The yesterday, today and tomorrow of liver transplant.

With a very long history of setbacks and successes, organ transplantation is one of the greatest medical achievements of the twentieth century. Liver transplantation is currently the most effective method for treating end-stage liver disease. From humble beginnings, improvements in surgical technique, perioperative management, and immunosuppressive therapy have yielded excellent graft and patient outcomes. Most established 'liver transplant' (LT) centres have a 1-year survival rate exceeding 90%, and a 3-year survival rate of over 80%. With immense success, the need for hepatic grafts substantially exceeds their availability. This problem has been partially addressed by using split grafts, living donor liver transplantation (LDLT), and extended criteria grafts (ECG). This article reviews the immense progress made in various aspects of LT including evaluation, increasing donor pool, surgical advances, immunosuppression and anaesthesia related aspects and the way forward. With ongoing cutting edge research in technologies like artificial liver devices, tissue bioengineering and hepatocyte 'farms', the future of LT is more exciting than ever before.

To compare the outcomes of pancreaticojejunostomy and pancreaticogastrostomy reconstruction after pancreaticoduodenectomy: A prospective observational study.

Background: We have been in constant search of novel innovations to decrease the high morbidity after Pancreaticoduodenectomy (PD). Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the two different methods of reconstruction after PD. However, the existing data is ambiguous in supporting either of them as the preferred technique of reconstruction. Methods: This was a single-center prospective observational study that included 64 patients who underwent PD over two years. We compared PG with PJ as a method of reconstruction after PD. The primary objective was to assess whether PG decreases the rate of postoperative pancreatic fistula (POPF) rates or not. Secondary objectives comprised analysis of perioperative outcomes, 30-day and 90-day mortality. Results: Pancreatic fistula was significantly lower in PG as compared to the PJ group (24% vs. 47%) with a p-value of 0.027. The incidence of clinically pertinent (grade B) fistula was only 3% in the PG group and 32% in the PJ group. PG group had a higher incidence of post pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). No statistically significant difference was seen between either group need for blood transfusion, re-exploration, re-admissions, ICU stay, or length of hospital stay, and 30-day and 90-day mortality. Pancreatic texture and high BMI were independent predictors for pancreatic fistula. Conclusion: PG when compared to PJ for reconstruction after PD, decreases the rate of POPF significantly; however, it is associated with an elevated risk of DGE and PPH. There was no difference in 30-day and 90-day mortality between both the treatment groups.

Spin Lifetime and Charge Noise in Hot Silicon Quantum Dot Qubits.

We investigate the magnetic field and temperature dependence of the single-electron spin lifetime in silicon quantum dots and find a lifetime of 2.8 ms at a temperature of 1.1 K. We develop a model based on spin-valley mixing and find that Johnson noise and two-phonon processes limit relaxation at low and high temperature, respectively. We also investigate the effect of temperature on charge noise and find a linear dependence up to 4 K. These results contribute to the understanding of relaxation in silicon quantum dots and are promising for qubit operation at elevated temperatures.

A critical study of quality parameters in health care establishment: developing an integrated quality model.

PURPOSE: The purpose of this article is to identify and critically analyze healthcare establishment (HCE) quality parameters described in the literature. It aims to propose an integrated quality model that includes technical quality and associated supportive quality parameters to achieve optimum patient satisfaction. DESIGN/METHODOLOGY/APPROACH: The authors use an extensive in-depth healthcare quality literature review, discerning gaps via a critical analysis in relation to their overall impact on patient management, while identifying an integrated quality model acceptable to hospital staff. FINDINGS: The article provides insights into contemporary HCE quality parameters by critically analyzing relevant literature. It also evolves and proposes an integrated HCE-quality model. RESEARCH LIMITATIONS/IMPLICATIONS: Owing to HCE confidentiality, especially regarding patient data, information cannot be accessed. PRACTICAL IMPLICATIONS: The integrated quality model parameters have practical utility for healthcare service managers. However, further studies may be required to refine and integrate newer parameters to ensure continuous quality improvement. ORIGINALITY/VALUE: This article adds a new perspective to understanding quality parameters and suggests an integrated quality model that has practical value for maintaining HCE service quality to benefit many stakeholders.

A Monte Carlo investigation of some important radiation parameters and tissue equivalency for photons below 1 keV in human tissues.

The attenuation coefficients are important input values in estimating not only the dose and exposure in radiotherapy and medical imaging, but also in the proper design of photon shields. While studies are widely available above 1 keV, the attenuation coefficients of human tissues for photon energies less than 1 keV have not been studied yet. In this study, the attenuation coefficients of water and some human tissues were estimated for low energy photons using the MCNP6.1 code in the energy region 0.1 keV-1 keV. Mass attenuation coefficients were estimated at photon energies of 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950 and 1000 eV for water and ten human tissues (Soft, Breast, Lung, Bone, Brain, Eye lens, Ovary, Skin, Thyroid and Prostate). Results were compared with those available in literature and a fairly good agreement has been obtained. These data were then used to calculate the mean free path, half value layer, tenth value layer, effective atomic number and specific gamma-ray constant (useful for calculation of dose rate) as well. Moreover, for comparison the effective atomic number of the water has been obtained using the results of this work and using the data available in NIST database from 0.1 to 1 keV. In addition, the human tissues were compared with some tissue equivalent materials in terms of effective atomic number and specific gamma-ray constant to study the tissue equivalency from the results, the muscle-equivalent liquid with sucrose has been found to be the best tissue equivalent material for soft tissue, eye lens and brain with relative difference below 4.1%.

Abdominal Trauma in Combat.

Evaluating and managing patients with abdominal trauma remains one of the most challenging, resource-intensive and satisfying aspects of combat care. It demands a thorough understanding of the pathophysiology of trauma and shock, excellent clinical acumen and the ability to think and operate rationally in a chaotic milieu.

Incidence of Hepatitis E Virus Infection in Recipients of Blood or Blood Products Transfusion.

BACKGROUND: Hepatitis E, generally known to be transmitted faeco-orally, has been shown to have significant transmission by blood borne route. Paucity of data on asymptomatic viremia in blood donors and higher incidence of Hepatitis E in haemodialysis patients and thalassemics mandate a prospective study of blood recipients to elucidate the exact incidence and natural history of post transfusion Hepatitis E. METHODS: A total of 2000 recipients of blood or blood products transfusion were followed up for two months to detect development of post transfusion Hepatitis E, by clinical examination, transaminases and immunoglobulin M anti hepatitis E virus (IgM anti HEV). Estimation of hepatitis E virus ribonucleic acid (HEV RNA) was done in patients with elevated levels of transaminases. RESULT: Out of 2000 patients, 5(0.25%) were positive for IgM anti HEV at the time of transfusion and were excluded from the study. Rest of 1995 patients were followed up for two months post transfusion. A total of 1303 (65.3%) patients were followed up for two months and 1636 (82.0%) patients at least once in two visits. None of the followed up patients reported development of jaundice or had clinically evident hepatitis, although 62 patients had raised transaminases detected at either one or both the visits. CONCLUSION: All followed up patients were tested for IgM anti HEV at both the visits and none were found to be positive. Patients with raised transaminases were subjected to HEV RNA and all were found to be negative.

Preliminary studies of the effect of doping of chromium oxide in SiO2-CaO-P2O5 bioceramics for bone regeneration applications.

Bioceramics of composition xCr2O3∙(43-x) CaO∙42SiO2∙15P2O5 (x varying from 0 to 8 mol%) have been synthesized in the laboratory by using sol-gel technique. The morphology and structure has been determined by using Powder X-ray Diffraction, Fourier Transform Infrared and Raman spectroscopy and Field Emission Scanning Electron Microscopy. The in vitro bio mineralization behavior has been assessed by immersion in simulated body fluid for 7 days. The results obtained in our studies have indicated excellent hydroxyapatite formation ability of our samples. Drug delivery property of synthesized samples has been checked by using UV-spectroscopy of antibiotic 'gentamicin'. The in vitro drug release profile was fitted best in the Higuchi model with the highest value of coefficient of determination (R2 = 0.9970). Antimicrobial properties have been evaluated from minimum inhibitory concentration and time kill assay values. The cellular response has been investigated by using human osteosarcoma MG 63 cell line. Also to check charge on the synthesized samples, Zeta potential studies have been conducted and it has been observed that samples carry negative charge when immersed in simulated body fluid. Negative surface charge provide suitable environment for cell adhesion and proliferation. Experiments have been undertaken to explore suitable composition with an objective of development of suitable implant material for bone regeneration applications.

Aggressive angiomyxoma of the spermatic cord: A rare entity.

Aggressive angiomyxoma (AA) is an uncommon tumor occurring in females and is rarely reported in males with propensity to recur. Due to its presence in perineal and genital region, it has to be differentiated from other myxoid neoplasms. The tumor expresses estrogen and progesterone receptors, which may have a role to play in tumor therapy. Wide local excision remains the mainstay of the treatment. We present a case of AA excised from left spermatic cord.

Study of environment friendly bismuth incorporated lithium borate glass system for structural, gamma-ray and fast neutron shielding properties.

The present work is aimed at incorporating the heavy metal oxide 'bismuth oxide' in lithium-borate glass system and studying its effect on the glass structure, durability, gamma-ray and neutron shielding ability. The density, XRD, Raman, FTIR, and UV-Visible spectroscopic techniques assisted in understanding the structure of ternary bismuth­lithium-borate glass system. It has been found that the glass samples are of amorphous nature and structure is mainly built up of BO4, BO3, BiO6, BiO3 units and non-bridging oxygens (NBOs). Bismuth-incorporated glasses possess improved water resistance ability. The gamma-ray shielding ability was evaluated from mass attenuation coefficient, mean free path, tenth value layer and effective atomic number and it was found to be improved with the addition of bismuth oxide content. The exposure build up factor was also computed to account for the secondary photons and multiple Compton scattering. The removal cross section for fast neutrons (∑R) was also evaluated to study the neutron shielding ability of our prepared glasses. The glasses were also compared with barite concrete and commercial shielding glass RS 360 for gamma-rays and, with H2O, graphite, ordinary and hematite-serpentine concrete for checking neutrons shielding ability. It was observed that our glasses have better radiation shielding properties than the compared materials. In the light of these obtained results, it was concluded that the prepared bismuth­lithium-borate glass system can be utilised for radiation shielding applications.

Elucidating the role of size of hydroxyl apatite particles toward the development of competent antiosteoporotic bioceramic materials: In vitro and in vivo studies.

Osteoporosis caused by overdose of steroids is one of the major concerns for the orthopedic surgeons. Current therapeutic strategies offer limited success due to their inability to regenerate damaged bone at osteoporosis site. Therefore, there is an urgent need to develop a material having bone regeneration ability and also, ability to cure osteoporosis simultaneously. In this work, nanosized and microsized hydroxyl apatite (HAp) particles doped with europium (Eu) were prepared for diagnostic and therapeutic applications in biomedical engineering. Particles were characterized by X-ray diffraction to confirm the formation of HAp phase and transmission electron microscopy technique has been used to explore the size of microparticle and nanoparticle. In vitro release of antibiotic drug and degradation behavior in two different pHs of phosphate buffered saline was checked. Controlled drug release behavior and conversion of degraded ions into HAp is estimated by Higuchi's and 3D diffusion model, respectively. Osteoporosis was induced in 36 female Wistar rats by administering dexamethasone once a week for four consecutive weeks. Rats were treated with different doses of nano-HAp (25, 50, and 100 µg/kg intravenous single dose) and single dose of microsized HAp (100 µg/kg). After treatment, authors have evaluated sensitive biochemical markers of bone in serum. Continuous improvement in ultimate stiffness and Young's modulus of femur shaft of rats was observed with the increase in the dose of nano-HAp from 25 to 100 µg/kg. Results strongly suggest that europium-doped nano-HAp is more effective for treating severe osteoporosis in humans. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1723-1735, 2019.

Investigation of bismuth borate glass system modified with barium for structural and gamma-ray shielding properties.

In the present paper, transparent and non-toxic Bi2O3-B2O3 glasses doped with BaO have been prepared by the authors which may replace the standard radiation shielding concretes and lead based commercial glasses for gamma ray shielding applications. The effects of BaO on the structural and optical properties of the prepared glass system have been investigated by Raman, FTIR and UV-Visible techniques. It has been observed that barium plays the role of a modifier and it is responsible for conversion of triangular [BO3] units to tetrahedral [BO4] units along with formation of non-bridging oxygen and increase in ionic character. It also improves the radiation shielding abilities of the glass system. The mass attenuation coefficients for gamma-ray photons at 662 keV energy by using 137Cs radioactive source have been measured by employing narrow beam transmission geometry. This was accompanied by theoretical computation of mass attenuation coefficients in the wide photon energy range varying from 1 keV to 100 GeV. It has been found that values of mean free path and tenth value layer decrease whereas, density and effective atomic number increase with the increase of barium oxide content. As compared with barite concrete and commercial shielding glass RS-360, our prepared Bi2O3 - BaO - B2O3 glasses have shown better gamma ray shielding properties. This implies that the prepared glass system is a better gamma ray absorber and it has the potential for use in gamma-ray shielding applications.

Preliminary investigation of the effect of doping of copper oxide in CaO-SiO2-P2O5-MgO bioactive composition for bone repair applications.

A diopside based bioactive system with a nominal composition of xCuO-(45.55-x)CaO-29.44 SiO2-10.28P2O5-14.73 MgO (x=0,1,3 and 5mol%) has been prepared by sol gel technique in the laboratory. X-ray Diffraction, Fourier Transform Infra-Red and Raman Spectroscopy, Field Emission Scanning Electron Microscopy along with Energy Dispersive X-ray Analysis and pH studies have been undertaken on the prepared samples before and after dipping the samples in simulated body fluid. It has been observed that hydroxyapatite layer starts to form with in 24h during immersion in simulated body fluid. Degradation studies have also been employed to check the degradation behavior in Tris-HCl. Dynamic light scattering studies show that particles are mostly agglomerated and have an average size of 356nm. Zeta potential studies have been undertaken to check the surface charge and it has been estimated that samples carry negative charge when dipped in simulated body fluid. Negative surface charge may contribute to attachment and proliferation of osteoblasts. Samples have also shown the antimicrobial properties against the Vibro cholerae and Escherichia coli pathogens. To check the non-toxic nature of the samples, cell cytotoxic and cell culture studies have been undertaken using the MG-63 cell lines. Samples have shown good response with good percentage viability of the cells in the culture media and hence, provides friendly environment to the growth of cells. The particle size, bioactivity, negative values of zeta potential, antimicrobial properties and good cell viability indicate the potential of the synthesized compositions as possible candidates for bone repair applications.

Hypoxia and glucose independently regulate the beta-adrenergic receptor-adenylate cyclase system in cardiac myocytes.

We explored the effects of two components of ischemia, hypoxia and glucose deprivation, on the beta-adrenergic receptor (beta AR)-adenylate cyclase system in a model of hypoxic injury in cultured neonatal rat ventricular myocytes. After 2 h of hypoxia in the presence of 5 mM glucose, cell surface beta AR density (3H-CGP-12177) decreased from 54.8 +/- 8.4 to 39 +/- 6.3 (SE) fmol/mg protein (n = 10, P less than 0.025), while cytosolic beta AR density (125I-iodocyanopindolol [ICYP]) increased by 74% (n = 5, P less than 0.05). Upon reexposure to oxygen cell surface beta AR density returned toward control levels. Cells exposed to hypoxia and reoxygenation without glucose exhibited similar alterations in beta AR density. In hypoxic cells incubated with 5 mM glucose, the addition of 1 microM (-)-norepinephrine (NE) increased cAMP generation from 29.3 +/- 10.6 to 54.2 +/- 16.1 pmol/35 mm plate (n = 5, P less than 0.025); upon reoxygenation cAMP levels remained elevated above control (n = 5, P less than 0.05). In contrast, NE-stimulated cAMP content in glucose-deprived hypoxic myocytes fell by 31% (n = 5, P less than 0.05) and did not return to control levels with reoxygenation. beta AR-agonist affinity assessed by (-)-isoproterenol displacement curves was unaltered after 2 h of hypoxia irrespective of glucose content. Addition of forskolin (100 microM) to glucose-supplemented hypoxic cells increased cAMP generation by 60% (n = 5; P less than 0.05), but in the absence of glucose this effect was not seen. In cells incubated in glucose-containing medium, the decline in intracellular ATP levels was attenuated after 2 h of hypoxia (21 vs. 40%, P less than 0.05). Similarly, glucose supplementation prevented LDH release in hypoxic myocytes. We conclude that (a) oxygen and glucose independently regulate beta AR density and agonist-stimulated cAMP accumulation; (b) hypoxia has no effect on beta AR-agonist or antagonist affinity; (c) 5 mM glucose attenuates the rate of decline in cellular ATP levels during both hypoxia and reoxygenation; and (d) glucose prevents hypoxia-induced LDH release, a marker of cell injury.

Concanavalin A amplifies both beta-adrenergic and muscarinic cholinergic receptor-adenylate cyclase-linked pathways in cardiac myocytes.

Concanavalin A (Con A) is a tetrameric plant lectin that disrupts plasma membrane-cytoskeletal interactions and alters plasma membrane fluidity. We used Con A as a probe to explore beta-adrenergic and muscarinic cholinergic receptor-mediated regulation of cAMP in intact neonatal rat ventricular myocytes. Preincubation with Con A, 0.5 micrograms/ml, attenuated 1 microM (-)-norepinephrine (NE)-induced downregulation of beta-adrenergic receptors and resulted in a 50% augmentation of cAMP accumulation stimulated by 1 microM NE. Con A also augmented forskolin (1-10 microM)-stimulated cAMP accumulation by an average of 37% (P less than 0.05); however, Con A preincubation had no effect on basal or cholera toxin-stimulated cAMP content. The muscarinic cholinergic agonist carbachol (1-100 microM) decreased 1 microM NE-stimulated cAMP generation by an average of 32% (n = 7, P less than 0.05); preincubation with Con A further enhanced the inhibitory effect of carbachol by 18% (n = 7, P less than 0.05). Carbachol (1 microM) for 2 h decreased muscarinic cholinergic receptor density in whole cells by 33%; preincubation with Con A prevented this receptor downregulation. Con A pretreatment did not affect (-)-isoproterenol- or forskolin-stimulated adenylate cyclase activity in cell homogenates, suggesting that an intact cytoarchitecture is necessary for Con A to augment cAMP formation. We conclude that Con A, through its modulation of beta-adrenergic and muscarinic cholinergic receptor signaling, amplifies both stimulatory and inhibitory adenylate cyclase-linked pathways in intact neonatal ventricular myocytes. These data suggest the possibility that plasma membrane-cytoskeletal interaction is an important regulator of transmembrane signaling because interference with this interaction results in alterations in cAMP accumulation mediated by both beta-adrenergic- and muscarinic cholinergic-adenylate cyclase pathways.

Scaffolds of hydroxyl apatite nanoparticles disseminated in 1, 6-diisocyanatohexane-extended poly(1, 4-butylene succinate)/poly(methyl methacrylate) for bone tissue engineering.

Poly(1, 4-butyl succinate) extended 1, 6-diisocyanatohexane (PBSu-DCH) polymers and Polymethylmethacrylate (PMMA) scaffolds decorated with nano hydroxyl apatite have been prepared and characterized for regeneration of bone in cranio-maxillofacial region. Synthesized scaffolds revealed good response in bone regeneration and excellent cell viability in comparison to commercial available glass plate, which lead to better proliferation of MG-63 cell lines. Additionally, they demonstrate high porosity and excellent water retention ability. Moreover, controlled degradation (in pH=7.4) and sustained drug release in pH (4.5 and 7.4) are advantages of these scaffolds to serve as delivery vehicles for therapeutic drugs. Samples also provide the protection against Escherichia coli and Methicillin Resistant Staphylococcus aureus microorganisms which can be helpful for quick recovery of the patient. In-vitro inflammatory response has been assessed via adsorption of human plasma/serum proteins on the surface of the scaffolds. Results suggest that prepared scaffolds have good bone regeneration ability and provide friendly environment for the cell growth with the additional advantage of protection of the surrounding tissues from microbial infection. With all these features, it is speculated that these scaffolds will have wide utility in the area of tissue engineering and regenerative medicine.

Emerging role of vasopressin.

Ionotropic agents are frequently used in vasodilatory shock like conditions of septic or nonseptic origin. Conventional catecholamines such as norepinephrine are used at a very high dose with possibility of adverse effects in many patients. One often encounters refractoriness to these drugs. Infusion of vasopressin (VP) which is detectable at inappropriately low level in advanced phase of septic shock might allow withdrawal of catecholamines, as it maintains adequate mean arterial pressure (MAP), improves urine output and leaves perfusion of vital organs unhindered. Vasopressin has been found to be superior to epinephrine in animal models and some human trials, especially in patients with resistant ventricular fibrillation (VF) while doing cardiopulmonary resuscitation (CPR). Analogues of VP have also been used for diuresis in patients of hepatorenal syndrome.