EU 

Hospital emergency departments lack policy and strategies for spotting child neglect or abuse

Reports and Proceedings

EUROPEAN SOCIETY FOR EMERGENCY MEDICINE

Berlin, Germany: In a survey of emergency department staff from across Europe, only around half said their hospital has a policy in place to help staff identify children who are being neglected or abused.

The research, presented at the European Emergency Medicine Congress [1], also shows that hospitals with such a policy are more likely to use strategies that are known to be effective in identifying children who are maltreated, including screening tools and staff training.

The study was presented by Féline Hoedeman, a PhD and medical student at the Erasmus MC Sophia Children’s Hospital in Rotterdam, The Netherlands. She said: “Abuse and neglect have devastating effects on children, families and society, but they can be very difficult to spot. Children who sustain injuries due to abuse are likely to present at an emergency department and previous research shows that staff can play an important part in identifying these children, especially if they have the right training, tools and resources.”

In collaboration with the Dutch Augeo Foundation, the European Society for Emergency Medicine (EUSEM), Research in European Paediatric Emergency Medicine (REPEM) network and the European Society of Emergency Nursing (EuSEN), the researchers from the Erasmus MC Sophia Children’s Hospital conducted a survey of healthcare professionals working in European emergency departments. The responses came from staff at 148 hospitals in 29 countries: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kosovo, Latvia, Lithuania, Malta, The Netherlands, Norway, Poland, Romania, Slovenia, Spain, Sweden, Switzerland, Turkey and the United Kingdom.

Only 51% of respondents said their hospital had a standardised child maltreatment policy. Twenty-four percent said they did not have such a policy. The remaining 25% either did not know or did not say whether they had a policy.

Those who said there was a policy were also more likely to report that their hospital had a child maltreatment screening tool (52% compared to 2% in hospitals without a policy), training on identifying maltreated children (63% compared with 30%), a child abuse team (73% compared with 27%) and a child maltreatment policy officer (51% compared to 20%). However, only 28% with a policy said that their hospital used all four of these strategies.

The researchers caution that the responses came from individual professionals and so are not representative of all hospital staff. 

Ms Hoedeman said: “Our study suggests that there are some hospitals where the right action is being taken to protect children. However, it also suggests that there are far too many hospitals where policy on child abuse and neglect is not in place or staff do not know the policy is there. Where that’s the case, staff are less likely to have the tools and knowledge they need and may be missing opportunities to help vulnerable children.”

The researchers plan to develop a toolkit, consisting of a hospital policy, training and a screening tool, to help identify children being neglected or abused. They have just completed a follow-up survey to investigate any factors that could help or hinder implementation of the toolkit.

Professor Youri Yordanov from the St Antoine Hospital emergency department, APHP Paris, France, is Chair of the EUSEM 2022 abstract committee and was not involved in the research. He says: “We know that having protocols and structured processes in hospitals can reduce medical errors and benefit patients. This study affirms that having a policy can support emergency department staff to spot children who are at risk.

“Although regulations and legal systems differ between European countries, the core components of a child maltreatment hospital policy should always be in place and can be adapted to different hospitals. We are starting to recognise that there is a lot of variability between hospitals when it comes to recognising child abuse and neglect and that’s something we need to urgently address.”

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METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

Not applicable

Marijuana-dependent patients at higher risk for infection after knee or shoulder arthroscopy procedures

Although more research is needed, physicians should discuss the potential risk of marijuana dependence with candidates for arthroscopy procedures

Reports and Proceedings

AMERICAN COLLEGE OF SURGEONS

 

IMAGE: MARIJUANA-DEPENDENT PATIENTS AT HIGHER RISK FOR INFECTION AFTER KNEE OR SHOULDER ARTHROSCOPY view more 

CREDIT: AMERICAN COLLEGE OF SURGEONS

Key takeaways 

• A higher infection rate found by new research should raise a “red flag” for patients and providers and should be discussed along with other risk factors before an arthroscopic procedure.  

• Higher rates of deep vein thrombosis (DVT) were also found among these patients, but the study’s analysis determined they were not statistically significant. 

• The study has identified the need for additional research to better understand the relationship between marijuana dependence and potential postoperative complications. 

SAN DIEGO: Patients who are dependent on marijuana may face higher infection rates following knee and shoulder arthroscopy—a minimally invasive surgery in which a small camera is inserted to diagnose and sometimes treat injury—according to a study presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

Using PearlDiver, a national insurance claims database, researchers from the University of Chicago performed a retrospective study of patients with marijuana dependence who underwent knee or shoulder arthroscopy for the postoperative complications of deep vein thrombosis (DVT), pulmonary embolism (PE), and infection.  

“Marijuana has been gaining so much popularity, but it’s a risk factor we aren’t really catching,” said lead study author Sarah Bhattacharjee, MD, who conducted the research while she was a medical student at the University of Chicago. Dr. Bhattacharjee is now a surgical resident in orthopaedic and sports medicine at the University of Washington. “The higher infection rate found by this new study should raise a ‘red flag’ for patients and providers and should be discussed along with other risk factors before an arthroscopic procedure.” 

Although the effect of marijuana use has been studied in pain management and cardiovascular health, few studies have looked at the potential effects of marijuana use by patients who are undergoing surgery. More states are legalizing marijuana, and the size of the cannabis market is predicted to reach $91.5 billion by 2028.1 Given that trend, the team of researchers from the University of Chicago set out to determine if marijuana-dependent users face an increased risk of complications following knee or shoulder arthroscopy.  

“There’s so much information out there on smoking, alcohol, and other substances, but not on marijuana use,” said study coauthor Jason Strelzow, MD, assistant professor of orthopaedic surgery, University of Chicago. “As providers and surgeons, we should be discussing marijuana use with our patients, something that we have traditionally shied away from.” 

Study details 

All patients undergoing knee or shoulder arthroscopy were identified retrospectively in PearlDiver. Next, patients who had a diagnostic code for marijuana dependence were also identified within each surgery category; this is a rigid definition requiring patients to three or more criteria, such as using marijuana longer than intended, difficulty in cutting down use, spending a lot of time in obtaining or recovering from marijuana, and high tolerance.  

The rates of DVT, PE, and infection within 90 days were assessed for all patients. Univariate analyses of marijuana dependence on all outcomes were performed, followed by a multivariate logistic regression analysis controlling for known patient comorbidities (other medical conditions). 

Knee and Shoulder Arthroscopy Video (VIDEO)

Key findings 

• The researchers identified 1,113,944 knee and 747,938 shoulder arthroscopy patients. Out of those 1,861,892 patients, 21,823 patients had a diagnostic code for marijuana dependence.  

• Within both subgroups, the marijuana dependence cohort experienced increased rates of infection and DVT, while the PE rate stayed the same.  For the shoulder arthroscopy group, the rates of infection increased from 0.7%  to 1.7%, the DVT rate from 0.2% to 0.4%, while PE stayed at 0.2%. In the knee arthroscopy group, the rates of infection increased from 1.1% to 2.6%, the DVT rate rose from 0.2 to 0.3%, and PE stayed at 0.3%.   

• In the multivariate analyses controlling for a variety of patient risk factors, including tobacco use or a history of diabetes, marijuana dependence was identified as an independent risk factor for infection within both cohorts. In this study, a statistical measure called a p-value (‘p’ stands for probability) was used to determine if the detected relationship was due to chance (p-values of 0.001 or below) or did, in fact, exist (p-values above 0.001). For the knee group, the p-value was 1.85, and for the shoulder group it was 1.65. 

(Note: The presenting author reported on updated data from the podium during the conference reflecting stable PE rates.) 

Dr. Strelzow hopes surgeons will use the study results to help inform marijuana-dependent patients about risks, benefits, and available alternatives, such as reducing or eliminating marijuana use six months prior to an arthroscopic procedure. 

Although the study focused on minimally invasive surgery, Dr. Strelzow said that “we would expect similar or larger effects with more open or invasive procedures.” 

Future research opportunities 

The study has identified the need for additional research to better understand the relationship between marijuana dependence and postoperative complications. In addition, given that the study used very rigid criteria for marijuana dependence, there are opportunities for future clinical studies to investigate how various levels of marijuana use impact postoperative complications.  Dr. Strelzow said he plans to study the impact of marijuana dependence on fracture healing. 

There are no author disclosures to report. 

Citation: Bhattacharjee S, et al. Marijuana and Joints: Outcomes Following Shoulder and Knee Arthroscopy, Scientific Forum, American College of Surgeons Clinical Congress 2022. 

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1Legal Cannabis Market Size Worth $91.5 Billion By 2028 | CAGR: 26.3%: Grand View Research, Inc. press release, July 27, 2021. Assessed at: https://www.grandviewresearch.com/industry-analysis/legal-cannabis-market?utm_source=prnewswire&utm_medium=referral&utm_campaign=HC_27-July-21&utm_term=legal-cannabis-market&utm_content=rd1 (.) 

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About the American College of Surgeons  

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons.  

Nicotine dose in a single cigarette blocks estrogen production in women’s brains

Reports and Proceedings

EUROPEAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY

 

IMAGE: AROMATASE (ESTROGEN SYNTHETASE) DETECTED IN THE THALAMUS (RED SPOT) view more 

CREDIT: JANA IMMENSCHUH

A dose of nicotine, equivalent to that found in a single cigarette blocks estrogen production in women’s brains. This may explain several behavioural differences in women who smoke, including why they are more resistant than men to quitting smoking. This work is presented for the first time at the ECNP Congress in Vienna.

Lead researcher, Associate Professor Erika Comasco (Uppsala University, Sweden) said:

 “For the first time, we can see that nicotine works to shuts down the estrogen production mechanism in the brain of women. We were surprised to see that this effect could be seen even with a single dose of nicotine, equivalent to just one cigarette, showing how powerful the effects of smoking are on a woman’s brain. This is a newly-discovered effect, and it’s still preliminary work. We’re still not sure what the behavioural or cognitive outcomes are; only that nicotine acts on this area of the brain, however we note that the affected brain system is a target for addictive drugs, such as nicotine”.

The effect has been shown in the thalamus, which is part of the limbic system in the brain. This system is involved in behavioural and emotional responses.

The researchers, from Uppsala University in Sweden, worked with a group of ten healthy female volunteers. The women were given a commercially available nicotine dose intranasally, and at the same time were injected with a radioactive tracer attached to a molecule which binds to the enzyme aromatase: aromatase, also known as estrogen synthase, is the enzyme responsible for the production of estrogen. MRI and PET brain scans enabled the researchers to visualise both the quantity of aromatase, and where it was located in the brain. The researchers found that a single dose moderately reduced the amount of aromatase in the brain.

It has been known for some time that women and men respond differently to nicotine, with women being more resistant to nicotine replacement therapy, and showing a greater tendency than men to relapse when trying to quit smoking. However, the biological basis for these differences is not understood. This is the first time that this inhibitory effect on aromatase production has been shown in humans. The effect on men was not studied.

Professor Comasco continued “This discovery leads us to believe that nicotine’s effect on estrogen production has a significant impact on the brain, but perhaps also on other functions, such as the reproductive system – we don’t know that yet. There are significant differences in the way men and women react to smoking. Women seem to be more resistant to nicotine replacement therapy, they experience more relapses, show greater vulnerability for heritability of smoking, and are at greater risk of developing primary smoking-related illnesses, such as lung cancer and heart attacks. We need now to understand if this action of nicotine on the hormonal system is involved in any of these reactions.

Of course this is a comparatively small group of women, we need a larger sample to confirm these findings. Nevertheless, the message is that nicotine has various effects on the brain, including on the production of sex hormones such as estrogen”. 

Commenting, Professor Wim van den Brink, Emeritus Professor of Psychiatry and Addiction at the Academic Medical Center, University of Amsterdam said:

 “This is indeed an important first finding. Smoking has many adverse effects in men and in women, but this particular effect of nicotine on the reduction of estrogen production in woman was not known before. It should be noted, however, that tobacco addiction is a complex disorder with many contributing factors. It’s unlikely that this specific effect of nicotine on the thalamus (and the production of estrogen) explains all the observed differences in the development, treatment and outcomes between male and female smokers. It is still a long way from a nicotine induced reduction in estrogen production to a reduced risk of nicotine addiction and negative effects of treatment and relapse in female cigarette smokers, but this work merits further investigation”.

Professor van den Brink was not involved in this work, it is an independent comment.

 

This work is presented at the 35th European College of Neuropsychopharmacology annual conference, which takes place in Vienna and online from 15-18 October, see https://www.ecnp.eu/Congress2022/ECNPcongress. Up to 5000 delegates are expected to attend. The ECNP is Europe’s main organisation working in applied neuroscience.

 

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METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

The U-curve: children born to younger or older parents have an increased risk of bipolar disorder

EUROPEAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY


Parental age and risk of bipolar disorder in children. This graph is adapted from the published original. Y-axis indicates odds ratio. view more
Credit: Giovanna Fico

Children of either younger or older parents carry an increased risk of bipolar disorder.  This risk is greater if you were born to a mother or father younger than 20 years old, if your mother was older than 35, or your father was older than 45. This tendency gives a ‘U-Shaped Curve’, showing increased risks for younger and older parents. This work is presented at the ECNP Congress in Vienna, after recent publication in the peer-reviewed journal European Neuropsychopharmacology.

Bipolar disorder, where sufferers can swing from moods of elation to moods of extreme depression, is one of the most common serious mental illnesses, affecting around 2% of people, and carries a high risk of suicide and premature death. It is known to have high heritability; if one parent has bipolar disorder there’s a 15% to 30% chance that this will be passed on to their children.

Study leader Dr Giovanna Fico, of the University of Barcelona, said:

“Parental age is a factor which affects many conditions, such as fertility and some neuropsychiatric disorders. What we have found is slightly unusual because both younger and older parents carry an increased risk of having a child with bipolar disorder. The increased risk is moderate, but real. We can speculate that younger parents may be affected by environmental factors, such as socio-economic problems, lack of support, but also stress or immunological factors, and that older parents may have genetic factors coming into play, but the truth is we don’t really know”.

The researchers, from Spain, Italy, Australia and the Netherlands, undertook a systematic review of studies from various countries which relate bipolar disorder to age. In total the studies included 13,424,760 participants, of whom 217,089 had bipolar disorder. They found that older men were more at risk than other groups of having a child with bipolar disorder. These men had 29% higher odds of having a baby with bipolar disorder than fathers aged 25 to 29 while older women had 20% higher odds than mothers aged 25 to 29. In parents younger than 20 years the increased odds were 23% (for mothers) to 29% (for fathers). All analyses were corrected for biasing factors, like familial history for bipolar disorders and the age of the other parent.

Giovanna Fico said “Again, we must stress that this risk is moderate, and it must be kept in perspective. However, for those already at risk, age is another factor that should be taken into consideration, and so it may be that doctors need to counsel both younger and older couples if they have a risk of bipolar disorder. We also see this U-shaped curve in some other conditions, such as autism and some cardiovascular diseases”.

She continued:

“We are planning to study several environmental factors which might be related to the risk of bipolar disorder, but also to its course of illness. For example, we would like to explore how the exposure to pollution, climate changes, urbanization might affect the risk of some psychiatric disorders, and we want to try to understand if these factors help or worsen the course of the disorder”.

 

Commenting, Professor Maj Vinberg (University of Copenhagen) said:

“This interesting systematic review article shows that children of young parents (up to 20 years) have a greater risk of developing bipolar affective disorder. The same pattern is seen in older parents, defined as fathers over 45 and mothers over 35.

The study raises several exciting research questions, including the possibility of early prevention and intervention. For example, in the daily clinical settings, it is crucial to be aware that young individuals with BD in their manic phases have more risky sexual behavior, which can associate with an increased pregnancy risk”.

This is an independent comment, Professor Vinberg was not involved in this research.

This work is presented at the 35th European College of Neuropsychopharmacology annual conference, which takes place in Vienna and online from 15-18 October, see https://www.ecnp.eu/Congress2022/ECNPcongress. Up to 5000 delegates are expected to attend. The ECNP is Europe’s main organisation working in applied neuroscience.

The published paper, “The U-shaped relationship between parental age and the risk of bipolar disorder in the offspring: A systematic review and meta-analysis”, Fico et al. Eur Neuropsychopharmacol  2022 Jul;60:55-75. doi: 10.1016/j.euroneuro.2022.05.004, can be accessed at: https://pubmed.ncbi.nlm.nih.gov/35635997/

None of the comments in this press release are in the published paper. A copy of the paper is available to journalists on request to the press officer.

 

Research calls for more open approach to adoption

Reports and Proceedings

UNIVERSITY OF EAST ANGLIA

A more open approach to adoption is needed so that adopted people do not lose relationships with people who have been important to them in their life, according to new research by the University of East Anglia (UEA).

Findings from two studies, published during National Adoption Week by UEA’s Centre for Research on Children and Families, also suggest this helps adopted people to have a better sense of their own identity.

The theme for this year’s National Adoption Week is about maintaining adopted children's relationships and identities.

Prof Elsbeth Neil, of UEA’s School of Social Work and one of the study authors, said: “Adoption has often been seen as ‘a fresh start’ with a ‘clean break’ from the child’s birth seen as necessary. But now new research with adopted adults demonstrates the problems this approach causes throughout the lifespan.

“Without information about their background and family of origin adopted people struggle with questions of identity, and many feel a sense of loss at losing significant relationships, or simply not having the chance to get to know parents, brothers, sisters or others in their birth family.

“Tens of thousands of adopted adults and their birth relatives have been affected by the lack of openness in adoption, but services to help them deal with the consequences of this need more priority.”

Prof Neil added: “Adoptees need quicker and easier ways of accessing their adoption records and they need access to affordable support services to help them work through the emotional impact of adoption and to support them in the process of finding their birth family where this is desired.

“This research also has messages for children being adopted today, in particular that the system needs to do more to actually maintain children’s relationships where they are safe and supportive, so they do not end up with these identity questions as adults.”

The first study looks at how adoption agencies respond to requests from intermediary agencies to support reunions between adopted adults and their birth families.

Intermediary services support adopted adults to contact their birth family, and vice versa they can support birth parents to make contact with their child who was adopted.

Before intermediary services can put people in touch with each other, they must ask the agency holding the adoption records to check the file for contact details, background information and to make sure that the adopted person has not placed a veto on being contacted by birth relatives.

This new research, carried out with adoption intermediary service Joanna North Associates, explores how quickly adoption agencies respond to these requests, and factors that may prevent a timely response. One of the key recommendations is that the needs of adopted adults and birth relatives should be given more strategic consideration at national and agency level.

Dr Joanna North said: “Our work in connecting adopted people to their lost family of origin has shown us the cost of human suffering when people cannot connect with their birth relatives in a timely fashion. These searches are time sensitive. On too many occasions the system has been so slow to respond to our requests for records that the subject of a search may have died before we reach them.

“The research we carried out with UEA shows the large variations in how long it can take agencies to check files, as well as the lack of resources and guidance to enable searches to be carried out quickly. 

“The government needs to ensure a consistent process from Local Authorities so that there is a minimum standard for helping adopted people access their records, reducing the suffering that this is causing.”   

The second study, conducted in collaboration with adoption support agency PAC-UK, analyses survey data from more than 200 adopted adults exploring their priorities around the topic of maintaining birth family relationships.

It found widespread support for the prioritisation of birth-family relationships, the need for more support for adopted adults and more open discussion about birth family links. The findings will be presented today during an online event organised by PAC-UK and led by adopted adults.

PAC-UK National Strategic Lead Mike Hancock said: “We are at an exciting time of potential change in adoption where questions are being asked about whether the severing of ties with birth family and the consequent secrecy around identity is beneficial to adopted children. The message we are getting for many adopted adults is that it is not.”

During a webinar on Thursday (October 20) Prof Neil will discuss ongoing work around the ‘theory of change’, focusing on the adoption system and highlighting key problems related to the lack of openness in adoption, and the issues this causes for adopted people, birth parents and adoptive parents.

The webinar will be run in collaboration with CoramBAAF, an independent organisation for professionals, foster carers and adopters, and anyone else working with or looking after children in or from care, or adults who have been affected by adoption.

Over the last few months researchers have been drawing on existing research and talking to a wide range of people with lived and professional experience. The event will include contributions from a range of people with lived experience including adopted adults, a birth parent, and adoptive parent. There will be a focus on what could be done differently to improve the adoption system.

Research briefings for the two studies are available at CRCF Research Briefings - Groups and Centres (uea.ac.uk)

Bumblebees have poor, but useful memories 

Study results reveal bumblebees' memories operate differently to humans'

Peer-Reviewed Publication

QUEEN MARY UNIVERSITY OF LONDON

 

IMAGE: BEE DRINKING FROM ARTIFICIAL FLOWER view more 

CREDIT: YONGHE ZHOU

Bumblebees  don’t seem to keep memories for how sweet a flower was, but instead only remember if it was sweeter than another flower, according to researchers at Queen Mary University of London, along with an international team of scientists. 

In new research in the journal eLife, bumblebees were first trained on two flowers, learning that one flower was sweeter than a second flower. Later, they learned that a third flower was sweeter than a fourth flower. Then bumblebees were given the choice between two of the flowers they hadn’t seen together before, for example the second and third or the first and third.  

Over a series of experiments, bumblebees’ preferences during the tests indicated that they could only retain very basic ranking memories for the flowers for very long. The bumblebees could only remember that a flower had been better or worse during training phase. Bees couldn’t seem to remember for more than a few minutes how sweet or rewarding the flowers were on their own or even how much sweeter they were compared to other flowers.  

Previous research shows that we humans actually keep memories for both absolute information (e.g. how sweet something is) and comparisons [Palminteri and Lebreton, 2021]. Starlings, a bird native to Europe, and the only other animal for which this question has been examined, similarly use a combination of absolute and comparative information when remembering options [Pompilio and Kacelnik, 2010].

Ms Yonghe Zhou, co-lead author on the paper and currently a PhD student at Queen Mary University of London, says: “Our results reveal an intriguing divergent mechanism for how bumblebees retain and use information about options, compared to humans and birds.” 

Prof Fei Peng, senior author currently at Southern Medical University, China, states “It may be that the different strategies used by bumblebees and humans may have evolved because of their different diets. Maybe because bumblebees evolved to mostly only eat flower nectar, they never needed to remember the details and could survive and thrive simply using simple comparisons.”  

Ms Yonghe adds: “Despite what may seem to be a poor memory strategy, bumblebees do very well in finding the most profitable flowers. It’s fascinating to consider how different animals, in their own ecological niche, can be similarly successful using such different strategies.” 

 

More Information: 

Research Paper: “Bumblebees retrieve only the ordinal ranking of foraging options when comparing memories obtained in distinct settings” Cwyn Solvi, Yonghe Zhou, Yunxiao Feng, Yuyi Lu, Mark Roper, Li Sun, Rebecca Reid, Lars Chittka, Andrew B Barron, Fei Peng. eLife 

DOI: https://doi.org/10.7554/eLife.78525 

 

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JOURNAL

eLife

DOI

10.7554/eLife.78525 

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Bumblebees retrieve only the ordinal ranking of foraging options when comparing memories obtained in distinct settings

Livers have the potential to function for more than 100 years

Research findings about a unique group of transplanted livers could help raise the age of potential donors, thus expanding the donor pool in the future

Reports and Proceedings

AMERICAN COLLEGE OF SURGEONS

 

IMAGE: LIVERS HAVE THE POTENTIAL TO FUNCTION FOR MORE THAN 100 YEARS view more 

CREDIT: AMERICAN COLLEGE OF SURGEONS

Key takeaways 

• Understanding the characteristics of livers that live to 100 could potentially expand the donor pool by using older liver donors more often. 

• New surgical techniques and advances in immunosuppression lead to better outcomes for patients receiving a liver from an older donor.  

• Optimizing both donor and recipient factors allow for much greater longevity for certain livers. 

SAN DIEGO: There is a small, but growing, subset of livers that have been transplanted and have a cumulative age of more than 100 years, according to researchers from University of Texas (UT) Southwestern Medical Center, Dallas, and TransMedics, Andover, Massachusetts. They studied these livers to identify characteristics to determine why these organs are so resilient, paving the way for considering the potential expanded use of older liver donors. The research team presented their findings at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

The researchers used the United Network for Organ Sharing (UNOS) STARfile to identify livers that had a cumulative age (total initial age at transplant plus post-transplant survival) of at least 100 years. Of 253,406 livers transplanted between 1990-2022, 25 livers met the criteria of being centurion livers—those with a cumulative age over 100 years. 

“We looked at pre-transplant survival—essentially, the donor’s age—as well as how long the liver went on to survive in the recipient,” said lead study author Yash Kadakia, a medical student at UT Southwestern Medical School. “We stratified out these remarkable livers with over 100-year survival and identified donor factors, recipient factors, and transplant factors involved in creating this unique combination where the liver was able to live to 100 years.” 

Centurion livers came from older donors 

For these centurion livers, the average donor age was significantly higher, 84.7 years compared with 38.5 years for non-centurion liver transplants. The researchers noted that for a liver to make it to 100, they expected to find an older average donor age as well as healthier donors. Notably, the donors from the centurion group had lower incidence of diabetes and fewer donor infections. 

“We previously tended to shy away from using livers from older donors,” said study coauthor Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can sort out what is special amongst these donors, we could potentially get more available livers to be transplanted and have good outcomes.”  

There are 11,113 patients on liver transplant waiting list as of September 22, 2022.* As Dr. Hwang noted, using older liver donors more often could potentially expand the liver donor pool. 

Further study details 

Centurion liver donors had lower transaminases, which are enzymes that play a key role in the liver. Elevated transaminases can cause problems in liver transplantation. Additionally, the recipients of centurion livers had significantly lower MELD scores (17 for the centurion group, 22 for the non-centurion group). A higher MELD score indicates that a patient is more urgently in need of a transplant.  

“The donors were optimized, the recipients were optimized, and it takes that unique intersection of factors to result in a really good outcome,” Mr. Kadakia said. 

The researchers found that no grafts in the centurion group were lost to primary nonfunction or vascular or biliary complications. There was notably no significant difference in rates of rejection at 12 months between the centurion group and the non-centurion group. Further, outcomes for the centurion group had significantly better allograft and patient survival.  

“The existence of allografts over 100 years old is revealing of the dramatic resilience of the liver to senescent events,” the study authors concluded.  

“Livers are incredibly resilient organs,” said Mr. Kadakia. “We’re using older donors, we have better surgical techniques, we have advances in immunosuppression, and we have better matching of donor and recipient factors. All these things allow us to have better outcomes.” 

Study coauthors are Malcolm MacConmara, MBBCh, FACS; Madhukar S. Patel, MD; Jigesh A. Shah, DO; Steven I. Hanish, MD, FACS; and Parsia A. Vagefi, MD, FACS. 

Citation: Kadakia Y, et al. Centurion Livers — Making It to 100 with A Transplant, Scientific Forum, American College of Surgeons Clinical Congress 2022. 

Centurion Liver Video (VIDEO)

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* Data. Organ Procurement & Transplantation Network. Accessed September 23, 2022. Available at: https://optn.transplant.hrsa.gov/data/ (.)  

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About the American College of Surgeons  

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons. 

Beyond humans – mammal combat in extreme environs

Goats and sheep combat in climate crisis

Peer-Reviewed Publication

WILDLIFE CONSERVATION SOCIETY

 

IMAGE: MOUNTAIN GOAT MOVES TO THREE BIGHORN RAMS; THE GOAT LATER DROPPED HIS HEAD AND ACTIVELY DISPLACED THE SHEEP AT A HIGH ELEVATION SNOW PATCH IN GLACIER NATIONAL PARK. view more 

CREDIT: FOREST P. HAYES

A new study from the Wildlife Conservation Society (WCS), Colorado State University, and the National Park Service indicates previously unknown high altitude contests between two of America’s most sensational mammals – mountain goats and bighorn sheep – over access to minerals previously unavailable due to the past presence of glaciers which, now, are vanishing due to global warming. 

The study also points to other coveted resources such as desert water and shade in brutal environs from Africa, Asia, and North America; species in these extreme environments contest access to these biologically important resources but such interactions have not previously been catalogued by individual species, their size, or their status as ‘native’ or ‘exotic’. 

“While humans continue to be justifiably concerned about the climate-induced havoc we’re wreaking planet-wide, much has remained unknown about species aggression among our mammalian brethren” said Joel Berger, the lead author and Senior Scientist for WCS and the Barbara Cox-Anthony Chair of Wildlife Conservation at Colorado State University. 

The findings from this work were distilled from fragmentary information dating backwards some four decades and included species as different as marmots and baboons, oryx and elephants, and rhinos, along with wild (i.e., feral) horses which displaced native pronghorn, mule deer, and elk from desert waters.

The study revealed that mountain goats with their saber-like horns emerged victorious over bighorn sheep in more than 98 percent of contests at three sites along a 900-mile gradient of above-treeline mountainous habitat from Colorado to Alberta, Canada. While mountain goats are a native species in northwestern North America, they are exotic in Colorado and Wyoming, including the Greater Yellowstone Ecosystem, where they were introduced. Concerns there and elsewhere have focused on the extent to which goats may displace or outcompete native bighorns. Although it remains unknown if interactions to access resources have increased over time as our climate degrades, human activity has both increased and decreased access by wildlife to restricted resources such as minerals and water through road building and by the creation of artificial water sources. 

The study appears in the journal Frontiers in Ecology and Evolution. Co-authors, Mark Biel, Chief biologist at Glacier National Park in Montana, and PhD candidate Forest Hayes at CSU, pointed out that high elevation aggression between species, whether passive or active, highlight the importance of limited resources, but it’s been well known that both bighorns and mountain goats will travel up to fifteen miles or more to access these limited resources.  Desert elephants travel distances even more impressive – up to 40 miles – to drink from distant waterholes in Namibia. 

“It’s been exciting to gather data in wind, snow, and cold on goats and sheep in both Glacier and at Mt. Evans, Colorado, which reaches to more than 14,000 feet,” offered Forest Hayes where “our observations both at close range and from distances of more than a mile provided unique opportunities for detecting and understanding ecological interactions.” 

Berger, Biel, and Hayes suggest a possible role of climate challenge through ground water depletion in desert areas but recognize humans may be a more immediate threat as water use for people increasingly jeopardizes the fragility of biodiversity in these systems.  “If we can’t offer species other than ourselves a chance, we’re just cooking our fates along similarly destructive paths” offered Berger. 

Associated partners and funders for this project were Colorado State University and the Wildlife Conservation Society, Glacier National Park Conservatory, Denver Zoological Society, Denver Mountain Parks, and Frederick Dulude-de Broin at LaVal University. 

###

 

WCS (Wildlife Conservation Society)

MISSION: WCS saves wildlife and wild places worldwide through science, conservation action, education, and inspiring people to value nature. To achieve our mission, WCS, based at the Bronx Zoo, harnesses the power of its Global Conservation Program in nearly 60 nations and in all the world’s oceans and its five wildlife parks in New York City, visited by 4 million people annually. WCS combines its expertise in the field, zoos, and aquarium to achieve its conservation mission. Visit: newsroom.wcs.org Follow: @WCSNewsroom. For more information: 347-840-1242.

 

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JOURNAL

Frontiers in Ecology and Evolution

DOI

10.3389/fevo.2022.991714 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Species Conflict at Earth’s Edges – Contests, Climate, and Coveted Resources

ARTICLE PUBLICATION DATE

17-Oct-2022

How do mushrooms become magic?

Research examines why some fungi evolve psychedelic properties

Grant and Award Announcement

UNIVERSITY OF PLYMOUTH

 

VIDEO: A TIMELAPSE VIDEO OF PSYCHEDELIC AND NON-PSYCHEDELIC FUNGI GROWING IN THE LAB view more 

CREDIT: UNIVERSITY OF PLYMOUTH

Psychedelic compounds found in ‘magic mushrooms’ are increasingly being recognised for their potential to treat health conditions such as depression, anxiety, compulsive disorders and addiction.

However, very little is known about how such compounds have evolved and what role they play in the natural world.

To address that, scientists from the University of Plymouth are conducting a first-of-its-kind study using advanced genetic methods and behavioural experiments to address previously untested hypotheses into the origin of psychedelic compounds in fungi.

This includes exploring whether such traits have evolved as a form of defence against fungus-feeding invertebrates, or whether the fungi produce compounds that manipulate insect behaviour for their own advantage.

The project will particularly focus on psilocybin, commonly found in so-called ‘magic mushrooms’. In chemical terms, it is very similar to serotonin, which is involved in the sending of information between nerve cells in animals.

The researchers are sampling psychedelic and non-psychedelic fungi, and using next-generation DNA sequencing to test whether or not there is a diverse animal community feeding on psychedelic fungi.

They are also using laboratory tests to investigate fungal-insect interactions, and whether the fungi undergo genetic changes during attack and development. They will also investigate the effect of psilocybin on the growth of soil bacteria.

The research will also involve using cutting-edge gene editing technology to try and create mutant fungi that cannot synthesize psilocybin. It is hoped this will help researchers better understand the role of a wide range of fungal compounds in future.

The study is being led by a team of experienced researchers in molecular ecology, animal-plant interactions and fungal biology in the University’s School of Biological and Marine Sciences. Driving the study are Post-Doctoral Research Fellow Dr Kirsty Matthews Nicholass and Research Assistant Ms Ilona Flis.

Dr Jon Ellis, Lecturer in Conservation Genetics, is supervising the study. He said: “In recent years, there has been a resurgence of interest in psychedelic compounds from a human health perspective. However, almost nothing is known about the evolution of these compounds in nature and why fungi should contain neurotransmitter-like compounds is unresolved.

“The hypotheses that have been suggested for their evolution have never been formally tested, and that is what makes our project so ambitious and novel. It could also in future lead to exciting future discoveries, as the development of novel compounds that could be used as fungicides, pesticides, pharmaceuticals and antibiotics is likely to arise from ‘blue-sky’ research investigating fungal defence.”

Dr Kirsty Matthews Nicholass said: “Within Psilocybe alone, there are close to 150 hallucinogenic species distributed across all continents except Antarctica. Yet, the fungal species in which these ‘magic’ compounds occur are not always closely related. This raises interesting questions regarding the ecological pressures that may be acting to maintain the biosynthesis pathway for psilocybin.”

The research is being funded by the Leverhulme Trust and builds on the University’s long-running expertise in novel elements of conservation genetics.

Researchers involved in this project have previously explored the genetic diversity among UK pollinators, the feeding preferences of slugs and snails, and developed an early warning system for plant disease.

 

Scientists are looking to address untested hypotheses into the

 origin of psychedelic compounds in fungi

The researchers have sampled psychedelic and non-psychedelic fungi

from the wild to explore a range of currently untested hypotheses

CREDIT

University of Plymouth

Dr Jon Ellis talks about the history of research into psychedelic compounds in nature

“Fungi generally receive less attention overall than animals and plants, partly because they are less apparent, people interact with them less and they can be hard to study. Historically, there have also been legal barriers which meant certain research has not previously been possible. Saying that, there were some very interesting studies in the 1940s and 50s into the use of LSD as a psychotherapeutic treatment for alcoholism and obsessive-compulsive disorder. Around that time, people also became interested in fungi from an anthropological perspective.

"One couple, the Wassons, went to Mexico and witnessed the ritual use of fungi for the first time in religious ceremonies. Articles they published brought public attention to psychoactive mushrooms. Around this time, there were also other charismatic individuals, such as Timothy Leary, who advocated the use of LSD more widely by the general public. In the 1960s, psychedelic compounds really came to widespread public attention and that ultimately led to governments introducing new laws to restrict their use.

"For some time, that also restricted the fundamental research that could be carried out. More recently, people have returned to that initial research and found that compounds such as psilocybin can have psychotherapeutic benefits. However, that has not addressed their evolution in nature, which is what makes the research we are doing so exciting.

"I hope our project can change the public perception of magic mushrooms. But beyond that, asking questions about the biological world is a fundamental part of our human nature and this project fits into a long narrative of research asking questions about biodiversity and its evolution.”