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This case study presents a liver transplantation (LT) in a patient with incidentally, intraoperatively detected complete portal vein thrombosis (PVT), classified as YERDEL stage 4, challenging traditional surgical boundaries. The patient's resilience and the innovative approach adopted by the surgical team exemplify the evolving complexities of LT in the context of advanced PVT. This report underscores the significance of detailed case documentation in medical literature, especially for complex transplant scenarios. It contributes to a broader understanding of surgical techniques and patient-centered approaches in LT. The narrative highlights the dynamic interplay between surgical advancements and vascular complications, advocating for the refinement of surgical methods and a reevaluation of conventional perspectives in transplantation. This case is pivotal in illustrating medical progress and the persistent pursuit of better outcomes in complex transplant situations.
RESUMO
The SARS-CoV-2 pandemic had a devastating impact on the world's population in the years 2020−2022. The rapid development of vaccines enabled a reduction in the mortality and morbidity of COVID-19, but there are limited data about their effects on immunocompromised children. The aim of this prospective study was to evaluate the safety and efficacy of the mRNA BNT162b2 (Pfizer/Biontech) vaccine in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Material and methods: Two cohorts of 34 children after allo-HSCT and 35 healthy children aged 5−11 years were vaccinated with two doses of the mRNA BNT162b2 (10 µg) vaccine. All children were evaluated for adverse effects with electronic surveys and the immunogenicity of the vaccine was assessed with anti-SARS-CoV-2 IgG titer measurements. Results: All reported adverse events (AEs) were classified as mild. The most common AE was pain at the injection site. All the other AEs (both local and systemic) were rarely reported (<15% patients). Both groups showed a similar response in anti-SARS-CoV-2 IgG production. Patients after allo-HSCT that were undergoing immunosuppressive treatment presented a poorer immunological response than patients off of treatment. Time since HSCT, patient age, lymphocyte count, and total IgG concentration did not correlate with initial/post-vaccination anti-SARS-CoV-2 IgG titers. Most patients who were eligible for a third dose of the vaccine had an excellent humoral response observed after two vaccine doses. Conclusions: The COVID-19 mRNA BNT162b2 vaccine is very well tolerated and highly immunogenic in 5−11-year-old children after HSCT. Children >2 years of age after HSCT who did not receive immunosuppressive treatment presented excellent antibody production after two doses of the vaccine, but children on immunosuppression may require a more intense vaccination schedule.
RESUMO
OBJECTIVE: To assess the depth of cure claims of two bulk-fill flowable RBC bases (SDR and x-tra base) using Fourier transform infrared (FTIR) spectroscopy, biaxial flexure strength (BFS), and Vickers hardness number (VHN) for specimen depths of 8mm (in 1mm increments). METHODS: The degree of conversion (DC) was measured by monitoring the peak height (6164cm(-1)) of specimens (11.0±0.1mm diameter, 1.0±0.1mm thickness) during light irradiation for 20s using a quartz tungsten halogen light curing unit at 650±26mW/cm(2). DC was measured up to 120s post irradiation and repeated (n=3) for irradiation depths up to 8mm (in 1mm increments). Further series (n=20) of eight discs were prepared, stacked, light irradiated and numbered from one to eight (distance from the LCU). The specimens were stored at 37±1°C for 24h and BFS tested with the fracture fragments used to determine the VHN for each specimen. RESULTS: X-tra base can be irradiated to 8mm without a change in DC, something the SDR material cannot claim. However, the DC results confirm both bulk-fill flowable RBC bases have a depth of cure in excess of 4mm. One-way ANOVAs of BFS and VHN data showed significant differences between irradiation depths for x-tra base and SDR with increasing irradiation depth (4mm) resulting in significant reductions in mean BFS and VHN. SIGNIFICANCE: The claims that the bulk-fill flowable RBC bases have a depth of cure in excess of 4mm can be confirmed but the differing chemistry of the resin formulations and filler characteristics contribute to significant differences in DC, BFS and VHN data between the two materials tested.
