However, the design of the present study with a restricted number

However, the design of the present study with a restricted number of available very old 3xTg mice does not allow more detailed biochemical and immunohistochemical analyses as well as additional behavioural testing. Such studies might include links between abnormal phosphorylation and conformational changes of tau, possibly also affecting GSK 3β known as an important enzyme for the generation of phospho-tau epitopes [65] and shown here in cells co-labelled with AT8. These

desirable efforts are mainly forced by the widely accepted crucial role of abnormal tau and tangle formation in AD and other tauopathies such as corticobasal degeneration, argyrophilic grain disease, progressive supranuclear palsy, Pick’s disease and fronto-temporal dementia (for reviews on

tauopathies see [6, 66, 67]). In AD patients, the number of CHIR-99021 nmr counted tangles post mortem correlated with the severity of dementia in lifetime [56]. Transgenic models already contributed to novel concepts for a better understanding of AD and other neurodegenerative disorders as summarized by several reviews [12, 14, 68, 69]. However, the incomplete nature of these models allows recapitulation of only a few aspects of the complexity in AD [1, 15, 70, 71]. Furthermore, models with less limitations might also settle controversies of whether deleterious effects of tau pathologies result from toxic gain-of-function by pathological tau or from critically affected tau function in the AZD8055 mw disease state [72]. Improved models might verify the proposed, partly neuroprotective role of tau phosphorylation [73]. Notably, Western blotting has revealed considerably enhanced Cytidine deaminase hippocampal GFAP levels in 7-month-old immunolesioned 3xTg versus naive mice. This might partially model the general and dramatic glial reaction as already described by Delacourte

in 1990 [74]. While fluorescence labelling also suggested enhanced gliosis associated with strong Aβ-immunoreactivity, it only allows for qualitative estimation. The observed activated glia surrounding plaques resembles the relationships of microglia and astrocytes to Aβ deposits in AD and in mouse models with age-dependent β-amyloidosis such as Tg2576 [75]. Microglia as active sensors and versatile effector cells in pathologically altered brain [76] have been reported as a driving force in plaque formation, whereas astrocytes were found as a leading factor in their degradation [77]. On the other hand, the proposed role for microglia in plaque maintenance [78] could not be confirmed by Grathwohl et al. [79]. However, microglia were found to be increasingly dysfunctional during ageing, possibly contributing to age-dependent neurodegeneration [80], which remains a promising target for therapeutic intervention.

49–2 76,

P = 0 02) Up to the last follow-up, 61 patients

49–2.76,

P = 0.02). Up to the last follow-up, 61 patients (83.5%) had returned to their previous work. The Rosén–Lundborg model can be a useful and simple tool for the evaluation of the functional outcome after nerve injury and repair temporally reflecting the processes of regeneration and reinnervation. © 2010 Wiley-Liss, Inc. Microsurgery, 2011. “
“In this report, we present our experience with subcutaneous rt-PA injection for salvage of free radial forearm flaps with vascular compromise. Three patients underwent reconstruction of defects of the soft palate or the lateral tongue with a free radial forearm flap. Patients underwent on average two attempted operative revisions with thrombectomy and intravenous heparin injections. After recurrent venous thrombosis Selleck Bioactive Compound Library 3–6 days after surgery, rt-PA (Alteplase

2 mg; 1,160,000 IE) was injected subcutaneously at multiple sites into the compromised flap as final attempt. In all three patients, successful thrombolysis with no or only partial soft tissue loss was achieved after subcutaneous injection of rt-PA. We therefore suggest subcutaneous rt-PA injection as an additional tool in managing difficult and recurrent cases of venous thrombosis in free flap head and neck reconstruction. © 2013 Wiley Periodicals, Inc. Microsurgery 33:478–481, 2013. “
“It is thought that the small intestine may provide a scaffold for pancreas regeneration. Herein, we investigated whether fetal pancreatic tissue could be Selleckchem Ponatinib transplanted into the segmental intestine in rats. Morin Hydrate Fetal pancreases from firefly luciferase transgenic

Lewis rat embryos (embryonic day 14.5 and 15.5) were transplanted into streptozotocin (STZ)-induced diabetic wild-type Lewis rats. As a scaffold for pancreatic development, rat small intestinal segments were utilized after the removal of mucosa, and fetal pancreases were grafted into the luminal surface through the stoma. We also transplanted fetal pancreases into the omentum. The survival of transplanted fetal pancreases was monitored by luciferase-derived photons and blood glucose levels. Transplanted fetal pancreas-derived photons were stable for 28 days, suggesting that transplanted fetal pancreatic tissues survived and that their intestinal blood supply was maintained. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. “
“Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA. Gabriel A. Del Corral is currently at Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA Early free flap coverage in lower extremity trauma is a practice largely supported by research that may be outdated and is frequently impractical due to logistics, resuscitation efforts, and associated injuries. Our objective was to re-evaluate this paradigm to determine whether reconstructive timing impacts outcome in modern clinical practice.


“Viral diseases restrict the development of the world shri


“Viral diseases restrict the development of the world shrimp industry and there are few studies on cell response to the presence of viral infections. We performed immunohistochemistry assays https://www.selleckchem.com/products/jq1.html to characterize hemocytes subpopulations involved in the immune process occurring in the LO of Litopenaeus vannamei shrimp. Tissue sections of animals that increased their LO spheroids and hemocytes infiltration after WSSV induced infection, were used. Three MABs namely, 40E10 (recognizing small granule hemocytes), 40E2 (recognizing

large granule hemocytes), and 41B12, which recognize α2-macroglobulin were used. Additionally one polyclonal antibody was used against the penaeidins antimicrobial peptides, and to detect WSSV a commercial immunohistochemistry kit (DiagXotics) was used. Numerous small granule hemocytes were detected in the stromal matrix of LO tubules, whereas large granule hemocytes were less numerous and located

mainly in hemal sinuses. The exocytosis of two molecules, which have been related to the phagocytosis process, i.e. penaeidins, and α2-macroglobulin, was detected in the external stromal matrix and the outer tubule walls. α2-macroglobulin inhibits phenoloxidase activity and its strong release in LO tissue may explain the absence of melanization in the immune processes occurring in it. The immunolabeling of vesicles within the LO spheroids with MABs 41B12 40E10 and antipenaedin antibody suggests that LOS are formed by phagocytic cells derived find more from small granule and hyaline hemocytes, with a possible role of peneidins and α2-macroglobulin acting as opsonines. Viral diseases represent the major constraint to shrimp culture development in the world. Despite the progress in knowledge of shrimp immune defense, few studies focus on the cell response to viral infection. Phagocytosis has been reported as a useful mechanism of viral clearance in penaeid shrimp and its suppression by inhibitors increases susceptibility Janus kinase (JAK) to WSSV (1). Molecular events involved in shrimp phagocytosis begin to be characterized. A phagocytosis

activating protein was isolated in Penaeus monodon and Marsupenaeus japonicus shrimp (2), its expression being induced by immunostimulation with WSSV, increasing the phagocyte index in P. monodon (2). This protein has sequence similarity with the ribosomal protein RPL26, which is upregulated in activated murine macrophages. During the process of phagocytosis it is found that the small G protein superfamily is necessarily required. Thus, Wu et al. (3) determined that a Rab GTPase could regulate the hemocytic phagocytosis in M. japonicus, forming a four protein complex consisting of Rab, β-actin, tropomiosin and WSSV envelop protein and Liu et al. (4) found that RanGTPase regulates the phagocytosis in the WSSV-resistant shrimp by interacting with myosin. Clearance of foreign material from the hemocoel of decapod crustaceans involves several distinct kinds of cells and tissues (5).

Cases of Aspergillus osteomyelitis in bones after surgery in that

Cases of Aspergillus osteomyelitis in bones after surgery in that area suggest that infection may also be caused by contamination during surgery. In a study published in 2005, 20 cases of osteomyelitis caused by Aspergillus spp. were analysed. Eighteen patients had definite bone involvement diagnosed (spondylodiscitis in 9, sternum/rib osteomyelitis

in 6, and peripheral bone involvement in 5). Fourteen of 20 patients were immunocompromised for various reasons. In seven cases, surgical intervention was required, 57% (four patients) responded well to the surgical therapy, while click here in three patients the therapy failed.[47] In a review by Stratov et al. [48], who investigated 42 cases of invasive Aspergillus osteomyelitis, surgery in combination with liposomal amphotericin B increased the success rate to 69% in comparison to 14% cure rate, when therapy consisted of amphotericin B alone, suggesting the important role of surgery in Aspergillus bone infections. Studenmeister et al.

[49] analysed (2011) 21 cases of vertebral osteomyelitis caused by Aspergillus spp. and found that while most cases were caused by haematogenous spread, one quarter of the patients developed the osteomyelitis after having surgery on the spine, suggesting contamination during surgery. Most of the 21 patients received surgical therapy. Patients who received combined surgical and medical selleck inhibitor therapy had favourable outcome, while antifungal therapy alone resulted in complete response in only two cases. However, reported cases of immunocompetent patients successfully treated with azoles alone – without surgery – suggest that successful buy Baf-A1 outcomes may be possible without surgery in selected cases.[49, 51] The potential of Aspergillus osteomyelitis to spread into the cartilage was reported in a study, in which the therapy of sternal osteomyelitis after open-heart surgery was discussed. In two of 20 patients Aspergillus spp. were isolated from the sternum. Both were presenting with a sterno-cutaneous fistula, needing aggressive surgical debridement,

wire removal and resection of the infected cartilage.[50] A similar case also requiring extensive cartilage debridement was reported recently.[53] Dotis and Roilides investigated 46 cases of osteomyelitis due to Aspergillus spp. in immunocompromised patients with chronic granulomatous disease in 2011. Thirty-one (67.4%) patients underwent surgical debridement, overall mortality was 37%. In 20 of 31 patients, extensive surgical debridement of infected bone material was necessary. The surgical intervention appeared to be a key success factor for the therapy. Twenty-three patients were infected with A. fumigatus and 20 patients with A. nidulans. Of the 23 patients with A. fumigatus, 12 underwent surgery and two died (17%). Of the 20 patients with A. nidulans, 16 underwent surgery and nine (56.3%) died.[51] Horn et al.

4 Albendazole is effective treatment for infection with Encephali

4 Albendazole is effective treatment for infection with Encephalitozoon species but is less effective for Enterocytozoon infections. Fumagillin is considered more effective for Enterocytozoon infections but it has significant bone marrow toxicity. To our knowledge, only 21 cases of disseminated microsporidiosis have been reported worldwide in non-HIV, solid organ transplant and bone marrow transplant recipients.5E. bieneusi was the most commonly isolated microsporidia and disseminated disease with Encephalitozoon species in non-HIV-infected,

transplant recipients is considered rare with only five such cases being reported worldwide.3 AZD8055 manufacturer Moreover, mortality rates are high and diagnosis was established post-mortem in many instances. This case is the first I-BET-762 in vivo disseminated microsporidiosis with Encephalitozoon species in a non-HIV, solid organ transplant recipient to be reported and successfully treated in Australia. None. “
“Cystatin-C (CysC) has been demonstrated as a sensitive and reliable biomarker to predict the onset of acute kidney injury (AKI). However, there are few studies concerned about the relationship between CysC and the outcomes of AKI. The aim of the present study was to determine whether CysC elevation prior to definite diagnosis of AKI is related to higher prevalence of death and dialysis

need outcome. A meta-analysis was conducted by searching PubMed, EMBASE and Cochrane Library database unless using the terms related to AKI combined with ‘cystatin-C’. Bibliographies of relevant papers were reviewed manually. Eligible studies were those investigating death and dialysis need outcomes after AKI with CysC measurement, and were limited to English articles. Non-human studies were excluded. Random effect Mantel-Haenszel statistical method was used. Six studies were finally enrolled, consisting of 2332 patients. All of these studies were hospital-based prospective cohort studies. The follow-up duration varied from 5 days to 1 year. The odds ratio values for baseline CysC elevation and death as well as baseline CysC elevation and dialysis

need were 2.34 (95% confidence interval [CI] 1.46–3.75) and 4.40 (95% CI 1.58–12.22), respectively (both P < 0.05). Patients with CysC elevated prior to AKI diagnosis have higher risk to develop death and need dialysis during short- and long-term follow-up after AKI, thus having worse outcomes. This population deserves more careful observation and might benefit from more frequent follow-up visits in the clinic. Future work is needed to get a consensus cut-off value defining CysC elevation. "
“Aim:  To identify the variations in paediatric renal biopsy pathology and clinicopathological features during the past 31 years. Methods:  A retrospective analysis of paediatric renal biopsies performed at a single institution in Shanghai from January 1979 to December 2009 was conducted.

The organization of these gVLR genes differs depending on the gen

The organization of these gVLR genes differs depending on the gene and species (2b). The possible combinations of VLRA and VLRB are estimated to generate a potential repertoire that is almost equivalent to the TCRs

and BCRs of jawed vertebrates, (> 1014) [22]. This observation suggests that VLRs are the antigen receptors of jawless vertebrates. Consistent with this, lampreys immunized with human erythrocytes or anthrax spores of Bacillus anthracis produce antigen-specific soluble VLRB molecules that act as antibodies [22], [23]. These observations indicate that, despite their lack of structural similarity to the https://www.selleckchem.com/products/PLX-4032.html antigen receptors of jawed vertebrates, VLRs function as antigen receptors in jawless vertebrates. During development of LLCs, LRR modules are inserted into the gVLR gene by a gene conversion-like

mechanism (2c) [19], [24]. Multiple LRRNT-, LRR1-, LRRV-, LRRVe-, CP- and LRRCT-encoding modules are located proximally to the gVLR gene. A homologous sequence is used to prime the insertion of those modules during VLR assembly. The sequences located at the ends of the most newly copied LRR module determine the next LRR module. In this way, LRR modules are unidirectionally inserted into the gVLR gene. Although, monoallelic assembly of the VLRA and VLRB genes occurs in the majority of cases, diallelic assembly has learn more been observed in a few cases [25]. In such instances, one mature VLR gene encodes a functional VLR structure, while the other does not. The

unsuccessful mature VLR gene contains an in-frame stop codon. These observations indicate that an inhibitory feedback mechanism regulates VLR assembly. The molecular mechanism of VLR assembly is still unknown. However, two CDAs, CDA1 and CDA2, have been identified as candidate molecules that may mediate gene conversion [19]. Generation of antibody diversity by gene conversion in birds, rabbits and cattle requires AID, which belongs to the apolipoprotein B mRNA editing enzyme, catalytic Thymidylate synthase polypeptide family of molecules [26]. Phylogenetic analysis and secondary structure prediction suggest that AID and CDA1 are more closely related to each other than are AID and CDA2. Over-expression of the CDA1 molecule in yeast confers a mutagenic phenotype and increases the rate of intragenic recombination. Previous reports have revealed that CDA1 and CDA2 are expressed in VLRA+ and VLRB+ LLCs, respectively [27]. Thus, the jawless vertebrate CDA1 and CDA2 molecules may control gene conversion-like processes in VLRA+ and VLRB+ LLCs, respectively. Jawless vertebrates possess both soluble and membrane-bound forms of VLRB [17], [28]. Soluble VLRB antibodies are organized into pentamers or tetramers of dimers, similarly to immunoglobulin M of jawed vertebrates. The cysteine residues that are located in the 3′-invariant stalk region are required for VLRB antibodies to form oligomers.

There are two

previously published proteomics studies usi

There are two

previously published proteomics studies using serum25 or liver tissue26 from patients across the spectrum of NAFLD. In the first and GPCR Compound Library supplier only other proteomics study using serum samples, Younossi et al.25 identified 12 protein peaks with significant differential expression when patient groups and controls were compared. In a recent proteomics study utilizing liver tissue from patients with NAFLD and controls, Charlton et al.26 identified nine proteins with differential expression between study groups, and all proteins exhibited functions previously implicated in the pathogenesis of NAFLD and NASH, including biological response to increased hepatic lipid content, inflammation, mediation of fibrosis, and fatty acid transport. Our study utilized an ion-intensity based, label-free quantitative proteomics approach (LFQP) that has gained popularity in recent years as the performance of mass spectrometers has improved.27–30 Using this LFQP approach, we detected 1,738 proteins in serum samples obtained from control subjects and NAFLD patients. Of these proteins, expression of 605 proteins differed significantly (q < 0.05) between any two patient groups. Further analysis revealed that expression of 229 proteins differed significantly when control subjects were compared with any

of the three NAFLD patient groups. There were no significant differences observed between the simple steatosis and NASH groups, Ribociclib manufacturer https://www.selleckchem.com/products/bmn-673.html suggesting that systemic markers of fatty liver and NASH may not be present in serum from patients with mild disease. However, there were 55 proteins that were different between the simple steatosis and NASH F3/F4 group and 15 proteins that differed between the NASH and NASH F3/F4 patients. These proteins may be particularly helpful in identifying biomarkers to diagnose and stage NAFLD and NASH. We further analyzed the biological significance of all priority 1 proteins with a significant change (q < 0.05) of at least 14% (1.14-fold change) based on the maximum observed change of the internal standard, chicken lysozyme. As described

below, several of these biological processes have been previously implicated in the pathogenesis of NAFLD and NASH and many of these identified proteins are only synthesized by the liver. Fifteen of the proteins that changed significantly are involved in immune system regulation and inflammation. One example is retinol binding protein 4 (RBP4), a protein we identified as having significantly decreased expression with increasing NAFLD severity. RBP4 is a cytokine synthesized by both the liver and adipose tissue that carries vitamin A in the blood and is involved in the development of insulin resistance.31, 32 Although some studies have shown an increase in serum RBP4 levels in patients with NAFLD,33, 34 a recent study by Nobili et al.

We evaluated and compared these alternative feeding behaviors in

We evaluated and compared these alternative feeding behaviors in relation to feeding kinematics and the shape of the mouth with high-speed digital imaging. VX-770 We tested the hypotheses that (1) L. labyrinthicus tadpoles use functionally different feeding kinematics when feeding on alternative food sources and (2) that the jaw sheaths of L. labyrinthicus tadpoles deform less during filter-feeding and substrate grazing compared with more common tadpoles not so specialized for macrophagous

carnivory. Our results show that filtering and scraping feeding behaviors differ significantly in both kinematics and shape of the mouth. During filter-feeding, tadpoles display longer gape cycles and attain a narrower maximum gape earlier in the cycle compared

with substrate grazing. Jaw deformation during opening and closing phases of the gape cycle is more pronounced during grazing on firm substrates. This deformation contributes to the achievement of a wider maximum gape during feeding. These differences appear to reflect behavioral adjustments by the tadpoles to maximize food intake. Feeding in tadpoles BMS-777607 concentration of L. labyrinthicus is not restrained by their typical carnivorous morphology. On the contrary, L. labyrinthicus tadpoles seem to be opportunistic feeders able to obtain nutrients from a variety of food sources by using different feeding strategies. “
“Patterns of infection and prevalence result from complex interactions between hosts and parasites, the effects of which are likely to vary by species. We investigated the effects of age, sex and season on the likelihood of individual infection, and the effects of host population size, sex ratio and age structure on parasite prevalence. We capitalized on data from a

long-term study of yellow-bellied marmots Marmota flaviventris potentially infected with fecal–orally transmitted intestinal Acetophenone parasites (Ascaris sp., Eimeria spp. and Entamoeba sp.), ectoparasitic fleas Thrassis stanfordi, and a flea- and louse-transmitted blood parasite Trypanosoma lewisi. Patterns of individual- and group-level infection varied widely by parasite. Yearlings were more likely to be infected with Tr. lewisi and Ascaris. Yearlings were also slightly more likely than adults to have Eimeria, but female yearlings had higher infection levels than female adults, while male yearlings had lower infection levels than male adults. Entamoeba infection decreased as the season progressed. Adults and males were more likely to be infected with Th. stanfordi. Ascaris prevalence increased with colony size. There were no significant relationships between colony size and prevalence of Entamoeba, Tr. lewisi, Eimeria or Thrassis. There was a small, but significant positive correlation between male-biased sex ratio and prevalence of fleas. The host population’s age structure affected the prevalence of infection of Ascaris and Eimeria.

Our study included 657 HCV infected patients with genotype 4 who

Our study included 657 HCV infected patients with genotype 4 who received interferon-based combination therapy and according to response to therapy they were divided into two groups:356

as responders and 301 as non responders. They were compared to 160 healthy control persons. LDL receptors Exon8c.1171G>A and Exon10c.1413G>A were Doxorubicin clinical trial assayed for all cases by real-time PCR-based assays. Correlation of LDL receptors polymorphism with HAI, META-VIR score, steatosis, and BMI were done to all cases. Results: There was no statistical significant difference in response rate between either different types of interferon used or LDL receptor Exon10c.1413G>A. However, there was statistical difference in frequency of LDL receptor Exon8c.1171G>A genotype between cases, control,responders and non responders. The G allele of LDL receptors Exon8c.1171G>A was predominant in cases Selleck Vismodegib and control than A allele and shows statistical significant association with response to interferon, so that carriers of A allele have 16.4 times risk for non response ( p<0.001). There was significant association between LDL receptors Exon8 c.1171G>A and HAI (<0.011). There was significant association between LDL receptors Exon8 c.1171G>A and BMI, where BMI mean level was highest in those carrying AA genotype. Again only significant association was found between LDL receptors Exon8 c.1171G>A and METAVIR score, steatosis (p<0.001) Conclusion: LDL receptor gene

polymorphism plays a role in the response of Nintedanib (BIBF 1120) the virus to treatment and in the modulation of disease progression in Egyptian population infected with chronic HCV. Frequency of the genotypes of LDLR gene polymorphisms in the studied groups: Disclosures: The following people have nothing to disclose: Mazen I. Naga, Mona A. Amin, Dina A. Algendy, Ahmed I. El Badry, Mai M. Fawzi, Ayman R. Foda, Serag M. Esmat,

Dina Sabry, Laila A. Rashed, Samia M. Gabal, Manal Kamal Introduction: Recent French report on viral hepatitis B and C recommended reinforced epidemiological surveillance, especially in populations with a high risk of infection. Prisoners are particularly affected by hepatitis B and C because of their behaviors, social status and isolation.This prospective study aimed to evaluate, in a population of incomers in French prisons, the prevalence and management of viral hepatitis and liver fibrosis. Patients and methods: HBV/HCV screening and a liver stiffness measurement with FibroScan (FS) were proposed to every incomer in prison, followed by a consultation of hepatology in case of a positive serology or a FS>7.1 kPa (significant fibrosis). Results: Between February 2012 and November 2013, 1791 incomers were included in 5 French prisons. Subject characteristics were: male 99%, mean age 32 years, BMI 23.5 kg/m2, drug injectors 7.5%, smokers 82%, opioid replacement therapy 11.3%, unemployed 38%, homeless 5%, first imprisonment 34.7%.

g , chronic rejection vis-a-vis chronic viral hepatitis) 65 The c

g., chronic rejection vis-a-vis chronic viral hepatitis).65 The concept that was developed from transplant AZD3965 price and infection models was generalized in the following way: “The migration and localization of antigen govern the immunologic responsiveness or unresponsiveness against infections, tumors, or self—and against xenografts or allografts.”65 In this view, all outcomes in the divergent circumstances of

transplantation, including those of microchimerism,150,171,172 were determined by the balance established between the amount of mobile donor leukocytes with access to host lymphoid organs and the number of donor-specific cytolytic T lymphocytes induced at the lymphoid sites (Fig. 11, inner graph).65 Long-term organ alloengraftment with this generalizable paradigm was a highly variable form of leukocyte chimerism-dependent tolerance, the completeness of which could be inferred from the amount of immunosuppression necessary to maintain stable function and structure of the transplant (Fig. 11). In a second article with Zinkernagel, the Pittsburgh-Zurich immunologic paradigm provided a road map for improved therapeutic strategies of transplant patient management based on two principles: recipient pretreatment and the least possible use of post-transplant immunosuppression.68 When applied clinically for different

kinds of organ transplantation,69 these strategies have minimized, or in some cases eliminated, the burden of chronic immunosuppression.173-178 More rational approaches also were developed for the treatment of opportunistic infections caused by noncytopathic GDC-0199 research buy microorganisms.70,168,179 A second trend coincided with and was empowered by the rise

of the Internet. One of the mandates of the 1984 National Transplant Act was the formation of an Organ Interleukin-3 receptor Procurement and Transplantation Network (OPTN). Another was the development of a Scientific Registry of Transplant Recipients (SRTR) with which patient and graft survival could be quantified from center to center along with center-specific parameters. After the Department of Health and Human Services (DHHS) awarded the contract for both functions to the United Network of Organ Sharing (UNOS), disputes about organ allocation within the appointed UNOS committee prevented the development of the required plan. In order to avoid a UNOS default of contract, a document was pieced together from two articles that were “in press”, which described the renal180 and nonrenal181 distribution systems already in place in Pittsburgh. In the contract derived from these manuscripts and presented to DHHS on the eve of the deadline, the overwhelming factor for liver distribution was recipient urgency of need.181 In contrast, time waiting dominated kidney distribution with major credit for HLA matching only when this was complete.