PD54-11 NOVEL DEVICE FOR RENAL COOLING DURING TRANSPLANTATION
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Résumé
You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I (PD54)1 Apr 2019PD54-11 NOVEL DEVICE FOR RENAL COOLING DURING TRANSPLANTATION Thomas Skinner*, Ali Dergham, and Luke Witherspoon Thomas Skinner*Thomas Skinner* More articles by this author , Ali DerghamAli Dergham More articles by this author , and Luke WitherspoonLuke Witherspoon More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557064.64143.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: In renal transplantation, warm ischemia time (WIT) describes the period of ischemia beginning with removal of the organ from ice and concluding at reperfusion. WIT is associated with delayed graft function, and adverse patient and graft long-term survival. Metabolic activity in cooled kidneys is minimal at 5°C and resumes above 15°C, a temperature reached after only 15 min of WIT. This is of clinical significance because WIT in renal transplantation is often > 40 min. The solution lies not in rushing the anastomosis but maintaining renal hypothermia during the process. Although various devices have been proposed, most suffer from being too bulky, inefficient, expensive, or prone to puncture. We set out to develop a novel, inexpensive device to maintain allograft temperatures ≤ 5°C, thereby limiting ischemic damage. METHODS: 3/16″ aluminum tubing was organized in a serpentine pattern to create a malleable, form-fitting cooling jacket. Coolant comprised 4°C saline solution flowing at 240 mL/min. Adult porcine kidneys (n = 4) (175 g, 13x7x3 cm LxWxH) were used to test the device. Kidneys were placed at 24°C; surface and core temperatures were monitored using implanted thermocouples. Device usability was tested by anastomosing porcine kidney vessels to GORE-TEX® vascular grafts with the cooling jacket in place in a simulated ex-vivo operative field. RESULTS: Our cooling jacket costs less than $3.00 to produce and is mouldable to any size kidney. The device resulted in mean surface and core temperatures at 60 min of (mean ± standard deviation (SD)) 5.8±0.6°C and 5.4±0.5°C respectively, significantly less than those of the control; 16.6±1.4°C and 16.6±1.2°C, respectively (p<0.00001 for both). Moreover, our device mitigated surface temperature increases (2.4±1.3°C vs. 12.9±0.9°C) and core temperature increases (2.8±1.7°C vs. 14.1±1.5°C) at 60 min (p<0.00001). Surface and core temperatures were significantly lower in cooled kidneys compared to controls within 5 minutes of removal from ice (p<0.05). Ex-vivo anastomotic testing was not inhibited or delayed by our device during testing by expert transplant surgeons. CONCLUSIONS: WIT is associated with many adverse outcomes. We developed a novel inexpensive, and easy-to-use aluminum cooling jacket that mitigated temperature increase, and maintained renal temperatures below metabolically-active levels. Source of Funding: None Ottawa, Canada; Kingston, Canada; Ottawa, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1009-e1009 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Skinner* More articles by this author Ali Dergham More articles by this author Luke Witherspoon More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».