The effect of portacaval transposition on carbohydrate metabolism: Experimental and clinical observations

An investigation was conducted of the influence of portacaval transposition upon carbohydrate metabolism in 45 dogs. In 17 dogs, hepatic glycogen content was measured before and from 45 to 75 days after transposition. A reduction in glycogen content, principally in the TCA soluble fraction, was noted in 14 animals. The mean loss of total glycogen was 51 percent, and the mean loss of TCA soluble glycogen was 70 percent. In control animals hepatic deglycogenation did not occur. Despite the reduction in hepatic glycogen content, the animals were capable of glucagon-induced glycogenolysis using very small test doses. After transposition, a greater response to intraportal injection was noted as compared to that obtained with systemic venous infusions. Other alterations in carbohydrate metabolism were also measured. These included a reduction in the duration and magnitude of the hyperglycemic response to oral glucose loads. The profile of glycemic response under these conditions was studied, and demonstrated to be greatest in the portal vein, least in the peripheral venous blood, and of intermediate magnitude in the peripheral arteries. Based upon the hepatic deglycogenating effect of portacaval transposition in dogs, this operation was used for the treatment of an 8 1 2-year-old child with glycogen storage disease and concomitant portal cirrhosis. The portacaval transposition was performed in preference to a standard portacaval shunt. The enzyme defect in the patient was extensively studied before and after transposition. Prior to surgery, she was demonstrated to have Type IIIB glycogenosis (amylo-1,6-glucosidase deficiency confined to the liver). Eight and one half months after operation, the quantities of glycogen in liver and muscle and the enzyme activities showed no significant alteration. The clinical response to portacaval transposition was gratifying. There has been a decrease in the hepatosplenomegaly, rapid growth, a diminution in the pre-existing hypersplenism, and a considerable increase in the child's physical activity. Most of these benefits are ascribable to the effective portal decompressive procedure. Whether any metabolic benefit derived from the portacaval transposition is problematical. © 1965

Factors determining short- and long-term survival after orthotopic liver homotransplantation in the dog

Without azathioprine therapy, the operative risk with orthotopic liver transplantation is small. Twenty-two of 23 animals survived 2 days or more, and 19 for 6 days or longer. All eventually died of rejection within 10 days. Changes in homograft histology and function were similar to those previously reported, with cellular infiltration and hepatocyte necrosis which was heavily concentrated in the centrilobular areas. In individual experiments, there was little evidence of immunologically induced segmental hepatic arterial or portal venous occlusion; hepatocyte loss was homogeneous, and fibrinoid vascular lesions were uncommon. There was, however, some evidence of damage to the sinusoidal endothelium by adherent mononuclear cells. The changing character of the mononuclear infiltration of the homograft was reflected by widespread proliferation of similar cells in the host lymphoid tissue. Specific changes in other host organs were not noted. Some of the biochemical and histologic alterations caused by unmodified rejection can also be produced by azathioprine. In 18 nontransplanted dogs, acute rises in SGOT, SGPT, and alkaline phosphatase, unaccompanied by hyperbilirubinemia, were noted within a few days after beginning administration of this agent. Although these abnormalities tended to regress within the 40 day period of observation, more than two thirds of the livers showed histologic evidence of centrilobular hepatocyte damage or necrosis-often with intrahepatic cholestasis, but always without mononuclear cell infiltration. The hepatotoxicity was not prevented by methionine. Weight loss and progressive anemia also occurred. Lymphoid tissue was depleted. The mortality from the toxicity study was 33 percent. The use of azathioprine to mitigate rejection increased the early mortality after homotransplantation, 32 of 116 dogs dying within the first week (28 percent), most commonly of pulmonary complications. The 84 animals living longer than 7 days had a greatly potentiated homograft survival, exceeding 25 days in 44 dogs, and 50 days in 24. Fifteen animals are still alive from 62 to 324 days postoperatively. Six dogs had all drugs stopped after 116 to 123 days. Only 1 has had a clinically evident late rejection and 5 are still alive from 63 to 204 days later. Three of these animals had repeat biopsies 77 to 182 days after cessation of therapy; one homograft which was normal at 4 months remained so 6 months later, another had an improved histologic appearance, and the third had deteriorated. The longest mean survival was in those animals receiving adjuvant therapy with L-methionine or S35-methionine, but the variability of the results was so great that a statistically significant advantage of these agents could not be demonstrated. Soon after operation red cell survival was decreased, but in chronic survivors there was no evidence of a grafthost reaction. There was great variability in the vigor of rejection, ranging from the uncontrollable (29 percent) to the clinically undetectable (23 percent). Most of the animals (49 percent) had some biochemical evidence of rejection which proved to be spontaneously reversible, to a greater or lesser degree, since intensification of immunosuppressive therapy was not required. These findings correlate well with the histologic studies. In virtually all animals, azathioprine delayed the onset of rejection but in those dying in the second and third postoperative weeks, the pathologic stigmas of rejection were very similar to the untreated controls. As in the untreated animals, the number of proliferating large pyroninophilic cells in the host's lymphoid tissues was roughly proportional to the number of mononuclear cells invading the homograft liver. After this time, the predominant histologic features in most animals were those of repair and regeneration, with either absent or relatively minor degrees or continuing destruction. Since the major rejection damage was centrizonal, the healing was most prominent in these areas with interconecting fibrosis around the central veins, centrilobular bile canalicular dilatation and cholestasis, and pseudolobule formation. In some of the homografts, increased connective tissue was also present in the portal tracts, but in others including the longest survivor there were no residual abnormalities whatever. In azathioprine-treated animals, damage to the vessels in the homograft portal tracts was found in only one liver. With electron microscopy there was some evidence of damage to the sinusoidal endothelium by adherent mononuclear cells, a finding which could be analogous to that described by Kountz and co-workers11 in the peritubular capillaries of renal homografts. If immunologically mediated hemodynamic alterations play an important role in liver homograft rejection by interrupting the blood supply to the hepatocytes, it seems most likely that they occur at this intrasinusoidal capillary level rather than in the larger vessels. © 1965

Serotyping for homotransplantation V. Evaluation of a matching scheme

An attempt was made to determine whether 36 long-term kidney homograft recipients and their donors were compatible for 7 major leukocyte groups. It was found that 21 of these recipients were surviving 2 to 3 years in spite of incompatibility for 1 or 2 major leukocyte antigens. Survival of mismatched grafts does not itself indicate that the antigens being measured are not transplantation antigens, for it was shown that the 15 recipients with no groups of mismatch were clinically superior to those with group incompatibilities. Moreover, histopathologic scores given to biopsy specimens taken 2 to 3 years after transplantation were significantly correlated with the number of group mismatches. Because the leukocyte groups were determined by cytotoxicity reactions of peripheral blood lymphocytes, the results may have been influenced considerably by chimerism in chronically dialyzed uremic patients or change in lymphocyte antigenicity or susceptibility to lysis upon prolonged immunosuppressive treatment. Although the possibility of these complications could not be ruled out in all instances, it was shown that 52 dialyzed uremic patients and 49 patients who had been treated with immunosuppression for over 1 year did not possess more or less antigens than a random population of normal individuals. It is concluded that: (1) the major leukocyte antigens are histocompatibility antigens, and (2) since survival can be attained at times despite mismatches for these groups, the antigens are of intermediate strength and kidney homograft rejection may occur if excessive numbers of antigens are incompatible or if particular combinations of antigens are mismatched. © 1966 by The Williams and Wilkins Co

Flexible formwork technologies – a state of the art review

Concrete is our most widely used construction material. Worldwide consumption of cement, the strength-giving component of concrete, is estimated at 4.10 Gt per year, rising from 2.22 Gt just ten years ago [1]. This rate of consumption means that cement manufacture alone is estimated to account for 5.2 % of global carbon dioxide emissions [2].Concrete offers the opportunity to economically create structures of almost any geometry. Yet its unique fluidity is seldom capitalised upon, with concrete instead being cast into rigid, flat moulds to create unoptimised geometries that result in high material use structures with large carbon footprints. This paper will explore flexible formwork construction technologies which embrace the fluidity of concrete to facilitate the practical construction of concrete structures with complex and efficient geometries. This paper presents the current state of the art in flexible formwork technology, highlighting practical uses, research challenges and new opportunities

Entangled Mechanical Oscillators

Hallmarks of quantum mechanics include superposition and entanglement. In the context of large complex systems, these features should lead to situations like Schrodinger's cat, which exists in a superposition of alive and dead states entangled with a radioactive nucleus. Such situations are not observed in nature. This may simply be due to our inability to sufficiently isolate the system of interest from the surrounding environment -- a technical limitation. Another possibility is some as-of-yet undiscovered mechanism that prevents the formation of macroscopic entangled states. Such a limitation might depend on the number of elementary constituents in the system or on the types of degrees of freedom that are entangled. One system ubiquitous to nature where entanglement has not been previously demonstrated is distinct mechanical oscillators. Here we demonstrate deterministic entanglement of separated mechanical oscillators, consisting of the vibrational states of two pairs of atomic ions held in different locations. We also demonstrate entanglement of the internal states of an atomic ion with a distant mechanical oscillator.Comment: 7 pages, 2 figure