Hepatic resection for hepatocellular carcinoma in patients with Child–Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?

AbstractBackgroundAccording to international guidelines [European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD)], portal hypertension (PHTN) is considered a contraindication for liver resection for hepatocellular carcinoma (HCC), and patients should be referred for other treatments. However, this statement remains controversial. The aim of this study was to elucidate surgical outcomes of minor hepatectomies in patients with PHTN (defined by the presence of esophageal varices or a platelet count of <100 000 in association with splenomegaly) and well‐compensated liver disease.MethodsBetween 1997 and 2012, a total of 223 cirrhotic patients [stage A according to the Barcelona Clinic Liver Cancer (BCLC) classification] were eligible for this analysis and were divided into two groups according to the presence (n = 63) or absence (n = 160) of PHTN. The demographic data were comparable in the two patient groups.ResultsOperative mortality was not different (only one patient died in the PHTN group). However, patients with PHTN had higher liver‐related morbidity (29% versus 14%; P = 0.009), without differences in hospital stay (8.8 versus 9.8 days, respectively). The PHTN group showed a worse survival rate only if biochemical signs of liver decompensation existed. Multivariate analysis identified albumin levels as an independent predictive factor for survival.ConclusionsPHTN should not be considered an absolute contraindication to a hepatectomy in cirrhotic patients. Patients with PHTN have short‐ and long‐term results similar to patients with normal portal pressure. A limited hepatic resection for early‐stage tumours is an option for Child–Pugh class A5 patients with PHTN

Ultrafast High-Energy Micro-Supercapacitors Based On Open-Shell Polymer-Graphene Composites

Micro-supercapacitors are poised to serve as on-chip power sources for electronics. However, the challenge to simultaneously increase their power, energy, and lifetime demands new material combinations beyond current carbon-based systems. Here, we demonstrate that electro-deposition of an open-shell conjugated polymer with reduced graphene oxide achieves electrodes with capacitance up to 186 mF cm−2 (372 F cm−3). The extended delocalization within the open-shell polymer stabilizes redox states and facilitates a 3 V wide potential window, while the hierarchical electrode structure promotes ultrafast kinetics. The micro-supercapacitor shows a high power density of 227 mW cm−2 with an energy density of 10.5 μWh cm−2 and stability of 84% capacitance retention after 11,000 cycles. These attributes allow operation at 120 Hz for fast charging and alternating current (AC) line filtering applications, which may be suitable to replace bulky electrolytic capacitors or serve as high-endurance energy storage for wireless electronics

Bcl3 prevents acute inflammatory lung injury in mice by restraining emergency granulopoiesis

Granulocytes are pivotal regulators of tissue injury. However, the transcriptional mechanisms that regulate granulopoiesis under inflammatory conditions are poorly understood. Here we show that the transcriptional coregulator B cell leukemia/lymphoma 3 (Bcl3) limits granulopoiesis under emergency (i.e., inflammatory) conditions, but not homeostatic conditions. Treatment of mouse myeloid progenitors with G-CSF — serum concentrations of which rise under inflammatory conditions — rapidly increased Bcl3 transcript accumulation in a STAT3-dependent manner. Bcl3-deficient myeloid progenitors demonstrated an enhanced capacity to proliferate and differentiate into granulocytes following G-CSF stimulation, whereas the accumulation of Bcl3 protein attenuated granulopoiesis in an NF-κB p50–dependent manner. In a clinically relevant model of transplant-mediated lung ischemia reperfusion injury, expression of Bcl3 in recipients inhibited emergency granulopoiesis and limited acute graft damage. These data demonstrate a critical role for Bcl3 in regulating emergency granulopoiesis and suggest that targeting the differentiation of myeloid progenitors may be a therapeutic strategy for preventing inflammatory lung injury

1-(4a,8-Dimethyl-1,2,3,4,4a,5,6,8a-octa­hydro­naphthalen-2-yl)-3-(4-methyl­phen­yl)prop-2-en-1-one

The title compound, C22H28O, was isolated from the aerial part of Inula viscosa­ (L) Aiton [or Dittrichia viscosa­ (L) Greuter]. The cyclo­hexene ring has a half-chair conformation, whereas the cyclo­hexane ring displays a chair conformation being substituted at position 2 by a 3-(4-methyl­phen­yl)prop-2-enoyl group. In the crystal, weak inter­molecular C—H⋯O hydrogen bonds link mol­ecules into chains in the [010] direction

Ethical climate and intention to leave among critical care clinicians : an observational study in 68 intensive care units across Europe and the United States

PurposeApart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.MethodsPerceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.ResultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.ConclusionThis is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL

Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control

Journal ArticleReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe