The new Eurotransplant Kidney Allocation System: report one year after implementation. Eurotransplant International Foundation

BACKGROUND: Upon the availability of a cadaveric donor kidney, a delicate allocation process precedes every transplantation. A remodeled Eurotransplant Kidney Allocation System (ETKAS)-derived from simulation studies-was installed in March 1996. The purpose was to adjust long waiting times and international exchange balances, while aiming at an optimal HLA-mismatch distribution. The new ETKAS consisted of a point-score system that was 100% patient oriented. METHODS: The impact of the new ETKAS on the composition of the waiting list, and the outcome of the allocation procedures during its first year, were evaluated and compared with the results obtained in 1995. RESULTS: The percentage of long-waiting patients and of patients with poorly matchable HLA phenotype increased significantly, from 9% to 19% and from 19% to 29%, respectively. Zero HLA-A-, HLA-B-, HLA-DR-mismatched patients still comprised 23% of the kidney transplant activity. The kidney exchange of the different Eurotransplant countries became balanced within 4 months; this persisted during the rest of the year. Pediatric patients had a high transplantation rate due to an assignment of extra points. The composition of the waiting list showed, after 1 year, fewer long-waiting patients and fewer patients with rare HLA phenotypes. CONCLUSIONS: The new ETKAS was able in its first year to meet the goals set at its introduction. In comparison with the old ETKAS, there was a better trade-off between HLA matching and waiting time. The value of computer simulation studies has been demonstrated impressively in the context of organ allocation.     

Hybrid cam mechanisms

This paper investigates the problem of driving a machine with several reciprocating heavy inertias. The drive should also realize some programmable flexibility of the motion, so that the operation of the machine, e,g., synchronization between different motions and duration of standstills, can easily be modified. The use of a single servomotor for every motion is not the best solution, since it does not allow for energy recuperation. This means that the installed servomotor power will be much higher than the required net peak power for the machine as a whole. The presented solution, however, reduces the servomotor peak torque and power by one order of magnitude, and makes energy transfer between the motions possible. The hybrid cam mechanism consists of a hybrid drive, which is a combination of a servomotor, a constant velocity motor and a cam follower mechanism. The operation principle exploits the nonlinear characteristics of the cam to add flexibility at low cost of energy. The hybrid solution is particularly successful for motions involving high peak acceleration. In addition, the concept can be used to reject disturbances. Simulations show the performance of the hybrid cam mechanism.     

Kaolinite-mullite reaction series: a TEM study

The kaolinite-mullite reaction series in single crystal kaolinite has been characterized by transmission electron microscopy. The exotherm observed at 980° C is attributed to the formation of a spinel phase. Mullite crystallites have also been observed with the spinel phase and both phases have a composition near that of 32 mullite. Subsequent heat treatment leads to the growth of mullite crystallites on the original kaolinite plates with the c-axis perpendicular to the plate.     

Crystal structure of synthesized CuGaTe2 determined by X-ray powder diffraction using the Rietveld method

A full profile X-ray powder diffraction structure refinement has been carried out on a sample of synthesized CuGaTe₂ using graphite monocromatized CuK step-scan data and a profile shape of the Pearson VII type. The most satisfactory convergence was achieved at R _p = 0.0666, R _wp = 0.0884, R _B = 0.0106 and R _F = 0.0102. The derived structural parameters at 26.5°C are: a = 0.602348(7), c = 1.193979(2) nm and x(Te) = 0.256(6). The ratio between lattice parameters, = c/2a = 0.9911 (0), differs from 1.0, indicating a tetragonal distortion, and non-ideal anion displacements, x(Te)1/4, is manifested by the existence of bond alternation of Cu-Te and Ga-Te with interatomic distances of 0.262(5) and 0.2578(5) nm, respectively. These results show a light tetrahedral deformation produced by four-fold tetrahedra of the copper cation in the CuGaTe₂ chalcopyrite-type structure.     

Accurate determination of the mean relative humidity in controlled climates at high humidities (new method)

The measurement of the relative humidity (RH) at high levels to the desired accuracy is still a problem, especially for levels above 90% RH. The reasons for this are:

• i The accuracy of the standard apparatus is lower at high RH than at moderate and low RH;
• ii The need for accurate measurement of the RH in moisture controlled rooms is greater at high RH than at lower RH, because for moisture sensitive products, such as fibreboard boxes and certain horticultural products, the influence of a minor deviation in RH on the properties of these products is considerably greater at high RH than at moderate and low RH.

     

Seven-pinhole tomography of the thyroid

In this paper we introduce a new application of the sevenpinhole (7P) collimator: tomographic imaging of the thyroid. The collimator design has been reoptimized for this particular application by diminishing the distance from the collimator plate to the crystal and by choosing a smaller pinhole diameter. To reconstruct thyroid images from the two-dimensional projection data we use a method which we developed for 7P tomographic imaging of the heart [1]. Phantom experiments and patient studies demonstrate that this new device is capable of producing tomographic images of good quality and high resolution. Therefore, it seems to offer a promising alternative to conventional planar imaging of the thyroid (using a single-pinhole collimator).     

Beam profile measurement of a solar-pumped iodine laser

Beam profile measurements have been made as a function of time within the laser pulse and C2F5I pressure. Measurements indicate that the profile is determined directly by the optical excitation volume, produced by the solar simulator, and that media distortion plays a minor role compared to the build up of quenching species during the lasing pulse.     

Site occupations and ordering behaviour of O phase in Ti2AlNb—based intermetallics

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Adenovirus-Mediated Inducible Expression of a PD-L1 Blocking Antibody in Combination with Macrophage Depletion Improves Survival in a Mouse Model of Peritoneal Carcinomatosis

Immune checkpoint inhibitors (ICIs) have demonstrated remarkable efficacy in a growing number of malignancies. However, overcoming primary or secondary resistances is difficult due to pharmacokinetics issues and side effects associated with high systemic exposure. Local or regional expression of monoclonal antibodies (mAbs) using gene therapy vectors can alleviate this problem. In this work, we describe a high-capacity adenoviral vector (HCA-EFZP-aPDL1) equipped with a mifepristone-inducible system for the controlled expression of an anti-programmed death ligand 1 (PD-L1) blocking antibody. The vector was tested in an immune-competent mouse model of colorectal cancer based on implantation of MC38 cells. A single local administration of HCA-EFZP-aPDL1 in subcutaneous lesions led to a significant reduction in tumor growth with minimal release of the antibody in the circulation. When the vector was tested in a more stringent setting (rapidly progressing peritoneal carcinomatosis), the antitumor effect was marginal even in combination with other immune-stimulatory agents such as polyinosinic-polycytidylic acid (pI:C), blocking mAbs for T cell immunoglobulin, mucin-domain containing-3 (TIM-3) or agonistic mAbs for 4-1BB (CD137). In contrast, macrophage depletion by clodronate liposomes enhanced the efficacy of HCA-EFZP-aPDL1. These results highlight the importance of addressing macrophage-associated immunoregulatory mechanisms to overcome resistance to ICIs in the context of colorectal cancer.