216 research outputs found
Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference
No full textThere is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices
Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study
No full textBackground: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January?December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien?Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/ 2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives
Finitary Čech-de Rham cohomology
No full textThe present paper continues (Mallios & Rapfis, International Journal of Theoretical Physics, 2001, 40, 1885) and studies the curved finitary spacetime sheaves of incidence algebras presented therein from a Čech cohomological perspective. In particular, we entertain the possibility of constructing a nontrivial de Rham complex on these finite dimensional algebra sheaves along the lines of the first author's axiomatic approach to differential geometry via the theory of vector and algebra sheaves (Mallios, Geometry of Vector Sheaves. An Axiomtic Approach to Differential Geometry, Vols. 1-2, Kluwer, Dordrecht, 1998a; Mathematica Japonica (International Plaza), 1998b, 48, 93). The upshot of this study is that important "classical" differential geometric constructions and results usually thought of as being intimately associated with C∞-smooth manifolds carry through, virtually unaltered, to the finitary-algebraic regime with the help of some quite universal, because abstract, ideas taken mainly from sheaf-cohomology as developed in Mallios (1998a,b). At the end of the paper, and due to the fact that the incidence algebras involved have been interpreted as quantum causal sets (Raptis, International Journal of Theoretical Physics, 2000, 39, 1233; Mallios & Rapfis, 2001), we discuss how these ideas may be used in certain aspects of current research on discrete Lorentzian quantum gravity
Vapor sorption in thin supported polymer films studied by white light interferometry
No full textIn the present study, we apply a white light interferometric methodology to study sorption of moisture and methanol vapor in thin films of poly(2-hydroxyethyl methacrylate) [PHEMA] and poly(methyl methacrylate) [PMMA], supported on oxidized silicon wafers. The measured equilibrium thickness expansion of each film, exposed to different activities of the vapor penetrant, is used to determine the sorption isotherm of the system. Results for relatively thick films (100 nm < Lo< 600 nm) are compared with corresponding literature data for bulk, free-standing films, obtained by direct gravimetric methods. Furthermore, PMMA films of thicknesses lower than 100 nm were employed in order to study the effect of the dry film's thickness, and of substrate, on fractional swelling. © 2006 Elsevier Ltd. All rights reserved
Liver Fat Quantification by Dual-echo MR Imaging Outperforms Traditional Histopathological Analysis
No full textRATIONALE AND OBJECTIVES: The aim of this study was to evaluate the accuracy of dual-echo (DE) magnetic resonance imaging (MRI) with and without fat and water separation for the quantification of liver fat content (LFC) in vitro and in patients undergoing liver surgery, with comparison to histopathologic analysis. MATERIALS AND METHODS: MRI was performed on a 1.5-T scanner using a three-dimensional DE MRI sequence with automated reconstruction of in-phase (IP) and out-of-phase (OP) and fat-signal-only and water-signal-only images. LFC was estimated by fat fractions from IP and OP images (MRI(IP/OP)) and from Dixon-based fat-only and water-only images (MRI(DIxON)). Seven phantoms containing a titrated mixture of liver and fat from 0% to 50% were examined. Forty-three biopsies in 22 patients undergoing liver surgery were prospectively evaluated by a pathologist by traditional determination of the cell-count fraction and by a computer-based algorithm, the latter serving as the reference standard. RESULTS: In vitro, both MRI(IP/OP) and MRI(DIxON) were significantly correlated with titrated LFC (r = 0.993, P < .001), with a smaller measurement bias for MRI(IP/OP) (+2.6%) than for MRI(DIxON) (+4.5%). In vivo, both MRI(IP/OP) and MRI(DIxON) from DE MRI were correlated significantly better with computer-based histologic results (P < .001) and showed significantly smaller measurement bias (4.8% vs 21.1%) compared to histologic cell-count fraction (P < .001). Measurement bias was significantly smaller for MRI(IP/OP) than for MRI(DIxON) (P < .001). CONCLUSIONS: DE MRI allows the accurate quantification of LFC in a surgical population, outperforming traditional histopathologic analysis. DE MRI without fat and water separation shows the highest accuracy and smallest measurement bias for the quantification of LFC
CONFIRMATORY FACTOR ANALYSIS AND ESTIMATOR COMPARISON OF TWO SHORT FORMS OF AN IRRATIONAL AND RATIONAL BELIEFS SCALE Author(s): Joanne Raptis
No full textThe present study examined two abbreviated versions of the Attitudes and Beliefs Scale-2 (ABS-2) to compare their factor structure and ability to achieve model fit to the data. The original scale, a measure of irrational and rational beliefs as defined by REBT theory, was designed with 72 items reflecting irrational and rational beliefs and each involving one of four cognitive processes and one of three content areas. The ABS-2 had been criticized for its length and the inconsistency of findings regarding its factor structure. Two groups of researchers independently created short forms of the ABS-2 using 24 of the original items. One scale used the items with the highest factor loadings, while the other also prioritized maintaining balance across all dimensions. To also explore the effects of using different estimators, the authors ran Confirmatory Factor Analyses (CFAs) for each short form twice, once using the Maximum Likelihood Robust (MLR) estimator and once using Diagonally Weighted Least Squares (DWLS). The sample consisted of over 1500 participants that included university students, psychotherapy outpatients, and individuals in a drug rehabilitation program. Results showed that both scales yielded virtually equal and excellent fit indices when using the DWLS estimator but not when using MLR. The model with the best fit was an eight-factor bifactor model with factors for the irrational and rational cognitive processes and a general factor. Two other models also yielded especially excellent fit, including a two-factor bifactor model for irrationality and rationality as well as a second-order model with items loading on either one of the four irrational cognitive processes and then a second-order irrationality factor or on one of the four rational cognitive processes and a second-order rationality factor. Ultimately, the results suggest that the assessment can provide meaningful subscales for scores of the total, irrationality, rationality, cognitive processes, and content domains. Additionally, the findings highlight the importance of critically considering one’s data and selecting an appropriate estimator as opposed to relying on default settings. Implications for the assessment of irrational and rational beliefs, furthering REBT research, and targeting treatment to client presentation across the three dimensions are discussed
The role of preoperative optimization of the nutritional status on the improvement of short-term outcomes after liver transplantation? - A review of the literature and expert panel recommendations.
No full textBACKGROUND
Malnutrition is a known risk factor for postoperative morbidity and mortality in patients awaiting liver transplantation (LT). Malnutrition is a potentially reversible risk factor, though there are no clear guidelines on the best mechanism for an improvement. It also remains unclear if preoperative nutritional interventions have benefits to post-transplant outcomes for transplant recipients.
OBJECTIVES
Primary objective: To identify if preoperative optimization of nutritional status is associated with improved short-term outcomes after LT.
SECONDARY OBJECTIVES
To determine if preoperative improvement of malnutrition improves short-term outcomes after LT, as well as, if weight loss in obese patients affects short-term outcomes after LT.
DATA SOURCES
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
METHODS
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. POSPERO Protocol ID: CRD42021237450 RESULTS: 3851 records were identified in searching the databases, 3843 records were excluded by not fulfilling eligibility criteria. Seven full-text articles were included for the final analysis of which three were randomized controlled trials, one was prospective observational studies, and three were retrospective observational studies. No appreciable difference in mortality, post-transplant complication rate was noted across the studies. Length of stay (LOS) was noted to be shorter in two observational studies of Vitamin D deficiency in liver transplant patients.
CONCLUSIONS
We have made a weak recommendation supporting pre-transplant nutritional supplementation due to possible benefit in reducing LOS as well as the lack of harms (Quality of Evidence low | Grade of Recommendation; Weak). No effective conclusions were reached for the secondary objectives due to the conflicting evidence. This article is protected by copyright. All rights reserved
The influence of socioeconomic inequity and guidelines compliance on clinical outcomes of patients with acute biliary pancreatitis. An international multicentric cohort study
No full textBackground: There is lack of data on the association between socioeconomic factors, guidelines compliance and clinical outcomes among patients with acute biliary pancreatitis (ABP). Methods: Post-hoc analysis of the international MANCTRA-1 registry evaluating the impact of regional disparities as indicated by the Human Development Index (HDI), and guideline compliance on ABP clinical outcomes. Multivariable logistic regression models were employed to identify prognostic factors associated with mortality and readmission. Results: Among 5313 individuals from 151 centres across 42 countries marked disparities in comorbid conditions, ABP severity, and medical procedure usage were observed. Patients from lower HDI countries had higher guideline non-compliance (p <0.001) and mortality (5.0% vs. 3.2%, p = 0.019) in comparison with very high HDI countries. On adjusted analysis, ASA score (OR 1.810, p = 0.037), severe ABP (OR 2.735, p < 0.001), infected necrosis (OR 2.225, p = 0.006), organ failure (OR 4.511, p = 0.001) and guideline non-compliance (OR 2.554, p = 0.002 and OR 2.178, p = 0.015) were associated with increased mortality. HDI was a critical socio-economic factor affecting both mortality (OR 2.452, p = 0.007) and readmission (OR 1.542, p = 0.046). Conclusion: These data highlight the importance of collaborative research to characterise challenges and disparities in global ABP management. Less developed regions with lower HDI scores showed lower adherence to clinical guidelines and higher rates of mortality and recurrence
Constitutive androstane receptor (Car)-driven regeneration protects liver from failure following tissue loss
No full textBackground & Aims Liver can recover following resection. If tissue loss is too excessive, however, liver failure will develop as is known from the small-for-size-syndrome (SFSS). The molecular processes underlying liver failure are ill-understood. Here, we explored the role and the clinical potential of Nr1i3 (constitutive androstane receptor, Car) in liver failure following hepatectomy. Methods Activators of Car, various hepatectomies, Car-/- mice, humanized CAR mice, human tissue and ex vivo liver slice cultures were used to study Car in the SFSS. Pathways downstream of Car were investigated by in vivo siRNA knockdown. Results Excessive tissue loss causing liver failure is associated with deficient induction of Car. Reactivation of Car by an agonist normalizes all features associated with experimental SFSS. The beneficial effects of Car activation are relayed through Foxm1, an essential promoter of the hepatocyte cell cycle. Deficiency in the CAR-FOXM1 axis likewise is evident in human SFSS. Activation of human CAR mitigates SFSS in humanized CAR mice and improves the culture of human liver slices. Conclusions Impaired hepatic Car-Foxm1 signaling provides a first molecular characterization of liver that fails to recover after tissue loss. Our findings place deficient regeneration as a principal cause behind the SFSS and suggest CAR agonists may bear clinical potential against liver failure. Lay summary The unique regenerative capacity of liver has its natural limits. Following tissue loss that is too excessive, such as through extended resection in the clinic, liver failure may develop. This is known as small-for-size-syndrome (SFSS) and represents the most frequent cause of death due to liver surgery. Here we show that deficient induction of the protein Car, a central regulator of liver function and growth, is a cause of liver failure following extended resection; reactivation of Car through pharmacological means is sufficient to prevent or rescue the SFS
A novel open-source web-based platform promoting collaboration of healthcare professionals and biostatisticians: A design science approach
No full textCollaboration among clinicians and statisticians is relatively poor, with many cases leading to poor quality research, reflected by low level of evidence studies published in the literature, thus affecting the overall quality of healthcare. We have developed a novel open-source web-based platform aiming in reinforcing the clinician-statistician relationship, using an iterative design research process by involving all end-users. Evaluation of this platform by healthcare professionals and biostatisticians was highly positive, as we first identified the pitfalls of their relationship and overcame them through the use of this platform. We are hoping that this will strengthen the clinician-statistician relationship in the short term and ultimately improve the quality of research and hence the quality of healthcare in the long term
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