Return of the cold: How hypothermic oxygenated machine perfusion is changing liver transplantation

Hypothermic Oxygenated machine PErfusion (HOPE) has recently emerged as a preservation technique which can reduce ischemic injury and improve clinical outcomes following liver transplantation. First developed with the advent solid organ transplantation techniques, hypothermic machine perfusion largely fell out of favour following the development of preservation solutions which can satisfactorily preserve grafts using the cheap and simple method, static cold storage (SCS). However, with an increasing need to develop techniques to reduce graft injury and better utilise marginal and donation after circulatory death (DCD) grafts, HOPE has emerged as a relatively simple and safe technique to optimise clinical outcomes following liver transplantation. Perfusing the graft with cold, acellular, oxygenated perfusate either via the portal vein (PV) alone, or via both the PV and hepatic artery (HA), HOPE is generally commenced for a period of 1-2 h immediately prior to implantation. The technique has been validated by multiple randomised control trials, and pre-clinical evidence suggests HOPE primarily reduces graft injury by decreasing the accumulation of harmful mitochondrial intermediates, and subsequently, the severity of post-reperfusion injury. HOPE can also facilitate real time graft assessment, most notably via the measurement of flavin mononucleotide (FMN) in the perfusate, allowing transplant teams to make better informed clinical decisions prior to transplantation. HOPE may also provide a platform to administer novel therapeutic agents to ex situ organs without risk of systemic side effects. As such, HOPE is uniquely positioned to revolutionise how liver transplantation is approached and facilitate optimised clinical outcomes for liver transplant recipients.

Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery

The sagittal split ramus osteotomy (SSRO) has been performed mainly on an inpatient basis because of the duration of anaesthesia and the potential risk of postoperative complications, such as bleeding, pain, nausea, and vomiting. However, advances in both surgical and anaesthetic management have enabled the reduction of these risks and shortened the length of hospital stay. Thus, the SSRO may be feasible even in the ambulatory setting in elective cases. The clinical records of all patients who underwent an outpatient SSRO between August 2011 and September 2020 at Lilla Craniofacial Clinic were reviewed retrospectively. Data on age, sex, duration of surgery, operative procedures, intraoperative bleeding, and admission status were investigated. In total, 143 patients underwent a bilateral SSRO. The SSRO was performed as an isolated procedure in 73 patients and concomitantly with other surgical procedures in the remaining 70 patients. Overall, 142 of the 143 patients were discharged on the day of surgery (99.3%); only one (0.7%) required an overnight stay because of a submental haemorrhage after genioplasty. No emergency hospitalizations or readmissions occurred after discharge. Multimodal perioperative management, both surgical and anaesthetic, facilitated enhanced patient recovery after surgery, and SSRO was performed successfully and safely as an ambulatory procedure.

Formation of novel polymeric nanoparticles

We have found that not only block copolymers but also ionomers can self-assemble in a selective solvent to form surfactant-free nanoparticles. The self-assembly can be induced by chemical reaction, polymer-polymer complexation, and microphase inversion in addition to the temperature. A recently developed microwave method for the preparation of uniform surfactant-free polymeric nanoparticles is also reviewed. Our results have revealed that for a given dispersion, the particle surface area occupied per stabilizer (surfactant, polymer chains, and ionic groups) is close to a constant.

Beta-alanine-based dendritic beta-peptides: dendrimers possessing unusually strong binding ability towards protic solvents and their self-assembly into nanoscale aggregates through hydrogen-bond interactions

A series of poly(beta-alanine) dendrimers 1-4 with Boc-carbamate as the surface functionality, beta-alanine as the dendritic branch, 3,5-diaminobenzoic acid as the branching agent, and 1,2diaminoethane as the interior core has been synthesized by a solution-phase peptide-coupling method. The structural identities and purities of the products have been fully characterized by spectroscopic and chromatographic methods. 1H NMR studies on the dendrimers indicated that the Boc-carbamate surface groups exist as a mixture of syn and anti rotamers in solution, and that the dendrimers adopt an open structure in polar solvents; this allows the free interaction of the interior core functionality with solvent molecules. Due to the cooperative effect of a large number of carbamate and amide groups, the dendrimers exhibit an unusually strong binding ability towards protic solvents and behave as H-bond sponges. As a result, the H/D exchange rates of the N-H protons are significantly enhanced in such dendritic structures, as compared to those of nondendritic carbamates and amides. These dendritic peptide dendrimers also exhibit a strong tendency to form nanoscopic aggregates in nonpolar or polar aprotic solvents through intermolecular H-bond interactions.

New eyebrow lift technique using a semiautomatic suturing device (maniceps) for patients with facial paralysis

Direct browlift and the traditional fascial suspension technique sometimes leave a prominent scar above the eyebrow. Coronal browlift, mid-forehead browlift, and endoscopic browlift leave no prominent scar, but they are sometimes not suitable for patients with facial paralysis because they have been developed for rejuvenative surgery. The authors present a new browlift fascial suspension technique for patients with facial paralysis. This method uses a semiautomatic suturing device (Maniceps), which they have used to graft three fascial strips to the forehead from the fascia lata, and to suspend and lift the eyebrow with only two small incisions posterior to the hairline. The authors treated 13 facial paralysis patients, with follow-up periods of more than 6 months. The lifted eyebrows adapted to stabilized positions within 3 months. The results in all 13 patients were satisfactory, with no severe complications. This new technique is very useful because it has wide applicability, including facial paralysis patients who experience severe ptosis.

Congenital choledochal cyst with pancreatitis

OBJECTIVE

To understand the relationship among congenital choledochal cyst, anomalous junction of pancreaticobiliary duct (AJPBD) and pancreatitis.

METHODS

25 children with choledochal cyst treated in our hospital were included in this study. Their ages ranged from 2 months to 14 years. Intraoperative cholangiography was performed in 24 children. Pancreatic samples obtained from the head and body of the pancreas at operation were observed under light and electron microscope. Serum amylase was analyzed one week before and after operation respectively. Bile amylase in the cyst and gallbladder was measured at operation.

RESULTS

The incidence of AJPBD was 70%. Inflammatory cell infiltration and fibrous hyperplasia were seen in the pancreatic specimens of 5 children, of whom 4 had AJPBD. No ultrastructural changes were found in 2 children without AJPBD, while different changes were seen in 6 with AJPBD, including those showing no pathological changes under light microscope. All the changes became more severe as the age of the patient increased. The bile and serum amylase levels were higher in children with AJPBD than those without AJPBD (P < 0.05).

CONCLUSION

Congenital choledochal cyst has a close relationship with AJPBD and pancreatitis. Pancreatic pathological changes have a long and chronic course from ultrastructural changes to macroscopic changes for the developing of pancreatitis.

[The detection of Toxoplasma gondii in abortion tissues of sheep using the polymerase chain reaction]

A polymerase chain reaction was applied to detect Toxoplasma gondii DNA in placental and fetal tissue samples of 47 unselected ovine abortions of the lambing season 1990/91 (Baden-Württemberg, Rhineland, Hesse). For the amplification a 190 bp or 223 bp sequence of the B1-gene of T. gondii was selected as the target sequence. Both sequences were detected in five abortions. All positive results were immunohistochemically confirmed using the peroxidase antiperoxidase technique (PAP-staining). Thus, in Germany, too, T. gondii infection in sheep during pregnancy should be considered as a possible cause of abortions, particularly in case of abortions of unknown genesis.

A new three-dimensional reconstruction method using algebraic reconstruction techniques

Three-dimensional image reconstruction plays a very important role in noninvasive diagnosis of biological systems and nondestructive evaluation of manufactured work-pieces. A new direct three-dimensional reconstruction algorithm, called TART (Three-dimensional ART), is presented in this paper. Oblique projection data are used and an ART-based algorithm is introduced to compensate for the limiting constraints of incomplete projection and/or limited angular coverage. The fact that oblique projection gives useful information to the reconstruction algorithm is shown mathematically. The algorithm can be used to solve the reconstruction problem under the conditions of both complete data and incomplete data. The algorithm first maps geometric information and projection data from an oblique plane into a horizontal plane, then calculates the weighting factors for the voxels based on this horizontal plane, and finally performs a 3-D ART reconstruction. Two experimental results illustrate the superiority of the algorithm over the previous reconstruction methods.