Hypothesis: Combined liver-kidney transplantation is safe (low morbidity and acceptable mortality) and effective in patients with end-stage liver disease. Although refinements in surgical technique have resulted in better patient and allograft outcomes, the negative impact of renal insufficiency on survival in patients undergoing liver transplantation has been widely reported, although some aspects are controversial. Design: Analysis of the clinical characteristics and outcome in the management of patients undergoing combined liver-kidney transplantation. The end points were operative mortality, morbidity, and long-term survival.

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Objectives: Many youth sex trafficking victims visit health care facilities while being trafficked. Little is known regarding whether frontline medical professionals recognize risk factors or are aware of effective interviewing approaches to identify and intervene for youth victims. The aim of the present study was to assess frontline medical professionals' knowledge of youth sex trafficking, adolescent development, and forensically informed interviewing to provide guidance for professional training. Methods: Two hundred seventy-seven frontline medical professionals [first responders and emergency department (ED)/clinical professionals] in Southern California completed an online survey about their background, training, perceptions of likely youth sex trafficking scenarios, knowledge of adolescent development, sex trafficking, and forensically informed interviewing.Results: Nearly all professionals recognized risk and the need to collect additional information, yet few (1% first responders and 12% ED) recognized that risk as sex trafficking. Forty-six percent of first responders also indicated that responding to nonmedical needs was outside of their job responsibilities. A mixed model analysis of covariance revealed significant interactions of gender by domain (P = 0.01) and domain by training (P = 0.045). Women evidenced better knowledge (78% accuracy) about sex trafficking and interviewing (73%) than adolescent development (64%), whereas men were more accurate with sex trafficking (64%) than adolescent development (61%) and interviewing (62%). For domain by training, tests of within subjects' contrasts showed a quadratic relation ( P = 0.02) was the best fit model, where training was most strongly associated with accuracy in sex trafficking knowledge. Conclusions:Frontline medical professionals are lacking in their knowledge of youth sex trafficking, interviewing, and especially adolescent development. An area in which interventions can be targeted is with training (because it emerged in a significant interaction). Training could combat unrepresentative depictions of victims, improve understanding of common victim characteristics, and highlight how forensically informed interviewing can improve medical professionals' ability to gather crucial history about victims' experiences and needs.

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Background: short-bowel transplantation has experienced a substantial growth worldwide following improved results from the late 1990s on, and its coverage by Medicare. According to the International Registry , a total of 1,292 intestinal trasplants for 1,210 patients in 65 hospitals across 20 countries have been carried out thus far.Objective: to know short-term (6 months) results regarding patient and graft survival from the first Spanish series of intestinal transplants in adult recipients.Material and methods: we present our experience in the assessment of 20 potential candidates to short-bowel transplantation between June 2004 and October 2005. Of these, 10 patients were rejected and 4 were transplanted, which makes up the sample of our study.Results: to this date 5 transplants have been carried out in 4 patients (2 retransplants, 2 desmoid tumors, 1 short bowel syndrome after excision as a result of mesenteric ischemia). Upon study completion and after a mean follow-up of 180 days (range 90-190 days) all recipients are alive, and all grafts but one (75%) are fully operational, with complete digestive autonomy. All patients received induction with alemtuzumab except one, who received thymoglobulin; in all induction was initiated with no steroids.Conclusions: intestinal transplantation represents a therapeutic option that is applicable in our setting and valid for recipients with an indication who have no other feasible alternative to keep their intestinal failure under control.