Comparison Adsorption of Cd (II) onto Lignin and Polysaccharide-Based Polymers

Given the predominantly negative impact of heavy metals on living organisms, the present study proposed to evaluate the adsorption performances under static conditions of Cd (II) from aqueous solutions on unmodified Sarkanda grass lignin compared to the adsorption performances of polysaccharide polymers chemically functionalized, obtained by synthesis and in their native state, but which, although effective, have a cost price that does not allow for large-scale expansion. To improve the retention of Cd (II) on this aromatic component of the biomass resulting from the processing of lignocellulosic materials, different experimental conditions (pH, concentration, dose and contact time) were followed. The Freundlich and Langmuir isotherms were used to describe the equilibrium conditions. Adsorption kinetics were assessed using the Lagergren I and Ho and McKay II kinetic models, furnishing informative insights into the process mechanism. Lignin adsorption capacity was also analyzed by performing biological tests on tomato seeds (Lypercosium esculentum), since heavy metals are known to be a stress factor for seeds by disturbing the osmotic equilibrium. Through the prism of the investigated parameters and under precisely established experimental conditions, unmodified Sarkanda grass lignin—an aromatic biopolymer—can be recommended as a promising adsorbent for the retention of Cd (II) from aqueous solutions, successfully replacing polysaccharide, especially cellulose-based polymers

18 years of Romanian national program of liver transplant - a retrospective analysis of 924 patients operated

Center of General Surgery and Liver Transplantation “Dan Setlacec”, Fundeni Clinical Institute, Bucharest, Romania, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Transplantul hepatic (TH) a devenit un tratament stabil pentru boala hepatică în stadiu final, cu peste 20.000 de proceduri la nivel mondial anual. Prelegerea prezintă și analizează înființarea și rezultatele Programului Național Român al TH. Material și metode: Între aprilie 2000 și decembrie 2018, 924 pacienti au efectuat 964 operatii de TH în România. Raportul dintre bărbați și femei a fost de 546/378, în timp ce raportul adult / pediatric a fost de 857/67, cu o vârstă medie de 46 de ani (mediană de 50 de ani, interval de 7 luni - 68 de ani). Principalele indicații TH au fost ciroza VHB (270 pac., 29%), CHC (196 pac., 21%) și ciroza VHC (141 pac., 15%). Rezultate: TH de la donator aflat in moarte cerebrala a fost efectuat în 805 de cazuri: TH total în 778 de cazuri, TH împărțit (split) în 20 de cazuri, LT redus în 5 cazuri, LT accesoriu în 1 caz și domino LT în 1 pac. TH de la donator inrudit a fost efectuat în 159 de pacienti:cu hemificat drept la113 pac (12%), secțiune laterală stânga la 30 pac (3%), cu hemificat stang la 14 pac (1,5%) și LDLT dual graft la 2 pacienti. Rata generală de morbiditate majoră a fost de 42% (cel puțin clasa IIIB Clavien-Dindo), în timp ce mortalitatea perioperatorie a fost de 8%. Rata de retransplantare a fost de 4,3% (40 de pac). Pe termen lung, ratele de supraviețuire estimate la pacienți cu 1, 3 și 5 ani au fost de 88%, 82% și, respectiv, 79%. Concluzii: Programul național de transplant hepatic abordează toate cauzele insuficienței hepatice acute și cronice sau a tumorilor hepatice la adulți și copii, folosind toate tehnicile chirurgicale, cu rezultate bune pe termen lung. Programul a evoluat constant în timp, ceea ce a dus la scăderea ratei mortalității pe lista de așteptare. * * * Introduction: Liver transplantation (LT) has become an established treatment for end-stage liver disease, with more than 20.000 procedures yearly worldwide. The lecture presents and analyzes the setting-up and results of the Romanian National Program of LT. Material and methods: Between April 2000 and December 2018, 924 pts received 964 LTs in Romania. Male/female ratio was 546/378, while adult/pediatric ratio was 857/67, with a mean age of 46 years (median 50 yrs; range 7 months – 68 yrs). Main LT indications were HBV cirrhosis (270 pts; 29%), CHC (196 pts; 21%), and HCV cirrhosis (141 pts; 15%). Results: Deceased donor LT was performed in 805 cases: whole LT in 778 cases, split LT in 20 cases, reduced LT in 5 cases, accesory LT in 1 case, and domino LT in 1 pt. Living donor LT was performed in 159 pts: right hemiliver in 113 pts (12%), left lateral section in 30 pts (3%), left hemiliver in 14 pts (1.5%), and dual graft LDLT in 2 pts. Overall major morbidity rate was 42% (at least IIIB Clavien-Dindo class), while perioperative mortality was 8%. Retransplantation rate was 4.3% (40 pts). Long-term overall 1, 3, and 5-year estimated survival rates for patients were 88%, 82%, and 79%, respectively. Conclusions: The Romanian National program for liver transplantation addresses all causes of acute and chronic liver failure or liver tumors in adults and children, using all surgical techniques, with good long-term outcome. The program constantly evolved over time, leading to decreased mortality rate on the waiting list

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)