SummaryBackgroundData on liver transplantation (LT) in acute on chronic liver failure (ACLF) are scanty.AimTo perform meta‐analysis on outcomes after LT for ACLF compared with ACLF patients not receiving LT or with LT recipients for indications other than ACLF.MethodsWe pooled data from 12 studies on LT outcomes among ACLF patients.ResultsAmong nine studies, 22 238 LT recipients for ACLF vs 30 791 for non‐ACLF were younger by 1.1 years, less males (64% vs 66.4%), and higher model for end‐stage disease score by 14.5 (14.4‐14.6), P < 0.01 for all. Post‐transplant patient survival at 30 day, 90 day, 6 months, 1 year and 5 years was lower in ACLF: 96.2% vs 98.1%, 92.6% vs 96.2%, 89.9% vs 94.4%, 86.0% vs 91.9%, 66.9% vs 80.7% respectively, P < 0.01 for all. ACLF patients stayed longer in hospital and ICU by 5.7 and 10.5 days respectively, P < 0.001, with similar post‐transplant complications [74.4% vs 55.5%, P = 0.12]. Among three studies, 441 LT recipients for ACLF vs 301 ACLF patients not selected for LT had better 30 day and 1 year survival: 95.2% vs 60% and 85.3% vs 28.2% respectively, P < 0.001. Outcomes were worse in ACLF‐3 and better for ACLF‐1 and ACLF‐2 patients at the time of LT.ConclusionIn this pooled analysis with a large sample size across the globe, LT for select patients with ACLF provided survival benefit. However, larger prospective studies are needed to further refine selection criteria, especially for ACLF‐3 patients as basis for improving outcomes and optimal utilisation of scarce donor pool.

Background Fetal Alcohol Spectrum Disorders (FASD) comprise a continuum of lifelong outcomes in those born prenatally exposed to alcohol. Although studies have shown no differences in rates by race, FASD is of particular concern for American Indian communities. One tribally-run prevention program is the Oglala Sioux Tribe (OST) CHOICES Program, which is modeled after the evidence-based CHOICES program that was focused on preconceptional prevention of alcohol-exposed pregnancy (AEP) by reducing risky drinking in women at-risk for pregnancy and/or preventing unintended pregnancy. Methods The OST CHOICES Program was made culturally appropriate for American Indian women and implemented with three communities, two on the reservation and one off. Data on drinking, sexual activity, and contraception use were collected at baseline and 3- and 6-months post-intervention. Data were analyzed using descriptive statistics, one-way ANOVA, and a random intercept generalized estimating equation (GEE) model. Results A total of 193 non-pregnant American Indian women enrolled in the OST CHOICES Program, and all were at-risk for AEP because of binge drinking and being at-risk for an unintended pregnancy. Fifty-one percent of participants completed both 3- and 6-month follow-up. Models showed a significant decrease in AEP risk from baseline at both 3- and 6-month follow-ups, indicating the significant impact of the OST CHOICES intervention. Women in the OST CHOICES Program were more likely to reduce their risk for AEP by utilizing contraception, rather than decreasing binge drinking. Conclusions Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail, we found a significant impact in reducing AEP risk. This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of settings and populations.

Objective To evaluate the ability of thio-urethane oligomers to improve the properties of restorative composite resins. Materials and methods Oligomers were synthesized by combining 1,6-hexanediol-diissocyante (aliphatic) with pentaerythritol tetra-3-mercaptopropionate (PETMP) or 1,3-bis(1-isocyanato-1-methylethyl)benzene (aromatic) with trimethylol-tris-3-mercaptopropionate (TMP), at 1:2 isocyanate:thiol, leaving pendant thiols. Oligomers were added at 0–20 wt% to BisGMA-TEGDMA (70–30 wt%). Silanated inorganic fillers were added (70 wt%). Materials were photoactivated at 800 mW/cm2 filtered to 320–500 nm. Near-IR was used to follow degree of methacrylate conversion (DC). Mechanical properties were evaluated in three-point bending with 2 mm × 2 mm × 25 mm bars for flexural strength/modulus and toughness (FS/E, and T) according to ISO 4049, and 2 mm × 5 mm × 25 mm notched specimens for fracture toughness (KIC). Polymerization stress (PS) was measured on the Bioman. Results were analyzed with ANOVA/Tukey’s test (α = 5%). Results Significant increase in DC was observed in thio-urethane-containing materials especially for the group with 20 wt% of aliphatic version. Materials composed by oligomers also promoted higher FS, E, and KIC in comparison to controls irrespective of thio-urethane type. A significant increase in toughness was detected by ANOVA, but not distinguished in the groups. The PS was significantly reduced by the presence of thio-urethane for almost all groups. Conclusions The use of thio-urethane oligomer to compose methacrylate-based restorative composite promote increase in DC, FS, E and KIC while significant reduces PS.

IMPORTANCE Research to date has not determined a safe level of alcohol or tobacco use during pregnancy. Electroencephalography (EEG) is a noninvasive measure of cortical function that has previously been used to examine effects of in utero exposures and associations with neurodevelopment. OBJECTIVE To examine the association of prenatal exposure to alcohol (PAE) and tobacco smoking (PTE) with brain activity in newborns.