Progress in liver transplantation.

Since the first clinical orthotopic liver transplant was performed 13 years ago, approximately 275 patients have undergone this procedure. The Denver series constitutes about 40% of this total experience. In our series, the overall 1-year survival has been 29%; the longest survivor is now 6(2)/(3) years posttransplantation. Most of the early deaths have been caused by technical complications, frequently related to difficulties in establishing and maintaining adequate biliary drainage. The late deaths have been from a variety of causes, including recurrent tumor, hepatitis, bile duct obstruction, and chronic rejection. Favorable indications for liver transplantation include biliary atresia, chronic aggressive hepatitis, inborn errors of metabolism, and certain other benign hepatic diseases. Alcoholic cirrhosis is a less favorable indication and primary hepatic malignancy is a relative contraindication. The immunologic criteria for donor-recipient selection are much less rigid than for renal transplantation. Biliary reconstruction is the principal technical problem encountered with orthotopic liver transplantation. Guidelines for the establishment of biliary drainage, its evaluation, and the management of postoperative biliary complications are discussed

Decline in Survival After Liver Transplantation

Twenty-three recent cases of orthotopic liver transplantation were individually reviewed in an effort to determine why survival had declined from the 50% one-year survival rate of an immediately precedent series. In the series of 23, only six (26%) achieved one-year survival. Faulty case selection, technical complications, the use of damaged organs, and complications of immunosuppression were the main causes of death. Attention was directed to the possible use of preoperative lymphoid depletion to improve the effectiveness and safety of immunosuppression. © 1980, American Medical Association. All rights reserved

Preliminary evidence of dual-marked lymphocytes in thoracic duct lymph fluid

Thoracic duct lymphocytes from patients receiving thoracic duct drainage as a pretransplant therapy were examined for cell surface markers. Patients followed over the drainage time period showed a variable but decreasing percentage of E-rosette-positive cells in the lymph fluid. A substantial percentage of these E-rosette-positive cells also had C3 receptors on their cell surface. Reactions of the whole lymphocytes with a heteroantisera to human B-lymphocyte antigens reflected the increasing proportion of B cells in the sample, but also indicated that a fraction of the T cells have Ia-like antigens on their surface. Some cells may have all 3 surface marker characteristics. Significance of these cells with respect to graft survival is discussed

Liver Transplantation for Advanced Liver Disease with Alpha-1antitrypsin Deficiency

ALPHA-1-antitrypsin deficiency associated with chronic obstructive airway disease was recognized in 1963 by Laurell and Ericksson.1 In 1969, Sharp2 described the first cases of alpha-1-antitrypsin-deficiency disease in children with cirrhosis. Since then, this inborn error has been recognized as one of the more common factors in cirrhosis of infancy and childhood,3 including “neonatal hepatitis.”4 Alpha-1-antitrypsin is a glycoprotein that accounts for a major portion of the alpha-1 globulin fraction of the serum.5 It is responsible for approximately 90 per cent of the antitrypsin activity6 of the serum, and it also inhibits several other plasma enzymes, including plasmin,7 elastase,8 collagenase,9 and. © 1980, Massachusetts Medical Society. All rights reserved

Predictors of indoor absolute humidity and estimated effects on influenza virus survival in grade schools

Background: Low absolute humidity (AH) has been associated with increased influenza virus survival and transmissibility and the onset of seasonal influenza outbreaks. Humidification of indoor environments may mitigate viral transmission and may be an important control strategy, particularly in schools where viral transmission is common and contributes to the spread of influenza in communities. However, the variability and predictors of AH in the indoor school environment and the feasibility of classroom humidification to levels that could decrease viral survival have not been studied. Methods: Automated sensors were used to measure temperature, humidity and CO2 levels in two Minnesota grade schools without central humidification during two successive winters. Outdoor AH measurements were derived from the North American Land Data Assimilation System. Variability in indoor AH within classrooms, between classrooms in the same school, and between schools was assessed using concordance correlation coefficients (CCC). Predictors of indoor AH were examined using time-series Auto-Regressive Conditional Heteroskedasticity models. Classroom humidifiers were used when school was not in session to assess the feasibility of increasing indoor AH to levels associated with decreased influenza virus survival, as projected from previously published animal experiments. Results: AH varied little within classrooms (CCC >0.90) but was more variable between classrooms in the same school (CCC 0.81 for School 1, 0.88 for School 2) and between schools (CCC 0.81). Indoor AH varied widely during the winter (range 2.60 to 10.34 millibars [mb]) and was strongly associated with changes in outdoor AH (p < 0.001). Changes in indoor AH on school weekdays were strongly associated with CO2 levels (p < 0.001). Over 4 hours, classroom humidifiers increased indoor AH by 4 mb, an increase sufficient to decrease projected 1-hour virus survival by an absolute value of 30% during winter months. Conclusions: During winter, indoor AH in non-humidified grade schools varies substantially and often to levels that are very low. Indoor results are predicted by outdoor AH over a season and CO2 levels (which likely reflects human activity) during individual school days. Classroom humidification may be a feasible approach to increase indoor AH to levels that may decrease influenza virus survival and transmission

Was it a HIIT? A process evaluation of a school-based high-intensity interval training intervention

This is the final version. Available on on open access from BMC via the DOI in this recordAvailability of data and materials: Data are available from the corresponding author on reasonable request.Background Despite a growing body of research investigating high-intensity interval training (HIIT) in schools, there are limited process evaluations investigating their implementation. This is concerning because process evaluations are important for appropriately interpreting outcome findings and augmenting intervention design. This manuscript presents a process evaluation of Making a HIIT, a school-based HIIT intervention. Methods The Making a HIIT intervention spanned 8 weeks and was completed at three schools in Greater Brisbane, Australia. Ten classes (intervention group) completed 10-min teacher-led HIIT workouts at the beginning of health and physical education (HPE) lessons, and five classes (control group) continued with regular HPE lessons. The mixed methods evaluation was guided by the Framework for Effective Implementation by Durlak and DuPre. Results Program reach: Ten schools were contacted to successfully recruit three schools, from which 79% of eligible students (n = 308, age: 13.0 ± 0.6 years, 148 girls) provided consent. Dosage: The average number of HIIT workouts provided was 10 ± 3 and the average number attended by students was 6 ± 2. Fidelity: During HIIT workouts, the percentage of time students spent at ≥ 80% of maximum heart rate (HRmax) was 55% (interquartile range (IQR): 29%—76%). Monitoring of the control group: During lessons, the intervention and control groups spent 32% (IQR: 12%—54%) and 28% (IQR: 13%—46%) of their HPE lesson at ≥ 80% of HRmax, respectively. Responsiveness: On average, students rated their enjoyment of HIIT workouts as 3.3 ± 1.1 (neutral) on a 5-point scale. Quality: Teachers found the HIIT workouts simple to implement but provided insights into the time implications of integrating them into their lessons; elements that helped facilitate their implementation; and their use within the classroom. Differentiation: Making a HIIT involved students and teachers in the co-design of HIIT workouts. Adaption: Workouts were modified due to location and weather, the complexity of exercises, and time constraints. Conclusion The comprehensive evaluation of Making a HIIT provides important insights into the implementation of school-based HIIT, including encouraging findings for student enjoyment and fidelity and recommendations for improving dosage that should be considered when developing future interventions.QUEX Institute for Global ExcellenceSports Medicine Australi