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This article argues that beneath the veneer of legitimacy in the organ, tissue, and body part transplantation systems exists a horrifying history of human commodification whose vestiges surprisingly linger in contemporary supply and allocation systems. This history, as the Article demonstrates, dates back to the colonial period in the United States, where “grave robbing” became an important feature in the advancement of medicine. This legacy lives on.
The scientific literature provides little evidence-based guidance in amount (quantitative fluid intervention) or type (qualitative fluid intervention) of fluid to optimize outcomes during liver and renal transplantation. Fluid intervention and vasoactive pharmacological support for transplantation depend on clinician preference, institutional resources and practice culture. Patients undergoing liver and renal transplantation should be managed on an individualized basis. No single approach will be effective. This chapter provides a contemporary overview of the fundamental principles underpinning fluid intervention for adult liver and renal transplantation. The overarching principles of fluid intervention for transplantation are to normalize the microcirculation by maintaining intravascular volume, tissue perfusion and tissue oxygenation, thereby protecting the new graft and other organs. The chapter also summarizes contemporary recommendations from expert panels for the perioperative fluid management and outcomes for adults undergoing liver and kidney transplantation.
There is a convergence on the protection of the traditional right to privacy and today’s right to data protection as evidenced by judicial rulings. However, there are still distinct differences among the jurisdictions based on how personal data is conceived (as a personality or proprietary right) and on the aims of the regulation. These have implications for how the use of AI will impact the laws of US and EU. Nevertheless, there are some regulatory convergences between US and EU law in terms of the realignment of traditional rights through data-driven technologies, the convergence between data protection safeguards and consumer law, and the dynamics of legal transplantation and reception in data protection and consumer law.
Focusing on Maylis de Kerangal’s 2014 novel, The Heart, this chapter explores the bioethical, temporal, and narrative implications of the reinvention of death as brain death and of the consequent development of organ transplantation therapies.
Mouse testicular tissue is composed of seminiferous tubules and interstitial tissue. Mammalian spermatogenesis is divided into three stages: spermatocytogenesis (mitotic divisions) in which spermatogonial stem cells (SSCs) turn into spermatocytes, followed by two consecutive meiotic divisions in which spermatocytes form spermatids. Spermatids differentiate into spermatozoa during spermiogenesis. Various factors affect the process of spermatogenesis and the organization of cells in the testis. Any disorder in different stages of spermatogenesis will have negative effects on male fertility. The aim of the current study was to compare the in vitro and in vivo spermatogenesis processes before and after transplantation to azoospermic mice using ultrastructural techniques. In this study, mice were irradiated with single doses of 14 Gy 60Co radiation. SSCs isolated from neonatal mice were cultured in vitro for 1 week and were injected into the seminiferous tubule recipient’s mice. Testicular cells of neonatal mice were cultured in the four groups on extracellular matrix-based 3D printing scaffolds. The transplanted testes (8 weeks after transplantation) and cultured testicular cells in vitro (after 3 weeks) were then processed for transmission electron microscopy studies. Our study’s findings revealed that the morphology and ultrastructure of testicular cells after transplantation and in vitro culture are similar to those of in vivo spermatogenesis, indicating that spermatogenic cell nature is unaltered in vitro.
The treatment of neonates with unrepairable heart valve dysfunction remains an unsolved problem because there are no growing heart valve replacements. Heart valve transplantation is a potential approach to deliver growing heart valve replacements. Therefore, we retrospectively analysed the semilunar valve function of orthotopic heart transplants during rejection episodes.
Methods:
We included children who underwent orthotopic heart transplantation at our institution and experienced at least one episode of rejection between 1/1/2010 and 1/1/2020. Semilunar valve function was analysed using echocardiography at baseline, during rejection and approximately 3 months after rejection.
Results:
Included were a total of 31 episodes of rejection. All patients had either no (27) or trivial (4) aortic insufficiency prior to rejection. One patient developed mild aortic insufficiency during a rejection episode (P = 0.73), and all patients had either no (21) or trivial (7) aortic insufficiency at follow-up (P = 0.40). All patients had mild or less pulmonary insufficiency prior to rejection, which did not significantly change during (P = 0.40) or following rejection (P = 0.35). Similarly, compared to maximum pressure gradients across the valves at baseline, which were trivial, there was no appreciable change in the gradient across the aortic valve during (P = 0.50) or following rejection (P = 0.42), nor was there any meaningful change in the gradient across the pulmonary valve during (P = 0.55) or following rejection (P = 0.91).
Conclusions:
This study demonstrated that there was no echocardiographic evidence of change in semilunar valve function during episodes of rejection in patient with heart transplants. These findings indicate that heart valve transplants require lower levels of immune suppression than orthotopic heart transplants and provide partial foundational evidence to justify future research that will determine whether heart valve transplantation may deliver growing heart valve replacements for children.
The view of our nature that I defend, animalism is a straightforward, plausible view that coheres well with the biological facts about human animals and with common sense. By contrast, its chief competitor, mentalism, in its various incarnations, implies that the self is a special object that bears a mysterious relation to the animals in which it is “realized.” Were it not for the strong intuition that we go with (some of) our brains when these are transplanted into other animals, animalism would stand out as the most plausible view about what we are. But our intuition is misleading. It is a mistake to think that we go with our brains when these are transplanted. What goes on in the brain tissue of human animals makes it possible for those animals to think, but, in situ, that tissue is not an object. Hence, it is not an object that can be moved to a different animal, and you and I are not (identical to) our brains.
Uterus transplantation involves a vascularised composite allograft for women with absolute uterine factor infertility, and is considered research. It requires a large medical and surgical multidisciplinary team, requires adequate psychological support and risks premature birth in the offspring. We compare it with the alternative of surrogacy, with the pros and cons regarding the prospective parents and offspring, the parental project collaborators, whether dead or live uterine donor or the gestating surrogate, and society at large. The possible aspects of cross-border reproductive care are also considered before concluding that it is still ‘a step too far’.
1. The acute-on-chronic liver failure (ACLF) syndrome describes acute decompensation of liver function in the context of chronic liver disease.
2. ACLF is associated with extra-hepatic organ failure and high mortality.
3. Underlying chronic liver disease reflects typical population prevalence; the acute precipitant is often alcohol toxicity, systemic sepsis or viral hepatitis, although up to half of cases have no discernible aetiology.
4. Systemic inflammation and bacterial translocation are major pathophysiological components.
5. At present, there are no evidence-based interventions for ACLF, other than supportive care in the intensive care unit and assessment for urgent liver transplantation.
An in vitro spermatogonial stem cell (SSC) culture can serve as an effective technique to study spermatogenesis and treatment for male infertility. In this research, we compared the effect of a three-dimensional alginate hydrogel with Sertoli cells in a 3D culture and co-cultured Sertoli cells. After harvest of SSCs from neonatal mice testes, the SSCs were divided into two groups: SSCs on a 3D alginate hydrogel with Sertoli cells and a co-culture of SSCs with Sertoli cells for 1 month. The samples were evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR) assays and bromodeoxyuridine (BrdU) tracing, haematoxylin and eosin (H&E) and periodic acid–Schiff (PAS) staining after transplantation into an azoospermic testis mouse. The 3D group showed rapid cell proliferation and numerous colonies compared with the co-culture group. Molecular assessment showed significantly increased integrin alpha-6, integrin beta-1, Nanog, Plzf, Thy-1, Oct4 and Bcl2 expression levels in the 3D group and decreased expression levels of P53, Fas, and Bax. BrdU tracing, and H&E and PAS staining results indicated that the hydrogel alginate improved spermatogenesis after transplantation in vivo. This finding suggested that cultivation of SSCs on alginate hydrogel with Sertoli cells in a 3D culture can lead to efficient proliferation and maintenance of SSC stemness and enhance the efficiency of SSC transplantation.
Since the fall of socialism in Eastern Europe, the former Soviet Union, and some states of Southeast Asia, the international financial institutions and individual donor states have initiated wide-scale legal-aid programmes to assist these states in their transition from socialism to a market economy. Whereas the aid from financial institutions vis-à-vis recipient states is often agreed upon specific conditionalities, the donor states design their foreign legal aid according to individual preferences, although sometimes with references to universal goals. Currently, various donor states provide legal aid to Uzbekistan. Given the fact that Uzbekistan is the former Soviet Republic that still bears multiple traces of a socialist legal system and additionally integrates indigenous informal law, this research provides an analysis of how different donor states base their legal-aid activities on entirely different philosophies and levels of gravity, and how receptive the hybrid structure of Uzbekistan’s law is towards such aid.
Asari clam (or Manila clam) Ruditapes philippinarum is an important bivalve for local fisheries. This species exhibits a large variation in shell morphology, and the shell roundness tends to be greater in more unsuitable habitats. To test whether the increments in shell size parameters (length, height and width) were affected solely by environmental conditions or by internal factors such as initial shell shapes or growth rate, a field caging experiment was conducted at two different sites of unsuitable and suitable habitats in Matsukawaura Lagoon, Japan, where shell shapes of wild clams were significantly different between the habitats. In the experiment, clams were released from the two sites to the same site or to the other site and were re-collected after 3, 6 and 12 months of caging. Caged clams originating from unsuitable habitats and released to suitable habitats showed a reduction in shell height relative to shell length, while clams from suitable habitats introduced to unsuitable habitats showed marked increases in both shell height and width. Generalized linear mixed models suggested that the increase in shell height was affected largely by the release habitat (environment) whereas the increase in shell width was affected largely by the individual growth rate. These results suggest that marginal growths in shell height and width respond differently to external and internal factors of clams, resulting in plasticity in their shell shapes according to the environments to which they are translocated.
Left ventricular assist devices enable recovery from severe heart failure and serve as a bridge to heart transplantation. However, chronic mechanical unloading can impair myocardial recovery. We aimed to assess myocyte size, fibrosis, apoptosis, and β-adrenoreceptor levels after rats with left ventricle unloading induced by heterotopic heart transplantation were administered carvedilol and metoprolol.
Methods:
Thirty rats with heart transplants were divided randomly into control, carvedilol treatment, and metoprolol treatment groups. Follow-up was conducted after 2 and 4 weeks of unloading.
Results:
Carvedilol and metoprolol treatments did not prevent the decrease in myocyte diameter in unloaded left ventricles. Metoprolol significantly decreased the ratio of the fibrotic area in the unloaded heart, measured using Masson’s trichrome staining after 2 weeks. However, carvedilol and metoprolol did not reduce apoptosis, based on measurements of terminal deoxynucleotidyl-transferase-mediated dUTP nick end-labelling positive cells and the expression of caspase-3 in unloaded hearts after 2 and 4 weeks. Metoprolol treatment did not significantly decrease the mRNA expression of myocardial SERCA2a in the unloaded heart after 2 weeks.
Conclusions:
Compared to carvedilol treatment, metoprolol treatment improved myocardial fibrosis and SERCA2a expression to a greater extent; however, neither drug prevented myocardial apoptosis.
The olive fruit fly, Bactrocera oleae, the most serious pest of olives, requires the endosymbiotic bacteria Candidatus Erwinia dacicola in order to complete its development in unripe green olives. Hence a better understanding of the symbiosis of Ca. E. dacicola and its insect host may lead to new strategies for reduction of B. oleae and thus minimize its economic impact on olive production. Studies of this symbiosis are hampered as the bacterium cannot be grown in vitro and the established B. oleae laboratory populations, raised on artificial diets, are devoid of this bacterium. Here, we sought to develop a method to transfer the bacteria from wild samples to laboratory populations. We tested several strategies. Cohabitation of flies from the field with the laboratory line did not result in a stable transfer of bacteria. We provided the bacteria directly to the egg and also in the food of the larvae but neither approach was successful. However, a robust method for transfer of Ca. E. dacicola from wild larvae or adults to uninfected flies by transplantation to females was established. Single female lines were set up and the bacteria were successfully transmitted for at least three generations. These results open up the possibilities to study the interaction between the symbiont and the host under controlled conditions, in view of both understanding the molecular underpinnings of an exciting, unique in nature symbiotic relationship, as well as developing novel, innovative control approaches.
In this article, the authors examine how the potential success of head/body transplantation raises questions as to how halakha—Jewish law and jurisprudence—might draw the line between determining whether a person is dead or alive. In presenting the primary Talmudic passages that refer to determination of life and death, and their discussion among halakhists and halakhic decisors, the authors show how the halakha might determine the demarcation between life and death as it applies to head/body transplants or potentially other innovations in medical technology.
The assessment of gastrointestinal (GI) specimens from immunosuppressed patients can be challenging, particularly because of the increased likelihood of multiple diseases and of rarer diseases. This chapter documents and presents the wide range of luminal GI pathologies that can develop in the three main groups of immunosuppressed patients, i.e. HIV/AIDS patients, individuals with primary immunodeficiencies, and patients receiving iatrogenic immunosuppression. These GI pathologies include infections, neoplasms, drug-related injuries, and diseases that are more specific to certain groups of immunosuppressed patients such as graft-versus-host disease in bone marrow transplant recipients.
Asymmetry between the supply of and demand for transplantable organs necessitates rationing and should ideally serve as a spur to ethical reflection and policy innovation. Transplantation policies can be animated by various principles, such as maximizing total benefits and fairness. Implicitly, these principles demand that we interrogate our beliefs about the meaning of and appropriate role for disability in the face of scarce resources. How we conceive of disabilities – whether as a “mere difference” or a “bad difference” – influences our thinking about both donation and allocation of organs and should, therefore, be made explicit.
Hepatic alveolar echinococcosis (HAE) is a potentially fatal disease caused by the larval growth of Echinococcus multilocularis. We analysed the clinical data of 178 consecutive HAE patients treated with definitive radical surgery at our institution. According to the surgical approach: group A patients underwent direct radical hepatic resection; group B patients first underwent percutaneous puncture external drainage, followed by radical hepatic resection 2 months later; group C patients underwent a two-step hepatic resection; and group D patients underwent liver transplantation. The baseline characteristics, mortality, postoperative complications and recurrence rates were evaluated. Symptoms were present in 79.8% (142/178) patients. Bi-lobar lesion was found in 34 (19.1%, 34/178) patients, 47.2% (84/178) of whom had ⩾2 lesions each. There were no intraoperative deaths. The postoperative mortality was 2.29% in group A, 8.62% in group D and 0% in groups B and C. The main cause of death was a serious postoperative complication (Clavien–Dindo grades III–V). Patients were followed-up systematically for a median of 35.8 months (8–72) without recurrence. Active HAE should be treated by radical liver resection, and the complicated alveolar echinococcosis of the liver has been managed whenever possible using principles of radical liver resection by experienced hepatic surgeons.
This chapter examines how transatlantic travel writing helped to redefine climate throughout the long eighteenth century. Beginning with the challenge that early modern travellers’ encounters with North American extremes offered to classical theories of climate, this chapter first considers how fears about the inevitable influence of degenerative air gave way to a sense that settlers could change the climate. By emphasising the improving survival rates of European crops and animals, advocates for North American settlement reframed evidence of certain types of productivity as evidence that the climate itself was improving. By thus narrowing the definition of climate, however, this pattern of writing also opened a gap between the stories of improvement circulating in Britain and settlers’ reports on conditions on the (still cold) ground – and so, for many early modern observers, this transatlantic exchange also inspired new scepticism about the political interests served by promises of a changing climate.
This chapter explores the relationship between Shakespeare and climate. Taking its inspiration from weather disruptions to the 2017 Shakespeare Association of America conference, it riffs on the tweets that this climatic disturbance generated and the themes they reveal. It deals with the issues of: climate and its material effects on Shakespearean composition and performance, whereby climate and culture may be said to be co-constitutive; the resistance in Shakespeare’s time to codifying climate, in partial acknowledgement of climate’s unpredictability; and thus the extent to which Shakespearean texts portend human and non-human entanglement in the Anthropocene.