Hypothermic machine perfusion in liver transplantation: a randomized trial

BACKGROUNDTransplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.METHODSIn this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.RESULTSA total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P=0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.CONCLUSIONSHypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Prevalence of lymphoedema more than five years after breast cancer treatment

AbstractAimA lack of consistency in the definition of breast cancer related lymphoedema (BCRL) and of uniform measurement criteria contribute to the wide prevalence range found in current literature. This report aims to describe the long-term prevalence of BCRL and secondly, to compare the long-term prevalence of BCRL when assessed by two objective measures and one subjective measure.MethodsThe upper-limbs of 145 post-surgical breast cancer patients were evaluated for the presence of lymphoedema using the water displacement method. Two circumference methods and patient perceived swelling were applied secondarily for comparison. Limb measurements were performed once, more than five years after surgery.ResultsThe long-term prevalence of BCRL using water displacement was 8%. Prevalence varied when the sum of arm circumference (SOAC), the arm circumference and the self-report methods were used: 16, 31 and 17% [P < 0.001], respectively. Of the women identified with BCRL using the water displacement technique, 82% were detected with the SOAC method, 82% with the arm circumference method and 91% by self-report. Using water displacement as the gold standard the methods with the highest specificities were the SOAC (90%) and self-report method (89%), arm circumference resulted in a low specificity of 73%.ConclusionThe prevalence of BCRL more than five years after surgical treatment differs depending on the measuring method used. Our data underlines the necessity for consensus on the diagnostic criteria for BCRL

Possibilities of increasing production and quality of strawberry fruits and several flowers by new blue fluorescent greenhouse films

Within the framework of the project SPECTRAFOIL funded by the EU and Grafe Color Batch (Germany), together with the industrial partners Palrig (Israel), Sunsaver (Spain) and several growers and research partners in Israel, Cyprus, Spain and The Netherlands, new fluorescent greenhouse films for several climates and several horticultural production systems were developed. One of the results of SPECTRAFOIL was the development of new blue fluorescent greenhouse films. Technical aspects were investigated, such as spectral light transmission, fluorescent effect, stability of pigments and films. The effect of different fluorescent films on the production and quality of strawberry fruits was investigated at A&F, Wageningen. In these experiments, strawberry plants were grown in small tunnels covered with films containing blue fluorescent pigments in different concentrations, which increased total light transmission and influenced light quality (more blue light) during the years 2002 and 2003. Both fruit production (number of fruits, fruit weight) and fruit quality (color, size, shape, dry matter, freedom from physiological disorders and diseases, balance between sugars and acids) were determined. Blue fluorescent films caused strawberry plants to produce a higher yield, a higher number of fruits and a slightly higher mean fruit size. Differences in fruit quality were small. Moreover, the effects of blue fluorescent films on different shrubs, perennials and annuals were tested at two growers in The Netherlands. Blue fluorescent films gave a 4 days earlier yield to Alchemilla and a 2 days earlier yield to Virburnum. Flower quality of Alchemilla was improved. This was probably due to higher day temperatures and lower humidity caused by a higher light transmission of the film. The same film caused a 5 days earlier yield to Celosia, at the same time improving flower quality. Blue fluorescent films have potentials to increase the yield of strawberry and force the flowering of perennials

Intra-observer agreements in multidisciplinary team assessments of pancreatic cancer patients

Background and Methods Treatment strategies for pancreatic cancer patients are made by a multidisciplinary team (MDT) board. We aimed to assess intra-observer variance at MDT boards. Participating units staged, assessed resectability, and made treatment allocations for the same patients as they did two years earlier. We disseminated clinical information and CT images of pancreatic cancer patients judged by one MDT board to have nonmetastatic pancreatic cancer to the participating units. All units were asked to re-assess the TNM stage, resectability, and treatment allocation for each patient. To assess intra-observer variance, we computed %-agreements for each participating unit, defined as low (75%) agreement. Results Eighteen patients were re-assessed by six MDT boards. The overall agreement was moderate for TNM-stage (ranging from 50%-70%) and resectability assessment (53%) but low for treatment allocation (46%). Agreement on resectability assessments was low to moderate. Findings were similar but more pronounced for treatment allocation. We observed a shift in treatment strategy towards increasing use of neoadjuvant chemotherapy, particularly in patients with borderline resectable and locally advanced tumors. Conclusions We found substantial intra-observer agreement variations across six different MDT boards of 18 pancreatic cancer patients with two years between the first and second assessment