World Congress on Organ Transplantation and Artificial Organs August 24-25, 2018 Tokyo , Japan

Biography:

Sang Soo Kim had focused at his research area to establish the pathogenesis of diabetes and its complication and to identify novel methods for early diagnosis and treatment of diabetic complications at Pusan National University Hospital. He had participated in a number of randomized clinical trials as Principal Investigator or Sub-Investigator. Specially, he had published a number of original articles related to diabetic complication (diabetic nephropathy and neuropathy) at peer-reviewed international journals. As a Visiting Scholar, he had conducted experimental studies for hypothalamic metabolism at Division of Endocrinology and Diabetes and Metabolism at Beth Israel Deaconess Medical Center, Harvard Medical School for 2 years.

Abstract:

The increasing number of people with diabetes has had a major impact on the prevalence of diabetic kidney disease, which is a metabolic disorder with high morbidity and mortality and is the leading cause of End-Stage Renal Disease (ESRD). To improve the lives of people with diabetic kidney disease (DKD) and to reduce the impact on society, early identification of the development or progression of DKD using appropriate screening and diagnostic tools is very important in order to provide timely and proper management. Albuminuria is considered as a sensitive marker of Chronic Kidney Disease (CKD) and Cardiovascular Disease (CVD) risk, and is used as the first clinical indicator of DKD. Although the presence of urinary albumin is recognized as an early marker of DKD, significant glomerular damage has already occurred by the time albuminuria is apparent. It has been suggested that Non-Albumin Proteinuria (NAP), rather than albuminuria, might be an important biomarker for early detection of the de­velopment and progression of DKD. We recently demonstrated that urinary NAP might be a sensitive and specific marker of tubular damage that predicts renal impairment in type-2 diabet­ic patients. Furthermore, non-albumin proteinuria showed additional value over and above that of albuminuria for predicting the progression of CKD in patients with type-2 diabetes. Whereas, there is no doubt that hypertension plays a pivotal role in developing DKD. Thus, the role of NAP as biomarkers in hypertensive disorder might be considered quite interesting in the future.

Biography:

Janez Rozman, Ph. D. was born in Novo mesto, the Republic of Slovenia, in 1956. In 1982 he finished his engineering degree at the Faculty of Natural Science at the University of Ljubljana in the Republic of Slovenia. He received a M.Sc. degree in 1988 from the same institution. The title was: Electron Microscopic Investigation of the Surface of Electrodes of Implants Removed from  Human Tissue. In January 1993, he finished his dissertation entitled: Selective Stimulation of Nerve Fibers at Faculty of Electrical Engineering University of Ljubljana. In January 1994, he his colleagues have established a small research company ITIS d. o. o. Ljubljana and formed his own research group Center for Implantable Technology and Sensors. His research interests concern investigation of possibilities in selective stimulation of autonomic nerves, ganglia, glands and other organs to improve their function in disease. Link to the references:http://izumbib.izum.si/bibliografije/Y20170120172405-A2227555.html.

Abstract:

Statement of the Problem: Electrical nerve stimulation has been widely applied in both neuroscience and clinical practice. Among numerous alternative neuro-modulation techniques, opto-thermal methods are becoming more and more popular. The foremost advantage of using infrared light (IR) pulses for nerve stimulation over electrical methods is high spatial resolution, lack of stimulation artifacts and lack of electrochemical processes.

Methodology & Theoretical Orientation: As concluded by Wells et all. (2007), neuronal activation using IR occurs mainly by a photo-thermal mechanism due to IR-induced brief temperature transients (dT/dt and dT/dx). The rapid temperature rise induces a transient change in the electrical capacitance of the neuron's plasma membrane, which in turn depolarizes the cell and induces a propagating action potential (AP). The wavelength was chosen based on the desired penetration depth in the nerve tissue. We propose to use short-wavelength infrared (SWIR, IR-B DIN) light with wavelength of 1936 microns emitted by a Light Emitting Diode and conducted using an optical fiber.

Findings: We developed the equipment including a measuring chamber, a SWIR source, optical chopper, multi-electrode recording spiral nerve cuff and CAP amplifier. The stimulator is capable of delivering extremely steep rectangular SWIR pulses ranging from 100 to 500 µs and energy of up to ∼1 J∕cm². The induced thermal transients should have a highly localized nature and fast temporal dynamics within the particular superficial region of on an isolated porcine vagus nerve.

Conclusion & Significance: This report describes the challenges related to the development of IR neuro-modulation therapies. Results will be relevant for further development of the VNS methods and implantable systems to be potentially used in clinical practice.

Biography:

Dr. Bruce Gelb is an Assistant Professor of Surgery at the NYU Langone Transplant Institute. He performs liver, kidney, pancreas, and living donor transplant surgery, as well as a key member of the Face Transplant team, leading the development and management of the immunosuppression regimens for the VCA program. He also serves as the Chair of the Quality Improvement Committee of NYU Langone Health.  Dr. Gelb also serves on the United Network for Organ Sharing (UNOS) Ethics Committee.  Dr. Gelb is concerned with a variety of issues in bioethics, with particular interest in the ethics of transplantation.  He currently serves as the President of the Board of Directors of the Global Bioethics Initiative, an NGO member of the United Nations Academic Impact with special consultative status with the UN Economic and Social Council.

Abstract:

Vascularized composite tissue allotransplantation (VCA) has become a feasible reconstructive option for patients with severe disfiguring injuries not otherwise amenable to conventional reconstructive techniques. Approximately 200 VCA transplants have been performed worldwide to date, 40 of which have been partial or full-face transplant surgeries.  The incidence of rejection exceeds 80% in the face transplant population.  This unacceptably high rate of early acute rejection is significantly higher than in abdominal and thoracic transplantation and has been attributed to the increased immunogenicity of skin containing grafts as well as frequent sensitization of the transplant recipient related to treatment of the original injury with allogeneic skin grafts and frequent blood transfusions. In August 2015, our transplant center performed the most extensive full face transplant in the world to date in a patient with a positive flow crossmatch (negative CDC crossmatch) utilizing a novel induction immunosuppression regimen targeting depletion of T cells and mature B cells utilizing rabbit anti-thymocyte globulin and a single dose of anti-CD20 monoclonal antibody.  The patient has been maintained on standard triple drug maintenance therapy (tacrolimus, mycophenolate, and prednisone).

At 35 months post-transplant, the recipient remains free from any rejection episode.  Periodic biopsies have been performed to confirming absence of histopathologic evidence of rejection.  The same induction regimen has been utilized in a second patient with similar early results.Early acute rejection in VCA transplant occurs at an unacceptably high rate.  Prevention of rejection episodes may improve long-term outcomes as has been seen in solid organ transplantation.  We are cautiously optimistic that this novel induction strategy targeting B and T lymphocyte depletion, along with conservative tapering of maintenance immunosuppression, may reduce the rate of early rejection in facial VCA.

Biography:

Ramesh K Batra is a Multi-Organ Transplant Surgeon at Yale University, USA. He has a special interest in bioethics in organ transplantation and is undergoing Higher Education in Ethics. His special interest includes maximum utility of deceased donor and living donor organs and how best to allocate the limited resource of organs.

Abstract:

The first kidney transplant in 1954 set the precedent for success of living donor kidney transplants for End Stage Renal Disease (ESRD) patients across the world. Kidney transplant from a deceased or a living donor in general is the gold standard treatment for ESRD patients over dialysis. The survival benefit offered is significantly higher with a Living Donor Kidney Transplant (LDKT) in comparison to a Deceased Donor Kidney Transplant (DDKT). Amongst the LDKT, much similar to the results for a DDKT, it is observed that a younger donor kidney leads to a longer graft and patient survival. Therefore, when a recipient with multiple donor options is evaluated by a transplant center, whilst controlling for other factors, a younger age becomes a preferred choice whilst selecting the appropriate donor. Therefore, it appears that selection of a living kidney donor is more likely based on the recipient outcome. But, from a purely living kidney donor perspective, the impact of nephrectomy on life expectancy and cumulative risk of ESRD worsens with advancing age of the donor. This impact is more pronounced for black males as compared to white. So, a younger black donor suffers higher long-term risks after kidney donation, although they provide a superior quality allograft for the recipient. Similarly, following a utilitarian approach, Estimated Post Transplant Survival score (EPTS) should also be applied to living donor kidney recipients when encountered with multiple donor options. A living donor transplant is geared with the primary responsibility towards minimizing risks to the donor and this consideration should be followed when choosing between a donor, rather than the objectivity of age. This consideration should also include the recipient age and their life expectancy to achieve maximum utility of the donated allograft, by utilizing the EPTS score.

Biography:

Chris Elliott is a Fellow of the UK Royal Academy of Engineering and a Barrister (trial lawyer) specializing in regulated technology. He has wide experience of the development of leading-edge technological products and their regulatory approval. For the last 7 years, he has specialized in the innovative measurement of blood pressure and the clinical exploitation of the results.

Abstract:

For many patients’ hypertension is asymptomatic, often called the silent killer. Early detection and treatment can massively reduce mortality but need accurate measurement. For most people that is not possible, either because they cannot visit a medical practitioner or, even if they could, their consultations are hurried and rare with little time for a proper measurement of resting BP. Emerging technologies can change this. BP measurement using sensors and software built in to the ubiquitous smartphone can be medically accurate and free to the user. When coupled with telehealth consultations, it opens up a new vision of hypertension management. When used with other sensors already in the smartphone, the diagnosis extends to cardiac volume, arrhythmias, single-lead ECG and heart valve timing. The author’s company is conducting clinical trials of a device that is small enough and cheap enough to be bundled with every smartphone, so opening up the prospect of 1 billion people per year gaining this capability at no direct cost, just as the camera in the phone imposes no direct cost. All of the measurements meet accepted accuracy standards because they use mature techniques like Riva-Rocci but with no cuff for blood pressure, infrared detection for body temperature, pulse oximetry for blood oxygen and others. The device is already in quantity production and is expected to be widely available in 2019. LMD’s sensor delivers actionable and reliable data to the user and clinician and has the potential to change hypertension management globally.

Biography:

Pushpanjali Swain is currently a Professor and Head of the Department of Statistics and Demography, National Institute of Health and Family Welfare, New Delhi, India. She was a WHO Fellow of Biostatistics and Epidemiology in 2007. She has contributed 25 research papers which were published in different journals at national and international level. She had monitored various large-scale surveys like District Level Household Surveys (DLHS) and Coverage Evaluation Survey (CES) of UNICEF of the country as a nodal person, monitoring of Annual Sentinel Surveillance for HIV Infection in India and coordinated the Integrated Behavioral and Biological Surveillance (IBBS) in the states of Rajasthan and Delhi in India

Abstract:

The objective of the study is to highlight the major contribution made by Auxiliary Nurse Midwife (ANM) to achieve the national targets of IMR, MMR and TFR through an innovative approach called mother and child tracking system in India and critically reviewed the achievements and shortcomings. India is a vast country with population of 125 crores having a large workforce about 2 lakhs of ANMs to take care of its women in the reproductive age group and children up to five years of age. ANM has been pillar to the India’s public health system to provide basic medical care to huge rural population in an extensive network of PHCs and health sub centres. It has been a concern of Government of India to reduce maternal deaths, infant and child mortality in the country. Also, India being signatory to MDGs and SDGs, various intervention strategy has been adopted like Nation Rural Health Mission in 2005. Under the mission large group of activists were identified and created at village level of 1000 population named ASHA to assist and support to ANMs. ANMs got the helping hand in terms of identifying pregnant women and infant and children in the village. For better planning and monitoring of the program an innovation project was launched in 2009 to track and plan for pregnant mothers and children through a web-based Mother and Child Tracking System (MCTS) to speed up the reduction of deaths of pregnant mothers and child deaths in the country. The study is descriptive in nature and used secondary data sources i.e. HMIS, rural health statistics, national health profile, sample registration system and national family health survey, etc. The data was analyzed for the period after implementation of MCTS and prior to the period of no MCTS to compare the speed of reduction of IMR and MMR. Studies show that awareness level of women in rural areas is low to avail services during pregnancy. MCTS is very much ANM centric. ANMs register all pregnant women and children below 5 years through MCTS and receive registration numbers. ANM gets the work plan weekly within her catchment areas so that she would know who are due for ANCs, delivery, post-natal care and immunization services. Once the due services given to pregnant mothers and children, the update of information was done in the portal. This process helped ANMs to update service. Analysis shows that there is an improvement of coverage of ANC, institutional delivery and immunization to infants and identification and addressing the prenatal and postnatal complications through the tracking system. Since the portal is internet based, in hilly and far flanged areas, services are not updated regularly due to power failure and slow network connectivity. Also, sub-center is not well equipped with internet and computer facilities so to update the services. She must go to block level to enter the data, there is a time lag between services and update so real time monitoring and tracking sometimes not possible. It shows that there has been significant reduction of IMR and MMR in the country during the period MCTS. Because ANM has been reminded about the quantum of job to perform every week and monitored by higher authority through the portal. Also, TFR is also declining and reached replacement level of fertility in most parts of the country except a few states.

Biography:

Subash Sapkota has obtained his MSc Human Anatomy (Medical) from Kathmandu University in 2015. He has worked as a Lecturer in Kathmandu University and is currently working in Gandaki Medical College. He is continuously involved in animal experiment and has potential in research field.

Abstract:

The study was carried out to investigate the effect of pyrethrum based mosquito coil smoke on the biochemistry and histomorphology of the Wister albino rats. The experiment involved two groups of rats (experimental group and control group, n=10), weighing between 150 to 200 g. Before exposure to pyrethrum coil, blood samples were collected from the femoral vein. After that the experimental rats were exposed to the smoke of pyrethrum for a continuous duration 8 hours daily in 27 m³ (3´3´3) well ventilated room for 10 weeks. Thereafter, the blood samples were taken through cardiac puncture and comparison was made with those in the control group. Apart from that different organs were collected after intracardial perfusion technique under Ketamine (80 mg/kg) and Diazepam (2.5 mg/kg) using 10% phosphate buffer formalin. The smoke from the coils induce significant increase (p≤0.05) in the levels of WBC, RBC, Hb and significant decrease (p≤0.05) in platelets, Blood Urea Nitrogen (BUN) and total protein in biochemical study. The elevated levels of hepatic enzymes were found in the serum of the rats exposed to smoke. This indicated that the enzymes were released from the damaged tissues into the bloodstream. Similarly, smoke induced histopathological changes, including inflammation of the tracheal epithelium, congestion of lung parenchyma with foci of pneumonia. Likewise, dilatation of sinusoids, pericentral vein and periportal tract inflammation and necrosis of hepatocytes were observed. In kidney patchy perivascular and interstitial inflammatory cells were seen whereas glomeruli and tubules appeared unremarkable. In conclusion, prolonged exposure to pyrethrum coil and mat can lead to deleterious effect on health affecting mainly pulmonary, liver and kidney functions apart from allergic reactions and risk of pyrethroid poisoning.

Biography:

Laju Maya Basnet is an Anatomist working as a Lecturer in Department of Anatomy, Nepal Medical College, Nepal since 2013. She has obtained her MSc Anatomy (Medical) from Manipal College of Medical Sciences, Pokhara, Nepal in 2012. She has published 2 original research articles, 2 case reports and a practical anatomy book.

Abstract:

Objective: The present study was undertaken to know the anatomical basis of Medial Sural Artery (MSA) and its perforators.

Methods: The popliteal arteries of 16 preserved cadaveric lower limbs were injected with a mixture of red ink and glycerine. The number, location, diameter of perforators; length and intramuscular course of pedicle; the branching pattern of MSA were observed and measured.

Results: The mean of 2.2±1.2 perforators (range, 0 to 4) was observed. The perforators were clustered between 8.6 to 25.7 cm from the popliteal crease and 0.3 to 7.5 cm from posterior midline of leg. The dominant perforators were observed in middle 1/3^rd of the leg. The average pedicle length was 12.04±3.27 cm. The intramuscular courses of pedicles were observed in deep and superficial strata in 65.7% and 34.3% respectively. The MSA originated from popliteal artery in 62.5% and common sural artery in 37.5%. An accessory MSA was found in 12.5%. Type I and Type III branching pattern of MSA were observed in 31.2% each whereas Type II was found in 37.5%. The mean external diameter of perforators and MSA were 0.85±0.27 mm and 2.2±0.43 mm respectively.

Conclusion: The metrical presentation of this study provides an easy access to know about the distribution of perforators and branching pattern of MSA which will help the surgeons to make a convenient plan to harvest the MSA perforator flap in Nepalese population

Biography:

Russell Miller is a Motivated health development professional seeking new long-term opportunity in the Life Science and Healthcare industries in Japan. Experience in laboratory, biotech and science communication fields both in Japan and US. He completed his Master of International Health from The University of Tokyo

Abstract:

Background & Aim: The prognosis of Pancreatic Ductal Adenocarcinoma (PDAC) remains poor due to the difficulty of disease diagnosis and therapy. Immunotherapy has had robust performance against several malignancies, including PDAC. In this study, we aim to analyze the expression of CD8 and FoxP3 on T cell lymphocytes in tumor tissues and analyze the possible clinical significance of these findings in order to find a novel effective immunotherapy target in PDAC using a murine model.

Methods: A tissue microarray using patient PDAC and matched non-tumorous samples was stained and analyzed for associations with clinicopathological characteristics. A preclinical murine model administrated with various immunotherapies was analyzed with growth inhibitor, flow cytometry, enzyme-linked immune-sorbent assay and immunohistochemistry.

Results: Infiltrating FoxP3⁺ regulatory T cells (Tregs) levels in tumor tissues were associated with survival, while CD8+ infiltrating T cells (TILs) were not. Considering the drawbacks of these measures alone, the number of CD8+ and FoxP3+ T cells were combined to create a new estimated value Integrated Immune Ratio (IIR), which showed excellent validity in survival risk stratification. IIR was further verified as an independent prognostic factor according to multivariate analysis. In our preclinical murine model, CD25 and TGF-β combination blockade had a higher tumor growth inhibitor value. This combination therapy significantly depleted periphery and intratumor FoxP3⁺ Tregs while increasing intratumor CD8⁺ T cell levels compared to controls or anti-TGF-β monotherapy (p<0.05). Anti-CD25 monotherapy alone also had the ability to deplete periphery and intratumor Tregs (p<0.05). Intratumor IL-10, TGF-β was notably lower associated with higher IFN-γ excretion in this combination immunotherapy. Such combination immunotherapy was further confirmed to synergize with anti-PD-1 monotherapy to improve tumor growth inhibition and Japan cure rates.

Conclusion: The combination of CD25, TGF-β and PD-1 blockade plays a potentially effective role in inhibiting tumor formation and progression. Our results also provide a strong rational for use of IIR in future immunotherapy clinical trials.

Biography:

Mirwais Amiri had completed 6 months Residence in Orthopedics at LRH Peshawar, Pakistan and then 1 year in Cardiology at PGMI HMC, Peshawar, Pakistan. He has later joined Afghan National Army Hospital (Late Sardar Mohammad Dawood Khan Hospital) in Medicine Department and then got opportunity to go to Escorts Heart Institute & Research Centre, New Delhi, India where he successfully completed three years tenure and did Fellowship in Noninvasive Cardiology and then rejoined Cardiology Department of Late Sardar Mohammad Dawood Khan Hospital (Afghan National Army Hospital).

Abstract:

Cardiovascular diseases are one of the leading causes of deaths in Afghanistan accounting for 19% of the total annual deaths (World Health Organization, Non-Communicable Diseases (NCD) Country Profiles, 2014). Cardiology at Amiri Medical Complex is developing as a key department, which has already treated a record number of cardiac patients in the history of Afghanistan in just three years of its establishment. The focus of the cardiology department is the delivery of top-quality and timely cardiac care to patients in the hospital setting that is critical to its success. Since April 2015, approximately 0.17M patients have visited the facility for treatment of which 0.1M (59%) has been treated for cardiac ailments. A total of 1,326 cardiovascular surgical procedures comprising of CABGs, valve replacements, corrective surgery for congenital heart disease and vascular surgeries have been done. Over 5,000 catheterization lab procedures comprising of diagnostic coronary and peripheral angiographies, right heart catheterization study, coronary angioplasties with stenting, ASD and PDA device closure, aortic and pulmonary valve balloon dilatation procedures have been done. The last one-year mortality rate for the cardiovascular surgical cases is 6.2% whereas for catheterization lab it is 0.47%. In short time, the Cardiology Department’s significant contribution to Afghanistan cardiac health with low mortality rate is a great breakthrough in the health history of Afghanistan.