without reservoir

Mucosal proctectomy with endorectal pull-through allows the removal of all colonic mucosa with preservation of continence. This operation was performed in 19 patients with familial polyposis coli and ulcerative colitis. A temporary loop ileostomy was used to defunctionalize the anastomosis. Intestinal continuity was restored in 17 of the 19 patients. Mean duration of follow-up was 29 months. All patients are continent, and the mean number of bowel movements per 24 hours is 6. Follow-up barium studies revealed a gradual dilatation of the terminal ileum within the rectal cuff which accounts for the decrease in the number of bowel movements. This operation eliminates the risk of carcinoma without compromising sphincter function.

Biarison in the treatment of degenerative joint diseases: comparison with indomethacin and placebo

A 4-week multiclinic double-blind trial was carried out on 216 ambulatory patients with various degenerative joint diseases in order to compare the efficacy and possible side effects of a new non-steroid anti-inflammatory agent, Biarison (900 mg/day), with those of indomethacin (150 mg/day) and placebo. According to most clinical assessments both active drugs were significantly more effective than placebo. No significant differences were found between the effect of Biarison and indomethacin on joint pain and joint movement. There was evidence that Biarison was more effective than indomethacin in patients with acute and severe symptoms. The commonest side-effect in all three treatment groups was gastro-intestinal irritation. With Biarison these symptoms were mostly mild and caused significantly fewer withdrawals from the trial than with indomethacin. In all three treatment groups, CNS disturbances were seldom recorded. They did not require discontinuation of Biarison but were responsible for two withdrawals from indomethacin and one from placebo. Since Biarison combines good efficacy with only mild gastro-intestinal side-effects and excellent CNS tolerance, it may be regarded as a promising therapeutic agent in the management of degenerative joint diseases.