Liver transplantation in Romania

Institultul Clinic Fundeni-Clinica Chirurgie Generală și Transplant Hepatic “Dan Setlacec”, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Analiza retrospectivă a 300 de transplanturi hepatice efectuate în Centrul de Chirurgie Generală și Transplant Hepatic “Dan Setlacec “.Retrospective analysis of 300 liver transplantation performed in General Surgery Center and Liver Transplantation “Dan Setlacec”

Postoperative Infectious Complications Worsen Long-Term Survival After Curative-Intent Resection for Hepatocellular Carcinoma

Background: Postoperative infectious complications may be associated with a worse long-term prognosis for patients undergoing surgery for a malignant indication. The current study aimed to characterize the impact of postoperative infectious complications on long-term oncologic outcomes among patients undergoing resection for hepatocellular carcinoma (HCC). Methods: Patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The relationship between postoperative infectious complications, overall survival (OS), and recurrence-free survival (RFS) was analyzed. Results: Among 734 patients who underwent HCC resection, 269 (36.6%) experienced a postoperative complication (Clavien-Dindo grade 1 or 2 [n = 197, 73.2%] vs grade 3 and 4 [n = 69, 25.7%]). An infectious complication was noted in 81 patients (11.0%) and 188 patients (25.6%) had non-infectious complications. The patients with infectious complications had worse OS (median: infectious complications [46.5 months] vs no complications [106.4 months] [p < 0.001] and non-infectious complications [85.7 months] [p < 0.05]) and RFS (median: infectious complications [22.1 months] vs no complications [45.5 months] [p < 0.05] and non-infectious complications [38.3 months] [p = 0.139]) than the patients who had no complication or non-infectious complications. In the multivariable analysis, infectious complications remained an independent risk factor for OS (hazard ratio [HR], 1.7; p = 0.016) and RFS (HR, 1.6; p = 0.013). Among the patients with infectious complications, patients with non-surgical-site infection (SSI) had even worse OS and RFS than patients with SSI (median OS: 19.5 vs 70.9 months [p = 0.010]; median RFS: 12.8 vs 33.9 months [p = 0.033]). Conclusion: Infectious complications were independently associated with an increased long-term risk of tumor recurrence and death. Patients with non-SSI versus SSI had a particularly worse oncologic outcome.info:eu-repo/semantics/publishedVersio

Tumor Necrosis Impacts Prognosis of Patients Undergoing Curative-Intent Hepatocellular Carcinoma

info:eu-repo/semantics/publishedVersio

Multi-Institutional Development and External Validation of a Nomogram for Prediction of Extrahepatic Recurrence After Curative-Intent Resection for Hepatocellular Carcinoma

Backgrounds: Extrahepatic recurrence of hepatocellular carcinoma (HCC) after surgical resection is associated with unfavorable prognosis. The objectives of the current study were to identify the risk factors and develop a nomogram for the prediction of extrahepatic recurrence after initial curative surgery. Methods: A total of 635 patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The clinicopathological characteristics, risk factors, and long-term survival of patients with extrahepatic recurrence were analyzed. A nomogram for the prediction of extrahepatic recurrence was established and validated in 144 patients from an external cohort. Results: Among the 635 patients in the derivative cohort, 283 (44.6%) experienced recurrence. Among patients who recurred, 80 (28.3%) patients had extrahepatic ± intrahepatic recurrence, whereas 203 (71.7%) had intrahepatic recurrence only. Extrahepatic recurrence was associated with more advanced initial tumor characteristics, early recurrence, and worse prognosis versus non-extrahepatic recurrence. A nomogram for the prediction of extrahepatic recurrence was developed using the β-coefficients from the identified risk factors, including neutrophil-to-lymphocyte ratio, multiple lesions, tumor size, and microvascular invasion. The nomogram demonstrated good ability to predict extrahepatic recurrence (c-index: training cohort 0.786; validation cohort: 0.845). The calibration plots demonstrated good agreement between estimated and observed extrahepatic recurrence (p = 0.658). Conclusions: An externally validated nomogram was developed with good accuracy to predict extrahepatic recurrence following curative-intent resection of HCC. This nomogram may help identify patients at high risk of extrahepatic recurrence and guide surveillance protocols as well as adjuvant treatments.info:eu-repo/semantics/publishedVersio

On-off and proportional-integral controller for a morphing wing. Part 1: actuation mechanism and control design

The main objective of this research work is the development of an actuation control concept for a new morphing actuation mechanism made of smart materials, which is built from a shape memory alloy (SMA). Two lines of smart actuators were incorporated to a rectangular wing to modify the upper wing surface, made of a flexible skin, with the intention to move the laminarto- turbulent transition point closer to the wing trailing edge. After a brief introduction of the morphing wing system architecture and requirements, the actuation lines' design and instrumentation are presented. The integrated controller controls the SMA actuators via an electrical current supply, so that the transducer position can be used to eliminate the deviation between the required values for vertical displacements (corresponding to the optimized airfoils) and their physical values. The final configuration of the integrated controller is a combination of a bi-positional (on-off) controller and a PI (proportional-integral) controller, due to the two heating and cooling phases of the SMA wires' interconnection. This controller must behave like a switch between the cooling and the heating phases, situations where the output current is 0 A, or is controlled by a PI type law. The PI controller for the heating phase is optimally tuned using integral and surface minimum error criteria (Ziegler-Nichols). The controller is numerically tested on the linear identified system in terms of time response, Bode diagram, amplitude and phase stability margins, and root-locus.Peer reviewed: YesNRC publication: Ye