Comparison of the collagen haemostat Sangustop(R) versus a carrier-bound fibrin sealant during liver resection; ESSCALIVER-study

Background: Haemostasis in liver surgery remains a challenge despite improved resection techniques. Oozing from blood vessels too small to be ligated necessitate a treatment with haemostats in order to prevent complications attributed to bleeding. There is good evidence from randomised trials for the efficacy of fibrin sealants, on their own or in combination with a carrier material. A new haemostatic device is Sangustop(R). It is a collagen based material without any coagulation factors. Pre-clinical data for Sangustop(R) showed superior haemostatic effect. This present study aims to show that in the clinical situation Sangustop(R) is not inferior to a carrier-bound fibrin sealant (Tachosil(R)) as a haemostatic treatment in hepatic resection. Methods: This is a multi-centre, patient-blinded, intra-operatively randomised controlled trial. A total of 126 patients planned for an elective liver resection will be enrolled in eight surgical centres. The primary objective of this study is to show the non-inferiority of Sangustop(R) versus a carrier-bound fibrin sealant (Tachosil(R)) in achieving haemostasis after hepatic resection. The surgical intervention is standardised with regard to devices and techniques used for resection and primary haemostasis. Patients will be followed-up for three months for complications and adverse events. Discussion: This randomised controlled trial (ESSCALIVER) aims to compare the new collagen haemostat Sangustop(R) with a carrier-bound fibrin sealant which can be seen as a "gold standard" in hepatic and other visceral organ surgery. If non-inferiority is shown other criteria than the haemostatic efficacy (e.g. costs, adverse events rate) may be considered for the choice of the most appropriate treatment. Trial Registration: NCT0091861

Pinning Down Social Vulnerability to Climate Change in Sindh, Pakistan: From Narratives to Numbers, and Back Again

This paper reflects critically on the results of a vulnerability assessment process at the household and community scale using a quantitative vulnerabilities and capacities index. It validates a methodology for a social vulnerability assessment at the local scale in 62 villages across four agro‐ecological/livelihood zones in Sindh Province, Pakistan. The study finds that the move from vulnerability narratives to numbers improves the comparability and communicational strength of the concept. The depth and nuance of vulnerability, however, can be realised only by a return to narrative. Caution is needed, therefore: the index can be used in conjunction with qualitative assessments, but not instead of them. More substantively, the results show that vulnerability is more a function of historico‐political economic factors and cultural ethos than any biophysical changes wrought by climate. The emerging gendered vulnerability picture revealed extremes of poverty and a lack of capacity to cope with contemporary environmental and social stresses

Temperature Dependent Zero-Field Splittings in Graphene

Graphene is a quantum spin Hall insulator with a 45 $\mu$eV wide non-trivial topological gap induced by the intrinsic spin-orbit coupling. Even though this zero-field spin splitting is weak, it makes graphene an attractive candidate for applications in quantum technologies, given the resulting long spin relaxation time. On the other side, the staggered sub-lattice potential, resulting from the coupling of graphene with its boron nitride substrate, compensates intrinsic spin-orbit coupling and decreases the non-trivial topological gap, which may lead to the phase transition into trivial band insulator state. In this work, we present extensive experimental studies of the zero-field splittings in monolayer and bilayer graphene in a temperature range 2K-12K by means of sub-Terahertz photoconductivity-based electron spin resonance technique. Surprisingly, we observe a decrease of the spin splittings with increasing temperature. We discuss the origin of this phenomenon by considering possible physical mechanisms likely to induce a temperature dependence of the spin-orbit coupling. These include the difference in the expansion coefficients between the graphene and the boron nitride substrate or the metal contacts, the electron-phonon interactions, and the presence of a magnetic order at low temperature. Our experimental observation expands knowledge about the non-trivial topological gap in graphene.Comment: Main text with figures (20 pages) and Supplementary Information (14 pages) Accepted in Phys. Rev.

Resolution of hyposmotic stress in isolated mouse ventricular myocytes causes sealing of t‐tubules

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98789/1/expphysiol.2013.072470.pd

Photodynamic therapy in the therapy for recurrent/persistent nasopharyngeal cancer

To determine the efficacy of Photodynamic therapy of patients with recurrent Nasopharyngeal Carcinoma we reviewed all available literature

Women and ARVâ based prevention: opportunities and challenges

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138349/1/jia29419.pd