bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pretransplant lymphocyte count predicts the incidence of infection during the first two years after liver transplantation
Authors: Fernández-Ruiz Mario , López-Medrano Francisco , Romo Eva María , Allende Luis María , Meneu Juan Carlos , Fundora-Suárez Yiliam , San-Juan Rafael , Lizasoain Manuel , Paz-Artal Estela , Aguado Jose María 
Published: September 2009

Abstract

Patients with end-stage liver disease (ESLD) show a low absolute number of peripheral blood lymphocyte subpopulations (PBLSs). We investigated if the baseline PBLS could categorize orthotopic liver transplantation (OLT) recipients into groups at high or low risk for infection after transplantation. PBLSs were prospectively studied in 63 consecutive patients (42 males; mean age ± standard deviation: 53.5 ± 10.3 years) with ESLD prior to OLT. Thirty-five patients (55.6%) developed a total of 79 infectious episodes during the first 2 years post-OLT. The median total lymphocyte count and PBLS levels [CD3+ T cells, CD4+ T cells, memory (CD45RO+) CD4+ T cells, T cell receptor αβ+ and γδ+ subsets, and CD19+ B cells] at baseline were significantly lower in patients with an infection compared with those without one (P < 0.05). There was a significant correlation between the risk of development of a post-OLT infection and a baseline total lymphocyte count < 1.00 × 103/μL (P = 0.001), a baseline CD3+ T cell count < 0.75 × 103/μL (P = 0.009), and a baseline CD4+ T cell count < 0.5 × 103/μL (P = 0.008). In the multivariate analysis, this association between the baseline total lymphocyte level and infection remained significant (odds ratio: 10.1; 95% confidence interval: 1.9-39.5). In conclusion, the pre-OLT total lymphocyte count identifies a subset of patients at high risk for infection. PBLS monitoring prior to OLT may offer an opportunity for surveillance, tapering of immunosuppression, and preemptive therapy. Liver Transpl 15:1209–1216, 2009. © 2009 AASLD.
Donor mannose-binding lectin gene polymorphisms influence the outcome of liver transplantation
Authors: Cervera Carlos , Balderramo Domingo , Suárez Belén , Prieto Jhon , Fuster Francisco , Linares Laura , Fuster Josep , Moreno Asunción , Lozano Francisco , Navasa Miquel 
Published: September 2009

Abstract

Mannose-binding lectin (MBL) is a C-type lectin produced mainly by the liver that binds to a wide range of pathogens. Polymorphisms at the promoter and exon 1 of the MBL2 gene are responsible for low serum levels of MBL and have been associated with an increased risk of infections. We prospectively analyzed 95 liver transplant recipients. Well-known functionally relevant polymorphisms of the MBL2 gene of the liver donor were examined by gene sequencing. Infectious events were collected prospectively. No differences in the incidence of infections were found according to the donor MBL2 genotypes. Survival was lower in patients receiving a liver graft from a donor with an exon 1 MBL2 variant genotype, and they had higher infection-related mortality (50% versus 14%, P = 0.040). No differences were found according to other polymorphisms involving the promoter and 5′-untranslated region. When we analyzed bacterial infection episodes, we found that patients receiving a liver from a donor with an exon 1 variant genotype had a higher incidence of septic shock (46% versus 11%, P = 0.004). Independent variables associated with graft or patient survival were as follows: receiving a graft from a donor with an exon 1 MBL2 variant genotype [adjusted hazard ratio (aHR), 9.64; 95% confidence interval (CI), 2.59-36.0], the Model for End-Stage Liver Disease score (aHR, 1.14; 95% CI, 1.05-1.23), and bacterial infections (aHR, 11.1; 95% CI, 2.73-44.9). Liver transplantation from a donor with a variant MBL2 exon 1 genotype was associated with a worse prognosis, mainly because of infections of higher severity. Liver Transpl 15:1217–1224, 2009. © 2009 AASLD.
Conivaptan increases serum sodium in hyponatremic patients with end-stage liver disease
Authors: O'Leary Jacqueline G. , Davis Gary L. 
Published: September 2009

Abstract

Hyponatremia is associated with increased mortality in patients with end-stage liver disease and a greater risk of perioperative mortality with liver transplantation. We performed a retrospective review of our experience with conivaptan as a means of acutely increasing serum sodium in end-stage liver disease patients. The primary group consisted of 15 patients with end-stage liver disease who remained hyponatremic despite discontinuation of diuretics and a 1-L fluid restriction. Twenty milligrams of conivaptan was intravenously administered over 30 minutes, and this was followed by an infusion of 20 mg over 24 hours for 1 to 4 days. A second group of 9 hyponatremic end-stage liver disease patients was treated with 1-L fluid restriction and conivaptan while remaining on diuretics. In the group without diuretics, the mean serum sodium was 124 mmol/L 1 day before and on the day of conivaptan initiation, but the serum sodium rose to a mean of 127.7 mmol/L by day 1 and further increased to 128.6 mmol/L by the second day of the infusion. Despite the continuation of diuretics, the second group of 9 patients also had an increase in serum sodium from the day of conivaptan initiation (125.7 mmol/L) to 2 days after the treatment (130.6 mmol/L). Eleven patients underwent successful liver transplantation, 2 remained on the list for transplantation, and 11 were not candidates for transplantation and either died (7) or were discharged home and lost to follow-up (4). In conclusion, a short course of conivaptan increases serum sodium in patients with end-stage liver disease and may reduce the risk of proceeding to liver transplantation. Further study in a prospective clinical trial is needed to confirm safety and efficacy. Liver Transpl 15:1325–1329, 2009. © 2009 AASLD.
Liver grafts from donors with central nervous system tumors: A single-center perspective
Authors: Kashyap Randeep , Ryan Charlotte , Sharma Rajeev , Maloo Manoj K. , Safadjou Saman , Graham Maureen , Tretheway David , Jain Ashokkumar , Orloff Mark 
Published: September 2009

Abstract

Traditionally, patients who die with a malignancy have been excluded from donation. However, it has become a common practice to accept organs from donors that have low-grade tumors or tumors with low metastatic potential. The aim of this study was to analyze our experience with the use of liver grafts from donors with central nervous system (CNS) tumors. A retrospective review of 1173 liver transplants performed between 1992 and 2006 identified 42 donors diagnosed with a CNS tumor. Thirty-two tumors were malignant, and 10 tumors were benign. Forty-two liver transplant recipients received livers from these donors. All patients were followed until May 2007 with a mean follow-up of 29 ± 17 months. Among 42 donors, there were 28 males and 14 females. The mean donor risk index was 1.78 ± 0.39. Twenty (47.6%) of the CNS tumors were glioblastoma multiforme (astrocytoma grade IV), 11 (26.2%) were other astrocytomas, and 1 (2.4%) was an anaplastic ependymoma. Twenty (62.5%) neoplasms were grade IV tumors, 8 (25%) were grade II tumors, and 4 (12.5%) were grade III tumors. Over 80% of the patients had at least 1 kind of invasive procedure violating the blood-brain barrier. The rate of recurrence for the entire group was 2.4% (all CNS tumors). There were 7 (7.2%) deaths in all. The most common cause of death was sepsis (n = 3, 7.2%). There was no difference in survival between recipients of grafts from donors with CNS tumors and recipients of grafts from donors without CNS tumors (1 year: 82% versus 83.3%, P = not significant; 3 years: 77.4% versus 72%, P = not significant). In conclusion, in our experience, despite violation of the blood-brain barrier and high-grade CNS tumors, recurrence was uncommon. Grafts from these donors are often an overlooked source of high-quality organs from younger donors and can be appropriately used, particularly in patients who, despite low Model for End-Stage Liver Disease scores, carry a high risk of mortality. Liver Transpl 15:1204–1208, 2009. © 2009 AASLD.
Predicting recurrence after liver transplantation in patients with hepatocellular carcinoma exceeding the up-to-seven criteria
Authors: D'Amico Francesco , Schwartz Myron , Vitale Alessandro , Tabrizian Parissa , Roayaie Sasan , Thung Swan , Guido Maria , del Rio Martin Juan , Schiano Thomas , Cillo Umberto 
Published: September 2009

Abstract

The up-to-seven (Up-to-7) criteria [with 7 being the sum of the size and number of tumors for any given hepatocellular carcinoma (HCC)] have been recently proposed to identify potential candidates for liver transplantation (LT) among patients exceeding the Milan criteria. The aim of this study was to compare the ability of the available pathologic staging systems (the Milan, University of California San Francisco, and Up-to-7 criteria) to predict recurrence. A study population of 479 HCC transplanted patients was identified from prospectively collected databases at Mount Sinai Medical Center (New York, NY) and the University of Padua (Padua, Italy). The best pathologic staging system was identified with log rank, proportion separation index (PSEP), and Cox analyses. Pathologic tumor characteristics (tumor number, tumor size, sum of diameters, macroscopic and microscopic vascular invasion, and grading) were then tested by univariate and multivariate Cox analyses in the prognostic subgroups within and beyond the calculated criteria. The Up-to-7 criteria performed as the best pathologic staging system, the calculated 1-, 3-, and 5-year recurrence probabilities being 4%, 8%, and 14% within the criteria (n = 355) and 22%, 45%, 51% beyond the criteria (n = 124; P < 0.0001) and the calculated PSEP being 0.27 (95% confidence interval = 0.23-0.31). In multivariate analysis, only biological variables (vascular invasion and tumor grade) significantly predicted recurrence beyond the Up-to-7 criteria. A 3-stage pathologic staging system with a potential to be applied in the preoperative setting was thus created: within the Up-to-7 criteria (recurrence rate = 8%), beyond the Up-to-7 criteria without macrovascular invasion and poorly differentiated grade (recurrence rate = 24%), and beyond the Up-to-7 criteria with macrovascular invasion and/or poorly differentiated grade (recurrence rate = 45%). In conclusion, HCC patients within the pathologic Up-to-7 criteria were associated with a low risk of recurrence after LT. Beyond these criteria, however, a significant proportion of patients with a good HCC biological profile had an acceptable risk of recurrence. Liver Transpl 15:1278–1287, 2009. © 2009 AASLD.
Determining temperature lapse rates over mountain slopes using vertically weighted regression: a case study from the Pyrenees
Authors: Pagès Meritxell , Miró Josep Ramon 
Published: September 2009

AbstractThis study took place in the Pyrenees Range, in the northeastern Iberian Peninsula. The Pyrenees extend longitudinally, separating the Iberian Peninsula from the rest of Europe, and high peaks around 3000 m arise from deep valleys. As a mountain range it creates a barrier to advection, in this case from the north and south, and typical meteorological phenomena of mountainous areas occur within it (inversions, Foehn effect, extreme wind‐chill, snow storms). Thus, two specific valleys in Catalonia were considered, Val d'Aran and Cerdanya. In both valleys automatic weather stations (AWSs) are available at similar heights. Although these valleys are only 100 km apart, they have different climates. However, the main reason for developing the study was that Numerical Weather Prediction (NWP) has problems when forecasting temperatures in complex terrain areas, mainly in the valley floor in winter season.Firstly, different equations based on a multilinear regression were obtained for each weather station. Multilinear regression was considered in this case as the most suitable downscaling method and data used were provided by the AWSs and MM5 (PSU/NCAR mesoscale model) numerical weather prediction model outputs.These equations were obtained to set up a Geographically Weighted Regression (GWR) method, although this one was modified and changed to a Vertically Weighted Regression (VWR) in order to create vertical temperature profiles. Copyright © 2009 Royal Meteorological Society
Power spectral analysis of perfusion signals on free radial forearm flap transplantation in humans
Authors: Sun Tzong‐Bor , Kuo Terry B. J. , Yang Cheryl C. H. 
Published: September 2009

AbstractForearm cutaneous perfusion is an established in vivo model in many clinical and basic researches to explore the peripheral circulation. The aim of our study is to characterize the dynamic properties of regional microcirculation after simultaneous denervation and revascularization in free forearm flap transplantations. Serial changes in laser Doppler flow and cutaneous temperature were measured during 14 forearm flap transplantations. Digitalized perfusion data were relayed for power spectral analysis based on the fast Fourier transform. Real time heart rate variability was measured to verify the influence of systemic autonomic nervous modulations. The basal flow expressed a threefold to fourfold increase, from 20.31 ± 3.25 to 73.79 ± 11.78 PU, after the transplantation. Frequency domain analysis of cutaneous blood flow variability showed significantly increased high frequency (0.15–0.4 Hz, 55.14% ± 3.31% to 65.31% ± 2.78%, P = 0.0035) and decreased very low frequency (0.003–0.04 Hz, 18.61% ± 2.70% to 9.25% ± 1.38%, P = 0.0049) power fraction after flap transfer. Simultaneous denervation and revascularization of forearm flaps increased the regional blood flow significantly that was caused by increased high frequency and decreased very low frequency fractional contributions in dynamic regulation of regional cutaneous microcirculation. They are associated with the sympathetic denervation and reactive hyperemia, respectively. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.
Management strategies following microsurgical flap failure
Authors: Lineaweaver William , Akdemir Ovunc , Schleich Arno 
Published: September 2009

AbstractAlthough increasingly rare, failed microsurgical flaps are a complicated clinical problem when they occur. Review of reports of management following microsurgical flap failure offers an outline of options. A substantial number of breast and extremity patients elect abandonment of reconstruction. The majority of head and neck, breast, and extremity patients proceed to nonmicrosurgical reconstructive options. Head and neck patients (38%) and 35% of extremity patients elect to have second microsurgical flaps, and 84% of these procedures were successful.Patient management following microsurgical flap failure includes strategic abandonment of reconstruction in some cases, use of conventional procedures in a majority of cases, and further microsurgical procedures in one‐third of cases. The reconstructive surgeon should have this range of possibilities available for these difficult cases. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis
Authors: Lowrie A. G. , Rao K. , Nanu A. , Erdmann M. W. H. 
Published: September 2009

AbstractFree fibular bone grafting is an effective treatment for early osteonecrosis of the femoral head in young patients. However, recipient vessels are often small rendering microvascular anastomosis difficult. We have developed a novel technique using retrograde flow through the branches of the lateral circumflex femoral artery to use the proximal end of the artery as the recipient vessel. A vessel diameter of up to 5 mm is obtained providing a good match with the peroneal vessels. We used this technique to perform vascularized bone grafting of the femoral head in 10 patients with Ficat grade 2 and 3 osteonecrosis. Pulsatile retrograde flow from the lateral circumflex femoral artery was observed in each case. Retrospective review gave a median follow up of 52 months (range 17–99). Symptoms improved in all 10 cases. There was no radiological deterioration over the period of follow‐up in eight cases. One patient underwent conversion to a total hip replacement 24 months after surgery. These results compare favorably with other studies. The lateral circumflex femoral artery turnover technique is a reliable and useful technique in vascularized bone grafting of the femoral head. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
Surgical decompression for notalgia paresthetica: A case report
Authors: Williams Eric H. , Rosson Gedge D. , Elsamanoudi Ibrahim , Dellon A. Lee 
Published: September 2009

AbstractNotalgia paresthetica is a rare nerve compression. From the Greek word noton, meaning “back,” and algia, meaning “pain,” “notalgia paresthetica” implies that symptoms of burning pain, itching, and/or numbness in the localized region between the spinous processes of T2 through T6 and the medial border of the scapula constitute a nerve compression syndrome. The compressed nerve is the dorsal branch of the spinal nerve. It is compressed by the paraspinous muscles and fascia against the transverse process of these spinal segments. This is the first report of symptomatic relief by decompression of this nerve. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
Upper extremity reconstruction using free SCIA/SIEA flap
Authors: Nasir Serdar , Aydin Mustafa Asim 
Published: September 2009

AbstractThe most suitable free flap alternative in upper extremity reconstruction has adequate and quality of tissue with consistent vascular pedicle. Free flap must provide convenient tissue texture to reconstruct aesthetic and functional units of upper extremity. Furthermore, minimal donor site morbidity is preferred features in free flap election. In our efforts to obtain the best possible outcome for patients, we chose, as a first priority, the free superficial circumflex inferior artery (SCIA)/superficial inferior epigastric artery (SIEA) flap over other free flap options for the soft‐tissue reconstruction of upper extremities. The authors retrospectively report the results of 20 free SCIA/SIEA flaps for upper extremity reconstruction during the past 3 years. Nineteen of 20 flaps were successful (95%): three required emergent postoperative reexploration of the anastomosis and one failed. Flap thinning (n = 4) was performed during the flap harvest, whereas some flaps were thinned with secondary debulking (n = 4). The functional and aesthetic results were evaluated as acceptable by all patients. Based on our results, a free SCIA/SIEA flap has the following advantages in soft‐tissue reconstruction of the upper extremity: (1) if necessary, flap thinning may be performed safely at the time of flap elevation and (2) flaps are harvested using a lower abdominal incision so that it causes minimal donor site scar. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
The efficacy of postoperative monitoring: A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps
Authors: Rozen Warren M. , Chubb Daniel , Whitaker Iain S. , Acosta Rafael 
Published: September 2009

AbstractBackground: An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone. Methods: A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook‐Swartz implantable Doppler probe. Outcome measures included flap salvage rate and false‐positive rate. Results: There was a strong trend toward improved salvage rates with the implantable Doppler probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta‐analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false‐positive rates. Conclusion: Flap monitoring with the implantable Doppler probe can improve flap salvage rates without increasing the rate of false‐positive takebacks. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
The correlation between calcium absorption and electrophysiological recovery in crushed rat peripheral nerves
Authors: Yan Ji‐Geng , Matloub Hani S. , Yan Yuhui , Agresti Michael , Zhang Lin‐Ling , Jaradeh Safwan S. 
Published: September 2009

AbstractThe correlation between calcium ion (Ca2+) concentration and electrophysiological recovery in crushed peripheral nerves has not been studied. Observing and quantifying the Ca2+intensity in live normal and crushed peripheral nerves was performed using a novel microfine tearing technique and Calcium Green‐1 Acetoxymethyl ester stain, a fluorescent Ca2+indicator. Ca2+was shown to be homogeneously distributed in the myelinated sheaths. After a crush injury, there was significant stasis in the injured zone and the portion distal to the injury. The Ca2+has been almost completely absorbed after 24 weeks in the injured nerve to be similar to the controls. The process of the calcium absorption was correlated with the Compound Muscle Action Potential recovery process of the injured nerves. This correlation was statistically significant (r= −0.81,P< 0.05). The better understanding of this process will help us to improve nerve regeneration after peripheral nerve injury. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
A subfascial variant of the deep inferior epigastric artery demonstrated by preoperative multidetector computed tomographic angiography: A case report
Authors: Garusi Cristina , Lohsiriwat Visnu , de Lorenzi Francesca , Manconi Andrea , de Fiori Elvio , Bellomi Massimo 
Published: September 2009

AbstractPrecise preoperative imaging by multidetector computed tomographic (MDCT) angiography for planning of deep inferior epigastric artery perforator (DIEP) flap dissection has been reported for enormous advantages in terms of reduced operative time and minimized flap‐related complications. This case report shows a particularly rare anatomical subfascia variant of deep inferior epigastric artery (DIEA) which can be preoperatively demonstrated by MDCT angiogram. Therefore, the intraoperative finding also confirms the radiologic data and results in meticulous flap harvesting during incision on anterior rectus sheath. Additionally, the authors emphasize on performing preoperative high quality imaging for DIEP intervention precisely for specific vulnerable course of subfascial plane DIEP, which is rare but tends to be at risk without foreknowing its exact course. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.