Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity

BACKGROUND

We compared clinical outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) against those of classical 2-stage hepatectomy in treating metastatic liver disease.

METHODS

Short-term outcomes, serial changes in volume of the future liver remnant (FLR), functional FLR volume, and tumor growth activity during the treatment period, were compared between our first 11 consecutive patients treated with ALPPS and 54 patients treated with classical 2-stage hepatectomy.

RESULTS

Mortality in the ALPPS group (9%) tended to be higher than in the classical 2-stage group (2%, P = 0.341). The FLR hypertrophy ratio (FLR volume after vs. before the procedure) 1 week after the first operation in the ALPPS group (1.54 ± 0.18) exceeded that in the classical 2-stage group (1.19 ± 0.29, P = 0.005), being similar to the ratio at 3 weeks after the first procedure in the classical 2-stage group (1.40 ± 0.43). However, functional volume of the FLR in the ALPPS group 1 week after the first procedure (52.1%) tended to be smaller than that in the classical group 3 weeks after the first procedure (59.2%).

CONCLUSIONS

ALPPS should be used with extreme caution, giving special attention to postoperative complications and grade of functional liver regeneration.

Effect of interfacial structure on bioinert properties of poly(2-methoxyethyl acrylate)/poly(methyl methacrylate) blend films in water

Poly(2-methoxyethyl acrylate) (PMEA) segregation to the water interface in a blend film disturbed the network structure of water molecules, resulting in effective suppression of platelet adhesion.

Rapid identification of 1-aminocyclopropane-1-carboxylate (ACC) synthase genotypes in cultivars of Japanese pear (Pyrus pyrifolia Nakai) using CAPS markers

In Japanese pear (Pyrus pyrifolia Nakai), fruit storage potential is closely related to the amount of ethylene produced. We have developed a rapid and accurate method for analyzing genes involved in high ethylene production during fruit ripening in Japanese pear. This involves cleaved-amplified polymorphic sequences (CAPS) of two 1-aminocyclopropane-1-carboxylate (ACC) synthase genes (PPACS1 and PPACS2). Two CAPS markers (A for PPACS1 and B for PPACS2), associated with the amount of ethylene produced, were identified. Marker A was associated with high ethylene producers and marker B with moderate ethylene producers. The absence of these two markers enabled the identification of low ethylene producers. Using these markers, we have identified ethylene genotypes for 40 Japanese pear cultivars and two Chinese pear (P. bretschneideri) cultivars that are commercially important and used in breeding programs. Furthermore, we performed linkage analysis of these two genes in the F(2) population, which revealed that the recombination frequency between the two markers was 20.8 +/- 3.6%. This information is critical to the selection of parents and in breeding strategies to improve storage ability of Japanese pears.

In vitro hydrodynamic characteristics among three bileaflet valves in the mitral position

The non-fully open phenomenon of the advancing standard medical bileaflet heart valves (the ATS valve) are frequently observed in clinical cases, even though there is no problem with their hemodynamic function. The movement of the leaflets was affected easily by the transvalvular flow because of the unique open pivot design of the ATS valve. In this paper, a comparative in vitro hydrodynamic test was conducted among 3 different types of bileaflet valves, and the effect of different shapes of downstream conduits, which induce different transvalvular flow, on hydrodynamic performance was studied. Three bileaflet valves, the ATS valve, CarboMedics valve (CM), and St. Jude Medical valve (SJM), with an annulus diameter of 29 mm for the mitral position were chosen throughout our experiments. First, pressure drops across the valves under steady flow were measured. Then, the valves were tested at the mitral position with our pneumatically driven pulsatile pump. In this pulsatile flow study, 2 different conduits (straight shape and abrupt enlargement shape) were in turn incorporated at the downstream portion of the mitral valve. A high-speed video camera was employed to observe leaflet movements. In a steady-flow test, the ATS and the SJM produced the same pressure drop, but the CM recorded a higher value. In the pulsatile study, it was observed that the ATS leaflets did not open fully in the mitral position when the downstream conduit with an abrupt enlargement shape was incorporated. However, the CM and the SJM always indicated a fully open movement regardless of the shape of downstream conduits. When the straight downstream conduit was incorporated, the ATS produced a similar pressure drop to that of the SJM, which coincided with the steady test results. When the enlargement conduit was incorporated, however, the ATS presented the lowest pressure drop despite the non-fully open movement. The conduit shape at the valve downstream had a significant influence on the closing volume. These findings indicate that the conduit shape at the valve outlet can affect the hydrodynamic characteristics of bileaflet valves.

The Ontario College of Occupational Therapists: a survey

A survey was conducted to examine how familiar Ontario occupational therapists are with the Ontario College of Occupational Therapists (OCOT), and to identify their attitudes concerning self-regulation. A questionnaire was mailed to 100 occupational therapists, 50 non-members and 50 members of the OCOT. Sixty-four (64%) occupational therapists comprised the final sample; 30 members and 34 non-members. The prototypical member is over the age of 30 years, has worked more than ten years, and has graduated from a diploma program in occupational therapy. The prototypical non-member has worked for less than five years, has graduated from a degree program in occupational therapy, and is under the age of 30 years. The results indicated that: (1) both members and non-members work full-time in a hospital setting in the area of adult physical medicine as staff therapists; and (2) are involved in their professional associations, i.e., the Ontario Society of Occupational Therapists (OSOT) and the Canadian Association of Occupational Therapists (C.A.O.T.). Both groups support the concept of a self-regulatory body, however they view its purpose quite differently. The study further suggested that the majority of occupational therapists surveyed are not aware of the many issues surrounding regulation, i.e., provisions asked for by the OCOT under the Health Disciplines Act. The results are discussed with their implications for the OCOT and for Ontario occupational therapists.