Management of Hepatocellular Carcinoma in the Setting of Liver Cirrhosis

Cirrhosis is an increasing cause of morbidity and mortality in more developed countries, being the 14th most common cause of death worldwide. Hepatocellular carcinoma (HCC) consists a significant health issue worldwide, responsible for more than 1 million deaths annually. The incidence and mortality rates vary across different geographical areas. Between 60 and 90% of HCC patients already have liver cirrhosis, attributed mainly to chronic hepatitis B and C, alcohol abuse, and non-alcoholic fatty liver disease (NASH). The surgical management of HCC in the setting of liver cirrhosis with curative intent includes liver resection, ablation or microwave coagulation, and liver transplantation (LT). Liver resection in a cirrhotic liver with HCC is associated with lower survival rates compared with liver transplantation (LT), depending on the diseases’ stage but on the contrary liver resection could be potentially offered in a larger population compared to liver transplantation. One of the biggest limitations of liver resection is the risk of tumor recurrence, which is high, and it may exceed 70% 5 years after the procedure. Liver transplantation is considered the best treatment for hepatocellular carcinoma at early stages because it removes the tumor as well as the underlying cirrhotic liver

Bilateral Morgagni Hernia: Primary Repair without a Mesh

We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral subcostal incision revealed a large right side anterior diaphragmatic defect with a hernia containing the ascending colon, the majority of the transverse colon and a huge amount of omentum. Also a second smaller defect was found on the left side with no hernia inside. After large bowel and omentum had been taken down to the peritoneal cavity, both defects were primarily closed using interrupted nylon sutures without the use of a mesh. The patient recovered very well, had an uneventful postoperative course and was released on the 5th postoperative day. 15-month follow-up failed to reveal any signs of recurrence

Minimally Invasive Surgery for Hepatocellular Carcinoma; Latest Advances

Surgical resection is the gold standard for hepatocellular carcinoma management for early stages of the disease. With advances in technology and techniques, minimally invasive surgery provides a great number of advantages for these patients during their surgery and for their post-operative care. The selection of patients following a multi-disciplinary approach is of paramount importance. Adding to this, the developments in laparoscopic instruments and training, as well as the promising advantages of robotic surgery along with other forms of technology, increase the pool of patients that can undergo operation safely and with good results worldwide. We review results from great centres worldwide and delineate the accurate multi-disciplinary approach for this

BDAQ53, a versatile pixel detector readout and test system for the ATLAS and CMS HL-LHC upgrades

BDAQ53 is a readout system and verification framework for hybrid pixel detector readout chips of the RD53 family. These chips are designed for the upgrade of the inner tracking detectors of the ATLAS and CMS experiments. BDAQ53 is used in applications where versatility and rapid customization are required, such as in laboratory testing environments, test beam campaigns, and permanent setups for quality control measurements. It consists of custom and commercial hardware, a Python-based software framework, and FPGA firmware. BDAQ53 is developed as open source software with both software and firmware being hosted in a public repository.Comment: 6 pages, 6 figure

Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

<p>Abstract</p> <p>Objective</p> <p>Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation.</p> <p>Methods</p> <p>We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well.</p> <p>Results</p> <p>A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%).</p> <p>Conclusion</p> <p>Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.</p

Developing an online predictor to predict product sulfur concentration for HDS unit

Hydrodesulfurization (HDS) is an important process in refining industries. Advanced control system (e.g. model predictive controller) requires on-line measurement of the product sulfur at the reactor outlet. However, most HDS processes do not have a sulfur analyzer at the reactor outlet. In order to predict product sulfur concentration usually a data based sulfur predictor is developed. Performance of data based predictor is usually poor since some of the input parameters (e.g. feed sulfur concentration) are unknown. The objective of this thesis is to overcome these limitations of data based predictors and develop an online product sulfur predictor for HDS unit. In this thesis, a hybrid model is proposed, developed and validated (using industrial data), which could predict product sulfur concentration for online HDS system. The proposed hybrid structure is a combination of a reaction kinetics based HDS reactor model and an empirical model based on support vector regression (SVR). The mechanistic model runs in off-line mode to estimate the feed sulfur concentration while the data based model uses the estimated feed sulfur concentration and other process variables to predict the product sulfur concentration. The predicted sulfur concentration can be compared with the lab measurements or sulfur analyzer located further downstream of the process at the tankage. In case there is a large discrepancy, the predictor goes to a calibration mode and uses the mechanistic model to re-estimate the feed sulfur concentration. The detailed logic for the online prediction is also developed. Finally a Matlab based Graphical User Interface (GUI) has been developed for the hybrid sulfur predictor for easy implementation to any HDS process