Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

Purpose: Historically, invasion of the inferior vena cava (IVC) represented advanced and often unresectable hepatic disease. With surgical and anesthetic innovations, IVC resection and reconstruction have become feasible in selected patients. This review assesses technical variations in reconstructive techniques and post-operative management. Methods: A comprehensive literature search was performed according to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English; (ii) at least three cases; (iii) hepatic IVC resection and reconstruction (January 2015-March 2020). Primary outcomes were reconstructive technique, anti-thrombotic regimen, post-operative IVC patency, and infection. Secondary outcomes included post-operative complications and malignant disease survival. Results: Fourteen articles were included allowing for investigation of 351 individual patients. Analysis demonstrated significant heterogeneity in surgical reconstructive technique, anti-thrombotic management, and post-operative monitoring of patency. There was increased utilization of ex vivo approaches and decreased use of venovenous bypass compared with previously published reviews. Conclusion: This review of literature published between 2015 and 2020 reveals persistent heterogeneity of hepatic IVC reconstructive techniques and peri-operative management. Increased utilization of ex vivo approaches and decreased use of venovenous bypass point towards improved operative techniques, peri-operative management, and anesthesia. In order to gain evidence for consensus on management, a registry would be beneficial

Soil Nutrient Composition in Afromontane Forests of Northern Ethiopia

Deforestation in the northern highlands of Ethiopia has left 35,000 forest fragments ranging in size from 3 to 300 ha (Bongers et al 2006). Deforestation produces edges which increase disturbance within the forest such as decreased water availability and increased light. To determine the degree of these edge effects and the nutrient status of these forests, I analyzed the nutrient composition of soils along a gradient from pasture, exterior forest, interior forest and canopy. I examined two forests at different elevations: Bahir Dar (1800 m) and Debre Tabor (2800 m). Deforestation had a strong, negative effect on soil nutrients. The pasture soils had the lowest % nitrogen, % phosphorus and % carbon in comparison to the other habitats. It also had a significantly lower pH. Isotope signatures and bulk density were also significantly impacted. Pasture soils surprisingly had the lowest C:N ratio due to its minimal carbon stocks. Differences in elevation did not significantly impact the effect of deforestation upon the soil. The differences in pasture soils properties and nutrient composition indicate that deforestation has a significant, negative effect on soil fertility and health

A Preliminary Assessment of Ethiopian Sacred Grove Status at the Landscape and Ecosystem Scales.

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Mineralocorticoid Receptor Blockade Improves Coronary Microvascular Function in Individuals With Type 2 Diabetes

Reduced coronary flow reserve (CFR), an indicator of coronary microvascular dysfunction, is seen in type 2 diabetes mellitus (T2DM) and predicts cardiac mortality. Since aldosterone plays a key role in vascular injury, the aim of this study was to determine whether mineralocorticoid receptor (MR) blockade improves CFR in individuals with T2DM. Sixty-four men and women with well-controlled diabetes on chronic ACE inhibition (enalapril 20 mg/day) were randomized to add-on therapy of spironolactone 25 mg, hydrochlorothiazide (HCTZ) 12.5 mg, or placebo for 6 months. CFR was assessed by cardiac positron emission tomography at baseline and at the end of treatment. There were significant and similar decreases in systolic blood pressure with spironolactone and HCTZ but not with placebo. CFR improved with treatment in the spironolactone group as compared with the HCTZ group and with the combined HCTZ and placebo groups. The increase in CFR with spironolactone remained significant after controlling for baseline CFR, change in BMI, race, and statin use. Treatment with spironolactone improved coronary microvascular function, raising the possibility that MR blockade could have beneficial effects in preventing cardiovascular disease in patients with T2DM