Risk factors and impact of early anastomotic biliary complications after liver transplantation: UK registry analysis.

BACKGROUND: Biliary leaks and anastomotic strictures are common early anastomotic biliary complications (EABCs) following liver transplantation. However, there are no large multicentre studies investigating their clinical impact or risk factors. This study aimed to define the incidence, risk factors and impact of EABC. METHODS: The NHS registry on adult liver transplantation between 2006 and 2017 was reviewed retrospectively. Adjusted regression models were used to assess predictors of EABC, and their impact on outcomes. RESULTS: Analyses included 8304 liver transplant recipients. Patients with EABC (9·6 per cent) had prolonged hospitalization (23 versus 15 days; P < 0·001) and increased chance for readmission within the first year (56 versus 32 per cent; P < 0·001). Patients with EABC had decreased estimated 5-year graft survival of 75·1 versus 84·5 per cent in those without EABC, and decreased 5-year patient survival of 76·9 versus 83·3 per cent; both P < 0.001. Adjusted Cox regression revealed that EABCs have a significant and independent impact on graft survival (leak hazard ratio (HR) 1·344, P = 0·015; stricture HR 1·513, P = 0·002; leak plus stricture HR 1·526, P = 0·036) and patient survival (leak HR 1·215, P = 0·136, stricture HR 1·526, P = 0·001; leak plus stricture HR 1·509; P = 0·043). On adjusted logistic regression, risk factors for EABC included donation after circulatory death grafts, graft aberrant arterial anatomy, biliary anastomosis type, vascular anastomosis time and recipient model of end-stage liver disease. CONCLUSION: EABCs prolong hospital stay, increase readmission rates and are independent risk factors for graft loss and increased mortality. This study has identified factors that increase the likelihood of EABC occurrence; research into interventions to prevent EABCs in these at-risk groups is vital to improve liver transplantation outcomes.

Moral hypocrisy: appearing moral to oneself without being so.

How can people appear moral to themselves when they fail to act morally? Two self-deception strategies were considered: (a) misperceive one's behavior as moral and (b) avoid comparing one's behavior with moral standards. In Studies 1 and 2 the authors documented the importance of the 2nd strategy but not the 1st. Among participants who flipped a coin to assign themselves and another participant "fairly" to tasks, even a clearly labeled coin that prevented misperception did not produce a fair result (Study 1). Inducing behavior-standard comparison through self-awareness did (Study 2). Study 3 qualified the self-awareness effect: When moral standards were not salient before acting, self-awareness no longer increased alignment of behavior with standards. Instead, it increased alignment of standards with behavior and produced less moral action. Overall, results showed 3 different faces of moral hypocrisy.

Osteoblast and osteoclast cell number and cell activity in postmenopausal osteoporosis.

This study evaluates osteoblast and osteoclast cell numbers and cell activities determined from quantitative histology of trabecular bone in human iliac crest bone biopsies. Subjects studied were postmenopausal osteoporotic patients (aged 53-81) for whom total body calcium and urine and serum clinical data were also available. Only 39% of the osteoclasts identified by acid phosphatase content were multinucleate; however, a significant correlation between multinucleate osteoclasts and the total number of osteoclasts was found (r = 0.87; p less than 0.001). The mean number of osteoclasts per square millimeter of total tissue area was 0.96 (+/- 0.14, SEM, n = 36); the mean number of osteoblasts was 6.8 (+/- 1.5, n = 14)/mm2 tissue area. Computed osteoclast activity (square millimeter bone resorbed per osteoclast nucleus per day) was 2.6 X 10(-4) +/- 1.0 X 10(-4) (n = 13). Computed osteoblast activity (square millimeter bone formed per osteoblast per day) was 2.9 X 10(-5) +/- 8.8 X 10(-6) (n = 13). Calculated mean rate of bone resorption was 1.6 X 10(-4) +/- 3.4 X 10(-5) mm2 bone resorbed per mm2 total tissue area per day (n = 19). These data indicate that although osteoclasts are not numerous in the iliac crest of postmenopausal osteoporotics, the individual osteoclast activity (in square millimeter bone resorbed osteoclast cell unit per day) is significantly greater (p less than 0.001) than the osteoblast activity (in square millimeter matrix deposited per cell per day). These data also point out that greater consideration should be given to the role that osteoclast cell activity may play in human postmenopausal osteoporosis.

Aircraft gas turbine materials and processes.

Materials and processing innovations that have been incorporated into the manufacture of critical components for high-performance aircraft gas turbine engines are described. The materials of interest are the nickel- and cobalt-base superalloys for turbine and burner sections of the engine, and titanium alloys and composites for compressor and fan sections of the engine. Advanced processing methods considered include directional solidification, hot isostatic pressing, superplastic foring, directional recrystallization, and diffusion brazing. Future trends in gas turbine technology are discussed in terms of materials availability, substitution, and further advances in air-cooled hardware.

Increases in number and size of osteoclasts in response to calcium or phosphorus deficiency in the rat.

In this study, the two determinants of the rate of osteoclastic bone resorption, cell number and cell activity, were evaluated to characterize the response to two chronic resorptive stimuli, a calcium-deficient diet and a phosphorus-deficient diet, fed to rats for 8 days. The number of osteoclast nuclei was determined directly and the resorptive activity of osteoclasts indirectly from cell size. In our sampling site in the tibial diaphysis, there were marked increases in osteoclast layer width (i.e., cell size) and in the number of osteoclasts and osteoclast nuclei in both test groups. Also, in both test groups the increase in the number of osteoclast nuclei was greater than the increase in osteoclast width, emphasizing the importance of osteoclast stem cell activity in the resorptive response. When the data on the control and test animals were pooled, there was a strong correlation between the width of the osteoclast layer and the number of osteoclast nuclei (r = 0.87, P less than 0.001). Thus, these two resoprtive stimuli produced proportional changes in osteoclast cell number and probably activity, raising the possibility that the resorptive response is sterotyped. These results also suggest the existence of a control mechanism which coupled the proliferative activity of osteoclast stem cells and the resorptive activity of osteoclasts. Despite the fact that the rats were subjected to chronic resorptive stimuli, forming surface and the total number of osteoblasts were also increased. Moreover, in data pooled from control and test rats, there was a strong correlation between the number of osteoclast nuclei and the number of osteoblasts (r = 0.92, P less than 0.001). This implies that chronic resorptive stimuli directly or indirectly stimulate osteogenic stem cells to increase production of osteoblasts as well as osteoclasts. The observed coupling of differentiated cell number probably contributes to the established phenomenon of coupling between the rates of bone accretion and resorption.