Operative terminology and post-operative management approaches applied to hepatic surgery:Trainee perspectives

Outcomes in hepatic resectional surgery(HRS) have improved as a result of advances in the understanding of hepatic anatomy,improved surgical techniques, and enhanced peri-operative management.Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period,however,greater acceptance and understanding of HRS has meant that care is transferred,usually after 24-48 h,to a standard ward environment.Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call,and it is therefore important to acknowledge the key points in managing HRS patients.Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken.Increasingly,enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia,careful fluid balance,nutrition and thromboprophlaxis.Complications can occur including liver,renal and respiratory failure,hemorrhage,and sepsis,all of which require prompt recognition and management.We provide an overview of the relevant terminology applied to hepatic surgery,an approach to the post-operative management,and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients.     

Non‐HLA‐matched 3rd party vascular allograft in renal transplant may lead to sensitization against donor HLA

3rd party donor vessels are often used for vascular reconstruction in organ transplantation. While current practice ensures that 3rd party vessels are blood group matched, HLA matching to the non‐intended recipient is not performed. This practice potentially sensitizes the recipient and may reduce their future chance of renal transplant from a larger pool of donors. We examined our cohort of renal transplant recipients who received non‐HLA‐matched 3rd party vessels for the de‐novo development of donor‐specific HLA antibodies. Our institution's Human Tissue Authority (HTA) blood vessel registers were examined to identify stored donor vessels and their non‐intended recipients. Donor vessel HLA status was cross‐referenced with the recipient HLA status. Between 2004 and 2014, five patients were identified that received 3rd party non‐HLA‐matched vessels for vascular reconstruction during renal transplantation. Three patients (60%) subsequently developed donor‐specific HLA antibodies. These data provide evidence that use of non‐HLA‐matched stored 3rd party vascular grafts may lead to sensitization in the recipient. Where time permits, HLA matching should be performed to avoid this allogeneic response. Laboratories monitoring DSA should be aware of any patient receiving a non‐HLA‐matched 3rd party vascular graft, and recipients may benefit from increased post‐transplant immunological vigilance.     

In-vitro and in-vivo cytotoxicity and efficacy evaluation of novel glycyl-glycine and alanyl-alanine conjugates of chitosan and trimethyl chitosan nano-particles as carriers for oral insulin delivery

Purpose

The aim of this research work was to explore the possibility of providing multifunctional oral insulin delivery system by conjugating several types of dipeptides on chitosan and trimethyl chitosan to be used as drug carriers.

基于增强图卷积神经网络的病毒形态识别方法研究

背景 透射电子显微镜（TEM）是检测病毒的重要手段,传统TEM检测常依靠专家手工观察,操作步骤繁琐,且已有机器学习方法易受到背景、噪声的影响,导致病毒检测方法准确率差、效率低且耗时长。 目的 探讨增强图卷积神经网络（EGCN）对TEM图像中的病毒形态自动识别问题,以提高TEM病毒检测的效率。 方法 EGCN模型利用卷积神经网络（CNN）提取像素间的局部特征信息,并结合样本特征之间的最近邻关系利用图卷积网络（GCN）进行图特征学习。在模型优化中联合优化群体超分类损失和分类交叉熵损失以提高EGCN模型对病毒类别信息特征的提取能力,较CNN对TEM病毒图像特征具备更强的特征提取能力。 结果 通过不同方法在15类TEM病毒图像数据集上开展实验,EGCN达到3.40%的top-1错误率、1.88%的top-2错误率、96.65%的精确度和96.60%的召回率,并通过一系列对比实验表明EGCN模型可以有效避免TEM图像中背景、噪声等的影响,提高对病毒识别的准确率。 结论 EGCN可以有效解决病毒形态识别任务,为病毒的诊断提供重要的参考价值。     

Utility of the INTERMACS profile at the time of assessment for heart transplant

The Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) profiles are associated with mortality in heart failure patients undergoing ventricular assist device (VAD) implantation and heart transplantation (HTx). We assessed the prognostic value of the INTERMACS profile at the time of assessment for HTx or durable VAD implantation as bridge to candidacy (BTC). A total of 503 consecutive patients considered for HTx or VAD between 2006 and 2016 were included. The associations between INTERMACS profile and (a) waitlist mortality or delisting, (b) probability of HTx, and (c) overall mortality or delisting were evaluated using multivariable analysis. Median follow-up time was 2.9 years (IQR: 0.9-5.5) during which 184 received VAD, 347 received HTx, and 73 died (27 waitlist, 46 post-transplant). INTERMACS I-II profile was associated with higher waitlist mortality or delisting (HR: 3.83, 95% CI: 1.22-12.03), and this risk was reversed by VAD implantation (HR: 0.12, 95% CI: 0.03-0.50). INTERMACS III-IV profile was associated with a higher probability of HTx (HR: 1.82, 95% CI: 1.37-2.40). INTERMACS profile was not associated with the composite outcome of overall mortality or delisting. These results emphasize the prognostic utility of INTERMACS at time of decision for advanced therapies and its potential value in selecting patients for different interventions.     

In-vitro cytotoxicity,antioxidant, bleomycin-dependent DNA damage and immunomodulatory evaluation of 1-(4-acetylphenyl)-3-aryloxypyrrolidine-2, 5-dione based derivatives

A one pot, economical, and efficient synthesis of 1-(4-acetylphenyl)-3-aryloxypyrrolidine-2,5-diones-based derivatives 5a-l have been accomplished in single steps and in satisfactory yields from 1-(4-acetylphenyl)-pyrrole-2,5-diones 3 and phenols 4a–l. All the compounds were characterized by physical, spectroscopic, and elemental analysis. The selection of the bioassays was based on proving the drug receptor binding concept. Compounds 5g, 5k, 5h, 5i, 5a, and 5f showed the highest inhibitory antioxidant activity using ABTS methods. Compounds 5k, 5g, 5c, 5h, 5b, 5d, 5f, and 5j manifested the best protective effect against DNA damage induced by bleomycin. Moreover, an in-vitro cytotoxic activity evaluation of all synthesized compounds was against four cancer cell lines using 5-Fluorouracil as a standard anticancer drug.     

Anterior Distal Femoral Osteotomy for Removal of Long Femoral Stems in Revision Knee Arthroplasty

Osteotomies of the proximal femur and proximal tibia in revision arthroplasty are well described while guidelines for distal femoral osteotomy are limited. Femoral stems are used with increasing frequency for fixation of revision components in knee arthroplasty and their removal is technically challenging particularly in the setting of infection. We describe a technique of anterior distal femoral osteotomy for revision knee arthroplasty to assist with removal of well-fixed long stemmed cemented or porous femoral components, as well as debridement of infection while preserving bone stock and soft tissue attachments.