The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres

Background: As literature largely focuses on long-term outcomes, this study aimed at elucidating the perioperative outcomes of liver transplant patients receiving a graft from two groups of unconventional expanded criteria donors: brain dead aged > 80 years and cardiac dead.Methods: Data of 247 cirrhotic patients transplanted at two high volume liver transplant centers were analysed. Confounders were balanced using a stabilized inverse probability therapy weighting and a propensity score for each patient on the original population was generated. The score was created using a multivariate logistic regression model considering a Comprehensive Complication Index & GE; 42 (no versus yes) as the dependent variable and 11 possible clinically relevant confounders as covariate.Results: Forty-four patients received the graft from a cardiac-dead donor and 203 from a brain-dead donor aged > 80 years. Intraoperatively, cardiac-dead donors liver transplant cases required more fresh frozen plasma units (P < 0.0001) with similar reduced need of fibrinogen to old brain-dead donors cases. The incidence of reperfusion syndrome was similar (P = 0.80). In the Intensive Care Unit, both the groups presented a comparable low need for blood transfusions, renal replacement therapy and inotropes. Cardiac-dead donors liver transplantations required more time to tracheal extubation (P < 0.0001) and scored higher Comprehensive Complication Index (P < 0.0001) however the incidence of a severe complication status (Comprehensive Complication Index & GE; 42) was similar (P = 0.52). ICU stay (P = 0.97), total hospital stay (P = 0.57), in hospital (P = 1.00) and 6 months (P = 1.00) death were similar.Conclusion: Selected octogenarian and cardiac-dead donors can be used safely for liver transplantation

Transition from orogenic-like to anorogenic magmatism in the Southern Alps during the Early Mesozoic: Evidence from elemental and Nd-Sr-Hf-Pb isotope geochemistry of alkali-rich dykes from the Finero Phlogopite Peridotite, Ivrea–Verbano Zone

The Ivrea-Verbano Zone (IVZ) in the westernmost sector of the Southern Alps is an iconic upper mantle to lower continental crust sequence of the Adriatic Plate and provides a geological window into the tectono-magmatic events that occurred at the Gondwana–Laurussia boundary from Late Paleozoic to Early Mesozoic. In this work, we document new geochemical and Nd-Sr-Hf-Pb isotopic data for Early Mesozoic alkali-rich dyke swarms which intruded the Finero Phlogopite Peridotite (northern IVZ) to provide geological constraints on the nature, origin and evolution of Early Mesozoic magmatism in the Southern Alps. The studied dykes are amphibole-phlogopite-bearing and show geochemical features varying between two end-member groups. A dyke group is characterized by HFSE-poor, Al-rich amphibole (Al2O3 up to 16 wt.%) with high LILE and LREE contents, high radiogenic 87Sr/86Sr(i) (0.704732 to 0.704934) and low radiogenic Nd isotopes (εNd(i) from –0.1 to –0.7), which support the occurrence of significant amounts of recycled continental crust components in the parental mantle melts and impart an overall “orogenic-like” affinity. This dyke group was largely derived from metasomatized lithospheric mantle sources. The second group is HFSE-rich with Al-poorer amphibole enriched in LILE and LREE, low radiogenic 87Sr/86Sr(i) (0.703761–0.704103) and higher radiogenic Nd isotopes (εNd(i) from +3.4 to +5.4) pointing to an “anorogenic” alkaline affinity and asthenospheric to deep lithospheric mantle sources. Some dykes show both orogenic and anorogenic affinities, providing evidence that the orogenic-like magmatism in the IVZ predates the alkaline anorogenic magmatism. The Finero dyke swarms therefore record a geochemical change of the Early Mesozoic magmatism of the Southern Alps from orogenic-like magmatism, typical of post-collisional settings, to anorogenic alkaline magmatism, common in intraplate to extensional settings, and places a temporal correlation of Early Mesozoic magmatism in the IVZ to those in the eastern and central sectors of the Southern Alps

Safety of liver resection and effect on quality of life in patients with benign hepatic disease: Single center experience

<p>Abstract</p> <p>Background</p> <p>Although liver resection has long been established for selected patients with benign hepatic disease, the success of surgical treatment of these patients cannot be evaluated exclusively through postoperative morbidity and mortality. Therefore, the aim of the study was to prove the safety of liver resection in the treatment of benign liver tumors and to evaluate the effect of surgical treatment on the patients' qauality of life.</p> <p>Methods</p> <p>A total of 146 patients who underwent liver resection because of benign liver tumors were included in this study. Postoperative outcome was assessed and patients evaluated their quality of life before surgery and at the present time using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ C-30).</p> <p>Results</p> <p>The rate of serious (> grade 2) complications was 4.1% with no postoperative death. The quality of life assessment revealed an overall improvement of general health status after resection (0.7 vs. 0.56, p < 0.001) and additionally a significant reduction of 6 out of 9 symptoms. Furthermore, compelling benefits in the patients' social and emotional coping could be detected after surgery.</p> <p>Conclusions</p> <p>Liver resection for benign liver disease is a safe procedure and leads to a significant improvement of quality of life in selected patients.</p

Spatial and temporal facies evolution of a Lower Jurassic carbonate platform, NW Tethyan margin (Mallorca, Spain)

The variety of depositional facies of a Lower Jurassic carbonate platform has been investigated on the island of Mallorca along a transect comprising six stratigraphic profiles. Twenty-nine facies and sub-facies have been recognized, grouped into seven facies associations, ranging in depositional environment from supratidal/terrestrial and peritidal to outer platform. Spatial and temporal (2D) facies distribution along the transect reflects the evolution of the carbonate platform with time showing different facies associations, from a broad peritidal platform (stage 1) to a muddy open platform (stage 2), and finally to a peritidal to outer carbonate platform (stage 3). Stage 1 (early Sinemurian to earliest late Sinemurian) corresponds to a nearly-flat peritidal-shallow subtidal epicontinental platform with facies belts that shifted far and fast over the whole study area. The evolution from stage 1 to stage 2 (late Sinemurian) represents a rapid flooding of the epicontinental shallow platform, with more open-marine conditions, and the onset of differential subsidence. During stage 3 (latest Sinemurian), peritidal and shallow-platform environments preferentially developed to the northeast (Llevant Mountains domain) with a rapid transition to middle-outer platform environments toward the northwest (Tramuntana Range domain). Stages 1 and 3 present facies associations typical of Bahamian-type carbonates, whereas stage 2 represents the demise of the Bahamian-type carbonate factory and proliferation of muddy substrates with suspension-feeders. The described platform evolution responded to the interplay between the initial extensional tectonic phases related to Early Jurassic Tethyan rifting, contemporaneous environmental perturbations, and progressive platform flooding related to the Late Triassic–Early Jurassic worldwide marine transgression and associated accommodation changes

Figure On Diversity: Benefits of Life Drawing and Representation in Arts Education

https://remix.berklee.edu/able-assembly-conference/1063/thumbnail.jp

A sequence stratigraphic approach to a Middle Triassic shelf-slope complex of the Ligurian Alps (Ligurian Briançonnais, Monte Carmo-Rialto Unit, Italy)

The Mesozoic sedimentary cover belonging to the Monte Carmo-Rialto unit of the Ligurian Briançonnais domain is composed of Scythian clastics and Anisian to Carnian carbonate rocks over 300 m thick. This paper focuses on the stratigraphy of this carbonate complex, its environmental significance and its evolution in light of dynamic stratigraphy. Our facies analysis of limestones and dolomites of the Triassic complex allowed us to reconstruct an environmental model. Data support a distally steepened carbonate ramp of Anisian age evolving to a more diversified Ladinian platform with an oolitic sand-bar belt separating the lagoon from the slope. The Monte Carmo-Rialto slope facies are the only witnesses of deep sedimentation in the Triassic terrains of the Ligurian Briançonnais domain, otherwise represented by shallow-water carbonate deposits. On the basis of facies succession, we have identified nine medium-scale cycles (3rd order sequences) in the study area, comparable to those evidenced in the Briançonnais s.s. domain by the French authors. Small-scale cycles analysis evidenced mainly shallowing-upward trends in the examined sequences; although a few evidences of transgression-related deposits (deepening upward cycles) have been found at the base three sequences, they have been mostly obliterated by dolomitisation and masked by local tectonics. For this reason we can undoubtly distinguish only the part of each sequence belonging to HST, while the TST, though present, still remains a partition that cannot be precisely characterised. In the same way, LSTs are not present in the Monte Carmo-Rialto unit, due to the original relative landward position of the examined area. Sequence stratigraphy analysis indicates different long-term dynamics for the two evolutionary stages of the Triassic Ligurian platform: a general landward backstepping to moderate progradation during the Early Anisian and true progradation during the latest Anisian and Ladinian. In addition, a good fit with the sequences proposed by the SEPM chart has been found, indicating a correspondence for the 3rd order sequences of the Middle Triassic

Effective thermal conductivity of cluster assembled materials using the self-consistent finite element method

International audienc

Effective thermal conductivity of heterogeneous two-phase material using the self-consistent finite element method

International audienceAdvanced materials often involve the mixture of a second phase material (the inclusions) in a host phase (the matrix). Indeed, materials with very specific properties can be synthesized by controlling the nature of each phase as well as the shape and spatial distribution of the inclusions. Therefore, homogenization tools yielding accurate effective transport properties are needed. We present a numerical extension of a pure analytical treatment of the problem, namely the self-consistent method

Late Triassic-Early Jurassic Paleokarst from the Ligurian Alps and its geological significance (Siderolitico Auct., Ligurian Briançonnais domain)

Nel domino Brianzonese ligure, le unità carbonatiche medio triassiche, note come Formazione di Costa Losera e Dolomie di San Pietro dei Monti, sono stratigraficamente seguite da una importante lacuna che segna il passaggio ai calcari neritici di Rio di Nava del Batoniano. Nell’ambito di una classica evoluzione di un margine continentale passivo, una stasi nella subsidenza, seguita da un sollevamento portò ad una erosione della piattaforma triassica in misura progressivamente maggiore procedendo verso le unità più interne, cioè verso la Tetide ligure. Tale erosione, che verosimilmente si verificò su di un substrato tettonicamente controllato, portò alla formazione di sequenze sedimentarie assai diversificate, talora mancanti di tutti i terreni triassici o persino dell’intero tegumento permiano. Nell’area studiata (ed in limitate aree esclusivamente appartenenti alla porzione più esterna dell’unità di Ormea), la lacuna mesozoica è ben più di una semplice superficie di erosione; i depositi ad essa associati (“Siderolitico” Auct.) sono costituiti sia da un corpo di peliti rosse interposto fra le sopracitate unità formazionali, sia da una breccia di origine carsica che penetra profondamente le sottostanti dolomie ladiniche. E’ stata condotta una ricerca stratigrafica di dettaglio su questi depositi, unitamente ad un’analisi delle microfacies e petrografico-composizionale, al fine di determinare le caratteristiche dei paleosuoli e del carsismo, di raccogliere maggiori informazioni sulla loro origine e sull’età. Inoltre, è stato discusso il significato regionale e l’importanza di questi depositi grazie ad un confronto a grande scala con il dominio brianzonese classico e con altre località dell’arco alpino occidentale che mostrano una unconformity del tutto simile. Alla luce dei dati raccolti, per l’evento carsico in esame viene proposta un’età compresa fra il Triassico Superiore e il Lias (sino al Baiociano Superiore ?)