Nutritional Intake after Liver Transplant: Systematic Review and Meta-Analysis

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Cardiovascular disease and its concurrent risk factors are prevalent after liver transplant (LT). Most of these risk factors are modifiable by diet. We aimed to synthesise the literature reporting the nutritional intake of liver transplant recipients (LTR) and the potential determinants of intake. We performed a systematic review and meta-analyses of studies published up until July 2021 reporting the nutritional intake of LTR. The pooled daily mean intakes were recorded as 1998 (95% CI 1889, 2108) kcal, 17 (17, 18)% energy from protein, 49 (48, 51)% energy from carbohydrates, 34 (33, 35)% energy from total fat, 10 (7, 13)% energy from saturated fat, and 20 (18, 21) g of fibre. The average fruit and vegetable intake ranged from 105 to 418 g/day. The length of time post-LT and the age and sex of the cohorts, as well as the continent and year of publication of each study, were sources of heterogeneity. Nine studies investigated the potential determinants of intake, time post-LT, gender and immunosuppression medication, with inconclusive results. Energy and protein requirements were not met in the first month post-transplant. After this point, energy intake was significantly higher and remained stable over time, with a high fat intake and low intake of fibre, fruits and vegetables. This suggests that LTR consume a high-energy, low-quality diet in the long term and do not adhere to the dietary guidelines for cardiovascular disease prevention.Peer reviewe

Pituitary insufficiency after operation of supratentorial intra- and extraaxial tumors outside of the sellar–parasellar region?

Recent studies investigating pituitary function after non-sellar brain tumor surgery showed that up to 38.2% of patients have pituitary insufficiency (PI). It has been assumed that the operation causes the PI, but preoperative hormone testing, which would have been necessary to prove this assumption, was not performed. The objective of this study is to answer the question if indeed microsurgery is the culprit of PI in patients with operatively treated non-sellar brain tumors. In this prospective trial, 54 patients with supratentorial non-sellar tumors were included. The basal levels of cortisol, prolactin, testosterone, estrogen, IGF-1, fT3, fT4, STH, TSH, ACTH, FSH, and LH were recorded preoperatively on days 1 and 7 after surgery. If basal hormone screening revealed an abnormality, a releasing hormone assay was performed. Before surgery, 24 of the 54 patients (44.4%) already had PI. Additional 25 patients showed either hypocortisolism or hypothyreoidism. As those patients had been pre-treated with dexamethasone and l-thyroxine, these findings were considered not to represent PI but drug effects. Hormone testing on days 1 and 7 after surgery revealed no changes. With 44.4% PI is a frequent finding in brain tumor patients already before surgery. The factors causing preoperative PI remain yet to be identified. The endocrine results after surgery are unchanged which rules out that surgery is the cause of PI

Pregnancy and low back pain

Back pain is ubiquitous in today’s society and is particularly common during pregnancy. There are multiple factors contributing to these symptoms during pregnancy including pelvic changes as well as alterations to loading. Potential imaging modalities are limited during pregnancy due to the desire to limit ionizing radiation exposure to the fetus. Treatments are generally conservative, exercise-based interventions and alternative modalities may also be considered. Low back pain associated with pregnancy does generally resolve postpartum

Evidence of niche partitioning under ontogenetic influences among three morphologically similar siluriformes in small subtropical streams

Ontogenetic influences in patterns of niche breadth and feeding overlap were investigated in three species of Siluriformes (Heptapterus sp., Rhamdia quelen and Trichomycterus poikilos) aiming at understanding the species coexistence. Samplings were conducted bimonthly by electrofishing technique from June/2012 to June/2013 in ten streams of the northwestern state of Rio Grande do Sul, Brazil. The stomach contents of 1,948 individuals were analyzed by volumetric method, with 59 food items identified. In general Heptapterus sp. consumed a high proportion of Aegla sp., terrestrial plant remains and Megaloptera; R. quelen consumed fish, and Oligochaeta, followed by Aegla sp.; while the diet of T. poikilos was based on Simuliidae, Ephemeroptera and Trichoptera. Specie segregation was observed in the NMDS. Through PERMANOVA analysis feeding differences among species, and between a combination of species plus size classes were observed. IndVal showed which items were indicators of these differences. Niche breadth values were high for all species. The niche breadth values were low only for the larger size of R. quelen and Heptapterus sp. while T. poikilos values were more similar. Overall the species were a low feeding overlap values. The higher frequency of high feeding overlap was observed for interaction between Heptapterus sp. and T. poikilos. The null model confirmed the niche partitioning between the species. The higher frequency of high and intermediate feeding overlap values were reported to smaller size classes. The null model showed resource sharing between the species/size class. Therefore, overall species showed a resource partitioning because of the use of occasional items. However, these species share resources mainly in the early ontogenetic stages until the emphasized change of morphological characteristics leading to trophic niche expansion and the apparent segregation observed

Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

No Abstract

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multi-disciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments