Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery.

BACKGROUND: The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. METHODS: In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman's two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. RESULTS: During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25-75), decreased from 23 (20-30) %/min to 18 (12.5-19) %/min (p < 0.001). Despite a generous crystalloid infusion rate (27 (22-35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p < 0.001) and reversed to baseline values post HIPEC. CONCLUSION: Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP.

Decohesion kinetics in polymer organic solar cells.

We investigate the role of molecular weight (MW) of the photoactive polymer poly(3-hexylthiophene) (P3HT) on the temperature-dependent decohesion kinetics of bulk heterojunction (BHJ) organic solar cells (OSCs). The MW of P3HT has been directly correlated to its carrier field effect mobilities and the ambient temperature also affects OSC in-service performance and P3HT arrangement within the BHJ layer. Under inert conditions, time-dependent decohesion readily occurs within the BHJ layer at loads well below its fracture resistance. We observe that by increasing the MW of P3HT, greater resistance to decohesion is achieved. However, failure consistently occurs within the BHJ layer representing the weakest layer within the device stack. Additionally, it was found that at temperatures below the glass transition temperature (∼41-45 °C), decohesion was characterized by brittle failure via molecular bond rupture. Above the glass transition temperature, decohesion growth occurred by a viscoelastic process in the BHJ layer, leading to a significant degree of viscoelastic deformation. We develop a viscoelastic model based on molecular relaxation to describe the resulting behavior. The study has implications for OSC long-term reliability and device performance, which are important for OSC production and implementation.

The Good Food Box Pilot Project as a Contribution to Addressing Food Accessibility in the Elderly.

The Good Food Box (GFB) is a program that offers fresh produce to community members. The implementation of a GFB pilot project targeting the elderly in Côte Saint-Luc (CSL) is described. Feasibility is evaluated in terms of partnerships necessary to realize the project and suitability of the GFB among seniors. Outcomes, lessons learned, and future directions are also discussed. GFBs were delivered biweekly for 10 weeks to 14 participants over the age of 65 years. Baseline and final surveys were administered to assess user satisfaction and effects of the project. Overall, participants were satisfied, finding the location convenient and the produce to be of excellent quality. Respondents also indicated an increased quantity of fresh fruits and vegetables in their home and an enhanced connection with the community. Many participants commented on excessive quantity and difficulty preparing certain products, demonstrating that the GFB may not be practical for all seniors. Smaller quantities and volunteer assistance could improve the program. Following the successful pilot project, the GFB was expanded to all members of the CSL community. Using the GFB as a major source of fresh produce will positively impact the health and quality of life for those who reside within the community.

Consultas de urgencia posteriores al terremoto del 27 de febrero 2010, en el hospital de Cauquenes / Post earthquake emergency conbsultatiosn at the Cauquenes hospital, February 27, 2010

Se realizó un estudio descriptivo transversal según frecuencia de consultas en el servicio de urgencia del Hospital San Juan de Dios de Cauquenes, tipo de lesiones, y apoyo utilizado, para caracterizar la morbilidad asociada al sismo ocurrido entre la Quinta y Novena regiones de Chile, el 27 de febrero de 2010. El Universo fue constituido por todos los casos atendidos posteriormente al desastre en dicho servicio, y la información fue recogida a partir de los sistemas de estadísticas continuas de este mismo establecimiento. Fallecieron en la comuna de Cauquenes, 15 personas el día mismo del terremoto, con una tasa de 3,5 por 10.000 habitantes; se registraron 1360 consultas en los primeros 10 días, con predominio de traumatismos superficiales, heridas y fracturas de los miembros. Los resultados obtenidos son de utilidad en el logro de un enfoque más racional para la atención, la prevención y el auxilio ante un desastre en regiones con similares características.

A descriptive, cross sectional study was carried out to characterize the morbidity associated with the earthquake that occurred on February 27, 2010, affecting the Fifth to Ninth administrative regions in Chile. The frequency of consultation, type of injury, and support used in the emergency department of the San Juan de Dios Hospital of Cauquenes were analyzed. The universe consisted in all the cases seen after the disaster at that emergency department, and the information was collected from the current statistics systems at the hospital. In Cauquenes County, there were 15 deaths the day of the earthquake, a mortality rate of 3.5 per 10,000 residents. 1360 consultations were registered in the first 10 days, mainly superficial injuries, wounds and fractures. The obtained results are useful for achieving a more rational approach to care, prevention and aid in a disaster situation with similar characteristics.