Drastic changes in the world have brought people unstable health states, and various stressors have always influenced the personality in people. From a psychological and ethical point of view, ego means consciousness about empirical individuality and a conscious personality that keeps contact with the reality and mediates id and super ego. In transactional analysis (TA), 3 egos (personality) are suggested to exist in a human, which are parent’s ego (P), adult’s ego (A), and child’s ego (C). Based on the theory of Berne and Dusay, transitional analysis and phycological test, egogram has been originated and used widely in medical, clinical, educational and social fields. It has 5 factors, which are Critical Parent (CP), Nurturing Parent (NP), Adult (A), Free Child (FC), Adapted Child (AC). Based on the principle of egogram, Tokyo University Egogram (TEG) was developed and standardized by sufficient statistical investigation. Furthermore, there are related research for egogram and psychosomatic medicine, hypertension, oral malodor, donors for organ transplantation, stress medicine, mental health, music therapy, education, business and so on. Consequently, egogram, TEG and TA have been helpful method to evaluate, investigate and treat for various psychological situation.

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Psychological Study of Egogram can be Helpful Medically and Socially for Better Life

In the field of psychology, transactional analysis (TA) was proposed by Eric Berne as a personality theory [1,2]. It is one of the psychotherapies to evaluate adequate human communication and contribute the personality trait and growth. He advocated three ego states including P (Parent), A (Adult), C (Child), which would be the fundamental PAC model.After that, John M. Dusey has developed the egogram including five egos, which are Critical Parent (CP), and Nurturing Parent (NP), Adult (A), Free Child (FC) and Adapted Child (AC) [3,4]. It seems to be simple and useful for clinical application and research.

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Use of Egogram for Psychological Development of the Adolescence

Pre-emptive kidney transplantation (PEKT) is considered one of the most effective types of kidney replacement therapies to improve the quality of life (QOL) and physical prognosis of patients with end-stage renal disease (ESRD). In Japan, living-donor kidney transplantation is a common therapeutic option for patients undergoing dialyses (PDKT). Moreover, during shared decision-making in kidney replacement therapy, the medical staff of the multidisciplinary kidney team often provide educational consultation programmes according to the QOL and sociopsychological status of the ESRD patient. In Japan, the majority of kidney donations are provided by living family members. However, neither the psychosocial status of donors associated with the decision-making of kidney donations nor the interactions of the psychosocial status between donors and recipients have been clarified in the literature. In response to this gap, the present study determined the QOL, mood and anxiety status of donors and recipients at kidney transplantation decision-making between PEKT and PDKT. Deterioration of the recipient's QOL associated with "role physical" shifted the decision-making to PEKT, whereas deterioration of QOL associated with "role emotional" and "social functioning" of the recipients shifted the decision-making to PDKT. Furthermore, increased tension/anxiety and depressive mood contributed to choosing PDKT, but increased confusion was dominantly observed in PEKT recipients. These direct impact factors for decision-making were secondarily regulated by the trait anxiety of the recipients. Unlike the recipients, the donors' QOL associated with vitality contributed to choosing PDKT, whereas the physical and mental health of the donors shifted the decision-making to PEKT. Interestingly, we also detected the typical features of PEKT donors, who showed higher tolerability against the trait anxiety of reactive tension/anxiety than PDKT donors. These results suggest that choosing between either PEKT or PDKT is likely achieved through the proactive support of family members as candidate donors, rather than the recipients. Furthermore, PDKT is possibly facilitated by an enrichment of the life-work-family balance of the donors. Therefore, multidisciplinary kidney teams should be aware of the familial psychodynamics between patients with ESRD and their family members during the shared decision-making process by continuing the educational consultation programmes for the kidney-replacement-therapy decision-making process.

Impacts of Interaction of Mental Condition and Quality of Life between Donors and Recipients at Decision-Making of Preemptive and Post-Dialysis Living-Donor Kidney Transplantation.

Background: In the field of psychology and psychosomatic medicine, Transactional Analysis (TA) was and developed by Berne and Dusey. Consecutively, egogram analysis has been prevalent by 5 egos including Critical Parent (CP), Nurturing Parent (NP), Adult (A), Free Child (FC) and Adapted Child (AC). In Japan, Tokyo University Egogram (TEG) has been used, and authors have continued egogram research for long.
Methods and Results: Subjects were 502 university students. They answered TEG questionnaire with the evaluation of the personality trait. Out of 29 personality pattern, 6 types were more than standard data. They are dependent, short-tempered, self-centered, conflict, solitude and pessimist types. During 10 years of our research, self-centered and solitude have been increasing, and good-hearted and playboy types have been decreasing.
Discussion: From current data, several tendency would be speculated: Lower NP seems to be a characteristic for modern university students. It may be related with a noticeable decline in overall morality among younger generations in Japan. Furthermore, the prevalence of internet in the world may influence of the behavior of young people. Not actual experience but information on the internet can make them refrain from active human relations to others. These results would be expected to become useful reference data.

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Characteristic Egogram State of Younger Generation

To the Editor: There is currently a serious shortage of organ sources. Therefore, living donor kidney is a critical source in addition to deceased donor kidney. Open donor nephrectomy is one of the most difficult operations in the field of kidney transplantation, and the core issues are the safety of the donor and the psychological stress to the surgeon, such as trying to minimize the surgical complication to the donor, maximize the success rate, and deal with the high expectation from the recipient.[1] By using 3D printing techniques, the relationship between the surgical site and the surrounding tissue structures can be displayed more intuitively and accurately before the start of surgery. This can help the surgeon to understand the anatomical structure of the surgical site more accurately before the beginning of surgery, and create an operational plan or carry out a simulated operation according to the printed model that is specific to the patient.[2] This study was approved by the Institutional Review Board/Ethics of The First Affiliated Hospital of Xi’an Jiaotong University, China (No. XJTU1AF2018LSL-3D001). All patients signed an informed consent form, were informed about the study, and agreed to have their clinical information used in the reported research. A total of 120 living kidney donors and their corresponding 120 transplant recipients who underwent living kidney transplantation were recruited at The First Affiliated Hospital of Xi’an Jiaotong University from January 2016 to December 2019. We randomly divided the donors and their transplant recipients into the 3D printing group and the traditional operation group. The 3D printing group was treated as follows: (1) To obtain raw data images of Digital Imaging and Communications in Medicine from donor kidney computed tomography angiography (CTA) and CT urography (CTU); (2) To use the Mimics software 21.0[3] system (Materialise, Belgium) to segment cross-section images, to extract printed tissue using the segmentation method of threshold and regional growth, and then to transmit to 3D printers in Laplace smoothing and StL format; (3) The 3D printer uses photoreceptor resin to finish model printing, and static 4 to 6 h is to make the model dry and stable. According to the printed models, an operation plan was created or a simulated operation was performed. One example of the donor's 3D-printed physical model is shown in Figure 1. The traditional operation group underwent routine pre-operative preparation that consists of CTA, CTU, and B ultrasound.Figure 1: CTA imaging report shows a single branch of the right renal arteriovenous type and a thickening of the wall at the opening of the left renal artery with fibrous plaques, resulting in moderate stenosis of the lumen (as shown by the arrow) (A); By printing the models, multiple angles can be visually observed, and renal structures could be touched (B and C). CTA: Computed tomography angiography.During CTA examination, 42 patients with accessory renal arteries were identified, including five with bilateral renal accessory arteries, 18 with right accessory renal arteries, and 19 with left accessory renal arteries; there were 14 cases of the accessory renal arteries in each group. Vascular variation was found in 22 cases (37%) of the 3D printing group before surgery, and in 11 cases (18%) of the traditional operation group after CTA and other routine examinations before surgery. The differences in the diagnostic rate of vascular variation between the two groups were statistically significant (χ2 = 5.06, P < 0.05). In the 3D reconstruction group, 24 cases of vascular variation that needed to be treated were found intraoperatively, with a consistent rate of 92% (22/24). Totally, 20 cases of vascular variation were found in the traditional operation group, and the diagnostic consistency rate was 55% (11/20), the difference between the two groups was statistically significant (χ2 = 7.82, P < 0.05). Total operation time (88.8 ± 8.2 min) of the 3D printing group was significantly shorter than that of the traditional operation group (100.4 ± 11.4 min), and the amount of intra-operative bleeding in the 3D printing group (79.9 ± 18.7 mL) was also lower compared with the traditional operation group (92.1 ± 19.4 mL; P < 0.05 for each). The first day after the operation, serum creatinine (sCr) in the 3D printing group was significantly lower than that of the traditional operation group (69.4 ± 14.4 μmol/L vs. 86.8 ± 12.9 μmol/L; P = 0.001). The recovery time of function for the transplanted kidney was faster in the 3D printing group than that in the traditional operation group (3.7 ± 2.7 days vs. 5.1 ± 1.6 days; P = 0.040). As was observed in the donor patients, the sCr decreased more rapidly on the first day after operation in the 3D printing group than that in the traditional operation group (430.2 ± 134.1 μmol/L vs. 565.7 ± 193.7 μmmol/ L; P = 0.001). In this study, the 3D printing group had advantages in terms of the operation time, intra-operative bleeding volume, the diagnosis rate of vascular variation, sCr change on the first day after the operation, and functional recovery time of the transplanted kidney. We found that 3D-printed models help the surgeon to better determine and plan for expected anatomical structures of the operation site before starting the procedure, make a more detailed operation plan according to the printed model, carry out a simulated operation on the model, find the operation site quickly, and avoid unnecessary steps, thus reducing the overall risks and improving the success rate of the operation. Especially for the vascular variation, the anatomical structures such as the initiation and the shape of the vessel can be defined by the 3D printing models, and are of great significance for preserving renal function as much as possible after transplantation. Furthermore, 3D-printed models can also help patients to better understand their conditions and the operation plans, and help improve the doctor-patient communication and relationship. sCr on the first day after operation in the 3D printing group was lower than that in the traditional operation group, which was mainly related to less intra-operative bleeding, shorter operation time, and anesthesia time.[4] The difference between the two groups is not statistically significant in terms of renal warm ischemia time, the incidence of perioperative complications, and the length of hospital stay. The 3D printing group had a shorter recovery time of the transplanted kidney function, which was likely due to the reduction of mechanical injury during the surgical procedure, a maximum degree of protection of the accessory renal artery, and effective renal unit retention after transplantation. 3D printing technology is a breakthrough in the field of kidney transplantation and it enriches the diagnosis and treatment of renal diseases. This study confirmed that using a 3D-printed model can optimize the living donor nephrectomy procedures in terms of the operation time, intra-operative bleeding volume, acute sCr changes, and recovery time of transplanted kidney function. All of these measures protect the kidney, reduce the difficulty of the operation, and facilitate doctor-patient communication, thereby improving patients’ outcomes. With a continual innovation of 3D materials and technologies, the application of this technology in transplanted kidney ureteral obstruction, renal tumor, stone, and organ printing has a broad prospect. Conflicts of interest None. 

3D printing technology in open living donor nephrectomy

Background Past studies have indicated that psychological problems in both transplant recipients and donors increase during the pre-operative period. However, few studies have evaluated the pre-operative psychological status of both the recipient and the donor. Methods This study included the donors and recipients of 36 adult living donor kidney transplants (LDKT) and 12 adult living donor liver transplants (LDLT) between January 2012 and December 2014. Their personalities were assessed using the Tokyo University Egogram (TEG) and the Yatabe-Guilford Personality Inventory (Y-G), while their mood states just before transplantation were evaluated via the Profile of Mood States (POMS). Results On the TEG, the mean Adapted Child (AC) score of the LDLT recipient group was significantly lower than that of the LDKT recipient group. On the Y-G, no differences in the distribution of the five personality types were recognized among the four groups. POMS depression scores in the LDLT recipient group were significantly higher compared with the other groups. Conclusion LDLT recipients exhibited a depressive mood just before transplantation, and also had a low AC score. Therefore, clinicians should pay careful attention to potential medical non-adherence and post-operative depression in LDLT recipients. Based on these pre-operative assessments of personality and mood states, the transplant team should include post-operative care to support the quality of life of the recipients as well as the donors.

Pre-operative Assessment of Psychological Characteristics and Mood States in Living Donor Kidney and Liver Transplantation

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Pre-operative Assessment of Psychological Characteristics and Mood States in Living Donor Kidney and Liver Transplantation