Live Donor Partial Hepatectomy for Liver Transplantation: Is There a Learning Curve?

Background: Donor safety is the first priority in living donor liver transplantation (LDLT). Objective: To determine the characteristics and outcome of live liver donors who underwent donor hepatectomy from January, 1997 to May, 2007 at Massachusetts General Hospital. Methods: 30 patients underwent LDLT between January, 1997 and May, 2007 at our institution. Results: The type of graft was the right lobe (segments 5-8) in 14, left lobe (segments 2-4) in 4, and left lateral sector (segments 2 and 3) in 12 patients. The mean donor age was 36 (range: 26-57) years. The mean follow-up was 48 (range: 18-120) months. No deaths occurred. Overall, 8 (26.6%) patients experienced a total of 14 post-operative complications. Donor complications based on graft type were as follows: left lateral sector (16.7%), left lobe (25%), and right lobe (35.7%). The experience was divided into two periods 1997-2001 (n=15) and 2002-2007 (n=15). Overall complications during 2 periods were 40% and 13.3%, respectively (p<0.001). The incidence of grade III complication also significantly decreased; 66.7% vs 33.3% (p<0.01). Conclusion: Partial hepatectomy in living donors has a learning curve which appears to be approximately 15 cases. This learning curve is not restricted to the surgeons performing the procedure but involves all aspects of patient care

Progress and status of APEmille

We report on the progress and status of the APEmille project: a SIMD parallel computer with a peak performance in the TeraFlops range which is now in an advanced development phase. We discuss the hardware and software architecture, and present some performance estimates for Lattice Gauge Theory (LGT) applications.Comment: Talk presented at LATTICE97, 3 pages, Late

Induction with Rabbit Antithymocyte Globulin following Orthotopic Liver Transplantation for Hepatitis C

Background: Hepatitis C (HCV) is the most common indication for liver transplantation in the US. Objective: Since steroids are the major stimulus of viral replication, we postulated that steroid-free immunosuppression might be a safer approach. Methods: From January 1995 to October 2002, we used steroid plus calcineurin inhibitor (CNI) immunosuppression after liver transplantation for HCV (steroid group, n=81). From October 2002 to June 2007, rabbit antithymocyte globulin (RATG) induction, followed by CNI and azathioprine (RATG group, n=73) was utilized. Results: There were no differences in 1- and 3-year patient/allograft survival rates. The incidence of acute rejection rate (19% vs. 28%), of biopsy-proven HCV recurrence (70% vs. 75%), and chronic rejection (6% vs. 9%) were comparable. The mean time to develop recurrent HCV was significantly longer in the RATG group (16.2 vs. 9.2 months, p=0.008). The incidence of severe portal fibrosis appears to be lower in RATG group compared to the steroid group; 14% vs. 4% (p=0.07). Conclusions: RATG induction is safe and effective after liver transplantation for HCV, but has no impact on the incidence of HCV recurrence and patient/allograft survival. However, a significant delay in time to HCV recurrence and a trend toward less rejection and portal fibrosis was observed

Insecticide resistance in Italian populations of Tribolium flour beetles

As a consequence of the widespread use of chemical insecticides in the control of insect pests in grain warehouses and in the food industry, insecticide resistance in grain insect pests has greatly increased all over the world. The goal of this work was to investigate insecticide resistance levels in Italian populations of Tribolium castaneum (Herbst) and Tribolium confusum du Val collected in grain and food storage facilities of 18 different localities. Six contact insecticides were tested on seven populations of the red flour beetle and on eleven populations of the confused flour beetle. Topical application bioassays were carried out on adults. Dose-mortality lines were estimated to determine the resistance ratios for each insecticide and population. A Principal Components Analysis (PCA) was performed on a data matrix describing the pattern of occurrence of the RR values of each insecticide across the set of data provided by 18 different sites. In both species, the slopes of LD-lines range within a rather narrow interval with respect to susceptible strains, while the highest RR value can be observed in a population of the confused flour beetle from Molise assayed with deltamethrin. The distribution of the experimental points in the PCA graph suggests that T. castaneum populations were generally more susceptible to malathion, diazinon and pirethrins than the T. confusum populations. RR values obtained in bioassays suggest that insecticide resistance is not a widespread problem in Italian strains of T. castaneum and T. confusum, but there are populations in which the phenomenon exists. An extended monitoring activity could, therefore, be crucially important in adopting proper control measures for pest management

Energy analysis for the connection of the nuclear reactor DEMO to the European electrical grid

Towards the middle of the current century, the DEMOnstration power plant, DEMO, will start operating as the first nuclear fusion reactor capable of supplying its own loads and of providing electrical power to the European electrical grid. The presence of such a unique and peculiar facility in the European transmission system involves many issues that have to be faced in the project phase. This work represents the first study linking the operation of the nuclear fusion power plant DEMO to the actual requirements for its correct functioning as a facility connected to the power systems. In order to build this link, the present work reports the analysis of the requirements that this unconventional power-generating facility should fulfill for the proper connection and operation in the European electrical grid. Through this analysis, the study reaches its main objectives, which are the definition of the limitations of the current design choices in terms of power-generating capability and the preliminary evaluation of advantages and disadvantages that the possible configurations for the connection of the facility to the European electrical grid can have. In reference to the second objective, the work makes possible a first attempt at defining the features of the point of connection to the European grid,whose knowledge will be useful in the future, for the choice of the real construction site

apeNEXT: A Multi-Tflops LQCD Computing Project

This paper is a slightly modified and reduced version of the proposal of the {\bf apeNEXT} project, which was submitted to DESY and INFN in spring 2000. .It presents the basic motivations and ideas of a next generation lattice QCD (LQCD) computing project, whose goal is the construction and operation of several large scale Multi-TFlops LQCD engines, providing an integrated peak performance of tens of TFlops, and a sustained (double precision) performance on key LQCD kernels of about 50% of peak speed

Partial abdominal evisceration and intestinal autotransplantation to resect a mesenteric carcinoid tumor

<p>Abstract</p> <p>Background</p> <p>Midgut carcinoids are neuroendocrine tumors that commonly metastasize to the intestinal mesentery, where they predispose to intestinal obstruction, ischemia and/or congestion. Because of their location, many mesenteric carcinoid tumors are deemed unresectable due to the risk of uncontrollable bleeding and prolonged intestinal ischemia.</p> <p>Case Presentation</p> <p>We report the case of a 60-year-old male with a mesenteric carcinoid tumor obstructing his superior mesenteric vein, resulting in intestinal varices and severe recurrent GI bleeds. While his tumor was thought to be unresectable by conventional techniques, it was successfully resected using intestinal autotransplantation to safely gain access to the tumor. This case is the first described application of this technique to carcinoid tumors.</p> <p>Conclusions</p> <p>Intestinal autotransplantation can be utilized to safely resect mesenteric carcinoid tumors from patients who were not previously thought to be surgical candidates. We review the literature concerning both carcinoid metastases to the intestinal mesentery and the use of intestinal autotransplantation to treat lesions involving the mesenteric root.</p

Interfacial Nanoengineering of Hydrogel Surfaces via Block Copolymer Self-Assembly

Synthetic polymer hydrogels are valuable matrices for biotransformations, drug delivery, and soft implants. While the bulk properties of hydrogels depend on chemical composition and network structure, the critical role of interfacial features is often underestimated. This work presents a nanoscale modification of the gel–water interface using polymer brushes via a straightforward “grafting-to” strategy, offering an alternative to more cumbersome “grafting-from” approaches. Functional block copolymers with photoreactive anchor blocks are successfully self-assembled and UV-immobilized on hydrogel substrates despite their low solid content (<30 wt %). This versatile technique works on both bulk- and surface-immobilized hydrogels, demonstrated on poly­(hydroxypropyl acrylate), poly­( N -isopropylacrylamide), and alginate gels, allowing precise control over grafting density. X-ray photoelectron spectroscopy and time-of-flight secondary ion mass spectrometry revealed a homogeneous bilayered architecture. By “brushing-up”, the hydrogels’ interface can be tailored to enhance protein adsorption, improve cell adhesion, or impair the diffusive uptake of small molecules into the bulk gels. This effective interfacial nanoengineering method is broadly applicable for enhancing hydrogel performance across a wide range of applications

History of clinical transplantation

How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York