The effects of terlipressin and direct portacaval shunting on liver hemodynamics following 80% hepatectomy in the pig

Liver failure is the major cause of death following liver resection. Post-resection portal venous pressure (PVP) predicts liver failure, is implicated in its pathogenesis, and when PVP is reduced, rates of liver dysfunction decrease. The aim of the present study was to characterize the hemodynamic, biochemical, and histological changes induced by 80% hepatectomy in non-cirrhotic pigs and determine if terlipressin or direct portacaval shunting can modulate these effects. Pigs were randomized (n=8/group) to undergo 80% hepatectomy alone (control); terlipressin (2 mg bolus + 0.5–1 mg/h) + 80% hepatectomy; or portacaval shunt (PCS) + 80% hepatectomy, and were maintained under terminal anesthesia for 8 h. The primary outcome was changed in PVP. Secondary outcomes included portal venous flow (PVF), hepatic arterial flow (HAF), and biochemical and histological markers of liver injury. Hepatectomy increased PVP (9.3 ± 0.4 mmHg pre-hepatectomy compared with 13.0 ± 0.8 mmHg post-hepatectomy, P<0.0001) and PVF/g liver (1.2 ± 0.2 compared with 6.0 ± 0.6 ml/min/g, P<0.0001) and decreased HAF (70.8 ± 5.0 compared with 41.8 ± 5.7 ml/min, P=0.002). Terlipressin and PCS reduced PVP (terlipressin = 10.4 ± 0.8 mmHg, P=0.046 and PCS = 8.3 ± 1.2 mmHg, P=0.025) and PVF (control = 869.0 ± 36.1 ml/min compared with terlipressin = 565.6 ± 25.7 ml/min, P<0.0001 and PCS = 488.4 ± 106.4 ml/min, P=0.002) compared with control. Treatment with terlipressin increased HAF (73.2 ± 11.3 ml/min) compared with control (40.3 ± 6.3 ml/min, P=0.026). The results of the present study suggest that terlipressin and PCS may have a role in the prevention and treatment of post-resection liver failure

Prospectus, February 1, 1984

TOOTH FAIRY PROMOTES DENTAL HEALTH; News Digest; Vote today or tomorrow for StuGo senators; PC Happenings: Parenting programs on TV, Jackson prints donated to Parkland; Letter to the editor; Get involved!!; Experience the uniqueness of people; Letter to the Editor; Student Government candidate platforms; Counseling center; A new look at the library; Story Shop stimulates young writers; Mechanics services at Parkland College; Life Science: largest division at Parkland; Dental hygiene service; Shop around for new phones; Dental clinic accepting new patients; Question: What is a friend? ; Classifieds; Kinks perform in State of Confusion ; Coppola\u27s \u27One from the Heart\u27 worth seeing; Machines star in series; Rodgers is still going strong; The Kinks still have what it takes to sound good; Parkland art collection valid part of education; Formigoni reaches out with color and space; Hubler talks about Champaign; Placement office finds jobs; What Is Art?; Cobras ease to victory; Men edge the Blue Knights; Track--two national qualifiershttps://spark.parkland.edu/prospectus_1984/1033/thumbnail.jp

What English Counts as Writing Assessment? An Australian Move to Mainstream Critical Literacy

This article focuses on the demands of assessment tasks to address the question: What is entailed in becoming recognised as an accomplished student-writer? In taking up this focus, the writers use authentic samples to show how tasks for assessing writing can be read as instantiations of particular approaches to English education. They investigate how the tasks inevitably draw on cultural knowledges as a primary resource and raise the issue of what is involved when writing assessment moves away, as it is doing in some Australian schools, from concerns with personal voice and individual growth to a socially critical, discourse-oriented approach

An Australian Proposal for doing Critical Literacy Assessment: The Case of Writing

In this article we present current thinking and practices in Queens land, Australia, about how to do critical literacy assessment in the English classroom. In taking this focus, we propose and discuss a framework that brings together interest in text analysis and social practices. Then, we apply the framework showing how it can be used to generate writing tasks and assessment criteria that are consistent with critical pedagogy. Finally, the challenges of moving to a socially critical, discourse-oriented approach to assessment are considered

Large hepatocellular carcinoma: time to stop preoperative biopsy

Background: Western countries, hepatocellular carcinoma (HCC) often presents at a large size, which is seen as a contraindication to transplantation and often resection. Although diagnosis by imaging and ?-fetoprotein is usually straightforward, nonspecialist units continue to use biopsy to prove the diagnosis before transfer for specialist surgical opinion. We have looked at the impact of this on our practice.Study Design: We retrospectively analyzed all large HCCs resected in our unit during the last 12 years. Survival data were calculated according to size and univariate and multivariate analyses were carried out to determine impact of preoperative, operative, and histologic factors affecting outcomes.Results: We identified 85 large HCCs (&gt; 3 cm) and classified 42 as giant (&gt; 10 cm). Overall survival at 1, 3, and 5 years was 76%, 54%, and 51%. Size did not influence survival, although more complex surgical techniques were required for giant tumors. Predictors of poorer disease-free survival were positive resection margin (p &lt; 0.001), multiple tumors (p = 0.003), macroscopic vascular invasion (p = 0.015), and preoperative lesion biopsy (p = 0.027).Conclusions: Our data shows excellent outcomes after resection for large HCC. This supports the management of such patients in large-volume units that are fully equipped and experienced in the management of these patients. Preoperative biopsy should be avoided, as this unnecessary maneuver appears to have worsened our longterm results.<br/

Survey of liver pathologists to assess attitudes towards digital pathology and artificial intelligence

AimsA survey of members of the UK Liver Pathology Group (UKLPG) was conducted, comprising consultant histopathologists from across the UK who report liver specimens and participate in the UK National Liver Pathology External Quality Assurance scheme. The aim of this study was to understand attitudes and priorities of liver pathologists towards digital pathology and artificial intelligence (AI). MethodsThe survey was distributed to all full consultant members of the UKLPG via email. This comprised 50 questions, with 48 multiple choice questions and 2 free-text questions at the end, covering a range of topics and concepts pertaining to the use of digital pathology and AI in liver disease. ResultsForty-two consultant histopathologists completed the survey, representing 36% of fully registered members of the UKLPG (42/116). Questions examining digital pathology showed respondents agreed with the utility of digital pathology for primary diagnosis 83% (34/41), second opinions 90% (37/41), research 85% (35/41) and training and education 95% (39/41). Fatty liver diseases were an area of demand for AI tools with 80% in agreement (33/41), followed by neoplastic liver diseases with 59% in agreement (24/41). Participants were concerned about AI development without pathologist involvement 73% (30/41), however, 63% (26/41) disagreed when asked whether AI would replace pathologists. ConclusionsThis study outlines current interest, priorities for research and concerns around digital pathology and AI for liver pathologists. The majority of UK liver pathologists are in favour of the application of digital pathology and AI in clinical practice, research and education.Funding Agencies|National Pathology Imaging Co-operative (NPIC); Data to Early Diagnosis and Precision Medicine strand of the Governments Industrial Strategy Challenge Fund [104687]; Leeds Hospitals Charity; National Institute for Health Research (NIHR); NPIC; National Institute For Health Research (NIHR) UCLH/UCL Biomedical Research Centre (BRC)</p

Weight Change During the Postintervention Follow-up of Look AHEAD

OBJECTIVE: Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS: These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year 8. RESULTS: Postintervention weight change averaged -3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10-18% in other trajectories (P \u3c 0001). The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1-8; and year 8, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies. CONCLUSIONS: Steep weight loss postintervention was associated with increased risk of mortality. Older individuals with longer duration of diabetes and multimorbidity should be monitored for excessive unintentional weight loss