Does the Presence of a Measurable Blood Alcohol Level in a Potential Organ Donor Affect the Outcome of Liver Transplantation?

The widespread application of hepatic transplantation has created a tremendous demand for donor organs. An assessment of donor parameters is thought to be important in selecting good donors; however, the criteria utilized have not been standardized. This study was performed to determine the effect of a measurable donor blood alcohol level on graft survival. Fifty‐two patients who underwent orthotopic liver transplantation at the University of Pittsburgh were included in the study. Twenty‐five patients received liver grafts from donors having a blood alcohol level between 0.04 and 0.4 g/I with a mean of 0.17 g/I. Twenty‐seven patients received a liver graft from a donor who had no measurable blood alcohol. There were no differences between these two groups of donors regarding the time of initial hospitalization until the time of donation. Graft failure within the first 30 days was 24% for those receiving an organ from an alcohol‐positive donor as compared with 22.2% in those receiving an organ from an alcohol negative donor. The recipient mortality rate was 16% and 11%, respectively. No relationships between the donor blood alcohol level and organ performance, frequency of primary graft nonfunction, or number of episodes of acute cellular rejection were evident. Based upon these data, the presence of a measurable blood alcohol level in a donor should not mitigate against organ donation. Copyright © 1991, Wiley Blackwell. All rights reserve

Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis

Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease, occurring mainly in patients with advanced cirrhosis and ascites, who have marked circulatory dysfunction,1 as well as in patients with acute liver failure.2 In spite of its functional nature, HRS is associated with a poor prognosis,3 4 and the only effective treatment is liver transplantation. During the 56th Meeting of the American Association for the Study of Liver Diseases, the International Ascites Club held a Focused Study Group (FSG) on HRS for the purpose of reporting the results of an international workshop and to reach a consensus on a new definition, criteria for diagnosis and recommendations on HRS treatment. A similar workshop was held in Chicago in 1994 in which standardised nomenclature and diagnostic criteria for refractory ascites and HRS were established.5 The introduction of innovative treatments and improvements in our understanding of the pathogenesis of HRS during the previous decade led to an increasing need to undertake a new consensus meeting. This paper reports the scientific rationale behind the new definitions and recommendations. The international workshop included four issues debated by four panels of experts (see Acknowledgements). The issues were: (1) evidence-based HRS pathogenesis; (2) treatment of HRS using vasoconstrictors; (3) other HRS treatments using transjugular intrahepatic portosystemic stent-shunt (TIPS) and extracorporeal albumin dialysis (ECAD); and (4) new definitions and diagnostic criteria for HRS and recommendations for its treatment

LAPORAN PRAKTIK PENGALAMAN LAPANGAN LOKASI SMP N 10 MAGELANG Jalan Soekarno-Hatta, No. 2, Magelang

PPL merupakan mata kuliah praktik yang bertujuan untuk membekali mahasiswa dengan pengalaman di lapangan untuk melengkapai kompetensi mahasiswa calon tenaga kependidikan. Kegiatan PPL merupakan kegiatan untuk memperkaya mahasiswa dengan pengalaman tentang pengelolaan sekolah dengan harapan mahasiswa mampu melatih kompetensi dan mengaplikasikan ilmu yang mereka pelajari. Mahasiswa belajar mengatasi permasalan-permasalahan yang ada di sekolah dalam hal manajemen sekolah dan kelas. Berdasarkan obervasi yang telah dilakukan, SMPN 10 Magelang memiliki fasilitas yang tergolong cukup memadai, sehingga mahasiswa PPL mencoba menyusun berbagai program kerja sebagai usaha penyempurnaan dari kondisi yang sudah ada. Pelaksaan PPL dilaksanakan mulai dari tanggal 2 Juli sampai 17 September 2014 bertempat di SMP Negeri 10 Magelang. PPL diawali dengan kegiatan observasi, persiapan mengajar, praktik mengajar di kelas, dan evaluasi. Kegiatan PPL dilaksanakan di kelas VII dan kelas IX. Selama melaksanakan PPL, mahasiswa tidak menemukan kesulitan yang berarti. Guru pembimbing sangat kooperatif dan baik hati untuk menularkan ilmu dan pengalaman yang didapat selama mengajar di SMPN 10 Magelang. Kegiatan PPL yang dilaksanakan selama lebih kurang dua setengah bulan memberikan hasil yang positif bagi mahasiswa yang diantaranya adalah penerapan ilmu pengetahuan dan praktik keguruan dalam bidang pendidikan seni musik yang mahasiswa peroleh di bangku perkuliahan. Dari pengalaman ini maahasiswa mempunyai saran agar kerjasama dan koordinasi antar pihak sekolah, universitas, dan mahasiswa dapat terus terjalin dengan baik dan lebih ditingkatkan

Multi organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging

Background and Aims: Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit versus harm for therapies. Our aim was to establish the feasibility of Magnetic Resonance Imaging to assess changes in compensated cirrhosis (CC), and relate this to disease severity and future liver related outcomes (LROs). Methods: 60 CC patients, 40 healthy volunteers and 7 decompensated cirrhotics were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T1 longitudinal relaxation time and volume assessment of liver, spleen and kidneys, heart rate and cardiac index. We explore MRI parameters with disease severity and differences in baseline MRI parameters in those 11 (18%) of CC patients who had future LROs. Results: In the liver compositional changes were reflected by increased T1 in progressive disease (p<0.001) and an increase in liver volume in CC (p=0.006), with associated progressive reduction in liver (p < 0.001) and splenic (p<0.001) perfusion. A significant reduction in renal cortex T1 and increase in cardiac index and superior mesenteric arterial (SMA) blood flow was seen with increasing disease severity. Baseline liver T1 (p=0.01) and perfusion (p< 0.01), and renal cortex T1 (p<0.01) were significantly different in CC patients who subsequently developed negative LROs. Conclusions: MRI allows the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement of contrast agent. MRI parameters of liver T1, renal T1, hepatic and splenic perfusion, and SMA blood flow were related to risk of LROs

The role of meditation and mindfulness in the management of polycystic ovary syndrome:a scoping review

Polycystic Ovary Syndrome (PCOS) presents multifaceted challenges affecting women's reproductive, metabolic, and psychological systems, consequently impacting their psychological and emotional well-being. The utilization of meditation and mindfulness interventions (MMIs) is found to be increasing for the management of PCOS. This scoping review systematically explored the current literature to identify the type and application of MMIs for PCOS management. A systematic search of literature was conducted using CINAHL, PsycINFO, Scopus, MEDLINE, and PubMed databases for identifying studies conducted on the usage of MMIs in women diagnosed with PCOS, irrespective of age. The comprehensive search identified 14 trials (comprising 17 citations) meeting inclusion criteria, involving 723 participants across various age groups. Among these, nine were randomized controlled trials (RCTs), while the remaining comprised non-RCTs. Several types of MMIs, including Rajayoga of Brahmakumaris, Yoga Nidra, OM cyclic meditation, unspecified forms of meditation, mindfulness-based stress reduction programs, mindful yoga, and mindfulness-based activities, were used. Outcomes were predominantly assessed in psychological domains (n=11), followed by anthropometric (n=9), quality of life (n=7), and metabolic metrics (n=7). The review findings suggest the integration of meditation with conventional treatment modalities. Preliminary data indicate that MMIs have the potential to improve psychosocial well-being and quality of life among PCOS-affected women. However, adequately powered studies with extended follow-up periods are required to investigate the mechanisms and therapeutic efficacy of MMIs, particularly concerning reproductive outcomes and weight management. Furthermore, diligent monitoring and reporting of adverse events and adherence are essential for a comprehensive understanding of MMI utilization in PCOS management.</p

SUN-116 Body Image Dissatisfaction in Polycystic Ovary Syndrome:Strong Associations with Depression, Anxiety, and Disordered Eating

Disclosure: P. Kempegowda: None. S. Broughton: None. A. Ling Jie Yee: None. S. Ali Baig: None. E. Blendis: None. E. Armeni: None. D. Collaboration: None. Background and Objective: Clinicians should have an awareness of the impact PCOS has on body image. However, research on this area is limited. This study explored the association between body image and quality of life, depression, anxiety, acne, and hirsutism in women with PCOS. Methods: This prospective study was conducted in the UK from July 2023 to November 2024. Women aged ≥18 years with PCOS diagnosis based on the Rotterdam criteria were eligible. Recruitment was conducted via social media and specialist PCOS clinics in Birmingham and London, UK. Eligible women were invited to complete an online survey which included: 1.Sociodemographic and Clinical Data: Age, BMI, ethnicity, education, employment, and socioeconomic status (assessed via the Townsend deprivation index). 2.Body Image: using the MBSRQ-AS, which evaluates appearance evaluation (AE), appearance orientation (AO), body areas satisfaction (BAS), overweight preoccupation (OP), and self-classified weight (SW). 3.Psychological Distress: using HADS (anxiety and depression subscales). 4.Eating Behaviours: using the SCOFF questionnaire for disordered eating. 5.Hirsutism: using modified Ferriman-Gallwey (mFG) score. 6.PCOS-Specific Quality of Life: using PCOS-Q. Statistical Analysis: Descriptive statistics were used to summarise demographic and clinical characteristics. Welch’s t-test compared MBSRQ-AS component scores with sex-matched norms. Ordinal logistic regression was performed to assess associations between MBSRQ-AS components and age, ethnicity, Townsend index, body mass index (BMI), anxiety and depression (HADS), hirsutism (mFG), eating disorder (SCOFF), and quality of life (PCOS-Q). Significance was set at p&lt;0.05. Results: The cohort (n=173) had a median age of 30 years (IQR 25-35) and a mean BMI of 33.0 ± 9.5 kg/m². Compared to sex-matched norms, participants exhibited lower appearance evaluation and body areas satisfaction scores (p&lt;0.001), indicating greater body dissatisfaction and higher overweight preoccupation scores. Poorer appearance scores in MBSRQ-AS evaluation were associated with depression (OR 1.21, p&lt;0.001), anxiety (OR 1.12, p=0.006), disordered eating (OR 1.43, p=0.011), and weight-related PCOS distress (OR 1.13, p&lt;0.001) independent of age, ethnicity, and deprivation. Similarly, lower body areas satisfaction was independently associated with Hirsutism (OR 1.06, p=0.006), while disordered eating was strongly associated with overweight preoccupation (OR 2.46, p&lt;0.001). All associations were independent of age, ethnicity, and deprivation. Conclusions: Women with PCOS exhibit heightened body image concerns, strongly correlated with psychological distress, disordered eating, and metabolic features. These findings underscore the need for integrative care addressing both metabolic and psychological aspects of PCOS management.Presentation: Sunday, July 13, 202

Reducing the Gap in Knowledge and Expectations between Clinicians and People with Polycystic Ovary Syndrome or Adrenal Conditions:Simulation via Instant Messaging—Birmingham Advance: Patient and Public Involvement (SIMBA-PPI) Study

Background: To evaluate the efficacy of SIMBA as an educational intervention for both HCPs and people with either PCOS or adrenal conditions and to study the change in knowledge of people with PCOS or adrenal conditions about the conditions and expectations from the HCPs involved in their care following SIMBA-PPI sessions. Methods: Two SIMBA-PPI sessions (SIMBA-PPI Polycystic ovary syndrome (SIMBA-PCOS) and SIMBA-PPI Adrenal conditions (SIMBA-Adrenal conditions)) were conducted in September 2021 and March 2022. In both sessions, HCPs interacted with moderators on patient management through WhatsApp. Patients with respective conditions underwent workshop-style learning in the same cases. SIMBA-PCOS transcripts were also translated into Brazilian Portuguese and workshops were held in both Brazilian Portuguese and English. The two groups (HCPs and patients) were then brought together to discuss exploring gaps in knowledge and expectations. The Wilcoxon Signed-Rank test compared differences in pre- and post-SIMBA self-reported confidence levels in HCPs and patients. Qualitative data from the online recordings were transcribed and analysed with inductive thematic analysis to identify gaps in knowledge and expectations from managing the cases. Results: 48 HCPs and 25 patients participated in our study. When compared to pre-SIMBA confidence levels, SIMBA-PPI sessions effectively improved clinicians’ confidence in managing PCOS (40.5%, p &lt; .001) and adrenal conditions (23.0%, p &lt; .001) post-SIMBA. Patient participants’ confidence in HCPs significantly increased in the PCOS session (SIMBA-PCOS: 6.25%, p = 0.01). Conclusions: Integration of PPI into SIMBA improved HCPs' confidence in managing PCOS and adrenal conditions. SIMBA-PPI also improved patients’ confidence in HCPs. Our findings suggest that participating in SIMBA-PPI sessions can reduce the gap in knowledge and expectations between patients and HCPs involved in their care

Hemodynamic alterations in cirrhosis and portal hypertension

Portal hypertension (PHT) is associated with hemodynamic changes in intrahepatic, systemic, and portosystemic collateral circulation. Increased intrahepatic resistance and hyperdynamic circulatory alterations with expansion of collateral circulation play a central role in the pathogenesis of PHT. PHT is also characterized by changes in vascular structure, termed vascular remodeling, which is an adaptive response of the vessel wall that occurs in response to chronic changes in the environment such as shear stress. Angiogenesis, the formation of new blood vessels, also occurs with PHT related in particular to the expansion of portosystemic collateral circulation. The complementary processes of vasoreactivity, vascular remodeling, and angiogenesis represent important targets for the treatment of portal hypertension. Systemic and splanchnic vasodilatation can induce hyperdynamic circulation which is related with multi-organ failure such as hepatorenal syndrome and cirrhotic cadiomyopathy