Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results.

ObjectivesTo describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage.MethodsFrom October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up. All patients had detachable coils placed to occlude the efferent shunt and retrograde gelfoam embolization to achieve complete thrombosis/obliteration of varices. Technical success, clinical success, rebleeding, and complications were evaluated at follow-up.ResultsA 100% technical success rate (defined as achieving complete occlusion of efferent shunt with complete thrombosis/obliteration of bleeding varices and/or stopping variceal bleeding) was demonstrated in all 20 patients. Clinical success rate (defined as no variceal rebleeding) was 100%. Follow-up computed tomography after CARTO demonstrated decrease in size with complete thrombosis and disappearance of the varices in all 20 patients. Thirteen out of the 20 had endoscopic confirmation of resolution of varices. Minor post-CARTO complications, including worsening of esophageal varices (not bleeding) and worsening of ascites/hydrothorax, were noted in 5 patients (25%). One patient passed away at 24 days after the CARTO due to systemic and portal venous thrombosis and multi-organ failure. Otherwise, no major complication was noted. No variceal rebleeding was noted in all 20 patients during mean follow-up of 384±154 days.ConclusionsCARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-esophageal variceal bleeding

Laparoscopic Pancreas Surgery: Image Guidance Solutions

Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause of cancer-related deaths. Surgery is the only viable treatment, but irradical resection rates are still high. Laparoscopic pancreatic surgery has some technical limitations for surgeons and tumor identification may be challenging. Image-guided techniques provide intraoperative margin assessment and visualization methods, which may be advantageous in guiding the surgeon to achieve curative resections and therefore improve the surgical outcomes. In this chapter, current available laparoscopic surgical approaches and image-guided techniques for pancreatic surgery are reviewed. Surgical outcomes of pancreaticoduodenectomy and distal pancreatectomy performed by laparoscopy, laparoendoscopic single-site surgery (LESS), and robotic surgery are included and analyzed. Besides, image-guided techniques such as intraoperative near-infrared fluorescence imaging and surgical navigation are presented as emerging techniques. Results show that minimally invasive procedures reported a reduction of blood loss, reduced length of hospital stay, and positive resection margins, as well as an improvement in spleen-preserving rates, when compared to open surgery. Studies reported that fluorescence-guided pancreatic surgery might be beneficial in cases where the pancreatic anatomy is difficult to identify. The first approach of a surgical navigation system for guidance during pancreatic resection procedures is presented, combining preoperative images (CT and MRI) with intraoperative laparoscopic ultrasound imaging

PHASE I ASSESSMENT OF GUARDRAIL LENGTH-OF-NEED

Report No. TRP-03-284-1

Effectiveness of Ledipasvir/Sofosbuvir with/without Ribavarin in Liver Transplant Recipients with Hepatitis C.

Background and Aims: Recurrent infection of hepatitis C virus (HCV) in liver transplant (LT) recipients is universal and associated with significant morbidity and mortality. Methods: We retrospectively evaluated the safety and efficacy of ledipasvir/sofosbuvir with and without ribavirin in LT recipients with recurrent genotype 1 hepatitis C. Results: Eighty-five LT recipients were treated for recurrent HCV with ledipasvir/sofosbuvirwith and without ribavirin for 12 or 24 weeks. The mean (± standard deviation [SD]) time from LT to treatment initiation was 68 (±71) months. The mean (± SD) age of the cohort was 63 (±8.6) years old. Most recipients were male (70%). Baseline alanine transaminase, total bilirubin, and HCV ribonucleic acid (RNA) values (± SD) were 76.8 (±126) mg/dL, 0.8 (±1.3) U/L, and 8,010,421.9 (±12,420,985) IU/mL, respectively. Five of 43 recipients who were treated with ribavirin required drug cessation due to side effects, with 4 of those being anemia complications. No recipient discontinued the ledipasvir/sofosbuvir. Eighty-one percent of recipients had undetectable viral levels at 4 weeks after starting therapy, and all recipients had complete viral suppression at the end of therapy. The sustained viral response at 12 weeks after completion of therapy was 94%. Conclusion : Ledipasvir and sofosbuvir with and without ribavirin therapy is an effective and well-tolerated interferon-free treatment for recurrent HCV infection after LT. Anemia is not uncommon in LT recipients receiving ribavirin

A Human-derived Dual MRI/PET Reporter Gene System with High Translational Potential for Cell Tracking

Purpose: Reporter gene imaging has been extensively used to longitudinally report on whole-body distribution and viability of transplanted engineered cells. Multi-modal cell tracking can provide complementary information on cell fate. Typical multi-modal reporter gene systems often combine clinical and preclinical modalities. A multi-modal reporter gene system for magnetic resonance imaging (MRI) and positron emission tomography (PET), two clinical modalities, would be advantageous by combining the sensitivity of PET with the high-resolution morphology and non-ionizing nature of MRI. Procedures: We developed and evaluated a dual MRI/PET reporter gene system composed of two human-derived reporter genes that utilize clinical reporter probes for engineered cell detection. As a proof-of-concept, breast cancer cells were engineered to co-express the human organic anion transporter polypeptide 1B3 (OATP1B3) that uptakes the clinical MRI contrast agent gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), and the human sodium iodide symporter (NIS) which uptakes the PET tracer, [18F] tetrafluoroborate ([18F] TFB). Results: T1-weighted MRI results in mice exhibited significantly higher MRI signals in reporter-gene-engineered mammary fat pad tumors versus contralateral naïve tumors (p \u3c 0.05). No differences in contrast enhancement were observed at 5 h after Gd-EOB-DTPA administration using either intravenous or intraperitoneal injection. We also found significantly higher standard uptake values (SUV) in engineered tumors in comparison to the naïve tumors in [18F]TFB PET images (p \u3c 0.001). Intratumoral heterogeneity in signal enhancement was more conspicuous in relatively higher resolution MR images compared to PET images. Conclusions: Our study demonstrates the ability to noninvasively track cells engineered with our human-derived dual MRI/PET reporter system, enabling a more comprehensive evaluation of transplanted cells. Future work is focused on applying this tool to track therapeutic cells, which may one day enable the broader application of cell tracking within the healthcare system

Cost-Benefit Analysis of Crash Cushion Systems

Crash cushions vary in geometry and cost. In this study, crash cushions were categorized in three different categories: redirecting with repair costs greater than $1,000 (RGM), redirecting with repair costs less than$1,000 (RLM), and nonredirecting sacrificial (NRS). Typically, RGM systems are less expensive initially, but life-cycle costs are high. RLM systems typically reciprocate this trend. NRS crash cushions (e.g., sand barrels) are generally less expensive but require total replacement after a crash has occurred, which may be impractical at high-traffic volume locations. Due to limited funding, there is often a need to identify the most cost-effective crash cushion category for highway scenarios with different roadway, traffic, and roadside characteristics. This study was commissioned to determine benefit-cost ratios for each crash cushion category in a wide range of roadway and roadside characteristics using the probability-based encroachment tool, Roadside Safety Analysis Program. Only RGM and RLM systems were cost effective for freeways and divided rural arterials, but all three categories competed against the unprotected condition on undivided rural arterials and local roads

Catalog and distribution atlas of the Scarabaeoidea (Insecta: Coleoptera) of El Salvador

Menos del 1% de la literatura sobre la biodiversidad de El Salvador es sobre invertebrados terrestres, lo que limita nuestro conocimiento de la diversidad, riqueza y distribución de este grupo en el territorio. Los Scarabaeoidea son megadiversos en múltiples ecosistemas y cumplen muchas funciones. Este trabajo tiene como objetivo catalogar los Scarabaeoidea en El Salvador. Se realizó una revisión exhaustiva de la literatura publicada y se revisaron numerosas colecciones entomológicas con material relevante. Se construyeron mapas para visualizar la distribución conocida de cada especie en el país. Existen 295 especies de escarabajos (incluyendo 19 nuevos registros en el país) representando 106 géneros en 7 familias en El Salvador. Se conocen seis especies precursoras. Veintidós especies se descartan como presentes en El Salvador, ya sea porque no son especies válidas o por identificaciones erróneas o registros dudosos. Este trabajo es la primera aproximación al conocimiento de los Scarabaeoidea en El Salvador, un territorio que usualmente se considera de nula importancia para la conservación de la biodiversidad regional debido a su reducida superficie, alta tasa de deforestación y sobrepoblación. Los resultados de este trabajo refuerzan la necesidad de realizar prospección biológica en el territorio para conocer, conservar y proteger la biodiversidad remanente. 2023 Universidad Nacional Autónoma de México. Todos los derechos reservados.Less than 1% of the literature on El Salvador s biodiversity is about terrestrial invertebrates, which limits our knowledge of this group s diversity, richness, and distribution in the territory. Scarabaeoidea are megadiverse in multiple ecosystems and perform many functions. This work aims to catalog the Scarabaeoidea in El Salvador. We conducted an exhaustive review of published literature and reviewed numerous entomological collections with relevant material. Maps were constructed to visualize the known distribution of each species in the country. There are 295 scarab beetle species (including 19 new country records) representing 106 genera in 7 families in El Salvador. Six precinctive species are known. Twenty-Two species are discarded as occurring in El Salvador, either because they are not valid species or because of misidentifications or dubious records. This work is the first approach to knowing the Scarabaeoidea in El Salvador, a territory that is usually considered of no importance for the conservation of regional biodiversity due to its small area, high rate of deforestation, and overpopulation. The results of this work reinforce the need for biological prospecting in the territory to know, conserve, and protect the remaining biodiversity. © 2023 Universidad Nacional Autonoma de Mexico. All rights reserved